THE BARRIERS LATINOS’ HAVE IN OBTAINING MENTAL HEALTH SERVICES
A Project
Presented to the faculty of the Division of Social Work
California State University, Sacramento
Submitted in partial satisfaction of
the requirements for the degree of
MASTER OF SOCIAL WORK
by
Monica Perez
SPRING
2014
THE BARRIERS LATINOS’ HAVE IN OBTAINING MENTAL HEALTH SERVICES
A Project
by
Monica Perez
Approved by:
__________________________________, Graduate Coordinator
Dale Russell, Ed.D., LCSW
Date
ii
Student: Monica Perez
I certify that this student has met the requirements for format contained in the University
format manual, and that this project is suitable for shelving in the Library, and credit is to
be awarded for the project.
__________________________, Division Chair
Robin Kennedy , PhD
Division of Social Work
iii
Date _________________
Abstract
of
THE BARRIERS LATINOS’ HAVE IN OBTAINING MENTAL HEALTH SERVICES
by
Monica Perez
Latinos are considered to be the fastest growing minority group in America.
However as this population continues to grow mental health service providers need to
consider the barriers that Latinos often confront when trying to obtain mental health
services. The purpose of this research study is to address and discuss the barriers that
Latinos have in obtaining mental health services. This study will utilize a qualitative
approach to address these barriers. The participants of study were employees of Turning
Point Community Programs. These individuals were selected based following, they are
currently employed through Turning Point Community Programs and work in the field of
mental health services. The survey that was completed was to analyze and understand
their level of knowledge regarding the Latino population and their engagement with this
population.
__________________________________, Graduate Coordinator
Dale Russell, Ed.D., LCSW
Division of Social Work
Date
iv
ACKNOWLEDGEMENTS
First I would like to thank my Lord and Savor Jesus Christ you have directed my
path, guided my thoughts, and loved me regardless of my endless faults. I thank you my
Sweet Jesus for loving me and allowing me to get through this experience. Second, I
would like to thank my sweet baby girls Kaylah and Olivia Bell-Perez. I know this has
been a tough journey, but we have now have come to the end of the road. Mommy loves
you and I hope that I have inspired you to reach for the stars. Clifford, my love, thank
you for standing by me, with me, and for me, any other man would have ran, but you my
darling have endured this experience with me. My darling parents Carmen and Jose Perez
thank you, for your sacrifice, love and devotion. To my brothers and sisters Roxy, Loren,
Carman, Walter and Rodrigo I love you and appreciate each and every one of you. Dr.
Russell, thank you for guiding me and encouraging me through this process, and finally
to those who are no longer here but made it possible for me to be here today, Mario,
Chilies, and Tia Tonita.
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TABLE OF CONTENTS
Page
Acknowledgements ..............................................................................................................v
Chapter
1. INTRODUCTION ...........................................................................................................1
The Problem .............................................................................................................1
Background of Problem ...........................................................................................1
Statement of Research Problem ...............................................................................3
Purpose of Study ......................................................................................................5
Theoretical Framework ............................................................................................8
Definition of Terms..................................................................................................8
Assumptions.............................................................................................................9
Justification ..............................................................................................................9
2. REVIEW OF LITERATURE ........................................................................................10
Accessibility...........................................................................................................10
Language ................................................................................................................12
Culture....................................................................................................................15
Stigma ....................................................................................................................19
Discrimination........................................................................................................23
Immigration............................................................................................................25
Acculturation..........................................................................................................28
3. METHODS ....................................................................................................................32
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Introduction ............................................................................................................32
Research Question .................................................................................................32
Study Design ..........................................................................................................32
Protection of Human Rights...................................................................................34
Study Participants ..................................................................................................34
Instruments .............................................................................................................35
Data Collection ......................................................................................................36
Data Analysis .........................................................................................................36
4. INTERPRETATION OF THE RESULTS ....................................................................37
Demographics ........................................................................................................37
Response to Survey Questions ...............................................................................38
Summary ................................................................................................................42
5. CONCLUSIONS AND RECOMMENDATIONS ........................................................44
Conclusion .............................................................................................................44
Recommendations ..................................................................................................46
Limitations .............................................................................................................47
Conclusion .............................................................................................................47
Appendix A. Survey Instrument ........................................................................................49
Appendix B. IRB Approval ...............................................................................................52
References ..........................................................................................................................53
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1
Chapter 1
Introduction
The Latino population is considered to be one of the leading and fastest growing
minority groups in the United States. As the population continues to grow the need for
mental health services will increase. Therefore it is important that mental health agencies
begin to understand the complexity of serving this population and create a plan to
decrease the barriers that Latinos often encounter when attempting to utilize mental
health services. Agencies often tend to ignore the cultural needs, language, traditional
practices and the fact that Latinos are a population from various countries with different
life experiences. Mental health providers may serve diverse populations however may
lack the knowledge, cultural understanding, and experiences which prevent Latinos in
obtaining mental health services. Therefore making it difficult to engage Latinos in
utilizing mental health services and creating additional barrier that prevent access to
treatment.
Background of the Problem
As the field of mental health continues to expand, and has become more
accessible to the general population, there are still limitation when it comes to connecting
and reaching the Latino community. The Latino population is composed of multilingual
and cultural experiences. It is not a one size fits all community we are as diverse in
culture, language, history and experiences. Though we share common similarities it is
important that mental health agencies and providers understand the richness and diversity
within our culture. The problem however is that most mental health agencies and
2
providers tend to place Latinos into one category. Agencies and providers will often
attempt to address these issues of diversity by providing their employees with some form
of cultural training/education in hopes that their employees will gain some knowledge
and understanding of the Latino community. This form of training/education does not
replace the need for agencies and providers to further educate themselves with their
individual client. The ability to affectively connect with your client is not solely related to
your ability to understand their cultural background but instead to connect with them
through language. The problem for most agencies is having sufficient bilingual providers
to serve the Latino population. Agencies often lack bilingual providers that are capable of
relating or understanding the experiences of their Latino patients and often attempt to
resolve this matter by contracting interrupters. The problem with that solution is that it
prevents the Latino patient/client from building the patient-service provider relationship,
and creating a barrier on building establishing a rapport. The Latino patient/client unable
to relay or understand the severity of their mental illness may chose to end treatment
before it even started. These are factors that create multiple barriers on why Latinos are
not able to access mental health treatment. Language barriers can compromise patientphysician communication and subsequently, the qualities of care patient receive (August
et al., 2011, p. 2356). Latinos who are willing to seek out services often prefer the
intimacy of being able to communicate with a mental health provider that not only speaks
in their native tongue, but that is also able to relate to their cultural experiences. These
individuals already struggle with the need of having to seek out mental health treatment
and may be even more conflicted with receiving a mental health diagnosis that they are
3
unfamiliar with. I have worked with some Latinos in the community who often state that
receiving a mental health diagnosis was traumatic, because of the lack in understanding
the illness, and having to endure a life time of treatment. A very common question was
“can you fix me”? The stigma associated with mental health treatment is a barrier that
Latinos have not yet overcome. The Latino culture still thrives on traditional familial
roles therefore men and women fear losing that sense of honor and control in their
familial position. The reality is that Latinos face multiple barriers in accessing or utilizing
mental health services however agencies and provider play the bigger role when it comes
to accessibility and utilization. Agencies most account for making mental health
treatment accessible to the Latino population, considering all factors when creating
policies and agendas.
Statement of Research Problem
The research problem is that there continues to be barriers in Latinos obtaining
adequate and appropriate mental health treatment. The direct implications of these
barriers are that Latinos who are in need of mental health services are being left
untreated. Though there are several factors that lead to Latinos not being able to obtain
mental health services, what I find to be more problematic is the lack of concern from
agencies and mental health providers on finding a solution. Instead it appears that we
continue to ignore the problem in hopes that someone else will consider finding the
solution. This then leads to Latinos mental health needs being ignored and services often
being denied.
4
Due to the stigma of mental health Latinos who are suffering from a mental
illness such as depression are more likely to isolate or may be alienated from their
community. Mental health symptoms and behaviors are still a fairly new concept to the
Latino community though there is some awareness. The sad reality is that mental illness
is often ignored by the family and community and these symptoms may often be
attributed to witch craft. Therefore the individual who is struggling with symptoms of
depression may often go untreated unless those symptoms begin to compromise their
physical health, i.e. anxiety, high blood pressure, lack of appetite and loss of energy.
