Dr. Greg Fritz (Host 1): Welcome back to Mindcast, the podcast from the children's mental health experts at Bradley Hospital. Today, we're talking about a really important topic, mental health concerns amongst Latinx youth.

Dr. Tanuja Gandhi (Host 2): We know that mental health affects all young people, but Latinx adolescents often experience unique stresses. These could range from cultural expectations to discrimination to language barriers. At the same time, many families face barriers in getting care, taking support, and getting the services they need to do well.

Host 1: So today, we're thrilled to welcome Dr. Yovanska Duarte-Velez, a psychologist here at Bradley Hospital who specializes in working with Latinx children, teens, and families.

Dr. Yovanska Duarte-Velez: Thank you so much for having me. I'm a clinical psychologist and researcher. And I have dedicated my career to understanding and treating depression and suicidal behaviors in Hispanic and Latinx youth. I also serve as the Clinical Director of the Mi Gente Program, which provides outpatient care for Latinx youth struggling with depression and trauma.

And let me first explain why I am using the term Latinx. I'm using the term Latinx to be inclusive of all genders and not having to say Latino, Latina or specify. So, Latinx is for females, males, and non-binary youth or trans youth who identifies and use different pronouns.

Host 2: Thank you, Yovanska. We are so pleased to have you join us today. This is a topic we've been thinking about a lot. And today, we'd like to take a deeper dive into it. But let's start with the big picture first. What mental health trends are we seeing in Latinx youth today? And more so, what challenges show up more frequently, particularly among Latinx teens?

Dr. Yovanska Duarte-Velez: Yes. So, Latinx adolescents face as many mental health challenges as any other teen. However, the most common challenges are depression, anxiety, and experience in trauma. For some of the unique stressors that they face, we could name several. But let's start with immigration and acculturation stress. This happens when a family arrives to the U.S. and the youth arrive with their parents. They usually confront the struggles in adapting to the new culture, the new language, and also the system, which could be really different from their country of origin, such as the school system and healthcare system.

Also, many Latinx families face several risk factors that actually have gotten worse because of the current social and political climate. For example, discrimination. We have seen more bullying, rejection, and discrimination based on identity, unfortunately, both at school and in the community. And this make it harder for young people to feel like they belong. Also, many first generation family feel disconnected from the society. Usually, it is based on fears. Maybe more recently, fear of being separated from other family members or due to new immigration policies in the case of some immigrant communities or some subgroup of immigrant communities. Besides all those issues in our political environment or social environment, we have also the expectation from parents to do well at school. Parents that come to this country usually have gone through a lot and a lot of sacrifice to be here. So, they have high, high expectations to their young kids and adolescents. They expect them to do really well at school academically and get nice professions, and that they could feel very high pressure sometimes for youth. Also, many families here support their families abroad, which add financial strain to the family unit.

Also, we can say that some teens feel this situation where they are kind of in between two cultures. And this happens a lot, mostly with second generation families. And also, those first generation that the kids arrive when they're younger, they start getting more used to the American culture. But at home, caregivers and parents are more used to continue their culture, their heritage, and sometimes it could be different for them. The message that they get at home and the message they get outside through the media at school, and sometimes even without realizing for many parents and for the general society, adolescents are kind of in the middle, like in between two worlds. And that could be challenging too.

Also stigma, and this is a big one. There's a lot of stigma around mental health. For some people or some communities, mental health doesn't even exist. They think, "What is that? That doesn't exist." Like, they just discount what that is. And that's a big issue because if you don't recognize or acknowledge that mental health is important, then how can you look for help when there's an issue in your emotions or emotional crisis or a mental health situation in your home? So, I think those are particular stressors that the Latinx families confront.

Host 1: I was wondering about one of them that you mentioned when the families are sending money back to their extended family in the origin country. Are the kids usually aware of that? And do they participate in helping the extended family, or is it done more covertly?

Dr. Yovanska Duarte-Velez: I think what I have seen in our practice is that they know, they know that their parents are supporting extended family abroad. And I guess, in some way, they understand that there's an abuelita, grandparent or an uncle or someone that is sick at another country. And they feel some way and they know their parents are contributing to that other family member that they talk to over the phone. But usually, they don't have work here unless they are adolescents that have enough age to work and they have a part-time, and they may contribute in some way. What we have seen is mostly caregivers, parents doing that extra work to be able to support extended families in their country.

Host 2: I think it's very similar to just general stories of immigration, right? Many families, you hear stories of struggle even to make it to another country, whether it's the U.S or any other country where families are leaving for a better life.

Dr. Yovanska Duarte-Velez: Yes.

Host 2: And many times there are also stories where extended families have supported that person and actually making it to another country. So, it's almost like you're giving back and supporting your family who's helped you get this far.

Dr. Yovanska Duarte-Velez: So in my experience, there is really no one story that describes such a complicated experience with different families. But I agree with you, these stressors are multifaceted. And there's so many things that we need to consider and people come here for different reasons. It's not just one story for everyone, right? We have a very diverse Hispanic and Latinx community. So, people come for different reasons. But what I have seen is that everyone is looking for that American dream to do things better for their kids so they can have a better life. And sometimes not recognizing that that comes with so many challenges.

