Depression, Anxiety, and Stress

In general, Latinos face disparities in access, availability,y and the provision of quality mental health services that are culturally and linguistically appropriate (USDHHS, 2010). The scarcity of services is more prominent in rural areas throughout the State. The lack of bicultural/bilingual providers has led to the use of interpreters, which poses other challenges. With the adoption of the ACA, there is more pressure to integrate behavioral health services into primary care. Stigma, language barriers, discrimination, lack of insurance, and fear of deportation are a few barriers that a Latino may face in accessing services. Nationwide, less than 20 percent of Latinos with a diagnosable mental health condition contact a general health practitioner, and fewer than 1 in 11 contact a mental health specialist (Less than 1 in 20 among recent immigrants) (NCLR, 2005).

BELOW ARE A FEW COMMENTS THAT PARTICIPANTS NOTED RE: THE CURRENT STATE OF MENTAL HEALTH:

  • With the ACA, the State is examining ways to integrate mental health into the primary care setting
  • Health happens in the context of the family
  • See a lack of knowledge, skills, and ability transfer from city to rural areas
  • Researchers have come through to implement brief intervention models but are not bicultural/bilingual; it is challenging to use interpreters
  • Still stigma (“la locera”) in the community among subgroups
  • Currently no personalization of treatment for the community; the Latino community is diverse; the idea that one model fits everyone does not work
  • People are using both the formal and informal mental health services — curanderos, traditional healers, religious leaders. A study in the 90s in Fresno examined whether Mexican Americans were using the informal sector. People that used the least services used the informal sector. Those who were using the informal sector used the formal sector as well. One of the big challenges when thinking of depression, anxiety, and stress is that a good portion of the population experiences the symptoms but don’t know what to do about it. The tragedy is physicians don’t recognize that and do a physical and run labs and tell them there is nothing wrong. There is a disconnect that happens that we need to pay attention to. There is often a behavioral component — lack of adherence, lack of control in diabetes. We need to train primary care providers for a more integrated system.
  • Health care providers seem to be afraid to ask questions about mental health because then they will have to spend more time speaking to the patient
  • National campaign on depression called “real men real depression,” because it is difficult for Latino men to recognize and seek services
  • Current policy of having two visits on one day charged for one visit, but if have on separate days, charged as two visits; mental health and physical health are not seen as integrated
  • Currently lack bilingual/bicultural providers
     

BARRIERS AS NOTED BY PARTICIPANTS:

  • Integrating behavioral health and primary care. Suffering from depression can be paired with chronic conditions such as diabetes, obesity, arthritis, or cancer. Need to think about it in context of the family. In primary care, be sensitive to the issue. Ask if they have children and ask how they are doing. Need to pay attention to parents. Lack of ability in psychologists and social workers in regards to primary care knowledge, skills, and ability to relate what has worked in a certain population to a more rural population. Would like to see the research to show that you can provide services well — you can be trained and you can become competent — even if you are not familiar with the population. It is a real challenge to use interpreters. Do not feel welcomed when there is not a staff person who speaks Spanish.
  • Lack of personalized treatment and empowering people to believe that they can be actively involved in the treatment process
  • Lack of understanding different levels of acculturation and generational differences —parents vs. boomer
  • ACA doesn’t provide health services to some immigrants
  • People are depressed in Montana, but many people are fearful of deportation, racial profiling; stressors cause poor coping strategies
  • To do research, there is a lack of available staff at CBOs as they are busy providing services
  • People are worried about being a guinea pig in research
  • Researchers don’t want to feel like helicopter researchers but would like to get to build trust; need time to build true partnerships
  • Neither organizations or researchers are asking the patients what type of research is needed
  • Latinos are often looked at as a single group with little diversity
     

POTENTIAL RESEARCH OPPORTUNITIES AND PARTNERSHIPS AS NOTED BY PARTICIPANTS:

  • Examining how chronic illnesses change when mental health is treated
  • Asking people to talk about their lived experiences of mental health
  • Examining the differences in rural vs. urban services — place matters
  • How do the patients feel about their health care?
  • Best practices for collaborating between researchers and organizations
  • Consider the potential of the interpreter becoming a navigator based on the “nurse navigator” program; also use “promotores” in a similar manner
  • Study postpartum depression, ACES, looking at migration
  • PCORI grants in the Latino community>
  • Need for research in cultural mediation in Alaska
  • Collaboration with the religious community
  • Evaluate education about mental health in the Latino community and follow treatment
  • Understand how coming to the U.S. impacts mental health

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Contact Information | Latino Center for Health | ginoa@uw.edu | lsm2010@uw.edu | 206-616-9365