Whether it's behavioral, anxiety, mood, personality or psychiatric, mental health disorders manifest in many forms. However, non-white youth often face damning obstacles when seeking access, assessment and treatment.
Barriers that negatively affect mental health access include cultural barriers (e.g., stigma, causal beliefs), culturally unresponsive services (language and ethnic discordance, poor cross-cultural understanding), limited access to care (cost, lack of insurance coverage) and unawareness or misunderstanding of services. Stigmatization of mental illness within the Latino community, particularly among immigrants, can drive asylum-seeking mentally debilitated individuals away from psychological assistance; and a lack of mental health education in multicultural communities likely feeds mental health disparities.
Frequently, many in the Latino community are not aware of indicators associated with depression, disorders or organic mental illnesses; and when Latinos, in fact, come into contact with this information it's often delivered in a culturally inadequate fashion. Also, unfortunately, when culturally-focused mental health education and services are available, clients are often uninformed about where to find these services. Likely, the three greatest structural barriers that multicultural communities face (perhaps more burdensome and damning than unfamiliarity with facilities) are health insurance costs, misdiagnosed/underdiagnosed and difficulties with assessment.
"We need to have improvement in the area of assessment and treatment," Dr. Luis Vargas, child psychologist and treasurer of the National Latino Behavioral Health Association, told Latin Post. "I'm a psychologist, and psychologists tend to use different tools and techniques considered to be more empirical, yet I think that's an area that we really need to focus on. We need to ask, are these instruments culturally appropriate? Culturally, in terms of how and what we typically think of culture, but also linguistically. Are we training people to deliver these assessments in Spanish? Are they translated? Are they normed? What population are they normed on?
"Training individuals to conduct bilingual or Spanish language evaluations is important to acculturated Latinos because you're dealing with fluency in either language," he added. "It's important to figure out how we're going to assess a patient. Whether it's in English or in Spanish, or in both. We haven't systematically looked at education, and how it is we can provide [mental health professionals] with the kind of broad skills that aren't just language-based to better navigate this area of Latino mental health."
Accessibility and service utilization continue to be big issues, yet it's important to remember that access has two sides to it. Latinos seek out services less than their non-Latino white counterparts; on the other hand, services tend to be less relevant and accessible in the Latino community. Dr. Vargas raised the questions: "Is the community provided services that people actually can get to? Also, are the service providers from the client's neighborhood?"
Twenty-five years ago, "parallel clinics" were placed in certain communities, which were different than general community clinics. Parallel clinics were staffed with people from that same community and services were provided by people likely of the same ethnic group. A retrospective study was done to gauge the results of the culturally-conscious parallel clinic, and it showed that community members had higher outcomes and higher retention rates. Dr. Vargas thought the findings were understandable, considering "putting a clinic in a community doesn't necessarily mean that people are going to come, but if you make that clinic more culturally similar or culturally responsive, then not only are people coming to that clinic, but they're staying with the service. They're not dropping out as often."
Today, the availability of bilingual- and Spanish-speaking services are scarce, which is a huge challenge when serving populations that prefer to communicate in their native language. There is a pronounced difference between serving a population using interpreters versus individuals who can actually speak the language. Also, data suggests that conferring with a health provider who speaks the same language produces better outcomes.
In 2006, research was published that revealed important findings about mental health interventions and specific cultural groups. The meta-analytical review, which spanned 76 studies, showed that interventions targeting particular cultural groups were four times more effective than interventions provided to groups comprised of individuals of a variety of cultural backgrounds. Also, interventions conducted in clients' native language (if other than English) were twice as effective as interventions conducted in English. Dr. Vargas, who cited this research in his interview, communicated that the adoption of cultural context benefits clients. He also shared thoughts regarding the criminalization of young Latinos struggling with mental health issues.
"There is a big problem in providing mental health services to youth, particularly Latinos and African Americans. They tend to get shunted into the juvenile justice system rather than the mental health system, and I see that as a huge problem. The approach to juvenile justice and mental health issues raise a whole quandary of problems and complications," said Dr. Vargas. "I've heard judges say, this is the criminalization of mental disorders among juvenile youth, particularly Latino and African American youth. It's difficult to see how some believe that Latino youth are being suitably treated in the juvenile justice system when they'd be much more appropriately treated in the mental health system."
While examining Hispanic or Latinos populations, it's also important to recognize that Mexican Americas differ greatly from individuals from South America or Argentina or Puerto Rico and/or Cuba when it comes to mental health needs. However, part of the difficulty in establishing that fact is that there is very little disaggregated data because it has been more expedient to lump each group together.
"It's much more convenient to push everybody together often when dealing with samples that aren't very big. In some of the more recent data, where people have been able to do big enough studies to disaggregate the data, it shows that there are differences among Latinos of different national origins, in terms of the kind of problems you experience or how your mind responds to some of the treatments that are offered. I think that's an area that's quite unresolved," Dr. Vargas stated.
Dr. Vargas believes that more can be done in his own field to improve access and outcomes for Latino youth, including training programs, the assessment of skills required to service that community and better preparing individuals to work within the community.
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