Latinos therefore are more likely to seek out treatment for these symptoms by their
primary care physician who unknowingly attributes the symptoms to the patient’s
physical health instead of their mental health. Primary care physicians are often the first
point of professional contact with which patients discuss mental health concerns,
particularly racial and ethnic minorities (August, Nguyen, Ngo-Metzger, & Sorkin, 2011,
p. 2357). The Latino cultures tend to value the opinions of medical providers which
attributes to the lack of utilization in mental health services. Given the higher prevalence
of mental health concerns in patients with a co morbid physical condition, in addition to
low rates of diagnosis, and treatment of mental health problems in primary care, in
general, and in minorities in particular, it is important for providers to elicit discussion of
older adult’s mental health status to properly identify, diagnosis and refer or treat
potential mental health problems (August et al., 2011, p. 2357). The problem then
becomes linking the patient to a mental health service provider, for a physician linking a
patient to a mental health service provider is not always a priority. The physician goal is
5
typically to address and treat the physical symptoms therefore denying their patient
proper access to mental health services. This creates an additional barrier for Latinos and
it is one that mental health service providers in collaboration with medical providers
should address.
Though mental illness is prevalent in the Latino community the diagnosis and treatment
is still a fairly new concept. This is why Latinos often prefer obtaining services from a
primary care provider instead of a mental health service provider. Latinos have little
knowledge on how to access these services and may struggle with the idea of having to
seek treatment. As a professional working in the field of mental health and one of two
Spanish speaking service providers within my agency, I have witnessed the difficulties
Latinos have in accessing services and understanding the process. This may be
associated with the arrival of newly arrived immigrants with various educational
backgrounds. Mental health agencies and providers often focus their service and
treatment to Latinos that are acculturated and are better informed of the symptoms of
mental health. That is why researching the barriers in Latinos ability to access mental
health treatment will allow providers to consider new and creative ways of engaging and
treating Latinos suffering with mental illness. All factors in this research should be
considered because barriers are not created solely by individuals but a failure in systems
that do not work together.
Purpose of the Study
The purpose of this study is gather statistical data regarding the barriers that
Latinos have in accessing mental health service. The hope is that this research study will
6
be used to improve the quality of mental health services that are currently being provided.
Agencies will be able to use this study as a format for discussion to address and improve
on existing policies that may create barriers in obtaining services. In addition to analyzing
barriers this research study will also provide agencies and providers with the ability to
comprehend the cultural needs of the Latino community therefore considering more
effective ways of engaging this population.
As professionals we at times ignore the mental health needs of Latinos within our
community. There are several attributing factors that service providers should consider,
for example accessibility, affordability, language, culture, stigma, discrimination,
immigration and level of education. Therefore it is important when working with this
diverse population to consider the various barriers that prevent Latinos from accessing
mental health services. Awareness will provide the avenue for advocacy in improving the
quality of services that agencies offer. Latinos traditionally are a collective community
and mental health agencies and providers work from an individualistic model therefore
advocacy does not simply imply systemic barriers, but also changing the standard on how
providers offer services. As previously stated the primary purpose of this study will be to
address the barriers in Latinos obtaining mental health services. However there is a
secondary purpose and that is to bring awareness of the deficiency and need of having
agencies hiring provider and clinicians that are bilingual and can offer mental health
services to the Latino population.
One of the barriers in working with the Latino population is associated with the
lack of bilingual providers. I recently had a conversation with a CEO of a prevalent
7
mental health program in Sacramento, CA. I asked this individual if he was aware that his
agency does not provide adequate or sufficient services to the Latino community,
specifically those who are Spanish speaking only. He responded by stating that he was
aware of the deficiency of bilingual providers within his agency however did not disclose
a solution to the problem. The inability or lack of willingness to seek out a resolution on
increasing more bilingual mental health providers is a barrier that agencies must consider.
Agencies and providers should not ignore the needs of this growing population. Mental
health services should be accessible to all therefore agencies should make it a priority to
recruit qualified bilingual clinicians to serve the needs of the Latino population that is
rapidly growing and in need of services.
Agencies need to consider the repercussions of individuals who are left untreated,
the increase in homelessness, substance abuse, incarceration, victimization, abuse and
neglect. Providers only need to look at the past and present history of homelessness and
addiction that has impacted our judicial system. Therefore further ignoring the problem
will delay the opportunity for agencies to work on a solution. The barriers that Latinos
have in obtaining mental health services should be a priority that is why the purpose of
this study will conclude with presenting solutions.
Theoretical Framework
The origin of social system theory is from general system theory, which lies in
several different physical and social science disciplines, such as engineering, biology,
psychology, sociology and management (Teater, p. 33). As with the social system
theory, the ecological perspective emphasizes the interaction and interdependence of
8
individuals and their environment, yet stems more from ecology, which are the study of
interdependence and their environment. This research study will use the social systems
theory and ecological perspective to discuss the barriers that Latinos have in obtaining
mental health services. Because ecology focused on the study of person-in-environment
and was based more on biology rather than on physical origins, theorist found the
language and approach to be more appropriate for explaining and assessing individuals in
their environment and provided a foundation for social work practice (Teater, p. 34). The
ecological perspective is applicable in this study since it will address how the person- inenvironment (Latinos) are affected by the barriers of access, language, culture,
acculturation, immigration, discrimination and stigma when it comes to the access of
services. Therefore this study will apply this theory in order for mental health agencies
and service providers to asses and identify barriers that are being created in order to bring
about change to mental health services and treatment for the Latino population.
Definition of Terms
Mental Illness: Is a medical condition that disrupts a person’s thinking, feeling, mood,
ability to relate to others and daily functioning (“National Alliance on Mental Illness," p.
1).
Mental Health: Refers to the symptoms associated with mental illness.
Latino/Hispanic: Refers to a person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin regardless of race (Humes, Jones, &
Ramirez, 2011, p. 2).
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Service Providers: Refers to agencies or individuals who provide mental health services
to the community.
Assumptions
The assumptions regarding this qualitative research study is that Latinos
encounter barriers when trying to access mental health services. These barriers are
created due to the lack of mental health providers that serve the Latino population and
that address the implications of how barriers prevent Latinos from accessing mental
health services. Therefore participants of this study will provide their personal opinion
regarding the services that Turning Point Community Programs offers the Latino
population. The goal is to locate barriers pertaining to language and cultural
understanding.
Justification
In conducting this research study Social workers working in the field of mental
health will be able to understand the barriers that Latinos have in obtaining mental health
services. Agencies will be able to use this study as a guide to improving the quality of
services that they provide this population. Therefore increasing utilization of mental
health services and reducing barriers that prevent treatment. Policies will be created and
implanted to better educate staff regarding the reasons why Latinos do not engage in
mental health services.
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Chapter 2
REVIEW OF LITERATURE
This literature review will address the following eight topics pertaining to the
barriers that Latinos have in obtaining mental health services, accessibility, language,
culture, stigma, discrimination, immigration and acculturation. The first section will
address accessibility in obtaining mental health services and treatment. The second
section will address language and the implication of not having adequate bilingual service
providers. The third section will address culture and the need for having culturally
competent mental health providers. The fourth section will address the discrimination
Latinos encounter. The fifth section will address the stigma that is associated with mental
illness in the Latino community. The sixth section will discuss immigration and how this
legality prevents Latinos from seeking out mental health services and treatment. The final
section of the literature review will address the need of having acculturation.
Accessibility
Service providers need to consider how accessible mental health services are to
the Latino community. In his report on racial and cultural disparities in mental health,
The Surgeon General pointed to the disparities in access as a cause for concern
(Snowden, Masland, Ma, & Ciemens, 2006, p. 235). Access of services is not limited to
location, transportation, and cost but also to how mental health agencies provide outreach
to the Latino community. For Latinos who work or reside in rural communities accessing
mental health services may be a challenge and a greater barrier may be not being
informed where to access mental health services. The journey of acquiring treatment
11
begins with the knowledge of where and how services can be obtained. Agencies need to
account for outreach in rural communities and the need to provide mental health
treatment for this demographic. Rural communities may have limited public
transportation which prevents Latinos from accessing services. Compared to urban areas,
rural areas generally have less availability and accessibility of mental health specialist
(Garcia, Gilchrist, Vasquez, Leite, & Raymond, 2011, p. 501). In order for Latinos to be
willing to engage in mental health services they to need to have access to those services.
