By Patricia Foxen, PhD, Deputy Director of Research, NCLR
Years ago, a young colleague of mine—let’s call her Rosa—experienced a break with reality. A shy, disciplined, hardworking woman in her early twenties, she started to exhibit erratic, self-destructive behavior and nonsensical speech. Rosa’s friends brought her to a hospital, where she was assessed and dismissed. Her co-workers contacted her parents, who had migrated to the Bronx from El Salvador in the 1980s, to plead with them to seek psychological help for Rosa. The couple seemed overwhelmed, denied that she needed such help, and stopped communicating with nonfamily members altogether. Eventually, after Rosa’s behavior escalated into a frightening episode, she was admitted to a psychiatric hospital, where she was heavily sedated for over a month, then discharged without a diagnosis. Years later, having finally found culturally appropriate mental health care, Rosa was diagnosed with bipolar disorder, treated, and able to resume a more stable life and career.
While Rosa’s story may seem more extreme than most, it illustrates an important issue within the Hispanic community: cultural and structural barriers to adequate mental health services too often impede young Latinos from getting the care they need. One such barrier is the fear of being stigmatized for having mental health problems, which leads some Latino families, particularly within immigrant communities, to avoid seeking psychological help for problems stemming from depression, conduct disorders, or organic mental illnesses such as Rosa’s. Many rely on support from the family, folk and community healers, and churches, especially when existing mental health services are perceived to be closed or lacking an adequate cultural understanding.
Indeed, a second barrier to mental health services is the lack of cultural and linguistic sensitivity within mainstream psychiatry and psychology, as well as the relative dearth of Latino mental health care providers. Even when culturally centered services do exist, potential patients or others who are in a position to help them are not always informed about where to find these services. And because mainstream mental health providers often interpret youth behaviors differently based on race and ethnicity, young Latinos like Rosa often end up being misdiagnosed or remain undiagnosed.
Structural barriers to accessing mental health care for Latino youth may also include a lack of health insurance, the high cost of mental health services, and low wages among Hispanic parents. A full 16 percent of young Latinos under age 18 lack health insurance, a proportion that has decreased through the years but is still three times higher than the uninsured rate of White youth. Another impediment to accessing mental health services, moreover, is the fear that immigrant parents have in approaching health service providers due to their legal status.
As a growing body of research shows, the combination of all of these factors means that psychologically vulnerable Latino youth are a largely undertreated group, despite the fact that they are at higher risk of mental health issues such as depression, anxiety, and substance abuse. This lack of adequate treatment may in turn contribute to low educational achievement, low self-esteem, and dropping out of school, and it may help explain disproportionate minority contact with the juvenile justice system.
Despite federal commitments to address mental health issues among minority youth, much remains to be done to reduce these barriers and ensure access to quality mental health services for young Latinos. We need increased outreach and education in Hispanic communities regarding mental health problems, their symptoms, and the value of psychological treatment. Such outreach must be coupled with a firm commitment to enhancing culture-centered, community-based mental health services that can help youth such as Rosa access adequate treatment and return to a stable and productive life.