Culture barrier risks Hispanic mental health
Spanish-speaking therapists needed
“The therapist just couldn’t understand my cultural background because it wasn’t her own. Jasmine Alcala
Soon after Jasmine Alcala gave birth to her son, Benjamin, her mind flooded with thoughts of catastrophe.
For Alcala, tragedy lurked everywhere. At her Long Beach, California, home, which she rarely left while caring for her newborn, she feared a home invasion. Behind the wheel, her heart raced at the possibility of a fatal car accident. At the grocery store, she fretted over the potential of armed robbery.
And nothing was as terrifying as the idea of not being with her son.
Alcala and her husband, Ruben, sought help. She joined several peer support groups for postpartum women and visited two therapists. Neither therapist was Hispanic, nor did they speak Spanish, making it difficult for Alcala, who is Mexican American, to communicate some of her deepest thoughts and feelings.
“The therapist just couldn’t understand my cultural background because it wasn’t her own,” says Alcala, 38. “Communicating needs to family was
where I could see the biggest difference. And if you’re not from that background … I don’t know how to explain it.”
Spanish-speaking Americans say they have a hard time finding mental health care services in their native language. Only 5.5% of U.S. psychologists say they’re able to administer mental health care services in Spanish, according to a survey released by the American Psychological Association in September 2016, the most recent data available. In all, 44.9% of psychologists say they are “quite or extremely knowledgeable” about working with Hispanic patients.
The demand for full-time psychologists within the Hispanic community is expected to surge 30% by 2030, according to the American Psychological Association. African Americans are predicted to see an 11% increase and whites a 2% decrease.
Critics say mental health providers are not keeping up with the nation’s growing Hispanic population, which reached 59.9 million in 2018, or roughly 18% of the U.S. population.
Community challenges
The National Alliance on Mental Illness found Hispanics tend to struggle with common mental health disorders such as generalized anxiety disorder, major depression, post-traumatic stress disorder and alcoholism at an average rate but are at higher risk for severe mental health problems, in part because of the poor quality of treatment they tend to receive.
Thirty-six percent of Hispanics with depression receive mental health care, as opposed to 60% of non-Hispanic whites.
Hispanics are less likely than non-Hispanic whites to take antidepressants, according to a report in 2014 from Albert Einstein College of Medicine in New York City. The study’s leading author, Sylvia Wassertheil-Smoller, says the most important factor preventing treatment is insurance status.
“There was a huge difference between people who were insured and people who were not,” Smoller says.
Jane Delgado, president of the National Alliance for Hispanic Health, says she has seen immigration affect the mental health of later-generation Hispanics.
“We don’t have to look too far back to understand those roots,” Delgado says.
Latina adolescents attempt suicide more often than any other group of female teenagers nationwide, according to the Centers for Disease Control and Prevention’s 2017 Youth Risk Behavior Surveillance.
Delgado says the most at-risk girls
tend not to be new arrivals but the daughters of first-generation immigrants, who “have to marry the culture of their older family members with the culture that is their future.”
Delgado says receiving medical care in your native language is especially important in mental health because conversation is a part of the treatment.
Only 4.4% of American psychologists identify as Hispanic. Roughly 53 million Americans speak Spanish, or more than 16% of the total population, the American Psychological Association found.
“You have to show the person you’re talking to that you value them as an individual,” says Delgado, a practicing psychologist.
More patients than therapists
Luis Cornejo, 33, works as a marriage and family therapist for Instituto Familiar de La Raza, a nonprofit mental health clinic in San Francisco’s Mission District. He cares for an entirely Spanishspeaking caseload. He says Hispanic culture tends to dismiss the need for mental health care.
“For many of them, they see mental health as a very Western thing that doesn’t really correlate with the traditions of Latino America,” Cornejo says.
Irán Barrera, 45, has spent his career studying the mental health care treatment gap. From 2014 to 2017, he directed the Consejo Project, a graduate program within Fresno State University’s Department of Social Work Education that studied the cultural frameworks that shape behavioral health within the Hispanic community.
