For 24 years, Diana Huerta has been the only member of her family living in the United States. The rest, still in Mexico, are in touch often, but talking to them on the phone doesn’t cure the anxiety and depression she feels from being isolated in a primarily English-speaking area.
Huerta tried to get on the waitlist for the only bilingual therapy clinic in Orange County, El Futuro, but there was always too much demand. Then the Carrboro location shut its doors in 2015 and she lost hope, turning to virtual sessions with a therapist in Colombia just so she could speak with someone who understands her.
“We realized that there is a lot of need, especially in the Hispanic community, about mental health, in the absence of clinics and therapists,” Huerta says in Spanish. “Especially with the language.”
Then, last May, Huerta and hundreds of other Latino community members in Orange County joined together to demand mental health support from Alliance Health, the private managed care organization (MCO) that serves uninsured residents and those who receive Medicaid in Orange County. Their call was answered with a $500,000 donation, which has gone into El Futuro’s services and community programming for Orange County.
That’s what sparked the program Mentes Fuertes, or Strong Minds. Part of a new community health initiative from El Futuro, the program includes 10 free psychoeducation sessions for Orange County residents who are at least 18 years old and have symptoms of anxiety or depression.
El Futuro hired four Community Health Workers (CHWs) to deliver the sessions. All of them speak Spanish and spent months undertaking the intensive training that’s part of Mentes Fuertes’ curriculum that’s adapted from Cognitive Behavioral Therapy and modeled after a similar program at the University of North Carolina at Greensboro, according to Estefania Castro, the project’s manager.
“It’s a program that we know works, it’s evidence-based and it takes a lot of skills from different therapies, from different modalities that we know work well in the Latino community specifically,” Castro says.
During each session, the CHW listens to the community member’s struggles and experiences before offering strategies and coping mechanisms that they can incorporate into their life, including mindfulness, behavioral activation, psychoeducation, and self-management.
Mentes Fuertes is the first mental health initiative that El Futuro has launched in years in Orange County. The Carrboro location closed due to lack of funding, and while the clinics in Durham and Siler City are still active, it’s a long drive for residents to get support.
The call for help last May came in the form of a public accountability assembly at St. Thomas More Catholic Church in Chapel Hill, in the midst of a mental health crisis stemming from years of Alliance Health’s predecessor denying Medicaid reimbursements to undocumented immigrants.
Organizations including Orange County Justice United and the North Carolina Congress of Latino Organizations banded together to organize the assembly, inviting religious leaders, public officials, and community members such as Huerta to speak about the importance of mental health transparency and community action.
Huerta lives in Hillsborough and works as a house cleaner. When she found long waitlists atEl Futuro, she looked at private therapy options, but the high costs prevented her from getting help.
“You use all your tools and all your knowledge to try to carry your emotions, and you say, ‘I can, I can, I can,’” Huerta says. “But you can’t if you need help.”
While North Carolina has over one million Hispanic residents, the Latino mental health crisis is not unique to Orange County. Across the nation, only 36 percent of Hispanic and Latino Americans received mental health services in 2021 compared to 52 percent of non-Hispanic whites.
But Orange County is unique in its perseverance and community action.
When Alliance Health’s chief operating officer Sean Schreiber announced the $500,000 pledge at the end of last May’s assembly, there was a spirit of victory in the air. Now, almost a year later, the community is finally feeling the impact of that money through the care they’re receiving from the CHWs, Castro says.
“We were so fortunate in finding the Community Health Workers that we did,” Castro says. “We hired the four best people for this role. Anytime anyone hears them speak, you can really feel the commitment that they have to our community and to this type of work.”
The four workers are part-time employees, balancing other jobs on top of their community work. They come from different backgrounds: an experienced advocate and organizer, a community project advisor, a childcare specialist, and a medical doctor.
At the launch of the program, the CHWs were a little overwhelmed with the amount of material they had to know, but after only a month of delivering sessions, Castro says, it quickly became apparent that the four workers were more than capable.
“Earlier this year, around February, one of the Community Health Workers came to us and said that someone had reached out to him and said, ‘Hey, you’re actually working with one of my friends and I have seen the change in her. And I want that for myself,’” Castro says.
That message came after only four or five sessions with the participant. Since then, the program has only grown in numbers: as of March, Mentes Fuertes had 48 recipients enrolled and had completed over 205 program sessions.
Despite the program’s early success, a new physical space for El Futuro is still up in the air. While the donation from Alliance Health was intended to initiate a multi-phase return of the brick-and-mortar clinic in Orange County, there are no plans to rebuild the Carrboro location.
In the meantime, the CHWs have held sessions in community spaces thanks to partnerships with agencies such as the Orange County Rape Crisis Center, St. Thomas More, and Holy Family Catholic Church. El Futuro does community outreach to find Mentes Fuertes participants in those spaces too, Castro says.
“It’s really nice because we do outreach at a host site and then that person can meet us at that host site, so they’re not having to go somewhere that they’re unfamiliar with,” Castro says. “They’re in community, still.”
The CHWs and community members share a connection through their shared language. In North Carolina, eight percent of the population five years and older spoke Spanish at home between 2018-2022. Not only do the CHWs speak Spanish as their first language, but they prefer it to English.
For people like Huerta, meeting with Spanish-speaking program staff would keep her from having to pay steep private therapy costs or look outside the U.S. for mental health support.
In addition to breaching language divides, one of the program’s biggest successes has been in adapting the curriculum. After months of the CHWs watching videos, reading manuals, doing extra training, and working through roleplays, Castro says she is amazed at how well the curriculum works, even in just a short time.
“We had seen the numbers, we knew that it worked, but I think them experiencing it for themselves, and me experiencing it through them—I’m honestly blown away,” Castro says. “It’s amazing that people have this level of impact.”
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