Latino Mental Health

Overview

Latinos are the largest minority in the United States, constituting roughly 54 million and making up 17% of the U.S. population. Latinos are also the fastest growing minority: the U.S. Census Bureau estimates that by the year 2030, the population may grow to nearly one fourth of the population . The Latino population is made up primarily by Mexicans (66.1%), Central and South Americans (14.5%), Puerto Ricans (9%), Cubans (4%), and other Hispanics/Latinos (6.4%).

Mental Health

The most debilitating health issue within the Latino community is depression. The most common depression among Latinos is major depression, which commonly starts early in life, usually before the age of 25 and leads to decreased productivity, poverty, as well as increased morbidity. Many never receive treatment for this illness, mainly due to the poor access to appropriate mental health care.  Around 17.7% of Latinos suffer from depression during their lifetimes. Latinos generally experience depression in the form of bodily aches such as headaches and stomach pains, while other symptoms can include:

        • Changes in sleeping and/or dietary patterns
        • Nervousness
        • Fatigue
        • Restlessness
        • Cognitive problems, such as difficulty concentrating or remembering
        • Irritability

These symptoms persist despite medical attention. The Latino community is less likely to receive care for depression in comparison to other minorities,: less than 1 in 11 seek help from mental health specialist and among immigrants, this is reduced to 1 in 20 . Among the latinos who do access mental health care, only 30% return for follow up visits.

Mental Health Status, Services, & Disparities

The main factors that affect Hispanic & Latino health care access and quality include:

  • Lack of insurance: The rate for uninsured Hispanic & Latino individuals is as high as 33%, compared to 16% of all Americans. Due to these high rates of uninsurance, they are at greater risk for lacking basic access to healthcare. It has also been found that citizenship and immigration status affect health access and availability: an astounding 58% of non-citizen Latinos/Hispanics are uninsured.
  • Lack of Latino personnel: According to NAMI, a survey conducted among 596 licensed psychologist APA members found that only 1% identified themselves as Latino. The Center of Medical Health Services also reported about 20 Latino mental health professionals for every 100,000 Latino individuals.
  • Inadequate sources of treatment: Latinos are more likely to seek treatment of mental illness outside of mental health settings such as churches or general health care practitioners. A major problem in finding appropriate health care is not knowing where to seek treatment: because it is common that Latino culture views mental health symptoms as physical illnesses, they generally seek treatment in the general health sector.
  • Immigration & Acculturation: It has been found that U.S. born Latinos have higher rates of mental illness than recent Latino immigrants. For example, Mexicans Puerto Ricans who have resided their countries of origin experienced lower rates of mental disorders than those living in the United States for less than 12 years. (CITE 9) Central and South Americans, however, bear an exception and have higher rates of mental illnesses, such as Post Traumatic Stress Disorder (PTSD) , in their countries of origin due to exposure to trauma and war.

The Mexican American Prevalence and Services Survey (MAPSS) reports that the most common barriers to receipt of mental health care services were:

  • Lack of knowledge of where to seek treatment
  • Lack of proximity to treatment centers
  • Transportation problems
  • Lack of available Spanish speaking providers who are culturally and linguistically trained to meet the needs of Latinos

Attitudes about mental illness and mental health services can affect the use of services, as well:

  • For example, among some Latinos, depression may be mistaken for nervousness, tiredness or a physical ailment, and may be viewed as something temporary.
  • Latinos’ reluctance to utilize mental health services can be described by the saying: “No se lava la ropa en casa ajena” (One must not wash their dirty clothes in someone else’s home). In other words, problems are handled within the family and should not be discussed or revealed outside of the home.
  • Among Hispanics with a mental disorder, fewer than 1 in 11 contact a mental health specialist, while fewer than 1 in 5 contact general health care providers. Even fewer Hispanic immigrants seek these mental health services.
  • While Latinos use mental health services less than the general population, rates of mental health service use among Latinos have increased
  • Many Hispanics/ Latinos rely on their extended family,community, traditional healers, and/or churches for help during a mental health crisis.
  • Estimates of the use of alternative and complementary therapies
  • Several studies have found that bilingual patients are evaluated differently when interviewed in English as opposed to Spanish and that Hispanics are more frequently undertreated.

How Can We Fix This?

