CHAPTER 6

Mental Health Care for Hispanic Americans

Conclusions

1.   The system of mental health services currently in place fails to provide for the vast majority of Latinos in need of care. This failure is especially pronounced for immigrant Latinos, who make the least use of mental health services. Latinos within known vulnerable groups are also of concern. Incarcerated Latinos, those who use excessive amounts of alcohol or drugs, and those exposed to violence, such as Central American refugees, are most likely to be in need of mental health care. There are many ways to improve services for Latinos, from reducing systemic barriers—especially financial barriers—to increasing the number of mental health professionals who are linguistically and culturally skilled. Also, because Latinos are more likely to seek mental health services in primary care settings, improving detection and care within the general health care sector is important.

2.    Latino youth are at a significantly high risk for poor mental health outcomes. Evidence suggests that they are more likely to drop out of school, to report depression and anxiety, and to consider suicide than white youth. Prevention and treatment are needed to address their mental health problems. Given the rapid expansion of this young population of Latinos, these interventions could have major implications for the ongoing health of the Nation’s youth.

3.   Sociohistorical data suggest that there should be mental health differences among Latino sub-groups. Although the data are limited, there is some evidence that Central Americans do have greater problems than other Latino subgroups, especially with post-traumatic stress disorder. However, there is little evidence of Cuban Americans having lower rates of disorder than other Latino subgroups. The National Latino Asian American Study (NLAAS) now being conducted will be the first psychiatric epidemiological study to use a representative sample of the Nation’s Latinos, which will enable researchers to test subgroup differences more systematically.

4.   In addition to the findings emphasizing the need for mental health care, a pattern of evidence for the strengths of Latino immigrants also emerges.Resilience is indicated by the lower rates of mental disorders for Mexican-born adults and children and island-born Puerto Rican adults compared with the rates for those born in the United States. Some of the ways in which Latinos cope with mental illness suggest strengths as well. The factors underlying these observed strengths are not clear, but they hold promise for identifying social and cultural patterns that promote mental health. These patterns could be particularly helpful in developing culturally sensitive interventions to prevent and treat the mental health problems that Latinos face.

5.   Mental disorders and distress can be interpreted on many levels, from the molecular aspects of neuroscience to the social world of consumers and families. Psychosis can be understood as the result of dysfunctions in neurotransmitters as well as the result of a deeply felt personal loss. To provide culturally responsive therapy for Latinos, it is critical that providers access the local world of their patients and their families. Doing so will suggest ways practitioners can integrate effectively the social and cultural context of their Latino patients with their own worlds to provide effective care.