The subject of mental health is one Hispanic families rarely choose to discuss. “Los locos” are usually considered other people’s problems.
Thus, Latino families often will choose to ignore symptoms and seldom seek out mental health care on their own, say Rochester area mental-health professionals.
“People don’t talk about it,” said Dalimarie Perez, senior program manager for the Latino program at Catholic Family Center’s Restart Substance Abuse Services. “We believe, ‘La ropa sucia no se lava en casa (You wash your dirty clothes at home).’ … We find excuses for mental health (symptoms) or substance abuse.”
But with the growth of the Latino community, improving access to bilingual and bicultural services, and greater awareness of services that are available, area professionals agree some progress has been made.
“Things are starting to get better,” said Dr. Telva Olivares, a psychiatrist and medical director of Lazos Fuertes, a joint venture between the University of Rochester’s Medical Center and Ibero-American Action League to provide bilingual services to area Hispanics. “We’ll never be big enough to take care of the whole city but … I see places like Lazos attracting residents and clinicians to provide good care.”
Another positive step is a new federal initiative to train youth counselors, social workers and therapists who work with Hispanic families to provide community education about mental-health disorders common among Latinos — such as depression, anxiety and eating disorders — that can lead to substance abuse and suicide.
Perez said CFC’s Restart was one of several agencies that worked with the U.S. Department of Health and Human Services to develop the bilingual multimedia training program called ¡Vida en la Comunidad para Todos! The program addresses substance-abuse prevention and offers resources for increasing awareness of mental-health issues in the Latino community, she said.
Perez and Guillermina Torres, coordinator of client services for CFC’s Latino program, offered daylong workshops May 12 on how to utilize the materials to serve Hispanic families.
“It helps parents to identify signs and go to the next step and see a professional on how to approach the issue,” said Perez.
The new program is a necessary tool because too often depressed children are not diagnosed at an early stage, she added. Their depression can lead to self-medication through drugs and alcohol and increases the likelihood that they will drop out of school or act out violently, Perez said.
“Sometimes Latinos only seek help in a crisis situation,” Torres said. “If they get it at an early stage, it’s more helpful and important.”
While he believes disparities in health care and access barriers persist, Dr. Héctor Detrés, a psychologist currently working as a counselor at the Edison School of Applied Technology, said community education is one of the keys to better care. “If you start educating people, they gain knowledge,” he said. “And knowledge is power.”
Lack of access to quality care, transportation and health insurance also remain as barriers to helping Hispanics recognize mental-health illnesses and seek treatment, said Detrés, who hosts a Spanish-language show offering family therapy Sunday nights on radio station 102.7-FM. There also is a potential for misdiagnosis if non-Latino medical professionals do not understand how Hispanics express emotions, which can appear very dramatic, he said.
“Hispanics are more reluctant to seek mental health in hospital settings,” Detrés added. “That’s a built-in cultural barrier. They’re used to dealing within their own communities and families.”
Depression or substance abuse also is prevalent among immigrants because of culture shock, said Perez, whose Restart program has doubled its client population in the past decade. Children may want to follow the American lifestyle of their new peers but encounter resistance from parents, sometimes leading to depression and anxiety among the children.
Similar symptoms also affect adults who moved to this country for a better life and instead find themselves living in poverty because they their inability to speak English holds them back from finding jobs, said Felix Marquez, a bilingual therapist at Restart. Suicide rates and alcoholism rates are three times higher for Hispanics than for the general population in the Rochester area, according to Lazos Fuertes literature.
“That creates a lot of low self-esteem,” Marquez said. “There are also a lot of families with mental-health problems that don’t know it until they come here.”
And those that do want to seek help often don’t know where to go because of language and cultural barriers, the experts agree. The last thing such people want to do is sit down with a translator to talk about a mental-health issue, Olivares said.
That’s why she sees Lazos Fuertes, which moved in December 2003 to 817 E. Main St., as a force for change. The program had begun at a small office in Brighton, but transportation difficulties prevented it from growing, Olivares said.
Since the move to Main Street, word of mouth has helped expansion of the clinic — which Olivares noted also serves as a training center for University of Rochester residents in psychiatry and family counseling — and enhanced its perception in the Latino community as a safe place to go, she added. The staff presently includes two full-time therapists and a part-time psychiatrist as well as secretarial and administrative support for the clinic’s 270 patients.
The center’s staff is culturally aware and trained to know to greet patients with a kiss or a hug, or to address an older person as “Don” or “Doña,” she said.
And when they walk into the brightly painted waiting room and see someone they know, patients are immediately more comfortable, Olivares added.
“It demystifies the idea of what a loco is,” she added. “They see each other and know they’re ordinary people. That’s the thing we do best. People have a sense of relief and comfort when they come in.”
Training more therapists and psychiatrists in such a setting will only help pave the way to better care for Hispanics, Olivares said. Financial support from such donors as Eastman Kodak Co., the Golisano Foundation, Rochester Area Community Foundation, Feinbloom Foundation, the Wilmot Foundation and Monroe County Office of Mental Health/Coordinated Care Services Inc. helped the center get off the ground.
But according to the 1999 “Survey of licensed practitioners of psychology: Activities, roles, and services” by the American Psychological Association, only about 1 percent of licensed psychologists who belong to the American Psychological Association identify themselves as Hispanic. According to the Center for Mental Health Services, there are only 29 Hispanic mental-health professionals for every 100,000 Hispanics in the United States, compared to 173 non-Hispanic white providers per 100,000 population.
“You have American people trying to treat Hispanics,” said Detrés, adding that built-in biases can lead to continued disparities in the quality of care Latinos receive. “We need a Martin Luther King. … Somehow, someone has to take seriously the issue of mental health among Hispanics.”
Perez said the mental-health community has seen a lot of positive changes in the past decade, with Restart staff able to refer clients to more agencies like Lazos Fuertes and to others — including Huther-Doyle of Rochester, DePaul Community Services, Hillside Children’s Center and Rochester Mental Health — that provide some bilingual services. But the number of bilingual therapists remains small, she added. And Olivares noted that she is only one of four Spanish-speaking psychiatrists in the city.
“We need more,” Perez said. “Even if (practitioners) don’t speak the language, they must be sensitive to the needs of the Hispanic population,” which include a family orientation and offering respect, sympathy and empathy.
Prospective clients “need to make a connection with the person or organization,” Perez added. “If they can’t identify with the person, they’re not going to go back.”