Culture

  • Providers should understand that Latino narratives include different past experiences, including trauma, injury, and social isolation. They should foster empowerment in an effort to awaken a social consciousness within Latinos.
  • Application of a culturally sensitive psychotherapeutic model.
  • Programs and models that include a life course approach will enable practitioners and organizations to understand the effects of resource disparities, racism, and other hardships that impact the mental health of Latinos.

Health care training

  • Train health providers to better understand and identify Latino specific symptoms.
  • Providers should be trained to understand the stigma related to mental health problems among the Latino community.
  • Develop instrumentation specific for Latinos.
  • Develop a sense of “confianza” (confidence, trust) between the health provider and Latino patient.
  • Utilization of an outreach program to educate Latinos on mental health issues.
  • Providers and outreach can be linked in order to provide a better experience regarding health care.
  • Outreach can also assist in health care appointments.
  • serving as translators rather than the patient’s child or other family members
  • can also possibly alleviate the transportation barrier as outreach is closely linked to the patient's’ community.

 

Diversity-related Suggestions

  • Mental health hotlines must have Spanish speaking staff and bilingual messaging.
  • More close-knit work with Spanish language media to spread outreach and education as much as possible.
  • Develop treatment programs, such as rehabs, to have culturally relevant treatment programs as well as staff designed for Latinos and their needs.
  • Mental health diagnostic scales should be adapted to meet the needs of Latinos.

 

  1. "United States". United States Census Bureau. United States Census Bureau.US Census. (2008) Income, Poverty, and Health Insurance Coverage in the United States: 2007. www.census.gov/prod/2008pubs/p60-235.pdf
  2. US Census. (2003) Summary Tables on Language Use and English Ability: 2000. www.census.gov/population/www/cen2000/briefs/phc- t20/index.html
  3. Alegria M, et al. (2007) Prevalence of psychiatric disorders across Latino subgroups I the United States
  4. Hough, R.L., J.A. Landsverk, and M. Karno. (1987). Utilization of health and mental health services by Los Angeles Mexican-American and non-Latino whites. Archives of General Psychiatry, 44, pp: 702-709.
  5. Schoenbaum, M., J. Miranda, and C. Sherbourne, N. Duan, K. Wells. (2004). Cost effectiveness of interventions for depressed Latinos. Journal of Mental Health Policy Economics, 7: pp. 69-76.
  6. U.S. Bureau of the Census. (March 2003). The Hispanic Population: Census 2003 Brief. U.S. Department of Health and Human Services. Office of the Surgeon General. Substance Abuse and Mental Health Services Administration (2001). Mental Health: Culture, Race, and Ethnicity. A Supplement to Mental Health: A Report of the Surgeon General. (SMA)-013613. <http://SAMSHA.gov>
  7. Acculturation can be defined as the process of adapting to a new culture as a result of changes in cultural attitudes, values, and behaviors that come from being in contact with two or more distinct cultures (Barlow, Taylor & Lambert, 2000).
  8. U.S. Department of Health and Human Services. Office of the Surgeon   General (2001). Mental Health Care for Hispanic Americans. In Mental health:   culture, race, and ethnicity. A supplement to mental health: A report of the Surgeon General. SAMHSA

 

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American Indian & Alaskan Native Mental Health

Overview

American Indians and Alaska Natives (AI/AN) make up approximately 1.5% of the U.S population. This means that about 4.1 million Americans identify themselves as having American Indian or Alaskan Native heritage, making them the smallest minority group in the country. Of these 4.1 million individuals 33% of them lack health insurance and about 57% of AI/AN rely only on the Indian Health Services (IHS) for care.

Mental Health

Unfortunately research on mental health among AI/ANs is limited due to the small size of population and large variation between individuals identifying as AI/AN. The limited existing research suggests that AI/AN youths and adults suffer a disproportionate burden of mental health disorders and problems

  • American Indians and Alaskan Natives experience psychological distress 1.5 times more than the general population
  • The most significant mental health concerns currently are high prevalence of depression, substance use disorders, suicide, anxiety, and PTSD
    • AI/ANs experience PTSD more than twice as often as the general population
    • Suicide is the second leading cause of death among 10-34 year old AI/AN, however the suicide rate among AI/AN over 75 is only one-third of the suicide rate of the general population
  • This is some variation in how American indians and Alaskan Natives experience mental health
    • Suicide rates among Alaskan Natives are twice the national average
    • Alaskan Natives experience five times more alcohol-related deaths than any other group
    • Native American use and abuse alcohol and other drugs at younger ages, and at higher rates than all other ethnic groups

Mental Health Status, Services, and Disparities

There are a wide range of different beliefs among American Indian and Alaskan Native people about illness, healing, and health. Their beliefs and theories about mental illness and how it develops may not align with standard diagnostic categories and criteria.

