According to the National Institute of Mental Health (NIMH), one in five adults in the United States lives with a mental illness. Of these, about 20% are Latino. Although Latinos show similar susceptibility to mental illness as other groups, there are mental healthcare disparities that make this group more vulnerable to severe and persistent mental illnesses and less likely to seek and get help. Various socioeconomic and cultural factors contribute to the underutilization of mental health services among Latinos. The discrepancy between the prevalence of mental illness and use of mental health services among Latinos highlights the importance of understanding disparities in access to and quality of treatment.
As the population of Latinos in the United States continues to grow, it is important to consider the heterogeneity of the Latino population. There is variability in terms of origin, English language proficiency, values and socioeconomic status (Kouyoumdjian et al., 2006). One key aspect on which Latino subgroups differ is acculturation–in particular, the degree to which Latinos have assimilated and adopted mainstream American attitudes, values, and behaviors (Berry, 2002). The role of acculturation among Latinos is particularly important because unacculturated Latino-Americans maintain closer ties to their native culture than those who are acculturated. Maintaining a strong cultural identity can make it more challenging for Latinos to integrate the beliefs and values of American culture. Some research suggests that the challenges and stressors new Latino immigrants face can put them at risk for developing mental health problems (Guarnaccia, 1997).
When people start living in a new culture, they experience internal pressures to succeed in a new country, a loss of their support system, language barriers, and socioeconomic stressors. Further research suggests that maintaining close ties with family and friends while simultaneously adopting aspects of the new culture may lead to positive mental health outcomes (Guarnaccia, 1997). However, close ties with native culture and family can create dependency on others and a worsening of symptoms, as less acculturation correlates with more reluctance in seeking treatment (Hsiu-Lan Cheng, n.d.). There is a critical need for more mental health research that specifically explores heterogeneity and acculturation of the Latino population in order to improve the quality of care afforded Latinos with mental illness. The overgeneralization of the Latino population can lead to health care disparities–differences among Latino subgroups might be associated with different needs for mental health services and delivery of treatment (Alegría et al., 2008).
Mental health stigma occurs because some people have negative thoughts toward those with mental illness or those receiving mental health treatment. It is important to understand mental health stigma among Latinos and other minority groups because they display higher levels of stigma than the white population (Corrigan & Watson, 2007). Belief that mental illness represents weakness of character and that those with a mental illness are dangerous and will not recover, along with the shame in needing to seek help, often prevent Latinos from seeking mental health services. A study published in 2015 reports that Latino study participants were asked about their perceptions of the factors that influence access to mental health care (Dinorah Martinez Tyson, n.d.). This study recognized stigma as one of the barriers in seeking mental health care and responses for community-level factors included negative reactions from the community and being seen as crazy (Martinez Tyson, n.d.).
Other factors that may relate to mental health stigma among Latinos are concern about privacy and distrust in mental health specialists. The Latino community tends to be very private and many may be reluctant to share their mental health problems with people outside their family (NAMI, n.d.). Unfortunately, when family is the only source of protection and support, it can result in a person not seeking or delaying professional help. Latinos and other minority groups have also reported their concern about whether a therapist would be able to address their needs and belief that use of antidepressants are related to being ‘‘crazy’’ (Thompson et al., 2004). In cases where they do seek help for mental health problems, Latinos often see a primary care physician instead of a mental health specialist to avoid stigma. Therefore, appropriate referral to mental health specialists, treatment, and adherence to treatment does not often occur. Latinos are also likely to seek assistance from a member of their church and religious organizations instead of a mental health professional.
Another thing that presents several challenges in the utilization of mental health services by Latinos is the language barrier. Lack of language proficiency limits Latinos’ knowledge of mental health services available, making it difficult for them to know where to seek help. Most importantly, language barriers limit Latinos’ ability to communicate effectively with a mental health care provider. Although English proficiency among Latinos in the U.S. is increasing, 8 in 10 older Latinos still speak Spanish at home (Krogstad & Lopez, 2020). According to a survey released by the American Psychological Association in 2016, only 5.5% of U.S. psychologists say they can administer mental health services in Spanish (Dingfelder, 2005). Thus, Latinos that do seek therapy often don’t return because they do not feel understood. Approximately 50% of Latinos that do seek treatment never return to a psychologist after the first session, whereas non-Latino whites have a 30% drop-out rate (Dingfelder, 2005). Research suggests that even Latinos who are fluent in English may find it easier to recount emotions and episodes from their childhood in their first language (Dingfelder, 2005). A study published in the Journal of Psycholinguistic Research suggests this is because organizing and talking about experiences in one language automatically connects that specific experience to that language (Lijtmaer, 2017). Limited or no access to providers that understand cultural issues can lead to misdiagnosis. The way in which people describe their symptoms can vary even among the different Spanish speaking Latino subgroups, and doctors unaware of these differences may misidentify symptoms and illness.
