ANA: Hey everybody, this is Ana González. And you’re listening to Mosaic. Most of you don’t know this, but I’m a bit of a nerd about mental health and psychology. My dad is a child and adolescent psychiatrist, and I grew up with medical journals weighing down our bookshelves. As an adult, I’ve had my own journey with therapy, and I think every person should have access to it.

This past year of the pandemic has made the importance of access to mental health even clearer to me. People are struggling with the isolation, the loss, the uncertainty, you name it. But access to mental health care is not a given. That’s especially true in non-english-speaking immigrant communities.

Our conversation today is with Sandra Victorino. She’s a licensed mental health counselor and the current Director of Workforce Development at Care New England. As a Spanish-speaking, first-generation Mexican-American, Sandra’s seen just how difficult it can be for Rhode Islanders to access appropriate mental health resources.

SANDRA: But it's, it's hard. It really is. There's not one solid system right now that someone can point at and say, “I need this kind of a therapist, and this is where I'm gonna find it in our state.”

ANA: What were the most pressing needs in non-English-speaking immigrant community in terms of mental health before the pandemic hit?

SANDRA: It's access. People don't know what they don't know. And I always say that all the time. And I don't think we realize, you know, in the countries of origin that are Latinos, you had to be extremely privileged to be able to have mental health therapy. Other than that, it was family taking care of family. And a lot of people have immigrated or left their countries of origin in a hurry, because they needed to for survival. And they end up in a state like Rhode Island. And they have, you know, one tía or aunt that lived here. And that's why they came here. But that aunt lives in subsidized housing. And so how am I how I can't stay there for long term. So that person or that individual sometimes ends up homeless.

And being able to learn how to get health insurance. I mean, I think we are doing a better job in our state of being able to show that. There are systems in place right now. I can think of, like, the Parent Network. And, you know, the Mental Health Association of Rhode Island is a really great resource. They're doing a lot of the behind the scenes work to be able to show or be able to help people get access...But ...I see this complex level of different needs, and the reasons – people that lose their jobs for the first time. I think if I lost my job, and I wasn't a case manager or slash therapist for so long, I wouldn't know how to get benefits or what to do. So I often tell people, I’m like, “Would you know what to do if you ended up in one of these situations?” And a lot of people tell me “No.” It's hard to navigate on your own.

ANA: Absolutely. Yeah, absolutely. I mean, I wouldn’t know what to do if I didn’t have a parent explaining certain things to me. Like, “No, you have to call this person. You have to make an appointment.” You know? You have to do these things. But it’s complicated. Especially when language is involved. Like, you have to be able to negotiate the front desk. And I can imagine how, or I know how hard it can be for people who do not speak English to get access to mental help because it’s, oftentimes, an afterthought in terms of care.

SANRA: Well, the other thing is that sometimes when people go get treatment at primary care offices, it's asking questions differently. The providers need to ask questions differently, even if they have an interpreter present, right. So if I don't, I come from a country of origin that doesn't understand mental health, or that sees mental health as a concern or an issue, because that's only for people that have wealth. Like, I've never heard of what depression is, my mom used to tell me to rezar and pray and, and things would get better. And, yeah, that was good, because it was a practice of meditation. But it didn't solve the complexity of being a kid that was in two worlds all the time, and having to teach both systems what I needed. So, not only did I have to teach my parents what was necessary at school, I had to teach the school that my parents may not be able to be at parent-teacher conference day because they were working long hours. And make sure that they weren't being judged as bad parents. I mean, I'm also the fourth out of five. So I had seen when my older siblings had experienced in school systems, where I learned that I needed to learn how to navigate it better. So I had privilege or advantage in that way, of learning from my siblings. I'm, you know, the one the only one that spoke both languages since I can remember I was speaking English and Spanish, where my siblings - all four of my siblings, even my younger sister -- only knew Spanish before they went to the school system. And that was tough for them.

ANA: How did you learn English?

SANDRA: My older siblings, yeah, I again, that was an advantage for me. I ended up a little bit more of a village than they did.

ANA: And so, growing up, you said that your parents didn’t talk about mental health, you didn’t know what depression was. What got you interested in this field?

SANDRA: So there's several things. I was supposed to be an optometrist. That's what I was planning on going to school and I had my first year of college. I ended up learning my story from my history professor. So, I didn't know my family's origin of being in the United States.

ANA: What was the course?

