HELP IS AVAILABLE: Are you or someone you know in trouble? Or feeling alone? You are not alone. You can reach the National Suicide Prevention Lifeline by dialing or texting 988. The Spanish Language Line can be accessed by pressing 2 after dialing. An online chat can be started at 988lifeline.org. A call, chat, or text will connect you with a local crisis center. The American Foundation for Suicide Prevention has additional resources at afsp.org/get-help.
One hot May afternoon, Ysabel Garcia’s hands started to tremble. Her heart pounded, and she felt like crying but couldn’t.
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She felt stuck. Disoriented. Confused. Just three weeks into living in the United States, Garcia, then only 15, wanted to end it all.
Leaving her barrio in the Dominican Republic and moving into her aunt’s house in Springfield had been jarring and she felt scared about living in a new country. Garcia had also started to feel like a burden to her parents, who had left their community and culture behind so she could have a better future.
Desperate, she did the only thing she could think of: She walked out of her aunt’s house without telling family members and searched for the nearest emergency room. When she arrived, she blurted to the first nurse she saw at the reception desk: “I’m going to kill myself. I need help.”
Garcia thinks back to that fateful day in 2008, grateful she survived. But now, as a leader in suicide prevention, she recognizes that many other Latinos throughout the state and country haven’t shared the same fortune over the years.
Since 2010, more than 300 Latinos in Massachusetts have died by suicide, according to the Massachusetts Violent Death Reporting System. While the state has one of the lowest suicide rates in the country, an analysis of Massachusetts data shows the rate for Latinos rose sharply between 2010 and 2020.
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In 2010, there were 3.8 Latino suicides per 100,000 residents. In 2020, the rate increased more than 55 percent, to almost 6 deaths per 100,000 residents. That’s the steepest rise among all racial and ethnic groups in Massachusetts. The only group that saw a decline over the decade was white people, although the rate remains the highest overall.
The problem of rising suicides among Latinos extends beyond state boundaries. Nationwide, the number jumped more than 70 percent during those years, according to a 2022 study. Mental health experts attribute the alarming spike to socioeconomic inequities affecting many Latinos, such as high poverty rates, lower education levels, and systemic discrimination — all exacerbated by the COVID-19 pandemic.
About 1 in 4 Latinos in Massachusetts lives in poverty, three times higher than white residents, researchers at the Mauricio Gastón Institute for Latino Community Development and Public Policy at the University of Massachusetts Boston have found. Although Massachusetts is known for being progressive, social opportunities are different for everyone, says Gonzalo Bacigalupe, a professor of counseling psychology at UMass Boston. “I think this fantasy that we are all on the same boat is just quite ridiculous,” he says. “We are on different boats.”
Add a language barrier, and recent immigrants and their families can feel helpless, says Jagdish Khubchandani, a professor of public health at New Mexico State University and lead researcher on the adult Latino suicide study. “Many don’t see a future,” he says, adding wryly, “How difficult could it be for a first-generation 25-year-old who cannot speak English to live in a heavily expensive state?”
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Some public health initiatives aimed at curbing suicide fail to address root causes in Latino communities, often lacking sufficient bilingual providers and awareness of cultural dynamics, Bacigalupe and other experts and advocates say.
Preliminary findings released this year, funded by a federal grant awarded to the state’s Suicide Prevention Program in September 2020, back up that assertion. The $3.25 million grant ($650,000 annually for five years) aims to help specific vulnerable populations in Massachusetts, including working-age Latino men, and to culturally modify existing statewide prevention initiatives.
Structural racism, limited access to bilingual mental health services, economic stressors, and mental health stigmas hinder suicide prevention efforts within the state’s Latino population, according to the grant’s behavioral science team overseen by Airín Martínez, a medical sociologist studying social determinants of Latino health through the lens of institutional racism. She is also an assistant professor of health policy and management at UMass Amherst. “Suicide is one of the most dysfunctional displays of a society,” Martínez says. “It shows that people aren’t connected, or it’s not a fair society.”
Through the grant, the Suicide Prevention Program aims to reduce suicidal behaviors and deaths by 10 percent within at-risk communities. To that end, the program supports initiatives such as focus groups for Latino men and training sessions for community providers on racial equity concerning mental health. One goal is to enhance programming by involving community members, ranging from advocates to barbers, to address systemic gaps, such as inadequacies in reporting Latino suicides and connecting families to helpful services, according to a Massachusetts Department of Health spokesperson.