American Indians who meet the criteria for depression, anxiety or substance abuse are significantly more likely to seek help from Traditional/Spiritual Healers than from specialists or other medical sources

  • Traditional health systems focus on balancing the mind, body, and spirit within a community context
  • Their focus is not on single parts of the body but rather treating the individual as a whole
  • Only 11-13% of AI/AN seek out professional mental health care when dealing with behavior/emotional mental health problems
  • Some research has found that an above average amount to Native American do seek out mental health services for alcohol and substance use

Protective Factors

Although American Indians and Alaskan Natives have a long history of oppression and mental illness there are many built in protective factors within their community that may help to combat the progression of mental health problems.

These protective factors include:

  • Strong identification with culture
  • Strong connection with family and community
  • Connection with the past
  • The wisdom and guidance of elders within the community

Because of the strong community connections and group identification within the American Indian and Alaskan Native communities there is an abundance of community support for individuals dealing with mental health problems

Barriers to Care

Although the Native American and Alaskan Native communities have built in support systems they still experience barriers to care and challenges to their health and wellbeing that interfere with access to treatment and the willingness to pursue treatment even where it is offered.

Some of the challenges to health and well-being that Native American and Alaskan Natives face are:

  • A long history of alcohol misuse and abuse within the community and culture.
  • Strong, and resilient cultures make it harder to accept change.
  • There are often clashes between  AI/AN and non-AI/AN views of mental health causes and treatment.
  • There is a history of communal trauma and oppression.
  • A lack of awareness about mental health issues and services and strong stigma associated with mental illness.
  • There is continual pressure to assimilate to the “American” way of life and abandon the traditions of the AI/AN culture to fit in.

Along with challenges to health and well-being Native Americans and Alaskan Natives also face many barriers that limit their ability to access care.

These access to care issues include:

  • Lack of education.
  • Rates of poverty and unemployment that are over twice the national average.
  • Lack of health insurance.
  • Limited availability of appropriate services.
  • Historical and cultural mistrust of health care provider.
  • Lack of accurate data and research on the American Indian and Alaskan Native population.
  • Lack of intervention strategies that integrate traditional/holistic approaches and biomedical health care.

How Can We Fix This?

Now that we know that there are many issues with the mental health care of American Indians and Alaskan Natives what can we do to ensure this population gets access to the care they need and deserve?

  • Increase awareness of mental health and its connection to chronic diseases
  • Conducts stigma awareness training with members of the community
  • Educate providers about unique mental health issues in the American Indian and Alaskan Native population
  • Advocate for policies that promote social justice, equity, and equality
  • Create and provide comprehensive, affordable, health coverage for everyone
  • Shift the focus of mental health care to prevention and early intervention
  • Better integrate  traditional healing and spiritual practices with modern biomedical health care
  • Develop a  more person-centered care philosophy and respect of the importance of family and community
  • Health care providers treating American Indians and Alaskan Natives should familiarize themselves with the belief system and traditional treatment for mental illness used in the community to better integrate care
  1. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
  2. Barcus, C. (2003). Chapter 5: Recommendations for the treatment of American Indian populations. Psychological Treatment of Ethnic Minority Populations, 24-28.
  3. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
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  5. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
  6. August special
  7. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
  8. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
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  10. American Indians - Alaskan Natives.Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
  11. Mental Health Disparities: American Indians and Alaskan Natives [Fact sheet]. (2014). Retrieved July 12, 2015, from American Psychiatric Association website: http://www.psychiatry.org/american-indians-alaska-natives
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African American Mental Health

Overview

There are an estimated 45 million African Americans in the United States, making up roughly 15.2% of the country’s population. The U.S. Census Bureau has estimated that the number of African Americans will grow to 74.5 million, or 17.9% of the U.S. population. Since those who identify as African American can include more than one race, these statistics include individuals who both identify solely as African American and include an African American identity.