In other key factor in accessibility is knowing how to locate services. Systemic problems
may limit the ability of families to benefit from mental health services (Gudino, Lau, &
Hough, 2008, p. 140). For example, a lack of mental health providers who conduct
outreach to minority communities to provide extended hours, or offer lower fees may
negatively impact the likelihood and feasibility of accessing mental health services for
many families (Gudino et al., 2008, p. 140). Therefore agencies need to consider if the
outreach that they are currently conducting is inclusive to rural communities, and how
these services can be further expanded in order to meet the needs of this underserved
population. Transportation limitation also impacts Latinos from being able to connect or
engage to mental health services.
The lack of adequate transportation in rural communities creates another barrier
for Latinos in accessing met health services. It is important for agencies to consider the
possibility that most Latino families may have access to one vehicle or depend on the
kindness of family for mobility. This often places the most vulnerable who are in need of
mental health services at risk such as the elderly and the young. Latino older adults
12
experienced their unmet needs in ways associated with their cultural background and
minority status (Barrio et al., 2008, p. 57). In a research conducted with older adults a
predominant them concerned an absence of available, appropriate transportation services,
which contributed to social isolation and restricted access to mental health services for
Latino older adults (Barrio et al., 2008, p. 68). Older Latinos are often at greater risk for
depression due to increase isolation therefore making services more accessible to meet
their needs will improve their quality of life. Children depend on their parents to get their
needs meet and when mental health services are difficult to access this places them at
greater risk of mental health problems. Among minority youth, however, those in
immigrant families may be at even greater risk of having unmet mental health needs,
minority children of immigrant parents may experience heightened access barriers
relative to minority children of U. S born parents (Gudino et al., 2008, p. 140). These
barriers in access to service should create for agencies and providers a sense of urgency
in improving the mental health services that their agencies offer. Mental health services
should not be a privilege but instead a benefit to all who are in need of treatment.
Language
When it comes to the barriers that Latinos have in accessing mental health
services language is a barrier that cannot be ignored. The ability to be able to effectively
communicate with a service provider is essential pertaining to treatment and building a
rapport. Often service providers will attempt to resolve this issue by contracting
interpreters to serve the needs of their Spanish speaking clients. However for most Latino
clients language is the key to engagement. When a client is able to trust that their mental
13
health service provider is able to verbally understand their needs they are more willing to
continue with treatment. Agencies should not ignore the need to hire bilingual service
providers to meet the needs of the Latino community.
The demographic make- up of the United States is rapidly changing such that
Hispanics are expected to compromise nearly 25% of the U.S. population by the year
2050 (Bridges, Andrews, & Deen, 2012, p. 359). As the demographics of United States
shift agencies should take a proactive approach in hiring and training bilingual service
providers that can meet the demands of a growing population. Latinos tend to under
utilize mental health services and often report that the reason for underutilization is the
lack of Spanish speaking professionals. While 40% of Hispanics living in the United
States are not proficient in the English language only 1% of licensed psychologist speak
Spanish (Bridges et al., 2012, p. 360). That is a drastic number to consider being that the
Latino population is the fastest growing minority group in the United States. The need for
mental health services will only continue to grow. Therefore reducing the barriers that
prevent Latinos from accessing mental health services will increase their utilization.
Increase in utilization is beneficial to the Latino community who may ignore the need for
treatment due to their inability to communicate with their service provider. Mental illness
is often disabling and is cumulative; hence, untreated mental illness also affects
communities (Snowden et al., 2006, p. 226). If Latinos ignore the need for treatment
communities may start to see an increase of more severe mental health symptoms within
this growing population. Hispanic immigrants and individuals with limited English
proficiency particularly tend to underutilize mental health services, even those with
14
insurance compared mental health care services utilization between white Americans,
English- speaking Hispanics, and Spanish-speaking Hispanics, with a diagnosis of
schizophrenia, bipolar disorder, and major depression (Dupree, Herrera, Tyson, Jang, &
King-Kallimanis, 2010, p. 48). Spanish speaking individuals who present with such
diagnosis of schizophrenia, bipolar and major depressive disorders need to be connected
to services that can provide them with treatment. Compounding the problem is the
limited availability of bilingual clinicians possibly resulting in less accurate diagnosis and
mismatches between treatment and resources (Algeria et al., 2007, p. 76). Limitation in
bilingual providers is placing this vulnerable population at greater risk of receiving
inappropriate treatment. For example, studies of Spanish speaking individuals have
found that those who are language discordant with their physicians are more likely to
report worse patient physician communication, fewer elicitations of and responsiveness
to patient problems and concerns from physicians and less receipt of lifestyle counseling
than individuals who are language concordant with their physicians (August, Nguyen,
Ngo-Metzger, & Sorkin, 2011, p. 2356).If Latino patients are not able to effectively
communicate their mental health concerns with their providers this places them in a very
vulnerable place. Patients therefore may not comprehend the instructions that they are
being provided. Therefore not understanding the severity or the need for treatment.
The lack of bilingual clinicians is a part of the barriers that Latinos encounter in
accessing services. Studies indicate that US residents limited English proficiency are less
likely to seek and receive needed mental health services (Algeria et al., 2007, p. 76).
Agencies therefore often fill the void of bilingual clinicians by utilizing translator
15
services to meet the needs of Spanish speaking Latinos. Under Title VI, recipients of
funds from the U.S. Department of Health and Human Services- including state Medicaid
agencies, managed care plans, and hospitals-must take steps to ensure that limited
English-proficient individuals receive, free of charge, the language assistance necessary
to afford them equal access to services (Snowden et al., 2006, p. 26). Agencies are
therefore accountable for ensuring that these services are available to those individuals
that are not English proficient. The down side of this policy however is the client patient
relationship is compromised with there is a lack of bilingual clinicians.
The problem with translator services is that they are not invested in the treatment
of the patient therefore patients often are not provided translation services by the same
individual. Agencies can address this issue by contracting with translator services for the
duration of the mental health treatment. Therefore, linking mental health service use and
satisfaction with services to immigration characteristics and ethnicity is critical in
planning service delivery (Algeria et al., 2007, p. 76). This will minimize the barriers that
Latinos have due to their limited English proficiency and lack of bilingual clinicians.
Language should not create the barrier for access to mental health service. As service
providers and professionals working in the field of mental health we should be solution
focused resolving and minimizing the barrier that Latinos encounter when it comes to the
access and treatment of mental illness.
Culture
Agencies and service provider need to account the role of culture in the Latino
community in order to affectively provide treatment and services. The influence of
16
culture can play an important role in shaping one’s view of mental illness
(Kouyoumdjian, Zamboanga, & Hansen, p. 400). Latinos come from a collective society
were family and community are of significant importance, and are influential in the
decisions that Latinos make. They look to family and community for guidance, insight,
and support, however this can create a barrier for Latinos when it comes to the treatment
and understanding of mental illness. Making it more difficult for Latinos to be informed
about mental health symptoms and ignoring the need for treatment.
Latinos perception of mental illness is significantly influenced by family morals
and values, which may be entwined with spiritual practices and beliefs. These values are
generational moved by traditional practices and life experiences, adding to the barrier of
Latinos obtaining mental health treatment. Latino clients may find their world views
quite dissimilar to those of their therapist, who are using standard models of
psychotherapy (Rastogi, Massey-Hastings, & Wieling, p. 5). Therefore it is more ideal
for Latinos to seek support and advice from family and friends rather than the counsel of
a mental health provider, especially if there is little to no understanding of the role that a
mental health provider has in the treatment of mental illness. Since family and friends are
considered a foundation for coping with mental health concerns, Latinos are likely to
utilize their social networks as a preferred coping strategy (Rastogi et al., p. 5). Mental
health agencies and providers work from a Westernized and individualistic model, which
are contradictory to the ideas and values of Latinos. Current programs delivering mental
health services, based on Western behavioral models often lack cultural relevance for
Latinos seeking treatment (Barrio et al., 2008, p. 58). Latinos may disengage from
17
services due to mental health provider’s inability to understand the importance of family
values, roles, and traditions. When considering treatment and services providers need to
consider incorporating the family as part of the treatment. The successful integration of
culturally competent practice with scientifically rigorous interventions may be achieved
through the use of cultural adaptation procedures (Chavez-Korell et al., 2012, p. 219).
