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Mental Illness Among Latinx and Hispanics In The United States

     Latinx people consider themselves of Latin American ancestry (Central America, South America, or the Caribbean). The term Latinx is used to eliminate a binary choice (male vs. female) that is limiting and excluding to trans individuals and others who identity as fluid or non-binary. Those who identify as Hispanic may be referring to ancestors from Spain or other Spanish-speaking countries.

     Since cultural identity is a construct shared by groups, recent immigrants may identify by their country of origin instead of as “Hispanic” or “Latinx”. It is also possible that members of this population may use different terms interchangeably.

     Hispanic/Latinx communities face disparities in both access to and quality of treatment. More than half of Hispanic young adults 18-25 with serious mental illness may not receive treatment. Without treatment, mental health conditions worsen.

     Approximately 34% of Hispanic/Latinx adults with mental illness receive unique barriers to care. The barriers are: (1) language barriers, (2) poverty and less health insurance coverage, (3) lack of cultural competence, (4) legal status, (5) acculturation, and (6) stigma

     A person can find it difficult to communicate with his or her provider because of language barriers. Sensitive or uniquely personal issues can be difficult for anyone to put into words, but it is especially difficult for those who may not speak the same language as a potential provider.

     Although Spanish is the official language in most of Latin America, some Latino/Latinas may speak other languages or dialects, such as Quechua, Nahuatl or Portuguese. Additionally, Latinx families may be bilingual or mixed-language families; therefore, it is helpful for providers to ask what the patient and families’ preferred language is before starting an evaluation and to use interpreters when necessary.

     15.7% of Hispanic/Latinx people live in poverty (compared to 7.3% of non-Hispanic whites). People who live in poverty have a higher risk of mental illness and conversely, people with mental illness have a higher risk of living in poverty.

     According to the Kaiser Family Foundation, in 2018, 19% of Hispanic people do not have health insurance.

     Health providers misunderstand and misdiagnose members of the Hispanic/Latinx community due to cultural differences. For instance, an individual may describe symptoms of depression as “nervios” (nervousness), tiredness or as a physical ailment. These symptoms are consistent with depression, but doctors who are not trained about how culture influences a person’s interpretation of their symptoms may assume it’s a different issue.

     Immigrants who arrive without documentation fear that they will be deported, so they do not seek help. Even though millions of children of undocumented immigrants are eligible for health insurance under the Affordable Care Act, many families either may not know about the eligibility or be afraid to register due to fear of separation.

     Acculturation is the degree to which a person has embraced or adopted the predominate culture of the place they live. Acculturation has been found to predict use of health care services, with a higher level of acculturation resulting in higher utilization.

     Hispanic/Latinx people may not seek mental health treatment because they may not recognize the signs and symptoms of mental health conditions or know where to find help.

     Many Hispanic/Latinx people are very private and may not want to talk publicly about challenges at home. This can lead to a lack of information and continued stigma about mental health within the community, as talking about it can be viewed as taboo. The phase “la ropa sucia se lava en casa” (“don’t air your dirty laundry in public”) is common in the Hispanic/Latinx community. Some people do not seek treatment out of fear of being labeled as “locos” (crazy) or bringing shame or unwanted attention to their families. Additionally, the church may be a source of distress if they are not well informed and do not know how to support families dealing with mental health conditions.

     When mental health is not commonly or openly talked about in a community, the people seeking treatment may have limited knowledge and comfort with different types of therapy and psychiatric medications. Providers should use a compassionate and collaborative approach to engage people in treatment planning. Incorporating education, symptom monitoring and engagement with community resources can be important to support a person’s decision to start therapy or psychiatric medication.

     The mental health provider must be culturally humble to provide quality care. This refers to his or her ability to recognize that culture plays a huge role in a person’s health and well-being and may sometimes affect the provider’s ability to best serve their patient’s needs.

     A provider who understands a patient’s culture and needs will know culturally specific information. For example, the patient might describe what he or she is feeling with a phrase like “Me duele el corazon.” The phrase literally means “my heart hurts”, it is an expression of emotional distress-not a sign of chest pain. A culturally sensitive doctor would be aware of this interpretation and would ask for more information instead of assuming that the problem is purely physical. The patient should go to their primary doctor to get an initial assessment or to get a referral for a recommended mental health professional. Community and faith organizations may also have a list of available mental health providers in your area.  

     When meeting with a provider, it can be helpful to ask questions to get a sense of their level of cultural awareness. Here are some sample questions:

• Have you treated other Hispanic/Latinx people?
• Have you received training in cultural competence or on Hispanic/Latinx mental health?
• How do you see our cultural backgrounds influencing our communication and my treatment?

RESOURCES:

https://www.nami.org/Your-Journey/Identity-and-Cultural-Dimensions/Hispanic-Latinx