Counselors in Uvalde work to battle mental health stigma in Latino community

The grief is palpable in Uvalde, Texas, three months after the shooting at Robb Elementary School took the lives of 19 young students and two teachers.

The streets of the small city are lined with signs and murals honoring the 21 lives lost in the May 24 tragedy, reading "Uvalde Strong" and "Pray for Uvalde." Residents frequent the memorial at the school where the massacre took place, getting lost in the mounds of photos, teddy bears, toys and books.

"This town is saturated with the remnants of death," said Sarah Almendariz Rivera, a San Antonio counselor who comes to Uvalde weekly to work with children.

She has a list of the victims' names on her counseling room door and says, "I've had so many kids that'll point to [multiple] names of the people that they knew."

Uvalde was a mental health desert before tragedy struck, according to residents.

Counseling services from across Texas arrived in the city in the weeks following the shooting to offer services to grieving residents who are still processing the loss.

They're working overtime, the counselors say, to not only earn the trust of residents experiencing immense grief, but also to battle the stigma against mental health care that runs deep in Latino communities.

Uvalde is over 72% Hispanic, according to the latest U.S. Census figures.

With few counselors in town and scarce resources, any residents looking for help before the tragedy may have had to drive more than an hour to get quality care.

Rivera said she reached out to local leaders and organizations about what resources were available for her clients. There weren't many, if any at all.

Rivera said one local organization gave her a handout with resources in San Antonio, a 1.5-hour drive from Uvalde.

Some counselors also told ABC News that fewer people have reached out for help than expected.

However, grief is not linear, Mary Beth Fisk, the interim director of the Uvalde Strong Resiliency Center, told ABC News.

"It's not really realistic to expect everyone to want counseling right now, but it's important to be there when you're ready," Fisk said.

Uvalde:365 is a continuing ABC News series reported from Uvalde and focused on the Texas community and how it forges on in the shadow of tragedy.

Latinos and mental health care

Hispanic adults are just as susceptible to mental health conditions as other demographics, but are less likely to receive mental health care, according to the National Alliance on Mental Illness (NAMI).

That can be attributed to several factors, according to Lyssette Galvan, the public policy director for NAMI Texas.

"They don't have health insurance, education about mental health, or they don't have the proper resources available in their community and in the language that they need," Galvan said.

Stigma around mental health and mental illness may shame people out of reaching out for help, Galvan said.

It can be difficult for Hispanic families to speak openly about personal and family struggles for fear of judgment or discrimination.

"Traditionally, what happens in the home stays in the home," Rivera said. "What happens behind closed doors stays behind closed doors."

Experts say that this stigma shuts out the tools needed to address emotional or behavioral issues when coping with grief, loss and more.

"By bringing awareness and educating the community, that's when we're going to be able to dismantle these barriers and actually have that open dialogue that we really severely need in order for people to seek and get the treatment that's needed," Galvan said.

Lack of access -- not being able to easily find or receive care due to being uninsured or just not living near facilities -- is another factor.

About 25% of people in the city are uninsured and about 20% of people live in poverty, Census figures show, making it harder to afford or attain mental health care, especially when it's far away.

"If there is not that presence in the town, it complicates just the willingness to get help. It's a timing issue, and often time equates to money, working or childcare issues," said Marian Sokol, the executive director of the Children's Bereavement Center of South Texas.

Texas was ranked as one of the worst states for mental health care access in 2022, according to nonprofit advocacy organization Mental Health America.

In April, Gov. Greg Abbott moved $210.7 million from the Texas Health & Human Services, which oversees public mental health programs, to a Texas-Mexico border security initiative. The agency told ABC News that the moving of funds would not impact mental health programs.

Abbott announced in July a $1.25 million grant to the school district in Uvalde for counseling students and faculty impacted by the mass shooting.

Mental Health America said that Texas has one school psychologist for every 4,962 students, though the recommended ratio is 1 to 500; one school social worker for every 13,604 students, though the recommended ratio is 1:250; and one school counselor for every 423 students, with a recommended ratio of 1:250.

The Uvalde Consolidated Independent School District currently has several open positions for school counselors and social workers.

Fixing a mental health desert

Counselors from the Children's Bereavement Center of South Texas were in Uvalde within days following the school shooting, according to Sokol.

They are one of several counseling groups that came to the area from out of town to offer help.

Counselors from these groups say they've created a variety of spaces to meet the needs of each individual.

The Children's Bereavement Center turned its counseling space into a home, with a kitchen, a dining area, a living room and a playroom.

The Uvalde Together Resiliency Center, a facility opened by the county after the shooting, offers several different types of therapy, including art, music, poetry and movement therapy.

Give an Hour, a national nonprofit organization, has a group of counselors in the El Progreso Memorial Library offering children a space for them to express themselves. They play with toys, eat snacks and talk with counselors about whatever they want to chat about.

Many organizations are also aiming to hire counselors from around the greater Uvalde region, to ensure that the community is being served by people who know it well.

Yvonne Clark, the founder of nonprofit It's Okay to Cry, says it's important that all of the counselors "meet your clients where they are" -- in churches, libraries and around town.

Creating safe spaces, respecting boundaries and closing the trust gap between counseling spaces and the community is what many counselors say will help the community heal.