Providers integrating this practice may yield greater results in engaging Latinos in
obtaining mental health treatment.
The significant role of culture within the Latino community places the most
vulnerable at risk of being left untreated for symptoms of mental illness. Latino youth are
at risk for internalizing problems, particularly in relationship to conflicts with their
parents (Rastogi et al., p. 5). Latino youth especially those who are children of immigrant
parents are faced with multiple cultural challenges the need to feel connected to their
Western environment while still maintaining their cultural practices and beliefs. Due to
their collectivistic values, the youth may experience more distress in response to these
conflicts, yet not have an outlet outside of the home to help them cope (Rastogi et al., p.
5). This is why mental health service providers and mental health agencies need to be
more informed on the family dynamics and the role that culture plays in mental health
treatment. Cultural misunderstandings, and cultural-based alienation, economic barriers
mistrust, stigma, and clinician’s bias all appear to play important role in explaining why
minority people do not seek treatment (Snowden et al., 2006, p. 226). Therefore is
important to account for service providers to be informed on the role that culture plays in
the Latino community. Culture carries traditions, beliefs, and customs that may be very
18
different then our own. Therefore agencies and provider need to set aside any biases that
may contradict their cultural practices. As agencies continue to expand on the services
that they are offering it would be of great benefit to invest the money, time and effort in
having employees that are willing to be flexible in learning and adapting to a new way of
treatment. Latinos needs for services and their underutilization highlights the need to
better understand and address the mental health concerns for Latino families
(Kouyoumdjian, Zamboanga, & Hansen, p. 394). Mental health service providers need to
expand on not only being culturally receptive, but to also be culturally knowledgeable of
the Latino experience. The Latino community is diverse in experience, education, and
lifestyle therefore when considering treatment providers need to account for the diversity
within our culture. Although Latinos may share some common characteristics, there can
be significant within and between- group variability (Kouyoumdjian et al., p. 395).
Taking this factor in to account will allow providers to be better equipped in
understanding the cultural needs of their clients. I am often amazed by the lack of
empathy that mental health agencies and providers have when it comes to addressing the
need of being culturally informed on the experiences and tradition of the Latino
community. There have been several personal experiences within my professional carrier
where I have observed the ignorance of my peers and employers, who mistakenly assume
that my ability to speak Spanish relates to sharing the same cultural experiences of other
Latinos. Consequently, one of the challenges in discussing mental health issues for
Latinos involves the vast cultural heterogeneity of this population (Kouyoumdjian et al.,
p. 395). In regards to the treatment of mental health in the Latino population agencies and
19
clinicians need to account for culture as an independent experience while taking into
account similarities. The problem pertaining to culture within the Latino population is
that agencies are not willing to expand their resources in educating their employees on
multicultural factors that have a direct impact regarding mental health treatment. If
agencies were to be more invested in treatment regarding the Latino population and if
there approach was more inclusive to culture as an experience Latinos would become
more engaged in accessing mental health treatment. Therefore reducing yet another
barrier that prevent access to appropriate and adequate mental health services.
Stigma
When it comes to seeking mental health treatment the Latino population continues
to struggle with the stigma associated with mental illness. Latinos will often avoid the
conversation pertaining to mental illness and seeking mental health treatment because of
the fear of rejection from their family and community. However it is often the most
vulnerable children and adolescents, who are in need of treatment and are not able to
access treatment because of the stigma. Barriers to mental health care for Hispanic
children and adolescents include access to care, language, the stigma of mental illness,
parental level of knowledge of mental illness and its corresponding treatment (Leal, p.
1028). Parents of children suffering from mental illness may ignore the symptoms of
associated with a mental illness, isolation, and withdrawn based on the fear of
stigmatization and also due to the lack of knowledge. The Latino parent instead may
attribute these behaviors as being something positive for the child and ignore the
possibility that these symptoms are attributed to a diagnosis such as depression. Children
20
in the Latino culture may be praised for being quite, and withdrawn parents often reward
these behaviors and encourage them. Latinos also fear the uncertainty of having a mental
health diagnosis, the long term affects of mental illness on a child or adolescent, can
influence parents decision regarding seeking mental health treatment. As previously
stated Latinos are a collective community and a mental health diagnosis can often leave
children, adolescents and families isolated from their family and community. The
stigmatization of Hispanic children and adolescents by others may be manifested by bias,
distrust, stereotyping, fear, embarrassment, anger, and/or avoidance of people, with
mental illness (Leal, p. 1028). I recall a conversation with a mother of an adolescent who
had been diagnosed with schizophrenia. She shared with me the fears she carried
pertaining to the behaviors and symptoms associated with this diagnosis. The rift it had
created between her immediate family and the isolation that they often endured. These
families like many other Latino families often feel too embarrassed to seek support as
there are not many agencies within the community that offer support groups to the Latino
population. Stigma reduces patient’s access to resources and opportunities; creates low
self-esteem, isolation, and hopelessness among patients; prevents the public from desiring
to pay for mental health care; causes friends and neighbors to withdraw from the labeled
individual; and leads to societal discrimination and abuse (Leal, p. 1028). Therefore
individuals who suffer from mental illness will continue to live in silence and fear,
families will continue to ignore the need for mental health services and agencies will not
expand the need to meet the services for the Latino community.
21
The stigma of mental illness is not limited to the Latino community, but also to
the way that health care providers interact and provide services to this population. Health
care providers can contribute to the stigma experienced by patients (Leal, p. 1028).
Engagement is highly dependent on the interactions that Latinos have with their service
providers, however if Latinos feel that the treatment that they are receiving is biased they
will disengage. In addition the diagnosis that parents receive from providers can further
enhance the stigma associated with mental illness. Health care providers and the public
may stigmatize against certain illness, and some diagnostic labels may be harmful when
they are not completely understood by patients, families, community members and policy
makers (Leal, p. 1028). In the field of mental health, service providers may be quick to
give a mental health diagnosis in order for service providers to continue to provide
services. Service providers therefore are more likely to give a severe diagnosis such as
schizophrenia, bipolar, or border line personality in order for mental health services to be
billable. This need for funding often conflicts with the need for service and also creates a
culture of mental health service providers that are more concerned with fee for service
instead of providing accurate treatment. Latino children and adolescents have various
cultural and life experiences that may attribute to their behaviors, ignoring these factors
will only further contribute to the stigma associated with mental illness. A study of
parents’ beliefs about the causes of children’s mental health problems found that ethnic
minority parents, including Hispanics, were less likely to endorse biopsychosocial beliefs
of the causes of mental illness (Leal, p. 1030). The Latino community carries old
22
traditions and beliefs regarding mental illness symptoms associated with mental illness
therefore may be attributed to witchcraft or demon possession.
This is why it is so critical that mental health service providers and clinicians
provide families with the information and treatment needed to stabilize the patient.
Parent or guardians are often provided with little to no education regarding the diagnosis
that their child has just received. Latinos rely on the knowledge and recommendations of
professionals to provide them with the support and resources needed to understand this
life altering diagnosis. However agencies often do not provide the wrap around services
needed to guide and support families therefore families are left living in fear, doubt, and
uncertainty of their child or adolescents future. The stigma of mental illness creates
barriers when it comes to the Latino population desire to access services. The stigma of
mental illness will continue to be a barrier for Latinos if mental health providers continue
to ignore the urgency for education and information not only regarding the symptoms of
mental illness, but also the treatment that is currently available. Treatment and education
play a key role in Latinos understanding mental illness. The term mental illness is a fairly
new concept that Latinos are still unfamiliar with. This is why symptoms of mental
illness are often ignored, but instead become more alarming when they compromise the
physical health of an individual. Those service providers that are insensitive to the
ignorance of Latinos knowledge of mental illness need to set aside their personal biases
and become more informed regarding the stigma that Latinos often come upon.
23
Discrimination
The discrimination that Latinos encounter attributes to the barriers in accessing
mental health services. Structural factors such as anti-immigration policies and poverty,
and the inequities and discriminatory practices that accompany these factors impact
Latino mental health and well being (Ayon, Marsiglia, & Bermudez-Parsai, 2010, p.
