BALTIMORE — It started in this southeast neighborhood last fall, not long after U.S. Immigration and Customs Enforcement officers raided Baltimore and other “sanctuary cities.”
In October, a popular 16-year-old Mexican-American boy died by suicide at home. The next month, a 42-year-old mother from El Salvador told her husband and two daughters to go Christmas shopping without her — a puzzling request for a family who liked to shop together. When they returned home, they found that their wife and mother had killed herself.
In December, a 28-year-old man from El Salvador went to a hotel room and ended his life after Christmas. In January, a man from Ecuador killed himself.
Those deaths, and other suicidal thoughts that came to light as the tightknit immigrant community struggled to find answers, raised a possibility: Is this part of a newly unfolding national mental health crisis for parents and children deathly afraid of being separated?
There are other factors at work — the possibility of copycats after a well-publicized suicide, and the difficulty of life for immigrants, many unauthorized, in a poor and sometimes violent urban neighborhood.
To better understand the tragedies, researchers here at Johns Hopkins University have begun to gather information on immigrant suicide. It’s a difficult task when national suicide statistics do not take immigration into account.
Baltimore public school administrators, who have also seen an increase in immigrant students seeking mental health support, are looking at the issue as well.
“Stress and depression in the immigrant community have always been there, but it is heightened now,” Johns Hopkins psychiatrist Rheanna Platt told Stateline. “I see more children being very distressed about the possibility that a parent will be deported.”
The suicides in this neighborhood were all members of the Sacred Heart of Jesus church, which has catered to recent immigrants since it opened in the 19th century to serve newcomers from Germany. Today it serves mostly Central Americans and Mexicans, many living here without documentation, at packed Spanish-language services and events.
The cluster of suicides in the parish might be a case of “suicide contagion,” a well-documented phenomenon in which exposure to suicide — such as the ones in this tightknit community — causes an increase in suicidal behavior, said Daniel Reidenberg, a psychologist and director of the Minnesota-based Suicide Awareness Voices of Education. “It is too soon to tell and there’s no way to know for sure, but I would be likely to come down on the side of ‘copycat suicide.’”
Researchers have found, though, that the stress of being an immigrant can cause or worsen depression and post-traumatic stress disorder, and may contribute to suicidal thoughts. Like Platt and other Johns Hopkins researchers, the Rev. Bruce Lewandowski, a pastor at Sacred Heart, believes the increasing pressure on undocumented immigrants in his parish factored into the suicides.
“You get somebody 17 years old in these immigrant families who’s basically running the household because his parents don’t know English,” Lewandowski said. “He’s a parent to his parents, the bridge between his family and the outside world. That’s a lot of stress.”
In coordination with public school administrators, Platt and a team of researchers plan to interview young immigrants to determine whether suicidal thoughts have jumped during the Trump administration. The project was prompted by the string of suicides by parishioners, and the reports of suicidal thoughts and attempts that came to light when advocates asked parishioners to speak up about the issue.
Many aspects of immigrant life are stressful, especially for the unauthorized and their children. But Platt said there’s evidence things have gotten worse, as raids and stories of family separation at the border fill families with dread.
Joshua Agren-Barnes, a social worker who helps refer families to mental health professionals at Johns Hopkins Bayview Medical Center, agreed that recent raids have taken a toll.
“Fear of deportation was an extremely common complaint at the end of 2017 and the beginning of 2018,” Agren-Barnes said. “The change in government has significantly increased fear in our families.”
Though the issue is clouded by lack of solid statistics, other immigrant communities have seen alarming mental health repercussions from recent hostility to newcomers.
Yuridia Nava, a high school counselor at Riverside Polytechnic High School in Riverside, California, said she often talks to immigrants, or the children of immigrants, who are contemplating suicide. Some, she said, faced an increase in taunting recently by peers who chant “Build the wall!” or “Go back to Mexico!”
She said she counseled a teenage girl who arrived in the country alone after her mother died in Central America. After a stint in federal detention, the girl lived with distant relatives who, Nava said, forced her to work to pay for rent and food. The girl’s classmates belittled her, Nava said, and she attempted suicide twice.
Children are “already dealing with a lot and feel so happy to be in our country and start over, only to face so many challenges here in our country,” Nava said.
America Paredes, a senior director at Mental Health America, an Alexandria, Virginia, based nonprofit that offers online screening tools, said the group’s research found that Hispanics, including non-immigrants, are less likely than other ethnic groups to seek help.
“Depression is like any other illness,” Paredes said. “If you wait too late to address it, it’s harder to recover.”
