Making Mental Health Services Work for Latino Youth

Bringing mental and behavioral health programs into schools increases early access to interventions, reduces the stigma around mental health issues, and normalizes the need for a healthy, supportive environment in schools. These were some of the issues addressed during last week’s Facebook Live event in celebration of National School Counselor Week, where NCLR’s Deputy Research Director Patricia Foxen was joined by Lourdes Rubio, Licensed Professional School Counselor for Arlington Schools, and Marisa Parrella, Senior Clinical Manager at Mary’s Center, for a discussion on school-based mental health programs for Latino students.

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Mental Health Services for Latino Students: Live Chat

Join us over on our Facebook page at 2 pm ET for a live chat to celebrate National School Counselor’s Week!

We’ll be chatting with school-based mental health experts about what Latino students need in school and the programs that can help them.

 

Evidence-Based Practices and Mental Health among Latino Youth: A Review of the Issues

By Patricia Foxen, PhD, Deputy Director of Research, NCLR

JUVENILE JUSTICE LatinAmericanCoalition-02_resizedIt is safe to assume that people who are concerned with the well-being of Latino families and youth—whether those people be policymakers, funders, advocates, clinicians, or community members—support effective, research-based mental health programs for Latinos. What is less clear is what that research and those programs look like. For nearly two decades, there has been push-and-pull between supporters of mainstream evidence-based practices (EBPs)—mental health treatments that have been proven to be effective through scientific study—and proponents of culturally centered interventions. These are programs that are designed to meet the mental health needs of particular groups, such as Latinos, within their environments and communities.

The idea of having a body of EBPs is alluring to many stakeholders because, ideally, it promotes clear-cut standards, measurable outcomes, and high-quality services. A very popular EBP in mental health, for example, is cognitive-based therapy, which has been shown to be an efficacious and cost-effective treatment for a range of mental health and behavioral problems across different groups, including Latino youth.

However, some important critiques of EBPs have been mounted over the years, particularly as they apply to communities of color. These critiques are important to heed, as they may help explain why major mental health disparities for communities of color continue to exist.  Continue reading

Acknowledging the Barriers to Mental Health Care in Latino Communities

By Patricia Foxen, PhD, Deputy Director of Research, NCLR

mental-health-brain-shutterstockYears ago, a young colleague of mine—let’s call her Rosa—experienced a break with reality. A shy, disciplined, hardworking woman in her early twenties, she started to exhibit erratic, self-destructive behavior and nonsensical speech. Rosa’s friends brought her to a hospital, where she was assessed and dismissed. Her co-workers contacted her parents, who had migrated to the Bronx from El Salvador in the 1980s, to plead with them to seek psychological help for Rosa. The couple seemed overwhelmed, denied that she needed such help, and stopped communicating with nonfamily members altogether. Eventually, after Rosa’s behavior escalated into a frightening episode, she was admitted to a psychiatric hospital, where she was heavily sedated for over a month, then discharged without a diagnosis. Years later, having finally found culturally appropriate mental health care, Rosa was diagnosed with bipolar disorder, treated, and able to resume a more stable life and career.

While Rosa’s story may seem more extreme than most, it illustrates an important issue within the Hispanic community: cultural and structural barriers to adequate mental health services too often impede young Latinos from getting the care they need. One such barrier is the fear of being stigmatized for having mental health problems, which leads some Latino families, particularly within immigrant communities, to avoid seeking psychological help for problems stemming from depression, conduct disorders, or organic mental illnesses such as Rosa’s. Many rely on support from the family, folk and community healers, and churches, especially when existing mental health services are perceived to be closed or lacking an adequate cultural understanding.

Indeed, a second barrier to mental health services is the lack of cultural and linguistic sensitivity within mainstream psychiatry and psychology, as well as the relative dearth of Latino mental health care providers. Even when culturally centered services do exist, potential patients or others who are in a position to help them are not always informed about where to find these services. And because mainstream mental health providers often interpret youth behaviors differently based on race and ethnicity, young Latinos like Rosa often end up being misdiagnosed or remain undiagnosed.

Structural barriers to accessing mental health care for Latino youth may also include a lack of health insurance, the high cost of mental health services, and low wages among Hispanic parents. A full 16 percent of young Latinos under age 18 lack health insurance, a proportion that has decreased through the years but is still three times higher than the uninsured rate of White youth. Another impediment to accessing mental health services, moreover, is the fear that immigrant parents have in approaching health service providers due to their legal status.

