Latinx/Hispanic

 
The Hispanic/Latinx community in the U.S. is very diverse, including people from many different nations and regions of the world. 
 
While the differences are many, there are some shared cultural factors that connect people across nationalities. There is a connection to Spain as both the colonial power and the mother land. A large portion of this culture speaks the Spanish language. There is also a shared connection of religious affiliations, strong family bonds, connections to extended networks and a resilient approach to life and work. 
 
It is indisputable that individuals of Mexican, Puerto Rican, Cuban, Central American and other descent have been part of the American cultural tapestry for centuries, and their presence and resilience enrich our communities and workplaces. 

Identity and Culture

Identity and culture for members of the Latinx/Hispanic community is as complex and rich as the story and trajectory of this population. In other words, there is no one Latinx/Hispanic culture.
 
In the context of health and mental health, it is important to understand these differences and even how community members self-identify. For example, Latinx, vs. Latino/a and/or Hispanic. Those who identify as Latinx may consider themselves of Latin American ancestry (Central America, South America or the Caribbean). Those who identify as Hispanic may be proudly referring to ancestors from Spain or other Spanish-speaking countries.  
 
Since cultural identity is a construct shared by groups, recent immigrants may identify by their country of origin instead of as “Hispanic” or “Latinx.” Since the Spanish language is typically gendered, the term Latinx is used to eliminate a binary choice (male vs. female) that is limiting and excluding to trans individuals and others who identity as fluid or non-binary. 

Barriers to Mental Health Care 

Latinx and Hispanic communities show similar vulnerability to mental illness as the white population, however, they face disparities in both access to and the quality of treatment. This inequality puts these communities at a higher risk for more severe and persistent forms of mental health conditions, because without treatment, mental health conditions often worsen.
 
Approximately 33% of Hispanic or Latinx adults with mental illness receive treatment each year compared to the U.S. average of 43%. This is due to many unique barriers to care. 

Language Barriers
Language barriers can make communicating with providers difficult, or even impossible, particularly when a person is seeking counseling for sensitive or uniquely personal issues. These topics can be difficult for anyone to put into words, but it is especially difficult for those who may not speak the same language as a potential provider. 
 
Less Health Insurance Coverage
According to the Kaiser Family Foundation, in 2018, 19% of Hispanic people had no form of health insurance. In addition to facing an already limited pool of providers due to language barriers, people identifying as Latinx/Hispanic have even fewer options when they are uninsured. 
 
Lack of Cultural Competence 
Cultural differences may lead doctors to misdiagnose those from the Latinx/Hispanic community. For instance, they may describe their symptoms of depression as “nervios” (nervousness), tiredness or as a physical ailment. These symptoms are consistent with depression, but doctors who are not trained in of how culture influences a person’s interpretation of their symptoms may assume it’s a different issue.
 
Legal Status
For immigrants who arrive without documentation, the fear of deportation can prevent them from seeking help. Even though millions of children of undocumented immigrants are eligible for health insurance under the Affordable Care Act, many families may be afraid to register due to fear of separation

Stigma 
Latinx/Hispanic individuals may not seek treatment because they don't recognize the signs and symptoms of mental health conditions or know where to find help.
 
Many in the Latinx community are familiar with the phrase el dicho "la ropa sucia se lava en casa” (similar to “don’t air your dirty laundry in public”). Many people in the Latinx/Hispanic community tend to be very private and often do not want to talk in public about challenges at home. This can lead to a lack of information within the community about mental health as talking about it can be viewed as taboo. 
 
This lack of information also increases the stigma associated with mental health issues. Many do not seek treatment for fear of being labeled as “locos”(crazy) or as having a mental illness because this may cause shame. Additionally, sometimes faith communities can be a source of distress if they are not well informed and do not know how to support families dealing with mental health conditions.

How to Seek Culturally Competent Care

Cultural competence is a doctor’s ability to recognize and understand the role culture plays in treatment in order to meet a person’s needs. When a person is struggling with their mental health, it is essential to receive quality and culturally competent care in order to improve outcomes.

A provider who understands one’s culture and needs will know culturally specific information. For example, someone might describe what you are feeling with commonly used phrases such as “Me duele el corazón.”While this literally means “my heart hurts,” it is an expression of emotional distress, not a sign of chest pain. A culturally sensitive doctor would be aware of this interpretation and would not assume you were talking about actual chest pain.
 
While we recommend going directly to a mental health professional, a primary care doctor can be a great place to start and may be able to start the assessment or give a referral to a mental health professional.
 
When meeting with a provider, ask questions to get a sense of their level of cultural sensitivity. Providers expect and welcome questions from their patients since this helps them better understand what is important in their treatment. Here are some questions to ask:

  • Have you treated other Latinx/Hispanic people?
  • Have you received training in cultural competence or on Latinx/Hispanic mental health?
  • ​How do you see our cultural backgrounds influencing our communication and my treatment? 

Whether you seek help from a primary care doctor or a mental health professional, you should finish your sessions with health professionals feeling heard and respected. You may want to ask yourself: 

  • Did my provider communicate effectively with me?
  • ​Is my provider willing to integrate my beliefs, practices, identity and cultural background into my treatment plan?
  • Did I feel like I was treated with respect and dignity?
  • Do I feel like my provider understands and relates well with me?

The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s very important for a person to feel that their identity is understood by their provider in order to receive the best possible support and care. 

More Information

  • If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357). 

  • If you or your loved one does not speak English, or speak it limitedly, you have the right to receive language-access services at institutions that receive funding from the federal government as well as the right to request a trained interpreter and to receive forms or information in Spanish.

  • If you do not have legal documentation, seek out clinics and resources that care for all members of the community. Latinx-based organizations often provide services regardless of legal status.

Resources

NAMI’s Compartiendo Esperanza
A 90-minute program to increase mental health awareness in Latino communities by sharing the presenters’ journeys to recovery and exploring signs and symptoms of mental health conditions. The program also highlights how and where to find help.

Compartiendo Esperanza: No Hay Salud Sin Salud Mental
Through stories and quotes, this booklet provides mental health information in a sensitive manner. Recovery is possible, and this booklet tells you where to find more information, seek help and be supportive. You can preview the booklet for free or buy hard copies through the NAMI Bookstore

Psychology Today
A directory of Latinx/Hispanic therapists.

Therapy for Latinx
A database of therapists who either identify as Latinx or has worked closely with the and understands the unique needs of the Latinx community. The website is also offered in Spanish. 

Mental Health America’s Resources for Latinx/Hispanic Communities
General mental health Spanish speaking resources, including a list of Spanish language materials and Spanish-language screening tools.

American Society of Hispanic Psychiatry 
Promotes the research, education, advocacy, and support for those in the Hispanic community. Offers a “Find a Physician” feature on their website.