In the wake of the suicides, Monica Guerrero Vazquez, then a graduate student in public health at Johns Hopkins, held community meetings to discuss youth stress and suicide. Parents new to the subject were grateful to have words like “depression” and “stress” to describe the problems they saw in their children, Guerrero Vazquez said.
“There’s a lack of data on this, but we cannot wait until we have data. That’s a long process. We needed what I call an emergency response,” said Guerrero Vazquez, who has since graduated with a master’s degree in public health. She gathered Spanish-language materials and enlisted mental health doctors to speak at the community meetings.
As soon as the meetings were announced, Guerrero Vazquez said, parents began to reach out. “I got a text message, ‘My daughter just tried to kill herself — she’s in the hospital. What can I do?’” Guerrero Vazquez said. The girl, 12, had taken pills she found at home because of taunting by schoolmates, who said that her parents would be deported and she would be left alone.
Another girl, 11, was treated for suicidal thoughts triggered by the sight of police officers, fearing they would deport her parents and she would be alone, Johns Hopkins’ Platt said. The pastor visited both girls in the hospital.
The suicide rate among Hispanics of all ages is lower than it is among other ethnic groups. Data from the Centers for Disease Control and Prevention does not distinguish between immigrants and native-born Hispanics.
“This is a city in crisis, and not just for immigrants,” said James Padden, who supervises mental health services for the Baltimore school district. Five suicide attempts documented by the schools in the last five years have been African-American middle school students, he said, though more immigrant students sought counseling last year.
Talking about suicide and doing it are two different things, said Paul Nestadt, a Johns Hopkins researcher who is involved in several suicide prevention projects. He noted that young Latinas’ ideation and attempted suicide rates are higher than other groups, though their death by suicide rates are lower.
“Ideation may be better thought of as willingness to express the need for help, or simply more expressiveness in general,” Nestadt said, referring to the reporting of suicidal thoughts.
Alfonso Valencia, the 16-year-old from Lewandowski’s parish who died last October, never said he needed help. His last words to his father, “Estoy bien” (I’m OK), came after an argument with a friend, and moments before he died by suicide in October.
“There were no warning signs,” Lewandowski said. “He had friends and a loving family.
“One Saturday he was here for his cousin’s quinceanera and he was happy,” he said, referring to the traditional 15th birthday party for Latinas. “The next Saturday was his funeral.”
Alfonso’s father, Enrique Valencia, said he could hear his son shouting over the phone that October night and opened the door to his room to check on him one last time.
Life had recently been hard for his firstborn son, carried as a baby in 2001 from California to Baltimore, where his father hoped to find a better life than working in the fields as an unauthorized immigrant from Mexico.
The family faced troubling times, though. Valencia found work as a bricklayer for a fraction of the pay offered to other workers. But he suffered a head injury on the job and had to stop working, leaving his wife to support the family, including Alfonso and two younger siblings.
“Alfonso wanted to quit school and work to support the family, but I told him ‘No, you have to stay in school,’” Valencia said. In Alfonso’s high school, he and his friends were robbed and beaten, his father said.
One student yanked a chain off his neck and threatened to kill him if he showed up at school again, his father said. But he kept going.
“Sometimes he would come home with bruises all over and he wouldn’t tell us what happened,” Valencia said. “Maybe he didn’t want us to worry, or he thought it was normal and he had to accept it.”
Baltimore public schools have provided grief counseling for Alfonso’s classmates, and about 125 students in the system are getting mental health services through the schools’ Newcomer Project, Padden said. It started in 2014 at the height of an influx of immigrants from Central America.
Students have reported feeling stressed because of stepped-up immigration enforcement and bullying in school, Padden said. The school district also is gearing up, together with the Johns Hopkins researchers, to gather more information in the fall about immigrant students and what other services they might need.
Nationally, Hispanic high schoolers are more likely than their white, black and Asian peers to report feeling sad and hopeless, according to the 2017 Youth Risk Behavior Survey. Their chances of thinking about or attempting suicide are about the same.
At a recent community meeting, Guerrero Vazquez and Johns Hopkins therapist Donna Batkis stressed the need to get help when feelings of despair seem overwhelming.
“When you’re going through it, it can seem like suicide is the only remedy,” Batkis said. “It’s important to remember that things are going to change. Stress can be managed. Depression will lift.”
About 25 people attended the meeting after Spanish services at St. Patrick’s, a nearby Catholic church. Many talked about the difficulty of seeking help, and the stress they see in children’s daily lives.
A young man raised his hand. He talked about the way recent experiences had triggered memories of something terrible he saw on his journey from Central America three months earlier.
“I had these feelings and was in the hospital,” he said. “Now I’m out, but I’m having them again.” Batkis and Guerrero Vazquez spoke to him privately after the meeting, and then whisked him off to an emergency room.