SANDRA: It was just like history, like your first entry level history class that you have to take when you go into college. He was Professor Henry Apperson. And he just was someone that was interested in helping. He was, you know, he did this with all of his students. He believed we needed to know our story in order to be able to grow and grow into our professional selves. So that was part of his requirement in his classroom. So I wrote my story. It was the first time that someone had ever asked me to write my story. So I wrote everything down that happened to me. How old I was when my parents started to do the migrant patterns. I was three years old when they started doing them. But he had me write down this story, and I just loved the fact that someone wanted to hear it. So, I handed it in, and he looked at me, and he's like, “Your parents were like, like the lettuce pickers.” And I'm like, “What do you mean, ‘lettuce pickers?’” He's like, “I studied in California, when I was younger, and there was a ton of, like, lettuce pickers.” And, and it was so funny that that's how he connected us. He's like, “You're part of the bracero program.” And he started to explain to me what the bracero program was, and educate me. And I was like, I don't know, I would have heard about this for my family.

ANA: Before you continue, what is the Bracero Program, for people who don’t know?

SANDRA: So it's a farmworkers that did labor work from Mexico. So there was a contract that was done around World War Two, between Mexico and the United States. And it brought farmhands into the United States. “Brazo” means “arm.” So that's how they came to the United States. My grandfather was, there's always a story. And I don't know if it's a folk story or not, but my mom's like, “Your grandfather had to eat a bunch of bananas, because he had to make weight before he would come in the United States.” [laughs] And so, um, yeah, my mom immigrated when she was around six years old. Through that program, it guaranteed your family to immigrate into the United States. And then my mom and dad met later on, and my dad saw a way of making a living for his family by doing this kind of work. And so we moved all over, from I was born in California, and we moved around the United States. And that's how I grew up. And they ended up landing in Texas.

ANA: So, you’re living all over the country, but your mom has lived in the United States almost her entire life, but she’s still very much Mexican, it sounds like.

SANDRA: Yes, because when she immigrated, she stopped going to school when she was around third grade, because it was really difficult for her to learn English. And at that time in the United States, you were not allowed to speak Spanish in school.

ANA: What would happen?

SANDRA: They were just mean. I've heard, I've read stories about kids being beaten. And, you know, asked to stand in corners. And so it was, it was a difficult time to be able to be different... I experienced tons of things growing up and being part of it. I can't imagine what she experienced. I mean, from going to schools outside in trailers. In third grade, they would put me out, all the migrant kids would have to go out on a trailer, and they would teach us words like “cat” and “hat.” And I was upset because I wanted an education.

ANA: This was in third grade?

SANDRA: Yeah. And the teacher was just mean, and she would belittle us, and I would see the rest of the kids outside in the playground when we would come together. And when I went back to that same school in fourth grade, I sat in the principal's office, and I said, “I want to be in the regular classrooms.” And they were like, “No, you need to be outside with all the migrant kids. Like you don't belong inside this class. Because you only come here for three months. There's, there's a lot. You're behind, and we can't teach you.” And I'm like, “No, I deserve to be in that classroom. So they called my parents. My parents showed up. And they're like, “What happened?” I'm like, “I want to be in the regular classes.” And they look at the principal. And the principal says, “Well, she, you know, she needs to be in those classrooms”. My dad's like, “So she's advocating for education. He's like, “I can't argue with her. Like, you don't understand who my daughter is. She's been fighting to go to school even before she was in kindergarten. She's gonna come to school and she's gonna sit here in your office unless you put on regular classes. She knows what she's doing.” And so they put me in regular classes. But once being in regular classes, then I was different than other migrant workers. So then I would be picked on by the migrant worker kids and I would be bullied by the regular kids because it was a predominantly white school.

And those are things that come back to me now. And I have to create understanding, but because of that history professor, I no longer had to hide.

So I learned after that, I asked more questions, right, I started to learn more and more about my family. And then I met my first professor in psychology, and I fell in love with the fact that everybody has a story. And everybody's traumas are different. And I was like, if only this information was passed to my family, things might have been different and or easier because we went through so many things where we didn't know how to navigate them. We didn't talk about certain things, or certain things were talked about. But there was never any resolution. And I really became interested in it and I just kept on taking psychology classes.

