Cultural Barriers to Mental Health Treatment Among Hispanics/Latino(a)s

By: Mary Martinez

In January of this year, Vecinos began offering integrated mental health services in its static and mobile health clinics.  The response thus far from our clients has been favorable, but we at Vecinos remain concerned about the many barriers Hispanics/Latinos face in seeking mental health services.  They are far less likely to seek treatment for mental health issues than non-Hispanic whites.

A 2014 Fact Sheet published by the American Psychiatric Association noted that 36 percent of Hispanics with depression received care compared to 60 percent of non-Hispanic whites and that Hispanics were more frequently undertreated for depression.  The American Psychological Association (APA) found that only one percent of psychologists identified themselves as Hispanic even though Hispanics represent 20 percent of the U.S. population as a whole.  The APA additionally reported that both language barriers and values created barriers to treatment for Hispanics experiencing mental health issues.

This corresponds with many studies citing the lack of culturally and linguistically competent mental health providers.  The majority of mental health professionals do not speak Spanish, nor have they been sufficiently educated in Hispanic/Latino(a) culture.  This often results in miscommunication and misinterpretations that can be very frustrating to the Hispanic/Latino(a) client.  Previous negative experiences related to language barriers, discrimination, or poor treatment were also cited as reasons Hispanics/Latino(a)s gave for not seeking treatment, along with a lack of confidence in the ability of services to meet their needs.

There is also a significant disconnect between American models of psychotherapy and the needs and values of the Hispanic/Latino community.  American models of therapy, which are Euro-centric, value individual traits and independence while Hispanic/Latino(a) culture values family unity, loyalty to family and friends, and one’s role in the community.  Hispanics/Latino(a)s are more likely to turn to family or friends when they have a problem or feel depressed or anxious.  They are also more likely to consult a member of the clergy or even a local healer.

In addition to language and values, some of the other barriers preventing Hispanics/Latino(a)s from seeking mental health services include negative perceptions about mental health care.  The National Alliance of Mental Health’s web page on Latino Mental Health notes (NAMI) the Hispanic/Latino community’s lack of information and misunderstanding about mental health.  In general, the Hispanic/Latino(a) community does not talk about mental health issues and many do not seek treatment because they don’t recognize the signs and symptoms of mental health conditions such as depression or anxiety nor do they know where to find help.

This lack of information and communication also increases the stigma associated with seeking help for mental health issues. Many Hispanics/Latino(a)s do not seek treatment for fear of being labeled as “locos” (crazy).  Others see it as a source of shame and don’t want their community to find out, even though one in five people in the United States is affected by mental illness.  Utilizing mental health services also raises privacy concerns.  Many Hispanics/Latino(a)s do not know that mental health information is confidential and cannot be shared with anyone without the patient’s consent.

The barriers

Some of the biggest barriers to seeking mental health services are economic and structural.  The percentage of Hispanics/Latino(a)s in the United States without health insurance ranges between 32 and 37%, compared with 16% for all Americans.  Hispanics/Latino(a)s without health insurance are forced to rely on community agencies which may be limited or non-existent, especially in rural areas.  In addition, anxiety about legal status and fear of deportation for themselves and/or members of their families, keep many Hispanics/Latino(a)s from seeking help.  Even when there is a willingness to utilize mental health services, the lack of transportation and/or money is prohibitive, as well as not knowing where to find such services.

The National Alliance for Mental Illness (NAMI) has some great resources for both mental health providers and Hispanic/Latino(a) clients seeking mental health services.  To improve the odds of getting a culturally-sensitive mental health provider, ask questions to get a sense of the provider’s level of cultural sensitivity.  Don’t be afraid to ask questions such as:

  • Have you treated other Latino(a)s?
  • Have you received training in cultural competence or on Latino(a) mental health?
  • How do you see our cultural backgrounds influencing our communication and my treatment?

Make sure you can work with this person and that you communicate well.  Let the provider know about your culture and values.  For example, if you want your family to be included as part of your treatment, say so.  If your lack of medical insurance or finances is preventing you from seeking services, contact a local health or mental health clinic to see what services you qualify for.  Vecinos is available to see patients or to provide referrals.

References

Aguilar-Gaxiola, S., Loera, G., Méndez, L., Sala, M., Latino Mental Health Concilio, and Nakamoto, J. (2012). “Community-Defined Solutions for Latino Mental Health Care Disparities: California Reducing Disparities Project,” Latino Strategic Planning Workgroup Population Report. Sacramento, Ca: UC Davis, 2012. https://health.ucdavis.edu/newsroom/pdf/latino_disparities.pdf

Dingfelder, S. F., “Closing the Gap for Latino Patients,” American Psychological Association Monitor, January 2005. https://www.apa.org/monitor/jan05/closingthegap

“Latino/Hispanic Communities and Mental Health.” Mental Health America. http://www.mentalhealthamerica.net/issues/latinohispanic-communities-and-mental-health. Accessed 8 April 2019.

“Latino Mental Health.” National Alliance of Mental Health (NAMI). https://www.nami.org/Find-Support/Diverse-Communities/Latino-Mental-Health. Accessed 10 April 2019.

Rastogi, M., Massey-Hastings, N., & Wieling, E. “Barriers to Seeking Mental Health Services in the Latino/a Community: A Qualitative Analysis.” Journal of Systemic Therapies, 31(4), 1-17. doi:10.1521/jsyt.2012.31.4.1, 2012. https://guilfordjournals.com/doi/10.1521/jsyt.2012.31.4.1

“Substance Abuse and Mental Health Services Administration, Racial/ Ethnic Differences in Mental Health Service Use Among Adults.” HHS Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.  https://www.integration.samhsa.gov/MHServicesUseAmongAdults.pdf

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