742). Latinos are a vulnerable population when it comes to discriminatory practices. The
reality is that policies that have been created often make it more difficult for Latinos to
access adequate mental health services. Agencies often ignore discrimination as a barrier
to mental health treatment and do very little to advocate for changes in policies that can
improve access to services. For example, the Latino population has been identified as a
high risk group for depression and anxiety connected to poverty, poor housing conditions,
and rigid work demands and poor health related to discrimination (Ayon et al., 2010, p.
743). Latinos often struggle to find employment and may take jobs with low wages and
no benefits, increasing the chances of mental illness. They may spend long days away
from family and friends while barring the responsibility of being the only financial
provider. Another factor that contributes to the discrimination that Latinos face is the
anti-immigrant attitudes that still exist within our society and communities. The negative
and stereo typical perception regarding immigrants often creeps into the way that we treat
our clients. For example some service providers may struggle with the traditional familial
roles that Latinos maintain and may view these roles as oppressive to women and
children. Therefore making it more difficult to engage with our clients and provide
appropriate treatment. It may be difficult for service providers to accept or acknowledge
24
their own prejudices regarding the Latino population. As the family is such a critical
aspect in Latinos lives and there is a high reliance on the family for material and
emotional support and help, it is crucial to understand how familismo influences Latinos
mental health (Ayon et al., 2010, p. 743). The attribute of familismo “pride belonging and
obligation” actually help Latinos dealing with mental illness have some form of
normalization. These factors encourage stability within the family and reduce the stress
associated with the daily discrimination that Latinos endure. Therefore mental health
service providers should account the strengths associated with familismo and incorporate
them as part of the treatment plan. Mental health service providers need to also explore
their own personal views regarding discriminatory policies and how their views impact
the way that they provide services. Discrimination is not just based on policies but also
our own personal life experiences. These experiences are a part of who we are and how
we view and consider the needs of others. Therefore exploring our views and perceptions
of the inequalities the directly impact Latinos will only remove barriers of discrimination
and help mental health agencies and providers seek out solutions for providing treatment.
Another barrier that needs to be considered is how discriminatory policies prevent
undocumented Latinos from having access to mental health services. Such policies
increase barriers to accessing needed services for undocumented individuals’ fear being
detected by immigration authorities and subsequently being deported (Ayon et al., 2010,
p. 743). The fear of deportation, losing your family, and friends is why many Latinos will
not seek out treatment for mental health symptoms. Latinos who are undocumented may
not trust in a system that is often against them as seen by the policies in place that deny
25
them services. This form of discrimination only increases the disparities in the utilization
of mental health services. Immigration status is a likely deterrent of mental health care
utilization in the United States (Chen & Vargas-Bustamante, 2011, p. 671). However
mental health service providers who depend on state and federal funding contribute to the
underutilization and access of mental health services by not advocating for policies that
are inclusive to all that are in need of treatment. The access to mental health services
should not be a privilege based on legal status especially with a population that is
projected to grow. Agencies should not ignore the need for services and instead should
support policies that reduce the barriers in accessing mental health treatment. Although
adequate access to mental health services can facilitate the adaptation process, lack of
health insurance is a major deterrent of mental health care utilization for US immigrants
(Chen & Vargas-Bustamante, 2011, p. 671). If Latinos are given proper access to health
insurance without the fear of repercussions they would be more willing to address the
mental illness that often prevents them from having a quality if life. When discriminatory
policies are created out of fear against a group of people that are different in culture,
language, and legal status it will only create a system that segregates and creates barriers
to mental health services.
Immigration
The immigrant experience creates barriers for Latinos when trying to access
mental health services. In many Latin American countries, homicide is among the five
main causes of death and is the principal cause of death in Brazil, Columbia, Venezuela,
El Salvador and Mexico (Fortuna, Porche, & Alegria, 2008, p. 435). These traumatic
26
events often result in Latinos increase of anxiety, depression and substance abuse.
However mental health professional and mental health agencies often never explorer
these possibilities and may know little to nothing regarding the Latino experience.
Especially for those Latinos that have fled their native countries due to political or social
persecution. Many countries within Latin American have experienced civil wars; many
individuals there live in poverty, and are exposed to violence. These events along with
the journey of immigration are attributing factors to mental health symptoms. The
problem is that many immigrants often are not informed or aware of the resources that
are available to them.
Another factor to consider is that many newly arrived immigrants live in
impoverished communities that are at times afflicted with lack of income, jobs, and high
crime rates. Unfortunately immigrants often come to the US only to experience additional
exposure to violence while living in neighborhoods and communities with high levels of
poverty (Algeria et al., 2007, p. 436). Latinos therefore are more susceptible to new
traumas further compromising their mental health. Agencies should address these issues
by exploring the possibility of these experiences and incorporate such questions as part of
the initial assessment. The combination of exposure to violence and non-identification by
providers has the potential to lead to negative outcomes, misdiagnosis, and lack of access
to treatment among this vulnerable population (Algeria et al., 2007, p. 436). Mental
health providers should consider the possibility that discussing past events related to
traumas may feel embarrassing. The Latinos population of men may be less likely or
willing to address past events. Men are more likely to be influenced by issues of stigma
27
and unlikely to seek help for trauma (Algeria et al., 2007, p. 437). The barrier that
agencies often ignore is connecting with the Latino male population. Instead agencies
often focus their services to women and children. Agencies need to consider the need for
creating and maintaining programs that are gender specific to Latino males that have
experienced political violence and are struggling with the status of being an immigrant.
There are many stereotypes that immigrants encounter and male Latinos may experience
more racial discrimination than women. Younger adults and males often report more
negative attitudes toward mental health treatment, as compared to middle-aged adults and
females (Gonzalez, Algeria, Prihoda, Copeland, & Zeber, 2009, p. 45). Males
traditionally are the head of households and play a more active role in social settings.
This does not mean that immigrant women are not exposed to discrimination due to their
status of immigration. However women are more likely to engage in mental health
services especially when their mental health symptoms compromise their ability to
function. The problem however for all Latinos is being able to connect with a mental
health service provider that can be empathic to their personal life experiences. It is crucial
that mental health providers account for the diversity in life experiences when working
with the Latino community. Agencies need to provide the necessary resources and
trainings to teach and support their staff with the tools needed to support this population.
If agencies continue to ignore policies pertaining to immigration Latinos will receive
inadequate services, and agencies will fail to engage this population. The need to improve
services should not be ignored as many Latinos continue to flee their native homelands
which are plagued with political violence and uncertainty.
28
Acculturation
The final barrier that will be discussed is acculturation pertaining to how it
impacts Latinos access to mental health services. For immigrant Hispanics adjusting to
the culture and language of the United States can be stressful and have a long-term
impact on physical and psychological well-being (Cervantes, Padilla, Napper, &
Goldbach, 2013, p. 452). Having to adjust to a new culture, language, and community can
create for Latinos stressors that they have never ensured before. As previously discussed
Latinos are a collective community that depends on the familial ties to support each
other. However when they are placed in a new and foreign environment they lack the
knowledge, skills and language to maintain or obtain relationships that are needed to
support them with this new transition. In addition to acculturative stress associated with
adapting to a new culture, Hispanic immigrants also experience discrimination, which
can influence negative mental health outcomes (Cervantes et al., 2013, p. 452). When
working with this population mental providers need to account how acculturation
influences mental health symptoms and treatment. However if providers lack little to no
understanding regarding this process they will not be able to meet the needs of their
clients. Adapting to new culture can be a life time experience and often providers can be
insensitive to their Latino clients by expecting or demanding that they adapt to their new
environment. The process of acculturation can also be very challenging for Latinos
particularly the older generation that holds on to traditional familial roles. Children and
Adolescents tend to have more of an accelerated process when it comes to adapting to
their new culture. This often makes them more vulnerable to internalizing mental health
29
symptoms and developing negative relationships The friendships formed during this time
can have important implications for adolescent’s outcomes such as substance use,
delinquent behavior, and academic achievement (Buchannan & Smokowski, 2011, p.
