1. Migrant Farmworkers &
Mental Health Access
Prepared by Kikelomo Ogunfowora
NACHC State Affairs

2. Migrant farmworker Definitions
Migratory Agricultural Worker
– Principal employment is in agriculture – Has been so employed within the last
24 months – Establishes a temporary home for the purpose of such
employment
Seasonal Agricultural Worker
– Principal employment is in agriculture on a seasonal basis – Does not migrate
Aged & Disabled Agricultural Worker
− Individual who has previously been migratory agricultural worker
but who no longer meets the requirements … because of age or disability

3. Who are migrant farmworkers?
According to a 2014 study by MHP Salud:
● 71% of farmworkers speak Spanish as their first language
● 78% of farmworkers identify as Latino or Hispanic
● Estimated 4-4.5 million farmworkers within the United States. 1-1.2 million are
migrants
● Predominantly male: 78% are male and 22% are female
● 41% of migrant farmworkers hadn’t visited a health center in the past 2 years
● 64% of migrant farmworkers do not have access to health insurance

4. Breakdown of Migrant’s Place of Birth

5. Farmworker Income
Full time workers = >150 Part time workers = <150

6. National Farmworker Network
Health Resources and Services Administration works to promote health equity through
quality services, a skilled workforce and innovative programs. In order to best serve
migrant/seasonal farmworkers, HRSA awards 330g funding to six grantees who
make up the National Farmworker Network.
Helps Health Centers to deliver tailored services
National Association of Community Health Centers
National Center for Farmworker Health
Migrant Clinicians Network
Health Outreach Partners
Farmworker Justice
MHP Salud!

7. Patterns of Health Care Center Utilization
● Nationally, health centers serve about 900,000 migrant farmworkers, which is less
than 25% of the population.
● Not adequate - what is possibly causing such low turn out:
- Lack of knowledge about services
- Less focus on preventative health
- Lack of transportation/ distance to clinics
- Fear, mistrust due to immigration status
- Not able to speak English
- Inconvenient clinic hours

8. Map of Health Center Locations
Texas
California
Washington
Minnesota
Michigan
Illinois
Florida
North Carolina

9. Overview of Health Challenges
Agriculture is one of the most hazardous occupations in the United States.
Farmworkers suffer from high rates of workplace injury.
Work related risks: musculoskeletal injuries, eye injuries, heat stress,
machines, pesticides
Living Conditions: urinary tract infections, lead poisoning, conjunctivitis
Chronic Diseases: diabetes, hypertension, obesity (malnutrition), HIV/AIDS,
asthma, tuberculosis

10. Mental Health Challenges for Farmworkers
Farmwork Stress vs. Stresses related to challenges of being Latino/Political Climate/
insurance
Almost 40% of migrant farmworkers display signs of clinical depression
1 in 4 migrant farmworkers experienced one or more mental health episode
Mental Health Concerns:
Anxiety, Depression, Substance Abuse, Stress, Domestic Violence
Contributing Factors:
Isolation, Separation from Families, Lack of respect from employers, Discrimination,

11. Barriers to Mental Health Care
● Prohibitive Cost
● Shortage of trained professionals in rural areas
● Migration- difficulties maintaining ties with counselors
● Immigration Status
● Complexity of US Healthcare system
Cultural Factors: Fatalism, More Focus on Family vs. Individual

12. Identified Coping Strategies
Humor
Music
Sleeping ( 8 hours a day)
Forming Close Social Bonds - families/friends
Playing sports
Discussing more equitable work conditions with authority figure

13. H-2B Visa Program
● H-2B allows US employers who meet specific requirements to bring foreign
nationals to the US for agricultural work
● Who pays insurance: contractor or farmworker?
● ACA makes health exchange an option
● Must enroll within 60 days
● Health exchanges are static & “bronze”
● Reconciliation

14. Role of Health Centers
● Health Center budgets range between $500,000 and $25 million.
● Primary, Preventive, Pharmacy, Emergency, Outreach & Enabling
● 165 Health Centers serving migrant farmworkers
● For every dollar provided by Bureau of Primary Care, health centers must
match it with three dollars.
● Education, Legal Advice, Workplace Advocacy
● Promodores- who can travel to patients

15. Cultural Understandings of Illness
● Financial and employment limitations, rather than folk health care practices, were more likely to
influence use of professional care systems.
● Low cost alternatives - tylenol
● These health care practices likely reduce the use of primary (e.g., immunizations and health
education) and secondary prevention services (i.e., health screenings, early diagnosis, and
treatment) and may help to explain healthcare disparities in this population.
● Common cultural health practices among members of this group include the use of herbal
medications, hot and cold foods, curanderos (faith healers), self-prescribed antibiotics, religious
rituals, and spiritual cleansing called limpias.
● Health care workers should recognize and be familiar with alternative and complementary remedies
in order to incorporate this information in the patient's plan of care, and to prevent this population
from solely using their own remedies

16. Best Practices
Mental Health Counseling Programs
Farmworker Advocacy for safer, more equitable work conditions
Language Classes - ESL
Spanish-language mental health service hotlines

17. Sources
CULTURAL HEALTH PRACTICES OF MIGRANT SEASONAL FARMWORKERS
Stress, Depression and Coping among Latino Migrant and Seasonal Farmworkers
Mental Health Barriers Among Migrant and Seasonal Farmworkers
http://www.ncfh.org/uploads/3/8/6/8/38685499/fs_mental_health.pdf
Psychosocial Stressors Associated with Mexican Migrant Farmworkers in the Midwest United States
Delivery of health services to migrant and seasonal farmworkers