Every morning when Noelia Rivera-Calderón got to high school, she’d run to the bathroom to throw up.

The first few times, the school nurse suggested she go home. But after that, the staff acted as if it were normal for her to be sick.

One day, a counselor noticed cut marks on Rivera-Calderón’s arm. He told her that she should stop hurting herself. That was the end of the conversation.

“I felt that the mental-health challenges I lived with were invisible to others,” said Rivera-Calderón, now 29 and living in East Kensington, “even when there were clear signs that something was wrong.”

Today, Rivera-Calderón is fighting for girls like her to be seen. She recently led a report from the National Women’s Law Center about the mental health of Latina students in Philadelphia, titled “We Are Not Invisible.”

The report chronicles the lack of attention that schools give to Latina students in middle and high school, even though they face higher rates of having suicidal thoughts and attempts than their white and black peers. In Philadelphia, one in five Latina girls has seriously considered suicide and one in seven has attempted, according to the report.

But the problem of invisibility expands far beyond high school corridors. Experts say Latina adolescents have been attempting suicide at a greater rate than other teenage girls for more than 30 years.

“But nothing’s been done,” said Carolina Hausmann-Stabile, an assistant professor at Bryn Mawr College who researches suicidal behaviors in minority youth. “This is the reality. We tend to neglect health outcomes among people we think have less value.”

With the increase in public officials expressing anti-immigrant sentiments, she doesn’t see this changing soon.

Carolina Hausmann-Stabile is an assistant professor at Bryn Mawr who researches suicidal behaviors in minority youth.
Courtesy Carolina Hausmann-Stabile
Carolina Hausmann-Stabile is an assistant professor at Bryn Mawr who researches suicidal behaviors in minority youth.

Latinas don’t die by suicide as often as other groups, likely because many use less lethal means, such as swallowing pills, Hausmann-Stabile said. But people who attempt once are more likely to attempt again.

“These kids are signaling something that if we don’t address, it will only get worse,” Hausmann-Stabile said.

More than a generational gap

Every Christmas morning in Wilkes-Barre, Raquel Sosa and her three siblings wake up to presents. Yet Sosa’s mother, who grew up in Mexico, spent her Christmases opening tamales as a gift.

The contrast has made Sosa keenly aware of how hard her parents worked to provide this life for her. Sometimes she feels guilty for being anything less than grateful.

“When they give us the life we have here,” said Sosa, now a 21-year-old student at East Stroudsburg University, “with cars and a home and food to eat, it’s hard for us to complain.”

Raquel Sosa is a senior at East Stroudsburg University and president of the college's Active Minds club, which aims to eliminate stigma around mental health.
Courtesy Raquel Sosa
Raquel Sosa is a senior at East Stroudsburg University and president of the college's Active Minds club, which aims to eliminate stigma around mental health.

That disconnect often creates tension for Latina girls beyond the normal generational gap that most teens experience with their parents, said Luis Zayas, dean of the Steve Hicks School of Social Work at the University of Texas and author of Latinas Attempting Suicide: When Cultures, Families, and Daughters Collide.

Many Latina girls also face expectations that they — and not their brothers — should care for the younger siblings, take on more household chores, and ultimately put the family’s needs above their own, he said. (That may help to explain why the rate of Latino boys who attempt suicide, though typically higher than white or black boys, has been consistently lower than Latina girls'.)

When their American ideals of individualism clash with their parents’ family-first values, the resulting conflict can make them feel like a burden, Zayas said. His research has shown that many Latina girls see suicide as a solution to their perceived failure to fulfill family roles and obligations.

Taking charge

Sosa didn’t learn the Spanish term for “mental health” (salud mental) until her late teens, when a family member attempted suicide.

Before that, mental health wasn’t talked about or even acknowledged, she said.

The experience inspired her to join her university’s chapter of Active Minds, a national organization dedicated to eradicating the stigmas around mental health. As she moves on to graduate school, Sosa hopes to become a psychologist, focusing on patients with suicidal thoughts and raising awareness among young Latinos.

“Many Latinx people think that’s a white issue, and it’s not happening with us,” Sosa said. “But if there was more education and resources in Spanish, they’d realize this is a problem.”

Angela Calderón has similar aspirations. After coauthoring the National Women’s Law Center report, the 18-year-old wants to continue working in mental-health advocacy.