Barrera says the “cold” nature of mental health institutions can dissuade Hispanic people from returning to therapy.
“The medical industry has its own language and its own culture,” Barrera says. “You come in here, then they tell you what’s wrong with you, and it’s,
‘Thanks for coming.’ Latinos, for the most part, we like to be asked, ‘How’s your day? How’s your kids? How’s your family?’ So right away, we feel discontented with the institutions.”
When Brandie Carlos, 31, of Los Angeles, lost one of her best friends to suicide in February 2018, she knew she would need additional support. She wanted to speak with a therapist, and she was certain she wanted that person to be Latina.
Even in Los Angeles County – which has 9% of the country’s total Hispanic population – finding a therapist that fit her needs wasn’t a simple task.
“For people that are the first in their family to attend therapy, there’s a lot to overcome before you get there,” Carlos says. “I ended up finding a Latina therapist, and I was just able to talk about certain things about my culture, or talk in Spanglish when I needed, and it was really helpful.”
Carlos, who works in digital marketing, designed a website to help Latino Americans search for bilingual therapists in their area who are culturally competent and speak Spanish. Therapy for Latinx includes 180 therapists in 20 states as of June 2019. Carlos says the website’s Instagram page averages about 1,500 new followers per month.
Demand for Spanish services
Across the nation, some private practices and health care institutions say they are working to provide more bilingual and bicultural mental health care at low costs, but the demand is beyond their abilities.
El Futuro, a nonprofit mental health and substance use disorder clinic based in Durham, North Carolina, is working to serve as many Spanish-speaking patients as possible. The state’s Hispanic population grew 22% from 2010 through 2017, according to census data.
El Futuro has a staff of about 20 therapists and two psychiatrists and treats patients from 20 of North Carolina’s 100 counties. It offers reduced or free care for some patients. “While we’re seeing 1,800 people per year, we’re still not seeing enough,” says Executive Director Luke Smith, a psychiatrist who helped found the clinic in 2001.
In 1977, Cynthia Telles founded the Spanish Speaking Psychosocial Clinic at the University of California-Los Angeles. Over the past 42 years, Telles says, her clinic has helped thousands of Spanish-speaking patients while training generations of mental health care professionals who go on to provide bilingual care at institutions across the country.
Telles, who is also the director of the UCLA Hispanic Neuropsychiatric Center of Excellence, says there are few, if any, federally funded programs like her own at other public institutions.
“There has to be support from the government for this kind of training to produce more mental health professionals that want to go back and serve the Latino/Hispanic community, but, also, there has to be the will, interest and commitment from the academic institutions to do the same,” Telles says.
In New York City, the Montefiore Medical Center in the Bronx implemented regular mental health screenings into its annual physicals in an effort to extend mental health care to the borough’s neighborhood, which is 43.6% black and 56.4% Latino, according to the Census Bureau. This means setting up patients who screen positive for mental illness with immediate consultations with in-house mental health clinicians, says Miguelina Germán, director of pediatric behavioral health services for Montefiore Medical Group.
“This model really works for all underserved communities,” Germán says.
In Miami, Anabel Bejarano is a clinical psychologist who trains future generations of bilingual, bicultural therapists as director of the master’s program in counseling at the University of Miami in Coral Gables, Florida. She recently opened a private practice. Before she could hang a sign outside her window, Bejarano says, she had a full caseload. About 80% of her clients receive therapy in Spanish.
For a few clients who can’t afford to pay full price, she lowers her fees.
For Alcala, finding a Spanish-speaking therapist made the difference in her recovery.
“Even though we grow up here in America and we’re American citizens and we consider ourselves proud Americans, there are things that we grow up with in our culture or in our family that are difficult to translate to an Englishspeaking therapist or English-speaking community,” Alcala says. “Being able to have someone with a Spanish-speaking background who understands the invisible rules of our culture just really made sense.”