It’s Derby Week in Louisville, which means large crowds at the racetrack all week long. On the other side of the track from the grandstand, hundreds of backside workers tend to the horses, working long days, often far away from their families, living in temporary housing until the racing season takes them to another track in another state.
Because of the transient nature of their work lives, track workers often struggle to find good health care, and mental health is even harder to access, especially when many of the workers speak Spanish as their primary language.
The Kentucky Racing Health Services Center is in its 11th year of operations, in a building just a couple of blocks away from Churchill Downs. They provide primary care services for track workers, both men and women, the majority of whom are Hispanic. And in the last year, the clinic has added a dedicated mental health provider.
Sara Robertson, the clinic’s director and an assistant professor of nursing at the University of Louisville, said the clinic’s staff was seeing patients with symptoms like stomachaches and headaches, with no discernible physical cause.
“So after we kind of checked them all out, we started asking, well, what’s your stress level like right now? And a patient might just start crying,” she said.
Catherine Batscha, an assistant professor of nursing at the University of Louisville, is the mental health provider at the clinic, providing both counseling and psychiatric medications to patients. Batscha works with a Spanish language interpreter who attends every session, so the patients get used to seeing them together. She said the patients she sees have many of the same issues as the general population.
“A lot of depression, a lot of anxiety, a lot of people who are separated from support and miss that very much,” Batscha said. “And I think the same kinds of things you hear from any hardworking population that needs to get up at 3:00 in the morning to go to their job.”
Before offering mental health services, clinic staff would refer patients to outside offices, but many patients had difficulty actually getting care. Robertson said offering their patients mental health services in the same clinic means more of them get the help they need.
“Patients either wanted help and couldn’t get there or they weren’t sure they wanted help enough to traverse the bus system or figure out where this strange office was,” said Robertson. “So when we can say, ‘it’s right down the hall,’ that makes a really big difference for our patients.”
The clinic has between 800 and 1,000 patient visits each year, and is open three days a week. The patient population drops between December 1 and April 1, when Churchill Downs is quiet, but is open all year to accommodate workers on nearby health farms. All patients must have a valid racing license but do not need health insurance.
Robertson said the addition of mental health services means the clinic can really address all the concerns of its patients.
“I think now we really are getting to the point where we realize that they go hand in hand,” she said. “You can’t treat physical complaints without treating mental health as well.”