Many women across the Central Valley have dedicated their lives to their families.
They take on the daily task of being a housewife.
"My name is Silvia, simply Silvia."
Meet Silvia – a housewife from Mendota. Like many other women in rural communities, she's devoted her life to her two sons and husband always greeting them with a smile and home-cooked dinners when they arrive home.
But about a year ago, her smile started to fade.
"My husband goes to work, my son goes to work, and my other son goes to school. I'm left all alone for the entire day, no one to talk to. I started falling into a deep depression."
Silvia says she's not exactly sure what triggered it, but the daily worry of paying bills and managing the limited money they had added more stress and anxiety.
"When I fell into that deep depression nothing interested me. I didn't want to watch TV, I didn't want to take a shower, I didn't want to leave the house, I didn't want to change clothes— nothing interested me. It was like I didn't exist in this world. I lost all hope, I would say: why do I want to live."
Silvia suffered from major depression - and she's not alone. According to a study released last year by the California HealthCare Foundation, the Valley has the highest rates of serious mental illness rate in the state. The region also has the fewest mental health professionals.
In Fresno County just over 5 percent of adults have a serious mental illness – diseases like schizophrenia, bipolar disorder and major depression. The numbers are even higher in surrounding areas, with Madera County reaching 7 percent.
"It's one of the great health care needs that I think that is under recognized in some ways generally in the public."
That's Gary Hoffman the clinical director at Adventist Health Behavioral Health in Hanford.
"Someone who is living paycheck to paycheck or whose future is uncertain due to economic changes and constant relocations, these stressors become additives, at some point a person starts giving up. Worthless, hopelessness, and helplessness -- we can see that with stressors in all segments in the population but definitely in the rural or poorer population."
Local physician Marcia Sablan owned a medical clinic in Firebaugh with her husband Oscar for more than three decades. She says the valley's rural communities face unique challenges when it comes to mental health.
"A lot of the mental health issues that come up in this town have to do with the social economic status. Our town is about 90 percent Hispanics but at the same time some high percentage of those are undocumented farm workers so that leads to an unstable state mostly about their income."
Hitting Rock Bottom
In Silvia's case, her darkest moments were after her husband and two sons left for the day.
She thought she hit rock bottom when she shut herself in her son's bedroom for 15 days without eating.
"During those days I didn’t think about anything I would just stay in a room. He would leave for work and come back and he would find me in the same spot. I didn’t clean the house, I didn’t prepare food, I didn’t eat, I just lay in bed. My head felt like a whirlwind inside."
Over the course of a few months Silvia lost almost 40 pounds. Despite major concerns from her family, she was still hesitant to look for help.
But it wasn’t until she almost took her own life that she realized she needed help.
"I grabbed a handful of pills, I no longer wanted to live. I shoved the pills in my mouth and that’s when I saw my son step out from his room," Silvia says.
"I snapped out of it but I felt like someone was tempting me. I took the pills out of my mouth and acted like nothing happened. After that I understood that I was about to do something really crazy."
Fighting Against The Social Stigma
With the help of her oldest son, Silvia went to see her primary care doctor.
She remembers sitting quietly in the passenger seat on her way to Firebaugh.
"Knowing that you are going to talk about your problems, or how you feel, or simply that you’re looking for help, it’s scary. You can’t talk about this with anyone, because if you do people make fun of you."
She says she was afraid to speak up because of the social stigma linked with mental illness.
"I heard a lady say that we were acting, that depression doesn’t exist, that people acted this way because they didn’t have a job and didn’t have anything to do with their lives."
Fresno County's director of behavioral health Dawan Utecht says that sentiment is all too common in the Valley.
"We don’t seem to have a problem talking about how high our blood pressure is, or what stage our cancer is but you don’t hear people talking about the type of mental illness that they have."
Breaking The Silence
In Silvia's case, finally deciding to seek help from a physician was a big step.
"I told the doctor: I'm not crazy, I'm not crazy I just want help because I don't want to live."
After visiting her primary doctor, Silvia was referred to a psychiatrist in Firebaugh and underwent intense counseling for several months. She was finally cleared in March.
"I feel happy, I have more hope," Silvia says. "My life now has meaning, I got my life back."
Back at her home in Mendota, Silvia still faces many challenges from finances to work at home. But with the support of her family and her physicians, she's made great progress.
Silvia says she hopes others in her situation will overcome their fears and help break the silence around issues of mental health in the Valley.