Getting the Message: Mental Illness, Language and Culture
Imagine that you or your family member is having a mental health crisis and you seek help from a psychiatrist, from an inpatient program or from a NAMI group. More than anything, at this point in your life, you need to feel like someone hears what you’re saying and understands where you're coming from.
Now imagine that everyone—the doctors, the nurses, the people in the support group—is speaking to you in another language. How much less welcoming would that be? How can you be assured that your message is getting through?
Beyond language, culture is a more subtle— but an equally important—factor in communication. It’s possible to understand the words but the complete message still doesn’t get through because of different cultural expressions or expectations. Imagine the difference between someone who lives in a big city and someone from a small town. The first person may be accustomed to quick, direct conversations while the second may prefer to take their time getting to know someone and might think it’s rude to not linger over a glass of iced tea. These are examples of different cultural views about time, communication and social expectations. If you want to reach out to both of these people successfully, it pays to learn about their culture.
The next three e-Advocate issues will examine culture as it affects people living with mental illness and members of the NAMI community in three parts. We will start with a case study of the Latino community and then move on to examine how cultural misunderstandings can get in the way of proper diagnosis while greater sensitivity is related to improvement of care for everyone. The last installment will contain tips you can use to improve cultural awareness for more successful communication. We welcome input from all NAMI members on this issue. Please e-mail us at firstname.lastname@example.org.
Who is a Latino?
Latinos are one of the fastest-growing ethnic groups in the country and make up roughly 15 percent of the U.S. population. As a group, Latinos are very diverse—originating from 22 Spanish-speaking countries, and identifying with a range of races and heritages. While some speak only Spanish, many are bilingual or speak only English.
Lost in Translation
Nelson Mandela said, “If you talk to a man in a language he understands, that goes to his head. If you talk to him in his language, that goes to his heart.” Even people who are fully bilingual can feel something is lost when they only have materials available in English. Not only are there some concepts that don’t translate directly into Spanish, there are different cultural reactions to English phrases. For example the phrase, “mental health” (salud mental) may be preferred by many Latinos over “mental illness.” Within families, younger generations may prefer materials in English while the older family members may feel more comfortable with information given in Spanish.
Latinos living with a mental illness such as schizophrenia are more likely to live with their families than most other groups. This family cohesion and the network of extended family can provide important emotional support and protection against stress from the outside world. Other close networks, such as religious groups, are common supports among Latinos as well. Many Latinos point out that their culture tends to speak in terms of “we,” while the majority American culture is more individualistic and emphasizes “I.” More family involvement can mean more stress for the caregivers, so to ensure that caregivers’ mental health isn’t ignored, treatment options should involve the whole family rather than focusing only on the individual.
Special Considerations in Mental Health
It’s an unfortunate fact that stigma against mental illness exists in most cultures. Stigma also affects Latinos, sometimes making it hard to recognize or admit personal or family member experience with mental illness. This can prevent individuals and families from seeking help, adhering to treatment or needed care from typical support networks within the community.
Latinos who are experiencing mental illness are much less likely to seek help directly from a mental health provider. Individuals tend to seek care from primary care physicians, who may not correctly identify the complaint. Thus, Latinos often reach a state of crisis by the time they actually receive needed help.
Outreach and Education
Martha Silva, president of NAMI New Jersey en Español, has compiled a list of things to keep in mind when reaching out to Latinos to provide mental health education and support. Among them: lack of participation doesn’t always mean lack of interest. Working several jobs, being unable to find transportation or caring for relatives in their native country can all prevent someone from showing up who shouldn’t be crossed off the list of interested participants. Partnering with supportive networks within the community, such as faith groups, can be a crucial step in effectively reaching out to Latinos. Reaching out sensitively again and again can have a big payoff.
NAMI has created a short video Mental Illness and the Latino Community: Converting Challenges into Something Positive (in Spanish with English subtitles). This footage from the NAMI 2010 Convention contains some inspiring messages from NAMI Family-to-Family teachers working within the Latino community. Perhaps nothing shows the importance of NAMI’s Latino outreach more clearly than stories about how Latino families have benefited from NAMI’s education programs and supports.
The Big Picture
This brief case study of the Latino community shows that a “one size fits all” mental health system does not meet everyone’s needs. Next month’s article will explore how cultural differences can actually interfere with correct diagnosis and treatment, while cultural competence can improve the overall understanding of mental illness.