 

Mental Health

Although African Americans constitute a relatively small portion of the U.S. population, they tend to experience mental health diagnosis and treatment in a significantly different way.

  • Adult African Americans are much more likely to report serious psychological distress-- about 20% more, according to Mental Health America.
  • Of those who do report serious issues, only a third receive treatment.
  • While the suicide rate for African Americans is relatively low-- around 5.4%-- there has been recent evidence to suggest that there is an increase in suicide rates for young African American males.
  • African Americans are also less likely to have private health insurance compared to Whites, and are conversely more likely to rely on public health insurance.

Mental Health Status, Services, and Disparities

African Americans are represented in most, if not all, mental health disorder statistics, but have a unique set of factors that can be considered a barrier or protective factor.

Barriers to Care

  • Lack of Access to Treatment: 28% of African Americans live at or below the poverty line. Nearly 18% of African Americans are uninsured, and almost half use public insurance. This is a large reason why many African Americans do not or cannot seek treatment, as care can be difficult to find and/or afford. African Americans also represent 40% of the homeless population, which is a risk factor itself for mental illness.
  • Misdiagnosis by Mental Health Professionals: African Americans, especially males, tend to be overrepresented in certain disorders or illnesses. Cultural factors may be at play here, as only a small portion of the professional psychiatric community is African American, and may not know how to correctly identify certain symptoms or mindsets that are unique to the African American experience.
  • Cultural Factors: As mentioned above, culture definitely plays a large role in determining how African Americans receive care. There has long been a stigma in the African American community in regards to mental health, leading some to forego treatment in lieu of familial or community support.
  • Stress: African Americans are more likely to experience certain risk factors that contribute to mental health disorders. For example, African Americans are more likely to experience violent crime, and therefore have relatively high rates of PTSD in the community.

How Can We Fix This?

Despite the above factors, some mental health professionals have noticed an increase in the amount of African Americans seeking mental health treatment. Though this is a great start, there is a lot that can be done to close the gap.

  • Increase cultural competency and awareness: African American cultural identity is important, and should be used to establish a positive dialogue between those who seek help and the professionals who provide treatment. Awareness efforts with an African American focus can help provide the necessary education to reduce the stigma within the community.
  • Increase the amount of services available in underserved areas: Since 2009, mental health funds have been cut by $1.6 billion across the country. Those who rely on public services for mental health care and treatment have been at a disadvantage, as resources have gotten harder to find. Greater access to these services will allow those who need treatment to get help quicker.
  1. "Black or African American Populations." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 28 Apr. 2015. Web. 10 July 2015.  
  2. "African American Communities and Mental Health." Mental Health America. N.p., n.d. Web. 10 July 2015.
  3. "African Americans." African Americans. American Psychological Association, n.d. Web. 12 July 2015.
  4. "Facts and Figures." AFSP. American Foundation for Suicide Preventionm, n.d. Web. 12 July 2015. <https%3A%2F%2Fwww.afsp.org%2Funderstanding-suicide%2Ffacts-and-figures>.
  5. "African Americans Have Limited Access to Mental and Behavioral Health Care." Http://www.apa.org. American Psychological Association, n.d. Web. 15 July 2015. <http://www.apa.org/about/gr/issues/minority/access.aspx>.
  6. "African Americans." NAMI: National Alliance on Mental Illness. National Alliance on Mental Illness, n.d. Web. 15 July 2015. <https%3A%2F%2Fwww.nami.org%2FFind-Support%2FDiverse-Communities%2FAfrican-Americans>.
  7. "African American Communities and Mental Health." Mental Health America. Mental Health America, n.d. Web. 16 July 2015. <http://www.mentalhealthamerica.net/african-american-mental-health>.
  8. "Mental Health & African Americans." Mental Health. Office of Minority Health, n.d. Web. 16 July 2015. <http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24>.
  9. "State Budget Cuts Report." NAMI: National Alliance on Mental Illness. National Alliance on Mental Illness, n.d. Web. 16 July 2015. <http://www2.nami.org/Template.cfm?Section=state_budget_cuts_report>.

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