The American Psychiatric Association (APA) has updated its Privacy Policy and Terms of Use, including with new information specifically addressed to individuals in the European Economic Area. As described in the Privacy Policy and Terms of Use, this website utilizes cookies, including for the purpose of offering an optimal online experience and services tailored to your preferences.

Please read the entire Privacy Policy and Terms of Use. By closing this message, browsing this website, continuing the navigation, or otherwise continuing to use the APA's websites, you confirm that you understand and accept the terms of the Privacy Policy and Terms of Use, including the utilization of cookies.

×
Community NewsFull Access

Puerto Rican Residents Return to Island for Mental Health Tour

Published Online:https://doi.org/10.1176/appi.pn.2015.4a22

Abstract

Psychiatry residents and fellows with roots in Puerto Rico return to the island to raise awareness of mental health issues and the need to increase access to care for the territory’s residents.

Instead of delivering didactic lessons about the array of challenges associated with mental health care in some Hispanic communities, several APA resident-fellow members (RFMs), with support from APA’s Division of Diversity and Health Equity (DDHE) and the Puerto Rico Psychiatric Society, decided to take this information from the lecture halls to the community, in hopes of producing positive change.

Photo: Llenza, Padilla, and Tirado-Morales

Llenza, Padilla, and Tirado-Morales have a group hug after successfully completing the Mental Health Awareness Tour Puerto Rico. (More images from this article can be accessed here.)

Vabren Watts

In February five RFMs with ties to Puerto Rico traveled to the island to carry out the first “mental health tour” of Puerto Rico. The tour arose from an idea of three residents who just wanted to “give back,” according to Auralyd Padilla, M.D., a child and adolescent psychiatry fellow at the University of Massachusetts Memorial Medical Center and a former APA/Substance Abuse and Mental Health Services Administration (SAMHSA) fellow.

“Two of my classmates and I wanted to come back to our medical school in Puerto Rico—Universidad Central del Caribe [UCC] School of Medicine—and encourage students to become interested in psychiatry,” Padilla told Psychiatric News. “As we were brainstorming, we thought it would be a great idea to contact media outlets on the island so that we could be a part of radio and television broadcasts to spread the message about various aspects of mental health such as recognizing symptoms of mental illness and accessing services to treat mental disorders.”

But the idea didn’t stop there. The RFMs decided to go to another medical campus in Puerto Rico, middle and high schools, and even offices of legislators, among other places, to talk about psychiatry and issues related to the mental health system in the predominately Spanish-speaking U.S. territory.

Destigmatization and education about mental illness were prominent themes during the three-day tour, which was held throughout the metropolitan area of San Juan, the island’s capital.

“Because of stigma surrounding mental illness, many people do not seek mental health services in Puerto Rico,” said Vanessa Llenza, M.D., a psychosomatic medicine fellow at George Washington University and a graduate of UCC School of Medicine. During an interview, Llenza, an APA/SAMHSA fellow, explained to Psychiatric News that mental health services on the island are more likely to be accessed by people who can afford to go to private providers than those who are more likely to use public-health services, resulting in low access rates for government-funded mental health services. “For this reason, we wanted to speak with legislators to see if there are ways to improve access.”

On Day One of the tour, one of the stops included a meeting at the Puerto Rico capitol with Debbie Figueroa, J.D., M.P.H., an epidemiologist with the Senate of Puerto Rico Health and Nutrition Commission. “Right now, the health care system of Puerto Rico offers some of the best health care benefits in the world, but we do not have the best services available,” she told the RFMs, especially when it comes to mental health services, since there is just one psychiatrist for approximately every 10,000 people. “We have many people with mental health problems that go unattended.”

According to Figueroa, the territory’s senate is pushing for health care reform through Bill 15, which would establish an integrated health care system that would include mental health care as a part of general health services. “It’s a medical plan that is about more access at lower costs,” Figueroa explained.

