GAPS AND DISPARITIES IN THE DELIVERY OF MENTAL HEALTH SERVICES TO THE HISPANIC AMERICAN COMMUNITY

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GAPS AND DISPARITIES IN THE DELIVERY OF MENTAL
HEALTH SERVICES TO THE HISPANIC AMERICAN
COMMUNITY

• Antonio A. Abad, MD
• President
• Association of Hispanic Mental Health
  Professionals

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• Every year, 44 million adults and 13.7 million
  children have a diagnosable mental disorder.
  Fewer than half of the adults and only one third
  of children receive adequate treatment. Latinos
  are less likely to receive psychiatric treatment
  than other ethnic groups
• African American and Latinos, as well as Native
  Americans and Asian Americans, have both fewer
  mental health visits and less chance of their
  mental problems being detected.
• Ethnic and cultural characteristics of Hispanic
  Americans, with significant differences for some
  ethnic groups, make some communities more
  vulnerable to certain mental illnesses, as well
  as to poor response and non compliance with
  treatment.

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• The Hispanic Community faces more stressors
  quantitatively and qualitatively than other
  minorities.
• Hispanic Americans with mental illness, due to
  stigma and cultural factors, are less inclined to
  seek treatment from the organized mental health
  system, and the outcome of their illness and
  treatment are poorer than in non-minority
  populations.
• Hispanic American adults and children are over
  represented, when assessing the prevalence of
  specific mental illnesses, and among individuals
  at high mental health risk.

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 Cultural and Ethnic Disproportions Affecting
the Latino Mental Health Status

• Latino youth experience proportionately more
  anxiety-related and delinquency problem
  behaviors, depression, and drug use than do
  non-Hispanic white youth. 
• Hispanic adolescents report more suicidal
  ideation and attempts proportionately than
  non-Hispanic whites and blacks.
• Twenty-six percent of older Hispanic Americans
  are depressed at any given time. Rates of
  depression among Latinas are the highest when
  compared to other groups.

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Cultural and Ethnic Disproportions Affecting the
Latino Mental Health Status

• Latinos serving in the military are at higher
  risk for war-related post-traumatic stress
  disorder than black and non-Hispanic white
  veterans.
• Studies have found rates of post-traumatic stress
  syndrome among Central America refugee patients
  ranging from 33 to 60 percent.
• Hispanic Americans experience unique
  culture-bound mental disorders.
•  

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Cultural and Ethnic Disproportions Affecting the
Latino Mental Health Status

• There is ample evidence for concern about the
  appropriateness of some diagnostic and treatment
  procedures. When compared to whites who exhibit
  the same symptoms, Hispanic Americans are more
  likely to be diagnosed with schizophrenia, and
  less likely with affective or anxiety disorders.
• Even though ethno-psychopharmacological research
  indicates that Hispanic Americans may metabolize
  psychiatric drugs more slowly than whites,
  Latinos often receive higher doses than do
  whites, leading to more severe side effects.
  Consequently, they are more likely to be
  non-compliant with medication than whites with
  similar diagnoses.

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Gaps and Obstacles to Providing Culturally
Competent Mental Health Services to the Latino
Community

• There are only 29 Hispanic mental health
  professionals for every 100,000 Hispanics in the
  US, compared to 173 non-Hispanic white providers
  per 100,000 only 1 percent of psychologists who
  are members of the APA is Hispanic. Less than 4
  percent of physicians are Hispanic.
• About 40 percent of Hispanics either do not speak
  English or do not speak it well. Therefore, there
  is a shortage of bilingual/bicultural and
  adequately trained mental health professionals
  able to provide competent treatment to Latinos
  and recent immigrants.
• Among the major contributing factors to poor
  health outcomes for Latinos is lack of health
  insurance. Thirty-seven percent of Latino adults
  do not have health insurance, compared to sixteen
  percent of all Americans.
• A recent survey indicated that forty-five
  percent of Latino adults experienced difficulty
  paying for medical care as compared to twenty-six
  percent of white adults.  
•  

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Gaps and Obstacles to Providing Culturally
Competent Mental Health Services to the Latino
Community

• A study on access barriers to health care for
  Latino children in New York City revealed that 25
  percent of parents interviewed pointed out that
  language discordance was among the single largest
  barrier to getting health care for their
  children.
• Latino patients with language discordant
  healthcare providers are more likely to omit
  medication, miss office appointments and rely on
  the emergency room for care and these are factors
  leading to poor health outcomes.

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Vision for the Future

• Increase public awareness of effective treatments
  in the community
• Overall quality of life improves tremendously
  when a mental disorder is diagnosed early and
  treated appropriately.
• Tailor treatment to age, gender, culture and
  psychopharmacological ethnic differences.

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Vision for the Future

• Ensure the supply of mental health services and
  providers
• Parity in the way services are provided
• Community-based approaches
• Culturally competent mental health professionals
• Facilitate entry into treatment
• Reduce financial barriers to treatment

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URGENT NEEDS

• There is an urgent need to create incentives for
  the training of more Latinos in the Mental Health
  field, including physicians, physician
  assistants, nurses, psychologists, social
  workers, activity therapists and other mental
  health professionals.
• There is a need to create incentives for mental
  health facilities that attract and retain
  bilingual/bicultural professionals among their
  clinical and adminstrative staff.
• There is a need to develop more culturally
  specific Mental Health programs for Latinos,
  particularly for the most underserved
  populations, such as the monolingual, children
  and adolescents, elderly, homeless, HIV victims,
  and for mentally ill individuals with criminal
  justice system contact.
• There is a need to support more research and
  public education into the mental health issues
  affecting the Hispanic American community.