Angela Calderón is a senior at El Centro de Estudiantes in Philadelphia. She coauthored the National Women's Law Center report on Latina mental health.
Courtesy National Women's Law Center
Angela Calderón is a senior at El Centro de Estudiantes in Philadelphia. She coauthored the National Women's Law Center report on Latina mental health.

During her freshman year of high school, Calderón found herself crying constantly and having anxiety attacks. But when she confided in her mother, she was told, “You’re just having a bad day. You’ll get over it.”

Other students told her it was normal. Latina girls are “fiery” and ”emotional,” they said. Even her guidance counselor seemed to dismiss her feelings as a passing phase.

“What I was saying didn’t really matter,” Calderón said.

But after transferring to El Centro de Estudiantes for her senior year, Calderón realized the difference that a supportive counselor can make. Now she checks in with any of the school’s three counselors regularly, even texting them when she’s having a bad day. They understand the unique challenges that Latino students face, she said.

“Everybody should have a place where somebody hears them,” she said.

For Rivera-Calderón, who led the National Women’s Law Center report, this is exactly what she wanted: more Latina girls raising their voices.

Noelia Rivera-Calderón (left) talks about the National Women's Law Center report on Latina students and mental health with student coauthors during a panel discussion.
Courtesy Noelia Rivera-Calderón
Noelia Rivera-Calderón (left) talks about the National Women's Law Center report on Latina students and mental health with student coauthors during a panel discussion.

Often, the conversation around mental health at schools revolves around test anxiety or college preparation, she said. While those are important issues, many minority students face different challenges.

A 2017 survey found more than half of all Latina girls are worried about a friend or family member being deported.

In Philadelphia, many Latinos live below the poverty line and face issues of drug use and violence in their neighborhoods.

The power of communication

When a Latina teen and her mother believe that they have good communication with each other, the likelihood of a suicide attempt drops by nearly half, Zayas said.

That’s why interventions need to involve the whole family.

Luis Zayas is the dean of the Steve Hicks School of Social Work at the University of Texas and author of "Latinas Attempting Suicide: When Cultures, Families, and Daughters Collide."
Courtesy Luis Zayas
Luis Zayas is the dean of the Steve Hicks School of Social Work at the University of Texas and author of "Latinas Attempting Suicide: When Cultures, Families, and Daughters Collide."

When Zayas was a practicing therapist in New York City, he often asked parents to attend the counseling session with their daughter. He’d ask them to share their story — not how they think their daughter should behave, but why they believe so and how their upbringing shaped that belief. Then he’d give the girl the opportunity to share her side.

“The idea is to generate empathy,” he said. “Then the therapist can help find a practical compromise.”

A program in New York City called Life Is Precious and another in California called Familias Unidas have had success with the family-based model.

Zayas would like to see more school districts create support groups, where children of immigrants can discuss the cultural conflicts that arise, and parents can have their own groups to try to understand what their children are going through.

In Philadelphia, Rita Torres-Cain is making the first move in that direction.

The 54-year-old Latina will soon be leading the first bilingual peer support group through the National Alliance for Mental Illness’ Philadelphia chapter. Set to start this summer, the weekly group will be open to adults with a personal experience of mental illness, and will eventually expand to include family members.

Rita Torres-Cain has dealt with bipolar disorder since she was a child. Her mother didn't believe in treatment, but now Torres-Cain is trying to change that type of thinking by starting a Spanish-language mental health support group.
MICHAEL BRYANT / Staff Photographer
Rita Torres-Cain has dealt with bipolar disorder since she was a child. Her mother didn't believe in treatment, but now Torres-Cain is trying to change that type of thinking by starting a Spanish-language mental health support group.

“We have to break this code that we don’t talk about stuff,” Torres-Cain said.

Growing up with schizoaffective bipolar disorder, Torres-Cain often battled suicidal thoughts and depression. But her mother, who had little knowledge of mental health and feared the community’s judgment, didn’t want her getting treatment. Instead, Torres-Cain self-medicated with drugs for years and was arrested on drug-related charges. She finally received mental-health care in prison.

Now she wants to make sure others get treatment sooner.

She said, “You don’t have to wait until your child is trying to kill themselves before saying there’s a problem.”

The NAMI Philadelphia bilingual peer support group will be held at Frankford Memorial Methodist Church, 1300 Dyre St. For more information, visit www.namiphilly.org or call 267-687-4381, Ext. 1.

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text TALK to the Crisis Text Line at 741741.