375). Parents of adolescents may not understand or relate to their child’s new behavior,
and due to the loss that they may still be grieving, often are not informed or aware of
resources and services that may be available to them. This only makes the adolescent
more vulnerable to becoming victimized or involved with illegal activity. Adolescents
who have friends that endorse negative behaviors increase the likelihood that the
adolescent will also engage in these behaviors (Buchannan & Smokowski, 2011, p. 376).
If mental health service providers were more inclined in addressing the needs of the
Latinos from a more diverse experience they will be more capable of providing the
services needed to reduce negative behaviors in adolescents. Integrating the process of
acculturation into the therapeutic approach will allow Latino adolescents and their
parents to have a better understanding as to why the negative behaviors are occurring.
Parents are often left out of the mental health treatment plan which creates another barrier
in supporting them with services. If parents are not provided with the support and
resources needed to understand how the process of acculturation is related to the
adolescents experience, Latino parents will not be equipped to address the needs of their
child.
When it comes to the process of acculturation mental health providers need to
also consider the bias that they carry in providing mental health services. Mental health
service providers and professionals also bring with them their views and life experiences
30
that attribute to the way that they provide services. This may create a problem for mental
health service providers who have a negative view pertaining to newly arrived
immigrants. They may lack empathy regarding immigrants and the acculturation process
that Latinos are experiencing. Many of these new immigrants also sustained strong ties
with their home communities and countries that maintained language and culture in ways
quite different from earlier immigrants (Guarnaccia et al., 2007, p. 511). Therefore the
process of acculturation will continue to be factor when it comes to Latinos awareness
and treatment of mental illness. Providers need to consider all aspect of acculturation
poverty being one of them and residing in communities that are afflicted with high crime
rates. These are additional stressors for Latinos that often contribute to increase of mental
health symptoms. Researchers have suggested that increased risk for mental illness
among acculturated Latinos may be due to the breakdown family network and family
support system (Ortega, Feldman, Canino, Steinman, & Alegria, 2006, p. 928). Latinos
rely heavily on family support and networks. When they lose these systems of support
they may lack the ability to connect to systems that are foreign to them, such as mental
health providers. They may also lack the insight of understanding the consequences of
ignoring mental health symptoms and obtaining treatment. It also may be challenging to
adapting to new roles and communities that once served as a system of support.
Therefore mental health providers and agencies should not ignore the process in which
acculturation occurs and instead educate and inform themselves of the trial and
tribulations that are directly influencing their clients.
31
The barriers Latinos encounter when trying to access mental health services are
just limited to the topic discussed in this literature review. They are several other factors
that were not discussed in this literature review that should be considered as barrier to
services, such as education, and affordability. Therefore mental health service provider
should consider the needs of their individual clients and take all aspects of possible
barriers into consideration.
32
Chapter 3
Methods
This chapter will describe the research methods that were used to conduct this
research study. The following procedures will be discussed study design, how the data
was collected, participants in the study, procedures used in the collection of data, and
protection of human subjects.
Research Question
The research question proposed for this study is, what are the barriers that Latinos
have in obtaining mental health services?
Study Design
The study design used to conduct this research was a qualitative method that
allowed the researcher to conduct a survey through Turning Point Community Programs.
A qualitative research method delves into a particular situation in order to better
understand a phenomenon within its natural context and perspective (Bui, 2008, p. 283).
In utilizing this method the researcher will be able to understand what barriers exist, that
prevents Latinos from obtaining mental health services. The criteria for participating in
this research study were participants who are actively working in the field of mental
health. Therefore the researcher will exclude participants who are not actively working in
the field of mental health. As for engagement the researcher will sent out an email to
Turning Point Community Program employees advising them of the study and requesting
volunteers. In order to avoid perceived conflict of interest the researcher will advise
participants that the conduct of this research is voluntary and that there is no
33
compensation for participating in the research study. All participants who volunteered for
this research study were advised via email that if they agree to participate in this study
that they are also giving “implied consent by completing the online survey”. The total
number of participants were seven one male and seven female employees whose role
within the agency is defined as Personal Service Coordinators. The information pertained
from this study will allow the researcher to identify possible barriers within this
organization that impact the way that services are provided or not provided to the Latino
community.
The purpose of this survey is to gain the knowledge and understanding of what
current services are being provided and how these services can be improved to address
the mental health needs of a growing population. It is important to understand that the
participants of this study have various backgrounds and experience when it comes to
working in the field of mental health. By conducting a qualitative study the researcher
and the participants will be able to freely answer questions regarding demographics,
levels of education, and perception of the current services that Turning Point Community
Program is providing the Latino community. A qualitative researcher starts with specific
situations, finds patterns and themes in the data, establishes a tentative hypothesis, and
then develops theories and conclusions (Bui, 2008, p. 14). Therefore utilizing this form
of research will benefit the study in locating any patterns and themes regarding barriers of
mental health services in the Latino population. The survey format and voluntary
participation allows for a level of confidentiality that may not be obtained by observation
and also prevents participants from feeling obligated to answer questions based on their
34
perceptions of what the researcher is asking. Some of the strengths of qualitative methods
are that the researcher has investigated a topic in depth, interpreted the outcomes based
on the participant’s not the researcher’s perspective’s, and created a holistic picture of the
situation (Bui, 2008, p. 14).
Protection of Human Subjects
The application for the study of human subjects was submitted to the Committee
for Human Subject Approval Department of Social Work Sacramento State University
Sacramento. This application (13-14-055) was approved on February 10, 2014 the level
of risk associated the study is considered exempt pertaining to all aspects of the research.
The participants of this study will not be exposed to any risk. This research study was
voluntary, and all participants were informed that this study requires no personal
participant information. All willing participants were advised of implied consent
meaning that if they agreed to take the online survey they were providing the researcher
with their consent to use the data for this qualitative study. Participants were not
promised or given any compensation for their willingness to participate. They were
advised that the research being conducted to was to gather data pertaining to the barriers
Latinos have in obtaining mental health services. Therefore the participants of this study
were all willing candidates that had agreed to complete the online survey.
Study Participants
The participants in this study were employees of Turning Point Community
Programs working in the field of mental health. Two of the participants are bilingual one
in American Sign Language and the other in Hebrew; none of the participants were
35
bilingual in Spanish. The majority of the participants 86% had a Bachelors degree or
Masters, 14% had a two year degree. Prior to any survey being conducted this researcher
obtained consent from the Human Subject Committee. The participants consisted of
individuals who are currently employed and provide mental health services through
Turning Point Community Programs. These individuals consisted of Personal Service
Coordinators, who are actively working in the field of mental health. Being that the
research study was on voluntary bases all employees were provided with the online
survey and given the opportunity to participate. Prior to taking the survey participants
were advised of the online survey and that the research being conducted was to identify
barriers that Latinos have in accessing mental health services. All possible participants
meaning that all employees were advised prior to the online survey that participating in
the survey was considered implied consent. Participants were therefore not required to
sign a consent form but were also advised that there was no physical risk associated with
this study.
Instruments
The only instruments required for this survey was a computer and key board,
which allowed participants to complete the online survey. Since the research study was
conducted at the discretion of the participants the researcher was not present to observe or
gather information. Instead participants were at their leisure to complete the online
survey as they pleased. The online survey did consist of twenty questions seven of those
questions asked participants to provide the following; gender, ethnicity, race, language,
years of employment in the field of mental health, does your agency provide services to
36
the Latino population and level of education. The remaining thirteen questions were in a
form of a likert scale levels used were strongly agree, agree, disagree and strongly
disagree.
Data Collection
In order to recruit participants the researcher sent out an email advising Turning
Point Community Programs employee that a research was being conducted regarding the
barriers Latinos have in accessing mental health services. All possible participants were
also advised that their confidentiality would not be compromised since there will be no
names collected therefore it would be anonymous. They were then advised that if they
desired to participate to complete the online survey, again all employees were informed
that completing the on line survey concluded that they were giving implied consent. The
data obtained will not require any personal information that can identify the participants
(i.e., name, date of birth or place of employment). After the research has been conducted
the data will be destroyed by May 1, 2013 by a shredder.
Data Analysis
Once the researcher has collected the data from the participants the information
will be evaluated using SPSS. This information will allow the researcher to gather
information regarding the barriers that Latinos have in accessing mental health services
within Turning Point Community Programs. The goal is to determine what systemic
barriers are currently prevalent and also to evaluate the number of current employees that
offer mental health services to the Latino population.