And then my grandfather moved in with us and he had onset dementia, and they had diagnosed him with schizophrenia. So, schizophrenia is supposed to be diagnosed, most of the time is diagnosed before you're 30 years old during a traumatic event. And the doctor said he had schizophrenia. And I was lost at words, and I was like 20 years old. And I'm like, “Why would he have schizophrenia?” And so I started doing a bunch of research. I was his interpreter, because there wasn't any interpreters in that hospital where he was meeting with psychiatrists. And I would take notes. I would document everything, how the medication was working, if it wasn't working, if he was cheeking it, and I would go back to the doctor, and I would report everything. He's just looked at me, like, “Who taught you this?” And I'm like, “I don't know. But I think you need to know every detail because the medication isn't helping. And it's really causing a lot of grief to my family.” So there's that component. And then I just kept on doing the advocacy work for my family, like when he needed to go to a nursing home. And I looked at my parents, and I said, “It's enough. Like we can't handle this diagnosis of dementia.” And helping them grieve through that.

MUSIC

ANA: Coming up on Mosaic, Sandra’s journey takes her to Rhode Island, where she learns what it means to be a therapist and experiences the impact of COVID. That’s after the break on Mosaic.

MUSIC

ANA: You're Listening to Mosaic. My guest today is Sandra Victorino, a licensed mental health counselor. Before the break we heard about Sandra's childhood in Texas and learning about her family’s history as migrant workers in this country. Now, Sandra lives and works in Rhode Island.

SANDRA: One of the things that I really appreciate about Rhode Island is that in Rhode Island, because it is so small, you can see the good and you can see the dysfunction. So as therapists, when we have families that come into therapy, and we can see the dysfunction, that family is 10 times easier to work with. And so that has been one of the things that I continue to see in Rhode Island is that it's gone through so many waves of immigrants coming through. And it's been kind of now it's like, woven into the culture in Rhode Island. And, you know, people are still challenging, what hasn't been done, and I can see that, and I want to be part of that and help out however I can. It also grew me professionally. I became a professional here. I've had some great mentors here. I know that they gave me access in a way that I wouldn't have been able to have on my own.

ANA: So you wind up working at the Providence Center as a licensed mental health counselor, correct?

SANDRA: Mhmm.

ANA: And so, this kind of brings me to how I met you and how I know you, which is through Zenaida. Zenaida was somebody I got connected to through one of her English teachers. And I did a whole episode about her and her life. You know, her story is this big realization that she has depression and that all of these terrible things have happened to her and that they're negatively affecting her mental health. She describes you, Sandra, – First of all she calls you “Sandra” and how and she's like, “She's one of my best friends. I love her so much. And she changed my life.” And her experience with therapy and finding somebody who could speak Spanish was the biggest game changer for her to help her improve her life. And I just, I'm gonna play an excerpt now from that episode, and you can hear the waist and it talks about therapy

ZENAIDA EXCERPT

ANA: So, that was an excerpt from an episode of Mosaic called “Zenaida and the vaivén”. And I’m sitting here with Sandra Victorino. Sandra, what is it like to provide that level of care, like life-changing care, to the Spanish-speaking immigrant community here in Rhode Island?

SANDRA: I have learned so much from every single person that walks through my door. The journey of therapy is, it's a beautiful one. I get to be someone's co-pilot in their journey, and they get to be the pilot. And then when I get to see them take off on their own. And I'm just, I'm standing there, and I see them take off. I'm like, “Yes!”

And, you know, I've always told people, you know, therapy is a lifelong process. It is not, you're not in it forever. But we change, you know, people change. Our taste buds change, like, why wouldn't we and our mind and the way our emotional feelings are, change? We often continue to use patterns that we did when we were younger, which served us well, because that's why we're alive. But it doesn't necessarily mean that they're the best ones for us in the next stage of our life.

And so, the Latino community has taught me so much about their different cultures, their different ways of understanding. And, you know, I most for most of my life, I was just raised around Mexican communities,... I've learned so much in Rhode Island, and I just want to be able to give that back. You know, now in my new role, I get to help people be employed. So I'm the director of Workforce Development at care New England, and I get to engage with the community, bring community into healthcare spaces, because I'm a huge believer that if we can see ourselves as the providers, if I can see that provider and they're Latino, it makes it 10 times easier, because they understand some of the baggage that I may not be able to speak of.

ANA: What kind of baggage would like if because, you know, a lot of people don't I know exactly what you're talking about. I could say 100 things right out but for people who don't grow up in Latino households or have Latino family members. Like, in your experience, what is that baggage? What are the differences that make it so much easier when there is somebody in the workforce who has the same experiences?