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Martínez stresses that her team’s research and findings are ongoing to better understand systemic barriers and cultural forces, and reimagine care. “We want to reapply for another grant because the work isn’t done,” she says about the funding, which is due to end in 2025. “We still have disparities, and one death by suicide is too much.”
Meanwhile, community leaders are filling the void too. To support the state’s diverse Latino population, made up primarily of Puerto Ricans and Dominicans, community groups have built alternatives that offer culturally informed, bilingual mental health care through traditional therapy services and peer support groups. Bacigalupe says these groups are underappreciated: by helping clients access housing, food, and education, they’ve become fundamental, he says.
In 2020, 12 years after she thought about ending her own life, Garcia founded the suicide prevention organization Estoy Aquí, Spanish for “I am here.” As a self-described psychiatric system survivor, Garcia believes in the importance of crisis care but says more money should be directed toward helping individuals avoid crisis mode in the first place. Her organization offers bilingual prevention efforts that explore the strengths of Latino identity and the connections between culture, systemic inequities, and mental health in Latino and Black communities.
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Garcia thinks in big terms, such as how to reduce despair. “We need to start asking why. Let’s go to the source of this river,” she says. “Why are [people] falling into the river drowning? I think that’s where Massachusetts is failing.”
Garcia’s parents didn’t know how to help when she confessed suicidal thoughts. Her mother had instilled the importance of education in her daughter from a young age and thought these emotional outbursts were growing pains. Not knowing what else to do, she told Garcia to stay in school.
Garcia went on to earn a bachelor’s degree in child psychology and a master’s in public health from Bay Path University in Longmeadow. Through her education and work, she realized that some Latino families, like families from other backgrounds, struggle to respond appropriately to their distressed children due to misconceptions about mental health.
In her supportive role to people seeking help through Estoy Aquí, Garcia tries to find common ground and has noticed certain responses come up repeatedly when a peer confides in loved ones: “Why are you complaining?” they ask. “We have food in the fridge. We have a ceiling.”
She has also noted that religion can have an impact. “If you complain or say anything about your mental health, that means that you don’t have faith in God,” Garcia explains. “Religion can be a strength for many Latinos, but how it is used and talked about can become a risk factor.”
As a teen, Garcia told her therapist she disliked her appearance and culture, but providers never addressed that in sessions. “I would talk about things like, ‘I want to be white,’ or I would say, ‘I don’t like Dominicans,’” she recalls. Now she understands those feelings had to do with encountering anti-Blackness and colorism growing up, and through dialogue, she helps others identify these negative influences and dismantle them.
Living in Massachusetts as an immigrant exacerbated her feelings of worthlessness, and she was frustrated with the new environment. “People making fun of my accent and English made me feel like I didn’t belong. Imagine how that creates conditions for suicidal thoughts,” Garcia says.
The day Garcia pleaded with a Springfield nurse to help, she stayed at the hospital overnight, and a nurse later notified her family about her whereabouts. In the morning, she left with a plan: Social workers would visit her family home. But, Garcia says, they came with assumptions and a lack of awareness of risk factors for Latino youth every time they arrived at her doorstep.
For two years, they thought her mental health resulted from parental neglect and that she had plans to take her life, even though she and her mom kept telling them otherwise. “They kept calling 911 almost every time they visited my home,” Garcia says. “I was hospitalized against my will three or four times in my first two years of living in this country.”
Looking back, Garcia wishes that the hospital staff and consultants had the resources to fathom the roots of her suicidal thoughts at the time. She needed care from people who understood her background, language, and experience coming to this country — without treating her as broken. “If they [had] asked me more questions, if they didn’t let their fear push them toward making decisions on my behalf, and took the time to dig deeper,” she says, “it would have made a huge difference.”
Felix N. Vazquez, born and raised in Holyoke, was taught to be the man of the house. His father, originally from Manatí, Puerto Rico, showed him throughout his life what it meant to “be a man” — unemotional and a tireless leader. “As a Latino father, he didn’t tell me, ‘This is how you’re going to be a man,’ but he modeled it to his standards,” Vazquez says. “I emulated the same thing — crying is not for men, and depression is just for the weak.”
In Latino culture, there’s a word for that: machismo.
These prevalent social standards for Latino men have had dangerous consequences. An archetype integrated into various Latin American cultures, machismo sets a standard of hyper-masculinity for many men — leaving little room for vulnerability or understanding emotions and sometimes becoming a risk factor for suicide.
