Latino Psychiatrists Key to Better MH Care in Their Communities

Latino psychiatrists used a first-time congressional outreach event to educate legislators about the large unmet need for psychiatric services in Latino communities.

Leaders of the American Society of Hispanic Psychiatry (ASHP) held their annual meeting on Capitol Hill last month to educate members of Congress and to encourage greater political advocacy by their members.

“We usually focus on research and education, but this year we wanted to advocate for policies that depend on the best-available, evidence-based mental health care,” said Alex Kopelowicz, M.D., ASHP president.

The psychiatrists presented data on disparities in mental health care received by Latinos and the general population, as well as specific treatment challenges for Latino members of the military and veterans. They found a receptive audience among members of Congress who attended the event, including Rep. Grace Napolitano (D-Calif.).

Napolitano said that one of the biggest challenges to improving mental health care in the Latino community is overcoming the strong stigma that for cultural reasons keeps people from seeking help and support for mental illness.

“This can be remedied if we educate, educate, educate,” Napolitano said.

Rep. Hilda Solis (D-Calif.) described several legislative efforts to improve care within the Latino community. The goal of the bill she introduced in January 2007 (HR 542) is to overcome the stigma of mental illness in both the military and Latino communities by requiring the Department of Veterans Affairs to offer mental health services in multiple languages, so that veterans with limited English proficiency can get appropriate, culturally competent care. Another of her bills (HR 3014), introduced in July 2007, would provide grants for programs that aim to eliminate racial and ethnic disparities in health status and health care provided.

Solis said she hoped HR 3014 would encourage the establishment of“ wrap-around” health care services, including mental health assessments and addiction treatment especially for young Latinos in prison. Such steps are needed to halt in particular the surge in recent years in the number of young Latina women and girls repeatedly incarcerated.

Why a Lobbying Push?

According to psychiatrists who spoke at the event, the legislation is a good starting point for the long-term effort needed to turn around numerous negative health care trends in Latino communities. Research presented included findings from a study in the December 2001 American Journal of Psychiatry that only 22 percent of Latino adults with a diagnosis-based need for mental health care receive it, compared with 38 percent of non-Latino white adults.

Andres Pumariega, M.D., chair of APA's Committee of Hispanic Psychiatrists, and others noted that many of the health care problems in the Latino community stem from children being raised by other children because parents have multiple jobs. This situation has been linked to high rates of conduct disorders, substance use, and suicide, he said.

Pumariega quoted statistics from the Centers for Disease Control and Prevention indicating that Latina girls have higher rates of suicidal ideation, planning, and attempts than girls from other ethnic groups.“ Latino youngsters really are dealing with a suicide epidemic,” he said.

Mental health problems among Latinos are compounded by the shortage of psychiatrists and mental health workers who can speak Spanish and are able to provide culturally competent care, said Margarita Alegria, Ph.D., a professor of psychiatry at Harvard Medical School. Her research has found that six-month waiting periods for access to Latino mental health professionals are common and that the quality of care provided by these professionals varies greatly. People who have sought mental health care from a poorly trained clinician report to others that they received little help from the treatment, which further discourages Latinos from seeking care, she said.

State-Level Solutions Sought

Latino mental health advocates also are seeking solutions at the state level. Henry Acosta, executive director of the National Resource Center for Latino Mental Health, described his organization's successful effort in New Jersey to pass the first state law that mandates the study of cultural competency as part of the accreditation training of all mental health workers. He noted that an ongoing shortage of Latino mental health professionals has necessitated the re-training of current mental health workers in cultural competency, instead of waiting for a future influx of Latino mental health workers that may not come.

Another recent legislative push in New Jersey established a grant program that specifically funds Spanish-speaking positions at the state's community health care centers.

The next steps for improving mental health care for Latinos will come from stepped-up participation and advocacy by Latino psychiatrists and other mental health workers in federal and state health care planning, said Elena Rios, M.D., president and CEO of the National Latino Medical Association. One way to make a difference at the federal level is participation in Healthy People, which provides 10-year national objectives for promoting health and preventing disease. The planning process for Healthy People 2020 is now under way and will wrap up after the new president takes office.

The planning process for the federal health planning effort is open to all Americans, but Latino psychiatrists need to contribute to ensure their community's needs are not overlooked.

“We're looking for the members of the Latino community who will step up and talk for the rest of the community,” she said.

Information about Healthy People 2020 is posted at<www.healthypeople.gov/HP2020/>. The text of the health care bills can be accessed at<http://thomas.loc.gov> by searching on their bill numbers, HR 542 and HR 3014. ▪