Lack of insurance also deters people from seeing a mental health provider. Spanish-speaking Latinos tend to be at higher risk for underutilizing mental health services due to low levels of insurance coverage, education, income, and acculturation (Dingfelder, 2005). In 2008, 11.2 million Latinos lacked medical insurance, making them the largest uninsured group in the U.S (Office of the Surgeon General, 2001). Within the Latino group, varying rates of health insurance coverage exist. Central and South Americans have the highest proportion of uninsured individuals (39%), followed by Mexicans (38%), Cubans (22%), and Puerto Ricans (19%) (Berk & Schur, 2001). This demonstrates that within the Latino population, access to mental health services is not consistent due to the heterogeneity of the population. Over half of all Latinos (52 %) are not confident they have enough money or health insurance to pay for a major illness (Blendon et al., 2014). Poor confidence in an insurance plan is a long-term issue that discourages many individuals from seeking and attaining the quality care and service they deserve. Individuals who refrain from going to see a mental health specialist are neither getting treatment for their currently existing mental illnesses nor receiving any forms of preventative care.
Low educational and economic status in the Latino community affects their access to mental health resources. Lack of a formal education can limit their understanding of the health system and the treatment methods available. Of Latinos over 25 years of age, only 56% graduate from high school, and only 11% graduate from college (Office of the Surgeon General (US), 2001). Latinos who immigrate to the United States are also at a disadvantage because they are not fully informed about the resources available to them. Often, these immigrants come from countries where healthcare is not readily available, and mental health resources are scarce or unavailable. The economic status of Latino immigrants is often dependent on the region they have originally come from and their circumstances upon arrival (NAMI, n.d.). Many Latino families encounter socioeconomic challenges that place them at risk of living in poverty (Alegría et al., 2008). The percentage of persons below the poverty line and the unemployment rates of persons 16 years and older all contribute to the level of access they have to particular mental health resources. In 2000, 6.8% of Hispanics aged 16 and older were unemployed compared to the lower unemployment rate of 3.4% for non-Hispanic Whites (Office of the Surgeon General, 2001). Hispanics who are employed often have bottom tier jobs. Only 23.3% of Hispanics earned $35,000 or more compared to 49.3% of non-Hispanics (Office of the Surgeon General, 2001). Although many Latinos encounter serious socioeconomic challenges, research suggests that recent-immigrant Latinos may especially be at risk of poverty. This is especially problematic because enduring poverty is yet another stressor that immigrants have to face when attempting to assimilate and adjust to their new environments. Living in poverty, struggling to find employment, and lacking the appropriate educational background create a cycle of stress and unhappiness for many Latino families.
Mental health disparities are prevalent within Latino communities. Though they are affected by mental illness just as much as the general population, Latinos are less likely to use mental health care. Certain cultural and socioeconomic factors exacerbate the likelihood of Latinos developing a mental illness. As the Latino population in the United States rapidly continues to grow, it is important to ensure that Latino families receive the mental health care they need. Mental health programs should focus on closing the gap between the need and utilization of mental health services among Latinos. Identifying factors that are related to mental health stigma is particularly important. Identifying negative attitudes and beliefs can help mental health organizations and providers in designing interventions that reduce stigma and improve outcomes on mental health service usage. Separately, efforts should be made to provide mental health training to physicians so they can better identify symptoms of mental illness in Latino patients. It is also imperative for researchers to study the different needs and socioeconomic factors that exist within Latino subgroups. Although research and literature examining the different barriers that prevent Latinos from seeking mental health care has grown, there are many more issues to be explored and improvements in service to be made.
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