NEW YORK—In the cavernous basement of Riverside Church, even her quiet, faltering voice echoed.

A centuries-old icon painting from a church in Bahir Dar, Ethiopia. Photo by Ayenat Mersie

The letter she was reading out loud, though not her own, was difficult to get through.

The anonymous note was from a man who watched depression consume his younger brother. She paused as she got to the dreaded nadir of the story—the little brother’s suicide, and wiped away tears as she read the anonymous man’s words of regret and anguish at his own inaction. The hushed audience of about a hundred Ethiopian Americans lifted their hands to do the same.

The group, comprised of members of the Medhani Alem Ethiopian Orthodox Church of New York, gathered in November to discuss a seldom-talked about issue in the Ethiopian American community—mental health. The woman to whom they were listening—also a member of the church—was one of several transitionary speakers between panel discussions that day. Ethiopian immigrants face a number of challenges when it comes to mental health—some that are shared by other immigrant groups, and others that are unique to their culture and religion.

Nearly half of all Ethiopians are members of the Ethiopian Orthodox Church, a church known for its conservatism, its emphasis on mysticism and its attribution of mental illness to demonic possession. But for what may have been the first time, an Ethiopian Orthodox Church was hosting a candid conversation about mental health.

According to the Migration Policy Institute, an independent think tank, there were about 251,000 Ethiopian immigrants (including their children) in the US in 2014. That makes Ethiopians the second-largest group of African immigrants in the country after Nigerians.

Most Ethiopian Americans live in the Washington, D.C., area, followed by California, Minnesota and Texas. In the New York City area, Ethiopian immigrants—according to the Migration Policy Institute—numbered around 5,000 as of 2014. Zewdie Fisseha of the non-profit Ethiopian Social Assistance Committee NYC estimates that the figure might be closer to 10,000.

But perhaps more striking than the size of the Ethiopian community in the United States is its newness: in 1980, there were only about 10,000 Ethiopians in the United States. Sixty percent of Ethiopians, according to the Migration Policy Institute, arrived in the United States after 1999.

That makes Ledet Muleta, one of the panelists at the event at Riverside Church, part of an earlier wave of migration from Ethiopia to the United States. She moved to the Washington, D.C., area in 1992 when she was 12. Growing up, she says, she saw “a lot of people migrating from Ethiopia, and not necessarily having what they had before” in terms of social support while facing the additional stresses that come with integration and assimilation.

Watching and experiencing this, she says, inspired her to become a psychiatric nurse and eventually to establish a charity focused on fighting mental illness stigma. She was the only panelist to deliver her presentation and answer questions entirely in Amharic, the national language of Ethiopia. Well, almost entirely: occasionally, she would pause mid-sentence, reaching for an Amharic word, before settling on English when an equivalent didn’t quite exist. Still, her delivery in Amharic meant that older members of the audience, many of whom had a shaky grasp of English, could follow along.

Language is one example of an acculturative stress, says Joseph Hovey, professor of psychology at the University of Texas Rio Grande Valley and founder of its Program for the Study of Immigration and Mental Health. “Acculturative stress is the stress that…people experience as they acculturate, as they migrate to a new society,” he says. They may experience not only language barriers, but also factors like unfamiliarity with social norms, concerns over immigration status and a mismatch of expectations and reality. Like other types of stress, acculturative stress can also lead to anxiety, mood disorders and depression.

Racial discrimination is another acculturative stress, which Hovey says can be a “a huge stress factor” for non-white immigrants. Ethiopians have a complex relationship with race and blackness. And according to some academics, as African immigrants they sometimes distance themselves from African Americans in hopes of improving the prospects for their own upward mobility

But, as psychology doctoral student Makeda Greene, who was also a panelist at the church event, later said in an interview, expecting exemptions from racial discrimination based upon nationality can be futile. And black immigrants are realizing that more today as instances of police killings of black men continue to make the news. There is a realization, she says, that “there’s no stamp across any black person’s forehead saying ‘I am from Ethiopia’ or wherever you’re from. They [police] just see you as black.”

Members of all immigrant communities, regardless of race, share the stress that can come with being separated from family and friends. And “the number one predictor of things like depression and anxiety and suicide risk,” Hovey says, “is social support.” Churches can play a critical role in this—not just from the help of pastors or priests, but also because of support from parishioners and the broader community they represent. Often, Hovey says, it’s “those who are involved in the church who report more effective social support because they have a wider network of people” to lean on.

And while parishes of the Ethiopian Orthodox church can provide the sort of social support that Hovey describes, the relationship between that church and mental health can be complicated. For one thing, religious tradition considers mental illness the result of demonic possession and, therefore, curable only through exorcism.

Muleta, the psychiatric nurse, says that, a lot of the time, it is assumed that people “who are suffering with mental illness have some sort of evil spirit.” As a result, their families can be too embarrassed to discuss it, and, therefore, too ashamed to seek help. These kinds of normative cultural assumptions about mental health, says Hovey, can feed into misinformation like the idea that getting professional help won’t work and that the mentally ill should seek out alternative, potentially ineffective treatments.

It is because of this complex relationship that Muleta says she was “really pleased” to see Medhani Alem Church organize the event at Riverside. The church’s involvement, she says, will help “destroy the myth of mental illness being associated with spirits, and help differentiate what mental illness is, versus other religious beliefs.”

A man walks by Medhani Alem Church in Bronx, New York City. Photo by Ayenat Mersie

Medhani Alem Church was founded in 1984 and spent the subsequent 30 years renting out rooms within the historic, Neo-Gothic Riverside Church in the Upper Manhattan neighborhood of Morningside Heights. By 2014, it had raised enough money from its parishioners to build its own church in the Bronx, though it still holds events such as the mental health panel at Riverside.

That discussion was organized by the church’s youth group, a fact that was not surprising to Muleta. When it comes to mental health, Muleta says, “the younger generation is a little bit more accepting than the older generation.” She has found that younger Ethiopians dealing with mental health issues are “able to discuss it a little bit more openly than previous generations.”

There is reason, therefore to be optimistic. Ethiopian immigrants are a particularly young group—the Migration Policy Institute estimates their median age to be 37, compared with a median age of 43.5 for immigrants as a whole.

Still, Muleta says that to the best of her knowledge, the Medhani Alem event was the first of its scale to discuss mental illness and to be held by an Ethiopian Orthodox Church anywhere.

She called it a “huge change” and something that she expects will influence not only Orthodox Ethiopians here in the United States, but also those back in Ethiopia.