“Machismo is this toxic ideology passed down from generation to generation that doesn’t allow men to speak on our pains until it’s too late,” Vazquez says. Now 36, he remembers the pressure to live up to his father’s expectations to provide financially, even as a young adult. At age 18, he moved out and sold drugs, another way to appear tough. “I raised so much hell on society,” he recalls.
In 2020, Latino men were three times more likely to die by suicide than women, according to the state’s death reporting system. Although this skewed trend is similar to other populations, experts say people from different backgrounds should not be treated the same. “They’re never going to have the same experiences,” says Stephanie Marrero, a licensed clinical social worker and mental health care advocate based in Springfield.
In December 2014, Vazquez’s life was shattered when his older brother, his hero, died from a heroin and crack cocaine overdose. Having lost touch with his brother the previous year, Vazquez fell into an abyss of guilt. For the first time, he thought about killing himself. He didn’t believe it was depression and suicidal ideation — it was just time for a change, he thought.
He stopped selling drugs and turned to a church in Holyoke, became a pastor, and found some relief. Still, he says, he felt like “too much of a man” to seek support, and what was building underneath were unprocessed feelings in response to losing his brother and being in a rocky marriage while simultaneously providing for his children.
Vazquez’s world turned dark and heavy, but his mentality rooted in machismo kept him going — a false sense of empowerment made him believe he was fine. Remembering the values his father instilled, Vazquez thought he just needed to suck it up, and soon he’d get over his depression.
In 2020, his depression worsened — he isolated himself and stopped answering phone calls and texts from family, friends, and church members. “I was suffering by myself,” he says.
About a year later, Vazquez cried in his bedroom in agony one night. The gut-wrenching feeling, the weight on his chest, and the lack of desire for anything became too much to bear. Alone, he grabbed his gun, held it in his lap, and thought about ending the pain rather than “deal with all the stress and expectations from my family, partner, kids, and parents — all these expectations that we think we have as men,” Vazquez says.
It took everything in him to put the gun down and choose life. (The most recent data show that in Massachusetts, firearms were used in 1 in 6 suicides among Latinos in 2020.)
Vazquez turned to his “lifesaver” — a therapist referred to him by a friend — who helped him unravel tangled emotions for the first time. Vazquez immediately felt the machismo facade fall. “I bottled so much in until I couldn’t. That’s where suicide becomes an issue in Latino culture,” he says, explaining that as a Latino man he felt it would be easier to end it all rather than speak up about his emotions. “It’s a cocktail for disaster.”
For Springfield counselor Marrero, many Latino male clients she’s worked with find therapy an unnatural experience because they’re not used to being vulnerable. “When they have the room to free themselves without any expectations of what culture is putting on them — it’s jarring,” she says. “They don’t know if they can fully trust the experience.” But by the end of sessions, she’s found they’re embracing it, just like Vazquez did.
After seeing his therapist for a few months, Vazquez unlearned the embarrassment and shame of expressing emotions, and in fall 2021, he changed careers and separated from his wife, later divorcing. Today he works to combat the school-to-prison pipeline as a restorative justice coordinator at Holyoke High School, a Latino-majority school.
Working with teenagers daily, he recognizes how many Latino kids are affected by machismo — the pain it can cause from a young age, especially with the lack of access to resources and opportunities to unlearn stigmas. “I still see a lot of, ‘No, Mister, I can’t tell you how I feel,’” he says. But he hopes to create change by normalizing mental health and being a “go-to person” for his students.
“We don’t have somebody that looks like us that we can go to and be like, ‘I’m depressed. I’m ready to kill myself because of my responsibilities and the facade that I put up,’” Vazquez says. He points out that having someone who can validate these experiences and work to dissect generational trauma, is critical.
With his children, three adolescent boys and a 7-year-old girl, Vazquez wants to set a new standard. “I have changed how I talk to my kids versus how my dad spoke to me,” he says. “He was very loving, but all he could provide was what he knew, which was to be tough.”
“I’ve never told my sons, ‘Suck it up, you’re the man of the house,’ because they’re not. They’re my sons and don’t have to figure it all out.”
Before leaving her hometown of Santiago, in the Dominican Republic, in 2008, Garcia felt unsafe and experienced frequent panic attacks. “I always had this sense of, ‘I need to protect myself when I go out,’” she remembers. So, the day her family left their Ciudad Corazón (“Heartland City,” Santiago’s nickname), Garcia was excited about her future. In mid-April, the Garcias flew to New York City and drove north to Springfield.