Training Opportunities Very Limited

The low number of psychiatrists receiving training in Puerto Rico is, however, contributing to the access problem. According to Hector Colon-Rivera, M.D., an RFM at Boston University Medical Center and an APA/SAMHSA fellow, a total of 200 students graduate each year from the four medical schools in Puerto Rico, and about 10 percent to 15 percent say they are interested in a psychiatry residency. Unfortunately, however, there are only 10 residency positions on the island, and open slots are not available each year.

“This forces us to seek training outside of Puerto Rico,” said Colon-Rivera, who graduated from the University of Ponce School of Medicine. “It is hard for us to come back because there is not a lot of opportunity for jobs or loan-repayment programs. These are major barriers not only for mental health professionals but other medical professionals as well.”

Though Figueroa told the RFMs that there are no plans to create more residency slots in Puerto Rico, she did promise to present the RFMs’ concerns to the island’s medical board.

Preparing the Next Generation

The tour continued on Day Two with the RFMs being interviewed on local television and radio programs, during which they addressed warning signs of mental illness in children and adolescents and myths and realities about mental disorders. The interviews were followed by a visit to the University of Puerto Rico School of Medicine, where the RFMs had a panel discussion with medical students about potential challenges faced by psychiatry residents from Puerto Rico who are training on the U.S. mainland. Discrimination was the main topic.

Photo: Resident fellow members on the radio

Resident-fellow members (RFMs) speak about myths and realities of mental disorders on a morning radio show at WKVM 810 AM in Puerto Rico. (More images from this article can be accessed here.)

Vabren Watts

“I don’t want to talk to you,” “Get me another doctor,” and “You’re not American” were some of the ethnically and racially charged statements that were made to Dimas Tirado-Morales, M.D., a child and adolescent psychiatry fellow at Drexel University College of Medicine and a graduate of UCC School of Medicine, when he attempted to treat patients during residency.

“Depending on the situation, I may ask patients to express what it is that is bothering them about me, and maybe we can figure it out,” said Tirado-Morales, M.D., who is also an APA/SAMHSA fellow. “Sometimes I try to educate the patient on racism, because some people do not realize that they are making statements that may be offensive to others.”

Lissette Rodrigues-Cabezas, M.D., a psychiatry resident at Northwestern University Feinberg School of Medicine, told the audience that culturally insensitive remarks are also made by colleagues when treating patients who are different from them.

Rodrigues-Cabezas, a native of Chicago of Puerto Rican descent, noted, “When a patient is being treated for symptoms of mental illness in a hospital or outpatient practice, it is often his or her first time coming to a psychiatrist. We need to make sure that patients feel that they are being heard. … We have to help them establish trust with psychiatrists and ensure that we are working collaboratively with them in deciding on a treatment plan, regardless of the patient’s ethnic background. If we do not practice cross-cultural psychiatry, it is very likely that person will never feel comfortable seeing a psychiatrist again.”

She said these basic tenets of practice are especially important when working with medical students. “We have to be good role models for medical students by being professional and compassionate to patients in order for these students to do the same when they are in our position.”

APA Will Continue to Battle Disparities

The final day of the mental health tour included a visit to Casa de NiɁos Manuel Fernández, a nonprofit group home for boys aged 8 to 18 who are survivors of trauma and have been removed from their homes. The RFMs spoke with the boys about how stress affects the body and behavior and ways to manage stress through friendly interaction with pets, for example, or through engaging in martial-arts activities.

The tour concluded at a shopping mall in Bayamon, where an informational booth about mental illness in Hispanic populations in particular was set up to engage shoppers in conversation.

Ranna Parekh, M.D., who is the director of DDHE and accompanied the residents on the tour, said that the trip was incredible on multiple levels.

“The positive reception that we got from the people at our shopping mall booth, the medical schools, the group home, and the island’s legislature was very inspiring,” she said. “The people were extremely thankful that APA and the Puerto Rico Psychiatric Society helped fund such an event that recognizes mental health issues and the need to increase mental health services in the Hispanic community. We will make sure that the work that has started in Puerto Rico will continue.” ■

More images from this article can be accessed here.