As a growing body of research shows, the combination of all of these factors means that psychologically vulnerable Latino youth are a largely undertreated group, despite the fact that they are at higher risk of mental health issues such as depression, anxiety, and substance abuse. This lack of adequate treatment may in turn contribute to low educational achievement, low self-esteem, and dropping out of school, and it may help explain disproportionate minority contact with the juvenile justice system.

Despite federal commitments to address mental health issues among minority youth, much remains to be done to reduce these barriers and ensure access to quality mental health services for young Latinos. We need increased outreach and education in Hispanic communities regarding mental health problems, their symptoms, and the value of psychological treatment. Such outreach must be coupled with a firm commitment to enhancing culture-centered, community-based mental health services that can help youth such as Rosa access adequate treatment and return to a stable and productive life.

Addressing Culture: Mental Health Care for Youth in Latino Communities

Patricia Foxen, PhD, Deputy Director of Research, NCLR

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Photo: Michael Coghlan

The psychological health of Latino youth has become an increasingly urgent issue for our nation to address. This is not only because of the rising importance of the young Latino demographic, but also because of the intimate connection between mental health and all other aspects of an individual and community’s well-being. Most young Latinos are coping, and even thriving, in the face of challenging circumstances. However, recent surveys show that Hispanic adolescents are more likely to struggle with mental health and substance abuse issues than Black or White teens. Latino youth who develop mental health problems, which can range from depression and trauma to substance abuse and conduct problems, are likely to fail or drop out of school, to not get appropriate treatment, and to be misdiagnosed, often due to a lack of cultural knowledge on the part of health practitioners.

Of particular concern is the fact that juvenile detention has become a dumping ground for minority youth with mental health issues. Indeed, a significant portion of incarcerated Hispanic youth has one or more diagnosable mental or substance use disorders. Within detention facilities themselves, mental health problems often go undetected and untreated. Moreover, Latino youth in these facilities are exposed to a highly punitive system and are more likely than White youth to be sentenced to adult prisons, which exacerbates psychological problems for these youth.

JUVENILE JUSTICE LatinAmericanCoalition-02_resizedWhat are the main factors that contribute to psychological vulnerability among Latino youth? Most risk factors stem from the social and environmental contexts within which a majority of Latinos reside. Over half of Latino kids under age 18 live in families where at least one parent is an immigrant. With parents who struggle at low-wage, unstable jobs—and in some cases are either undocumented or have been deported—Latino adolescents often have to work to supplement their family’s income. These teens often take on other adult roles as well, which can contribute to disrupted schooling and heightened anxiety. An especially difficult dynamic for young second-generation Hispanics, who are the majority of Latino youth, is the fact that immigrant parents and their U.S.-born children often acclimate to U.S. society in different ways and at different rates, often causing significant tension within the family. This type of dynamic, labeled “acculturative stress” by clinicians has been closely associated with a wide range of mental health issues for youth, including high suicide attempt rates among young Latinas.

Poverty among Latino families is another major risk factor. Sixty-three percent of Hispanic kids live in low-income families (compared to 29 percent of White children). Many attend overcrowded schools and live in poor neighborhoods characterized by crime, gangs, violence, and drugs. For those who live in areas of rampant anti-immigrant sentiment, discrimination and bullying can exacerbate already tough circumstances. The stress of living in such environments is hazardous to the well-being of young Latinos, and researchers have connected this stress to a higher likelihood of major depressive disorders, anxiety, antisocial activity, and physical aggression.

ModelsForChange_1In order to improve Latino youths’ prospects of attaining healthy, productive lives, greater efforts must be made to change the environmental factors described here. Also it is important to enhance culturally appropriate psychosocial services and provide the resources that will enable youth to receive treatment. Numerous examples of effective, culturally centered, research-based interventions exist (including, for example, Jovenes Nobles, Cuento Therapy, as well as mainstream therapies that have been culturally adapted to particular groups). While these should be customized and expanded to Latino communities throughout the country, further support should also be given to developing and evaluating promising new programs that respect local, community-based treatment approaches. Within the broader juvenile justice sector, systems reform and community outreach—as promoted, for example, by the Models for Change initiative and the W. Haywood Burns Institute—should be supported.

The key to successful mental health interventions for Latino youth is that  interventions take into account the broader context of culture, family, and community. The interventions should focus on building on the strengths of young Latinos, healing community wounds, and providing concrete pathways toward success and mental health. These programs can go a long way toward curbing the growing incidence of psychological distress among young Hispanics, and ensuring that our Latino youth become vibrant, productive adults.