It’s the end of national suicide prevention month — a time to highlight resources for people at risk or affected by this heavy and still-stigmatized issue.
Epicenter spoke with a game-changer in this area, Rosa M. Gil, the founder, president and CEO of Comunilife, Inc. The organization, which is based in Brooklyn, Queens, the Bronx, Washington Heights, Poughkeepsie and Yonkers, is largely known for its work providing affordable and supportive housing to vulnerable communities. But it’s also been in the spotlight for “Life is Precious”— a Latina teen suicide prevention program.
Now in its 15th year, the program is the only New York City-based winner of the Substance Abuse and Mental Health Services Administration (SAMHSA)’s 2023 behavioral health equity challenge. It grapples with two startling statistics from a 2019 state task force report:
- Suicide was the second leading cause of death for Latina teens in the state of New York
- Latina teens attempted suicide at a higher rate than any other youth group
Gil, co-author of “The Maria Paradox,” a book on Latinas and self-esteem, has held a slew of roles in social work, mental health, health care quality and access across NYC universities, hospitals and government agencies. Epicenter spoke with her about the origins, lessons learned and prospects of Life is Precious.
The conversation was lightly edited for clarity.
Epicenter: Could you take us to when you first started the Life is Precious program?
Gil: About 18 years ago, we had an outpatient mental health clinic in the South Bronx. We’d realized there was an increase in the number of referrals to the outpatient mental health clinic for Latina adolescents with suicide ideations and suicide attempts. We began to wonder what was really happening in the community that was creating this type of stress and high level of referral to an outpatient mental health clinic.
We first started looking in the SAMHSA registry to see what were the evidence-based practices for suicide prevention for Latina adolescents. There were none. When I told my board of directors, they said, “Well, if nobody’s doing this, then we have to do something about it.”
So we did just that. I was first finding out from the community: What was the problem? Why were we seeing so many adolescents with suicide ideations and attempts? We got a little funding from the State Office of Mental Health and we did some qualitative research. We had focus groups from that and we randomly sampled parents and [separately] adolescents and began to ask them questions. That’s the most effective way of creating a program, getting input from the community on how it sees a problem.
Epicenter: What did you learn from your research?
Gil: I looked into the literature in terms of community-defined, evidence-based practices, and the University of South Florida had a project. Through that, we found that parents felt that there was too much stress on the families and the adolescents, and that that school did not understand the challenges,or stressors of immigrant Latino families. Guidance counselors in high schools felt that there were problems but they didn’t understand that, for example, Latino mothers have to work extra hours to be able to support the family.
The adolescents told us that if we wanted to be helpful, we needed to find a safe place to provide services, both to parents and adolescents. They told us, “we don’t want to go to a mental health clinic … The only thing that mental health clinics do is push pills, medications.” This is all a perception of what mental illnesses are in our community, and quite frankly, outpatient mental health clinics in New York State are generally not culturally competent. The family says, “we don’t want our daughters or friends of our families to go to a mental health clinic because es para locos, and they are not locos.”
We asked, “What about the schools?” and some of the families said, “The guidance counselors call when our daughters are not doing well, they’re blaming us for that.”
They told us, “what you need to do is to get a safe place so the girls can come after school. You need to provide help with tutoring homework.” Even the girls told us, “whenever we don’t pass another grade, we feel very bad about ourselves. It maybe makes us think about hurting ourselves. You have to have activities for us to get involved in the afternoons.” And that’s how some of the key elements of program activities we learned from the community.
Epicenter: So the Latina teens’ and parents’ attitudes mirrored each other?
Gil: Well, one of the things we noticed related to girls in the focus group whose parents came from Puerto Rico or the Dominican Republic is that girls said, “you better talk to them, because when we go out with our boyfriend and stay until about eight o’clock, nine o’clock, then we really get full ears.” Mothers are saying “well, in the Dominican Republic, we never did that.” And then we found out through the girls that the expectation of behaviors among adolescents in Spanish-speaking countries is different from the expectation of the behaviors of adolescents in the United States. We grow up with a sense of independence and autonomy, but that doesn’t sit too well with the cultural expectations in the Latino culture and society. Girls are supposed to be docile, dependent, and always adhere to adults. Independence and autonomy is not necessarily a cultural value.
Epicenter: How did that recognition inform how you built your program?
Gil: The Latino community generally is about collectivism, not individualism, while the United States is about individualism, competition. That’s not where we come from. So when the girls asked us to work with the parents, they really asked us to be cultural brokers, to really help the mothers to understand what is acceptable behavior for adolescents in the United States. Then we taught the girls that their mothers grew up in another country, so they too have to understand where they’re coming from.
In the program we work with families in many ways. We teach them what mental health is, what the roles of psychiatrists are. In New York City and New York State there are [few] family therapists; the preferred treatment mode is individual psychotherapy. We know that in the Latino culture, family therapy is one of the best and most effective treatment interventions, so what we have done in the Life is Precious program is not only work with the girls but also with the mothers.
Epicenter: Those intergenerational and intercultural differences — was that an added stressor that you were hearing from some of the Latina girls and youth you worked with?
Gil: Absolutely. There was a question in the focus group: “Who is your role model?” And I always thought that the answer was going to be Jennifer Lopez. I learned my lesson: never assume without asking and learning the answer from the community, because they identified a family member as their role model. And one of the problems in the delivery of mental health services in the United States to the Latino community is precisely that, that the mental health delivery system had never understood the major cultural values of the Latino community and then offered that in interventions.
Epicenter: Where are you now in Life is Precious, and what’s next?
Gil: The early findings show that the girls in the program do better. There’s more progress in reducing suicide ideation among Latinas in Life is Precious as compared to outpatient mental health care. So that’s the trajectory. Our goal is to become an evidence-based practice, so this model can be used not only for the rest of the state, but also for the rest of the country. Puerto Rico is considering implementing this model in San Juan. South Carolina was also interested in this program. And we get many calls from [health departments in] Texas and California, as to how they can implement these programs in those states.
Epicenter: Were there any lessons you took from building and maintaining the program?
Gil: What I learned is how important defining what the problem is and how the community sees a way of helping those problems. We professionals tend to be in ivory towers; we think we know it all. And then we develop these programs and we often forget that it’s really the people who are going to use the program who are going to have to decide what they need, and how best we can offer that.
This is part of a series of articles exploring health inequities in New York funded by a grant from the Commonwealth Fund.