She noticed the big, clean streets and heard collages of languages. As Garcia settled into a bigger house, she was surprised about the consistent electricity and running water, a stark contrast to the routine blackouts in her former barrio.
But the thrills of discovering a new home didn’t last. People teased her about her accent after hearing English words trickle out of her mouth, making her feel ostracized.
Many immigrants, like Garcia, experience confusing emotions at first. Jagdish Khubchandani says this affects mental health, especially as people adjust to a new life in a different country. “People start thinking about their status, their fears, will they have to go back to a place they came from that is full of conflict,” he says. “That leads to these mental health issues, which could cause suicidal thoughts and behaviors.”
Most suicide deaths among Massachusetts Latinos since 2010 were among those born in Puerto Rico and outside the United States; in 2020, they accounted for 31 percent of Latino suicides. Experts say reasons such as culture shock, inequitable access to social services, or financial situations can be contributing factors.
But Bacigalupe says the additional effects on mental health of anti-immigrant rhetoric and Latino stereotypes in public discourse must also be considered. “Everything adds up,” he says. “There’s a point in which it’s going to become super toxic.”
Throughout the 20th century, Latinos in Massachusetts became a significant labor source for struggling businesses, the Gastón Institute reports. As factories in industrial cities such as Holyoke or Springfield shuttered, occupational and geographic isolation left many Latinos with limited chances for social or economic advancement, despite living in one of the wealthiest states in the country.
Unrelenting financial challenges change how people think and process emotions, which experts say can lead to suicidal thoughts. “You don’t feel valued, and the sense of belonging is cut off,” Khubchandani says. “You’re more vulnerable to being depressed because you’re constantly in a state of helplessness.”
Anna Hadingham works closely with residents who struggle with social and economic hardship. “We can’t ignore the economic impacts — the fact that [Latinos] live through extremely unfair and exclusionary economic systems that are forcing them at age 14 to think about providing for their family,” says Hadingham, director of youth programs at La Colaborativa, a nonprofit organization based in Chelsea that supports the Latino immigrant community in Greater Boston. She has worked with teenagers whose paychecks keep their families housed.
Even though many Latinos in Massachusetts experience economic insecurity, Gastón researchers note that communities saw progress before the spread of COVID-19 in 2020. But the pandemic changed everything as the virus disproportionately affected Latino and Black communities. Unemployment rates in the first quarter of 2020 surged for everyone in the state, but Latinos experienced the most significant increase, surpassing 25 percent.
Although more recent suicide data are unavailable from the state, because the reporting system experiences a lag in releasing figures, the 2020 numbers capture a small picture of the connection between the pandemic and Latino suicides.
Latinos requested suicide prevention services at higher rates in 2020, according to the Massachusetts COVID-19 Community Impact Survey. During the early days of the pandemic, when the Trump administration was coming down hard on immigration, Garcia says, migrants and their families experienced a lot of stressful physical responses due to uncertainty about living in the United States and isolation — a suicide risk factor for everyone.
All roads to suicide prevention initiatives tailored to Latinos in Massachusetts seem to lead to Garcia. Her colleagues say she was among the first advocates to jump into action and speak out candidly. “Ysabel carries this topic for the most part on her back,” Marrero says.
In 2020, Marrero crossed paths with Garcia on a Facebook group, and as a suicide survivor herself, was drawn to Garcia’s passion for creating spaces for people to communicate. “She normalizes taboo conversations and does it unapologetically, speaking to problems that stand behind mental health — the lack of access and representation and the struggle to get help,” Marrero says.
After going in and out of hospitals for over two years as a teen, Garcia realized she wasn’t healing. After her last hospitalization, she found a way to find relief without violence, surveillance, or coercion: She turned to peer support groups and community-based healing. Being in a peer support environment opened her eyes to mental health care alternatives. After that, Garcia took the initiative to join a series of groups — in person and online — and to connect with people who can relate.
Through her work at Estoy Aquí, Garcia hopes to set a standard of honest communication and save lives through community conversations about housing, increased wages, and other ways to decrease poverty rates — a way to help everyone.
“There is not enough investment in joy,” she says, boiling it down to even simpler terms. “What are the things that make life worth living? Let’s invest in that.”
Anna Guaracao is a researcher at Boston Globe Today. Send comments to magazine@globe.com.
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