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Cultural Beliefs Keep Many Hispanics From Getting MH Care

Cultural barriers and stigma about mental illness contribute to Hispanic populations in the United States having limited access to mental health care and poor knowledge about where to receive it.

Stigma and a lack education about mental illness cause great suffering for Latino families, MaJosé Carrasco, M.P.A., director of the NAMI Multicultural Action Center, told attendees at the Congressional Hispanic Caucus Institute.

In the minds of some Hispanics, "mental illness is associated with danger and violence and is often attributed to a lack of character or to punishment from God," she said.

Carrasco moderated t he program, which was organized by Rep. Grace Napolitano (D-Calif.), at the caucus's Public Policy Conference in Washington, D.C., in October. Napolitano's district around Norwalk, Calif., was the site of a demonstration project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) that sought to prevent suicides among high-risk Hispanic girls in three middle schools and one high school beginning in 2001.

Research has found that, compared with non-Latino whites, Latinos in the United States are more likely to under-utilize mental health services, turn to primary care clincians when they do use such services, and receive less guideline-compatible mental health care.

Salud mental—mental health—among Hispanic Americans is complicated not only by cultural attitudes but also by limitations on the care many can receive. "Latinos need to be able to recognize the illness they have and then have access to treatment," Carrasco said.

The problems faced by the Hispanic community in general are especially acute for young people, said Andres Pumariega, M.D., chair of psychiatry at Reading Hospital and Medical Center in Reading, Pa., and a professor of psychiatry at Temple University School of Medicine in Philadelphia. Pumariega, who represented APA at the conference, is chair of APA's Committee of Hispanic Psychiatrists and chair of the American Academy of Child and Adolescent Psychiatry's Committee on Diversity and Culture.

Increasing rates of depression, substance abuse, anxiety disorders, and behavioral disturbances are being identified in Hispanic youth, said Pumariega. Data from the Centers for Disease Control and Prevention revealed that Hispanic youth, especially young women, have higher rates of sadness or hopelessness and of suicidality than other ethnic or racial groupings in the United States. For instance, 7.3 percent of white youths and 7.6 percent of black youths have attempted suicide, compared with 11.3 percent of all Latino youth and 14.9 percent of young Latino women.

Young people who are immigrants or the children of recent immigrants face other major stressors beyond minority status, said Pumariega. The migration process itself, legal or otherwise, is highly stressful. Many also have a hard time assimilating into U.S. society and face discrimination, even while they are losing many of the protective cultural values and strengths of family and community. Some are exposed to community violence.

More funding is needed for all children's mental health services, but school-based services would have particular value for this population, said Pumariega. "Access to care is important, and we can improve access by providing care where the youth are. Collaboration between mental health and educational professionals enhances services and is less stigmatizing, too."

The 2007 Mental Health in Schools Act (HR 3430), introduced by Napolitano and others in August, would provide grants for comprehensive mental health programs in elementary and secondary schools. A similar bill has been introduced in the Senate.

If the bills pass, such programs could "open schoolhouse doors for minorities," whose high dropout rates are not accidental, said Pumariega.

Overall, mental health issues in the Hispanic communities in the United States could first be addressed by increasing awareness of mental illness symptoms, said Carrasco. She noted the efforts of Univision, the Spanish-language television network, which won an award from SAMHSA for its "Salud es Vida....¡Entérate!" (Health Is Life.. .Inform Yourself!) initiative. However, local radio and television stations and newspapers must also do more, she said.

A fact sheet from the U.S. surgeon general on Hispanic mental health is posted at <http://mentalhealth.samhsa.gov/cre/fact3.asp>. The Congressional Hispanic Caucus Health Task Force's priorities for the 110th Congress are posted at <www.house.gov/baca/chc/tsk-health.shtml>.

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