Host 2: Right. Right. Yep. Okay.

Host 1: So, culture plays such an important role in how families understand emotions and think of mental health, right? But maybe you could say something about the cultural influences on how Latinx teens express their stress or emotions or their struggles.

Dr. Yovanska Duarte-Velez: So, culture absolutely shapes how emotions are expressed, how we all express our emotions. And I think with the Latinx community in particular, I can say that it depends on the messages that the youth have heard for so many years. Some messages that I feel that we have heard myself right and my community about mental health could be from, "We have given you everything. And you basically shouldn't be sad because we came here and we really work hard to give you everything you need." So, the youth could learn from very early age, "Oh, I should not be sad. If I am, I will be ungrateful to my parents and I disrespect--" which is something very, very important in the Latinx community. So, that's one message that kind of, let's say, inhibit the adolescents to speak about their feelings. That's one. But also, they can grow up here in the message that you need to be tough because they have been tough. They have been strong. And to be strong means not to show your weakness. And weakness is related to showing emotions.

So, those messages, what they do is to make the youth hide their feelings. So if they're feeling sad, if they're struggling with different emotions, they would want to just hide it as much as possible. And if you hide your emotions, then it will come out in some other ways, like irritability or some anger toward their parents, and they don't know why they are feeling like that. Or it could show up as physical pains, headaches, stomach aches and so and so.

Other messages also have been related to even mental health doesn't exist. So, some parents, it is not a thing. "I haven't even heard of mental health. It's not a thing." So if you have heard that, then how can you express to your parents that I am feeling really, really bad, or I'm feeling super depressed or super anxious. So, it is difficult to understand. However, there are some parents that have more knowledge about mental health, and they have done the work to know more. Maybe because a crisis happened at home. Or maybe because their teen, they call them from school saying, "Hey, your youth says this," and sometimes it happens, you know, they said that they want to die or that they want to end their life. And that's kind of a huge crisis when you have that struggle.

Host 2: They are ticking, right?

Dr. Yovanska Duarte-Velez: Yeah. Yeah. And so, it's like a warning call to then realize, "Oh my God, yes, this really exists. There's a mental issue here. There's a mental health challenge. And they need to address them, and they do because they love their kids, but sometimes it takes some time to get there.

Host 2: For some families, the idea of therapy as we've discussed still feels uncomfortable. What would you say to parents who worry that seeking help means something is wrong with your kid?

Dr. Yovanska Duarte-Velez: I would say that mental health is part of the overall health. Just like we care for our physical health, we need to care for our mental health, and the two are actually connected. Therapy is not a sign of failure. It's a place for extra support and guidance during challenging times. And I have always been very transparent about this with the families I see. I'm a mother too, and I have been on the other side. Going to therapy with my child for support, and it has been incredibly helpful.

Many teens benefit from short term skill-based therapy. I have seen that for my own, and I have seen it for many, many years in other youth out there. So, it's not forever. At mi for example, we usually start with a plan of four to six months. Then. We review progress and goals together to decide on extra steps if we need to extend that or just finish there. So, asking for help is okay, and this is something very important that parents too could model to their kids. It takes courage and strength to recognize when you need support.

Host 1: What do you say to a parent who's concerned about their teen and isn't sure where they should start? How would you advise them?

Dr. Yovanska Duarte-Velez: So, I think they could start by expressing their concerns to the school social worker or counselor or to their pediatrician. They may be able to do a first screening and provide some referrals. They could also call directly to their closest community mental health center. If language is an issue for them, they can ask to be paired with a bilingual provider. If transportation is an issue, they could ask if they offer telehealth as an option.

Additionally, they could seek for community organizations that provide different types of support for youth and families. And I think in this time, it's very, very important to create a community of support. And if caregivers are concerned about their teen's safety because they have been talking about wanting to die, or similar phrases, they could call 988 for additional guidance.

Host 2: This has been an incredibly helpful conversation. What I've understood today is that mental health concerns are not specific to any community. I mean, mental health is just as important as physical health. But what makes it unique is the different experiences in the context of culture, sometimes religion, ethnicity, background, their lived experiences and so many other both modifiable and non-modifiable factors, which make it a much richer and sometimes harder experience to understand.

Before this, I thought about, you know, how we approach Latinx communities and how we should be offering treatment. And today, I've learned that the conversations about mental health are still the same, but it's important to be informed about the cultural experience, to have an impactful and effective conversation. I think we haven't dug deeper into this discussion as we were hoping. And my dream is that we could come back to it in another episode and continue this conversation to discuss about some of the other important things when it comes to mental health concerns about Latinx communities.

Host 1: I'll echo that. I have several questions that we don't have time to go into today, but we'll do it the next time we're together. So, thank you, Yovanska, for sharing your insight and strategies with us today and with our listeners.

Dr. Yovanska Duarte-Velez: Thank you for having me.