37
Chapter 4
Interruption of the Results
This chapter will address the findings from the survey and are presented here in
the same order as the questions were posed to clinicians. Readers who are interested in
the precise phrasing of the inquiries are invited to consult the copy of the survey
instrument that can be found in Appendix A.
Chi-square tests were utilized to test for statistical significance between race (Q3)
and the clinicians’ level of agreement with certain various statements (Q8-Q20). Where
statistical significance association between race and level of agreement were identified,
they were flagged for significance. Statistically significant results, which are results that
can generally be relied upon, are indicated where applicable; results that are not
statistically significant are also noted.
Demographics
The participants of this study were asked seven questions in order to establish
demographic information. The characteristic of these questions were pertaining to gender,
ethnicity, race, language, years of experience in the field of mental health and level of
education. The largest groups of responders are female (71 percent). The rest of the
responding clinicians are male (29 percent). Clinicians’ were asked their ethnicity by
answering whether they were Latino or Hispanic, or not. One-hundred percent of
clinicians responded they were “Not Latino or Hispanic.” The only two racial
backgrounds of the responding clinicians are Black or African American and White.
38
White clinicians represent a little more than half (57 percent). Black or African American
clinicians represent a little less than half (43 percent).
The largest group of clinicians does not speak another language (67 percent). The
remaining clinicians do speak another language (33 percent). The languages spoken by
the clinicians, who speak another language, are conversational American Sign Language
and Hebrew. More than fourth-fifths of responding clinicians have been working in the
mental health field between one and five years (86 percent). This is followed by a little
more than one-tenth of responding clinicians who have been working in the mental health
field for more than five years (14 percent). The majority of the clinicians have completed
either a Bachelor’s Degree or Master’s Degree (86 percent). This is followed by the
remaining clinicians completing an Associate’s Degree (14 percent).
Response to Survey Questions
When participants were asked regarding recruitment of Spanish speaking
clinicians this is how they responded. All Blacks or African Americans (100 percent)
agreed with the statement, “I feel that my agency recruits Spanish speaking clinicians to
address the needs of our Latino clients,” and half of White clinicians agreed with this
statement (50 percent). The remaining half White clinicians disagreed with this
statement. A chi-square test on this question produced no statistical significance
association with race and the above statement. The p-value equals .147. Though some
participants agreed with the statement it is important to know that Turning Point
Community Programs does not actively recruit Spanish speaking clinicians nor do they
pay their Spanish speaking clinicians any incentive for being Spanish speaking.
39
“Our agency provides translator services.” Blacks or African Americans agreed
or strongly agreed with this statement (33 and 67 percent). With regards to the same
statement, half of the White Clinicians agree (50 percent) and half disagreed (50 percent).
A chi-square test on this question produced no statistical significance association with
race and the above statement. The p-value equals .233. When Latinos are seeking mental
health services language can create barriers therefore not being able to effectively
communicate your concerns will only further prevent engagement in mental health
services.
“The translator services we offer are easily accessible.” When it comes to Black
or African American Clinicians, they agree and strongly agree with this statement (67
percent and 33 percent). White Clinicians disagree and strongly disagree with the same
statement (75 percent and 25 percent). A chi-square test on this question produced no
statistical significance association with race and the above statement. The p-value equals
.072. Accessibility to translator services may further prevent Latinos from obtaining the
mental health treatment that they are seeking. It can also affect the way in which
clinicians are willing to provide services, possibly creating a limitation to expansion of
services.
“Our agency offers mental health resources in Spanish.” White Clinicians agree
and disagree with this statement (75 percent and 25 percent), which Black or African
Americans agree and strongly agree with the same statement (67 percent and 33 percent).
A chi-square test on this question produced no statistical significance association with
race and the above statement. The p-value equals .350. Though these results vary by
40
percentage resources in Spanish are often limited to informational pamphlets. Agencies
should account for the ability to provide resources to support groups and classes
educating Latinos regarding mental health symptoms.
Two-thirds of Black or African American Clinicians disagreed with the statement,
“Cultural competence training is offered by my agency,” while one-third of them strongly
agreed with this statement. With regards to this same statement, one-hundred percent of
White Clinicians agreed for this same statement. A chi-square test on this question
produced no statistical significance association with race and the above statement. The pvalue equals .030. Being able to provide clinicians with proper cultural training regarding
the Latino population will lonely further enhance their ability to understand their cultural
needs.
Research data reveals that two-thirds of Black or African American Clinicians
disagree they are encouraged to attend cultural competence training (67 percent) and onethird strongly agrees (33 percent). With regards to the same statement, three-fourths of
White Clinicians agree (75 percent) and one fourth disagrees (25 percent). A chi-square
test on this question produced no statistical significance association with race and the
above statement. The p-value equals .118.
I have an understanding of the stigma of mental health in the Latino community.”
The majority of white clinicians agree with this statement (75 percent); the remaining
clinicians disagreed with this statement (25 percent). When it comes to Black or African
American clinicians, the majority agrees with this statement as well (67 percent), while
the rest disagrees with this statement (33 percent). A chi-square test on this question
41
produced no statistical significance association with race and the above statement. The pvalue equals .809. The barrier of stigma associated with Latinos being able to obtain
mental health treatment is factor that needs to be address and accounted. Latinos are often
fearful of seeking mental health services based on the stigma that is associated with
mental illness.
“As a provider, I am aware of the acculturation process that Latinos endure” (75
percent) and the remaining disagree (25 percent). With regards to the same statement,
Black or African Americans agrees (67 percent), while the rest disagrees (33 percent). A
chi-square test on this question produced no statistical significance association with race
and the above statement. The p-value equals .809. Acculturation has a significant role in
regards to how Latinos may view mental illness and treatment. The further along that
Latinos are in the acculturation process the more willing that are to be engaged in
services.
The data reveals that clinicians awareness of language barriers Latinos have in
obtaining mental health services. According to the data, one-hundred percent of Black or
African Americans agree they are aware of such barriers. The majority of White
Clinicians also strongly agrees and agrees there are aware of these barriers as well (75
percent). The remaining one-fourth of clinicians disagree that they are aware of such
barriers (25 percent). A chi-square test on this question produced no statistical
significance association with race and the above statement. The p-value equals .350.
Clinicians’ agreement on the importance of their agency to conduct outreach in
the Latino community. While Clinicians are 100% in agreement that their agency should
42
conduct this type of outreach, Black or African American Clinicians had a more mixed
level of agreement. The majority of Black or African American Clinicians’ strongly
agrees or agrees (66 percent), while the remaining disagrees (33 percent). A chi-square
test on this question produced no statistical significance association with race and the
above statement. The p-value equals .155.
According to White Clinicians’, they are not encouraged to participate in Latino
cultural events. When asked their level of agreement to this question, all of them said
they disagree (100 percent). Similarly, majority of Black or African American
Clinicians’’ also disagree (67 percent), while only a third of them agree (33 percent). A
chi-square test on this question produced no statistical significance association with race
and the above statement. The p-value equals .212.
“I believe the services our agency offers need to be improved in order to meet the
needs of our Latino clients.” Two-thirds of Black or African American Clinicians
disagrees with this statement (67 percent), while one-third (33 percent) agrees. White
Clinicians’ on the other hand, either strongly agree or agree with the same statement (75
percent and 25 percent). A chi-square test on this question produced no statistical
significance association with race and the above statement. The p-value equals .084.
Summary
In conducting this study the researcher has learned that barriers in obtaining
mental health services do exist. It is important to know that not one of the participants in
this study was of Latino or Hispanic descent. They instead were African American/ Black
or Caucasian. In addition to race and ethnicity none of the participants were Spanish
43
speaking limiting their ability to provider mental health services in Spanish. In regards to
culture though Turning Point Community Programs does offer cultural competence
training very little is known regarding the time that is spent on the teaching of the Latino
experience. Therefore chapter 5 will further expand on the limitation, recommendations,
and implication for social workers.
44
Chapter 5
Conclusions and Recommendations
This final chapter will focus on summarizing the limitations, recommendations,
and implication for Social workers regarding the barriers that Latinos have in obtaining
mental health treatment. It will also focus on the knowledge and information that was
gained in conducting this research study.
