Mental Health in the Hispanic Community Part 2

Previously in this series, we explored the different reasons why mental health treatment is more difficult to access among Latinx/Hispanic communities in Chester County and beyond. Today, we hope to continue this conversation by discussing the implications of these findings.

There are a few best practices mental health care providers can use to better serve Latinx/Hispanic immigrant communities. For example, a 2018 article comparing the barriers to mental health services between Latinxs in the US and Spain recommended the following ways to address barriers to treatment (Falgas et al.):

• The use of educational campaigns, use of peer navigators, and prevention programs targeting the self-reliant attitudinal barriers to mental health care treatment
  
• Implementing the following structural changes to improve entry and retention among Latinx/Hispanic immigrants:  
• Improving the access to public transportation
• Flexible hours of service operation
• Improvement of educational campaigns about services available
• Increasing the amount of Spanish-speaking mental health care providers

Did you know: Only 33% of Latinxs/Hispanics with mental illness receive treatment each year compared to the US average of 43%? (Cardinal Innovations Healthcare, 2020). Enacting these recommendations may help increase the amount of Latinxs/Hispanics with mental illness who receive treatment.

Culturally Competent Care

While increasing accessibility of care for these communities is important, it is equally important to consider the quality of care they will receive as well. Specifically, how can we make our therapeutic practices more culturally competent? Culturally Competent Care is defined as “…attaining the knowledge, skills, and attitudes to enable administrators and practitioners within the system of care to provide effective care for diverse populations, i.e., to work within the person’s values and reality conditions.” (SAMHSA, 2021).

Cultural competence is always a work in progress. Instead of being considered as a ‘final destination’ that a therapeutic practice can arrive at, it is rather a value to consistently aspire to. A 2020 article titled Culturally Competent Therapy with Latinxs: Addressing Isolation explores this concept in further detail:

“These factors – family separation, discrimination, and lack of social support – can lead to social isolation and loneliness which, in turn, can contribute to mental health issues such as depression…. The lack of clinical guidance on this topic leaves therapists unequipped to address important contributions to presenting problems and barriers to treatment for Latinx clients. For example, many therapists may not know how to help clients increase their social connectedness when their clients are facing stigma, discrimination, or potential language barriers. Perhaps even fewer understand how social isolation is influenced by intersectional factors and intergroup differences, including acculturation level, country of origin, age, gender, socioeconomic status, and geographic location. A better understanding of these factors, along with resources for tangible application and intervention, can help therapists more confidently and effectively help Latinx clients increase social connectedness.”

Cultural Competence has been organized into three distinct aspects (Hawkins et al., 2020):

1. Clinical Knowledge – therapists’ understanding of their clients’ worldviews and cultural contexts. Relationship building with clients is supported by an increase in knowledge about clients’ cultures. This includes honoring the diversity of cultures that constitute the broad umbrella of Latinx/Hispanic identities (ex. differences in identification with native culture versus US culture, differences among regions in Central and South America, etc.). Perhaps most importantly is the clinician’s understanding of how different cultural factors influence the presenting problem and treatment options for problems faced by Hispanic/Latinx clients.
   
2. Clinician Attitudes/Beliefs – therapists’ understanding of their own cultural conditioning and how this conditioning affects the personal beliefs, values, and attitudes of culturally diverse populations. This process often begins by therapists’ developing a greater awareness of their own cultural background and ethnic identity, which lends itself to greater understanding of identities that differ from their own. The importance of valuing differences – instead of discounting them – helps avoid cultural biases and stereotypes from hurting the therapeutic alliance.

3. Clinician Skills/Behaviors – therapists’ ability to determine and use culturally appropriate intervention strategies. Hawkins et al. suggests three areas of intervention to address social isolation and other related presenting problems among Latinxs/Hispanics:
   
4. Assessment – This includes inquiring about social isolation and relevant factors influencing mental health outcomes as part of the initial assessment with Latinx/Hisapnic clients. Also important to assess for are how cultural influences – like racial/ethnic identity, racial discrimination, family ties, cultural traditions, immigration status, etc. – may influence clients’ presenting problem. One particular tool that could assist therapists is the DSM-5’s The Cultural Formulation Interview.
   
5. Building a trusting relationship – “…in a focus group study of what Latinxs desire in healthcare, several themes emerged, including trust and forming a personal relationship. Participants reported that healthcare providers should actively aim to create trust by looking the patients in the eye, being interested in the person as a whole, and asking about their families (Uebelacker et al., 2012).” Additionally, undocumented immigrants may fear disclosing information in the event that a mental health professional may report their status. Speaking directly about mandated reporting and emphasizing the confidentiality of the therapeutic process may help to alleviate this fear.
   
6. Connecting to supportive social networks – These supportive social networks may consist of the clients’ family members, referrals to additional social services, connection making with other Latinx/Hispanic community members, and additional resources (such as support groups, immigration attorneys, Spanish-speaking doctors and tutors, etc.). This expanded therapeutic role may be unfamiliar to many therapists, but can be made easier with organizational-level community building with surrounding resources and cultural organizations that cater specifically to Latinxs/Hisapnics.

Here at Family Service of Chester County,  we are constantly striving to better meet the needs of anyone who makes the decision to entrust us with their mental health concerns. We are proud to announce that we are currently trying to increase the number of bilingual services available to Chester County residents by hiring additional Spanish-speaking counselors. Are you interested in making a difference? Click here to learn about the open positions. We are also offering a $500 referral bonus so please spread the word!