SANDRA: It's the living in two worlds experience, right? It's the immigrant story, right? A lot of immigrants -- and when I think about Rhode Island, we have so many immigrants here -- it takes everybody for the whole family to make it. And that's hard. It's super hard and you know, each country that you immigrate from has a different story of, you know, trauma that comes from that country. So if a provider can't think about those things for me at times, then they can't ask me the questions. And again, we go back to: what we don't know. And there are some amazing providers that are not from the those countries of origin, or not diverse, and have been able to do it, I've seen it happen. So that, you know, I have some colleagues that just keep on learning about the histories and the traumas and the work that other communities have to do versus, you know, those communities that are, you know, white and English-speaking.

ANA: At Care New England, in this role as the Director of Workforce Development, what sort of initiatives to see that change? To get more people, a more diverse workforce? What kind of work are you doing?

SANDRA: So I'm really trying to connect with communities, I mean, that's exactly what I used to do in order to find the resources for my clients. If you don't know the community you're working with, you don't know where to send people. And so I've tried to connect with different community organizations, seeing how we get the information about the jobs out there. We're doing a lot of educational work on what it is to hire diverse candidates. And then upskilling, or creating space for people to learn and grow. Because we have all of the resources we need here, we just need to be able to teach people and provide them the proper training. I always say it takes a village to create a person and as people from diverse communities, I know that like, it's what has made me strong enough to continue to do the work that I do. And I walk into different spaces, and I help and support to bring education. So then I'm like, all right, who else needs to be in this room or in this table? Because that's how people learn, too, is by being at the table. It's creating those pathways. And that's my job is to make sure that it's easier for the next generation. And that's the way I see it.

ANA: Wow, I mean, just hearing everything you just said: from the time you were in fourth grade, sitting in that principal’s office to, like, helping your grandfather deal with his illness and end-of-life care, I see you as such an advocate. And with Zenaida’s story, too. She got a job after being in therapy with you. She went back to English classes. She dealt with her trauma. She dealt with her grief. She got a job that she’s still at. It’s such an amazing way that mental health care can really change lives. But we’re in the middle of this pandemic, or hopefully, towards the tail end of this pandemic. And it’s been such a tough time. So, like, what do you tell people when they are experiencing symptoms of a bigger issue or a mental health decline?

SANDRA: So depending on the decline, you know, and the risk, so you know, there's always, you know, making sure that you get someone to the hospital or calling 911, those are always really important. And I always say, you know, you can go to your ER, but you know, it's always good to connect with your providers. Connect with your providers and call or call the number in the back of your health insurance card, because they're going to be able to give you a list of the providers that you have access to. And that way you're not paying out of pocket. Your primary care doctor in the primary care offices, they have some therapists there that can offer assistance, and that's intermediate or triaging, so they help you connect to a provider that's going to be full time with you. Ask for help. If you know someone that's going to therapy, they probably will be able to give you some more information about it as well.

ANA: Ok. And what about people who don’t have health insurance?

SANDRA: Clínica Esperanza, I would say, you know, here in Rhode Island has done an excellent job of trying to figure something out for those that are non-insured. And there are therapists that do things pro bono. There are other therapists that have a sliding scale fee. So, that means it's based on your income. So, there's options such as those that are out there that people can look into. But really, like, you know, if people want to reach out to the Latino Mental Health Network as well, you know, we're on social media. So, it's the Latino Mental Health Network of Rhode Island. We've had people that will send us Instagram DM messages or through Facebook, and we try to help people out as best as possible, but we don't provide the individual therapy but we do send it out to our network if necessary.

ANA: Ok, great. I think, the education and access and knowledge is half the battle of getting people into the door to get the help they need.

SANDRA: 100%. And take a friend if you need to. It's not easy. You know, sometimes you need that emotional support to go. Even from scheduling the appointment. Like sometimes it's just nice to have someone that holds us accountable to following through for our own care because we normally take care of our friends, but we don't do the best job of taking care of ourselves.

ANA: Absolutely. I know that’s true. Well, Sandra Victorino, thank you so much for joining us today on Mosaic Conversations.

SANDRA: Thank you for having me. It's been a pleasure.

ANA: That was Sandra Victorino, Director of Workforce Development at Care New England and a bilingual/bicultural licensed mental health counselor. You can learn more about Sandra and her work at mosaicpodcast.org.

Mosaic is a production of The Public's Radio. Edited by Sally Eisele. Produced by James Baumgartner. Our original music is by Bryn Bliska. Our intern is Michelle Liu. Torey Malatia is the General Manager of The Public’s Radio.

Support for this program comes from the Carnegie Corporation of New York. Supporting democratic engagement and the advancement of international peace and security at carnegie.org.