Conclusion
The research study conducted through Turning Point Community Programs offers
an opportunity for mental health services providers and clinicians to be more informed as
to the barriers that Latinos have in obtaining mental health services. Since this research
was conducted solely based on the information provided by Turning Point Community
Programs it is important to note that this agency is not the only mental health agency
within the Sacramento area. Therefore mental health agencies should consider these
findings to determine how effectively they are providing services to the Latino
population. How often have I not seen or observed the struggles that Latinos have in
accessing mental health services. In working with this population I often encountered
little to no programs that address the cultural needs of this community let alone the ability
to provide services in Spanish. I been employed by three local mental health agencies and
I am often the only Social worker that is Latina and that is able to speak Spanish. I often
encounter biases and lack of understanding regarding how to provide and engage the
Latino population in mental health services and treatment.
45
When it comes to agencies providing services in Spanish they often advertise or
promote this service, however I have often found that services in Spanish are typically
provided through interrupters. Though agencies may consider the use of interrupters to be
cost effective and beneficial to their agencies, Latinos in need of mental health services
may not engage in treatment with a provider who is not able to communicate with them
in Spanish. So much information can be lost in translation. Therefore mental health
agencies need to consider the importance of recruiting Spanish speaking employees.
Some may consider this issue to be a personal problem, not one that would impact
the greater society, just the minority. However as previously stated Latinos are
considered to be the fastest growing minority group in the United States and as this
population continues to grow the need for mental health services will need to be
expanded. The reality is that Latinos who migrate to the United States are often fleeing
poverty, war, and abuse. Therefore many of them may already be suffering from some
form of undiagnosed mental illness .Latino immigrants often reside in poor and violent
communities that are gang and drug infested. This places them at high risk of being
victims of violent crimes and only intensifying or triggering past mental health
symptoms.
These facts are often ignored by mental health service providers when working
with this population. In addition most mental health service providers lack little to no
understanding regarding the Latino or immigrant experience. Therefore creating barriers
to treatment, the barriers that exist when it comes to accessing mental health services are
again not only systemic but are caused by the lack of training and empathy to the Latino
46
experience. Though agencies such as Turning Point Community Program offer cultural
training for their employees these training are often vague and do nothing to address the
needs of this population. Again leaving mental health service providers uninformed and
unequipped to offer adequate or appropriate services.
Recommendations
The need for mental health treatment will always exist, therefore service provider
need to consider what needs to be done in order to improve access to treatment for the
Latino population. There are several things that should be considered, and that I
recommend in order for Latinos to obtain mental health treatment. The first
recommendation is recruiting Latino clinicians that are bilingual. When agencies recruit
and promote the hiring of Spanish speaking clinicians they are able to reduce the barrier
of language which is a key factor in maintaining engagement. Agencies should limit the
use of interrupters though interrupters are sometimes needed they should not be the only
way of providing services in Spanish. The second recommendation is providing
employees with cultural competence training specifically geared towards the Latino
population. Often the knowledge and understanding of culture is limited to our own
experiences and interpretation, and that can create biases and stigma regarding the Latino
culture. Agencies should also consider participating in cultural events where Latinos are
present and can be informed about the services that are offered. Latinos struggle in
connecting with resources and often rely on word of mouth from friends, neighbors and
family, therefore if agencies make themselves more present Latinos will become more
informed on how to access mental health services. In addition this will allow Latinos to
47
become educated and informed about mental health services and treatment, possibly
reducing the stigma associated with mental illness. The final recommendation and to me
the most important is that mental health agencies should consider how they provide
treatment to the Latino population. Latinos are a collective society and they are strongly
interdependent, however the theories and practices used in mental health treatment stem
from Westernized principals. Which is contrary to Latinos this is why it is so critical that
agencies find more cultural competent ways of providing treatment. For Latinos mental
health treatment is not individualistic it is collective.
Limitations
The research study had several limitations. First the sample size was small only
limited to seven participants who worked for Turning Point Community Programs. A
larger sample size would have provided more in depth information regarding the barriers
that Latinos have in obtaining mental health services. Also the survey conducted did not
ask direct questions pertaining to specific barriers, but instead perceptions pertaining to
the services that are offered at this particular agency. This research study would have also
benefited from the insight of Latinos as to why they consider barriers in obtaining mental
health services. Finally the demographic of the participants was limited to Caucasian and
African Americans who may define or see barriers from a different perspective to that of
Latino clinicians.
Conclusion
The purpose of this research study was to provide social workers and mental
health service providers a platform to analyze and discuss barriers that impact Latinos in
48
obtaining mental health services. This population will only increase in numbers and as
social workers it is important that we consider how to advocate for services. As social
workers we have a responsibility to bring about social justice. Therefore we cannot
ignore the inequalities that continue to deny services and treatment to undocumented
immigrants that suffer from mental illness. The need to hire and train clinicians regarding
the culture and experiences of the Latino population was also an important factor in
selecting to research this topic. It is important that future clinicians and mental health
agencies that work with this population make changes in how they offer their services.
Finally in order for clinicians to provide effective treatment they need to think outside the
box, and find effective and creative ways when working with the Latino population. As
previously stated the treatment of mental health services should not be limited to text
book, or theories, but to life experiences, that impact families and individuals.
49
Appendix A
Survey Instrument
1. Gender
What is your sex?
a. Male
b.
Female
2. Ethnicity
Please specify your ethnicity.
a. Hispanic/Latino
b. Mexican/Mexican American
c.
Not Hispanic or Latino
3.
Race
please specify your race.
a. American Indian or Alaska Native
b.
Asian
c.
Black or African American
d.
Native Hawaiian or Other Pacific Islander
e.
White
f.
Mexican
4. Do you speak another language besides English? ____________________
5. How long have you been working in the field of mental health?
a. 0-1 years
b. 1-3 years
c. 3-5years
6. Does your agency currently provide mental health services to the Latino population?
a. Yes
b. No
7. What is the highest level of education have completed?
a. High School/GED
b. Some College
c. 2-year college degree (Associates)
d. 4-year college degree (BA, BS)
50
e. Master’s Degree
f. Doctors Degree
Please select only one answer for each question. Choose the answer you feel most accurately
represents your beliefs.
8
9
I feel that my agency recruits Spanish
speaking clinicians to address the needs of our
Latino clients.
Strongly
Our agency provides translator services.
Strongly
Agree
Disagree
Agree
Disagree
Agree
Disagree
Agree
10
11
12
13
14
15
16
The translator services we offer are easily
Strongly
accessible.
Agree
Our agency offers mental health resources in
Strongly
Spanish.
Agree
Cultural competence training is offered by my
Strongly
agency.
Agree
I am encouraged by my agency to attend
Strongly
cultural competence training.
Agree
I have an understanding of the stigma of
Strongly
mental health in the Latino community.
Agree
As a provider I am aware of the acculturation
Strongly
process that Latinos endure.
Agree
I am aware of the language barriers that
Strongly
Latinos have in obtaining mental health
Agree
Strongly
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
services
17
18
19
It is important to our agency to conduct
Strongly
outreach in the Latino community.
Agree
As an employee I am encouraged by my
Strongly
agency participate in Latino cultural event.
Agree
I believe the services our agency offers need
Strongly
to be improved in order to meet the needs of
Agree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
Agree
Disagree
Strongly
Disagree
our Latino clients
20
As a mental health provider I value and
Strongly
Agree
Disagree
Strongly
51
respect the need for mental health services in
the Latino community.
Agree
Disagree
52
Appendix B
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
DIVISION OF SOCIAL WORK
To: Monica Perez
Date: February 10, 2014
From: Research Review Committee
RE: HUMAN SUBJECTS APPLICATION
Your Human Subjects application for your proposed study, “The Barriers in Latinos
obtaining mental health services”, is Approved as Exempt. Discuss your next steps with
your thesis/project Advisor.
Your human subjects Protocol # is: 13-14- 055. Please use this number in all official
correspondence and written materials relative to your study. Your approval expires one
year from this date. Approval carries with it that you will inform the Committee
promptly should an adverse reaction occur, and that you will make no modification in
the protocol without prior approval of the Committee.
The committee wishes you the best in your research.
Research Review Committee members Professors Maria Dinis, Jude Antonyappan, Serge Lee, Francis Yuen, Kisun Nam, Dale Russell,
53
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