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Article Excerpt
The Latino population in the United States is growing at an exponential rate. As a medically underserved population, Latinos experience many health disparities, including those related to mental health. Current research suggests that Latinos in the United States are at high risk for problems such as anxiety, depression, somatization disorders, and substance abuse, yet, often these health needs go unmet. This article suggests that an effective method of reaching and treating more Latinos is through medical family therapy. Because Latinos may be more likely to seek help from a physician for mental health complaints, and because marriage and family therapists may be most culturally congruent in their orientation to therapy, collaboration between health care providers and medical family therapists is logical.
Keywords: medical family therapy, Latinos, health disparities
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The Latino population is the fastest growing and largest minority group in the United States (U.S. Census Bureau, 2000). Most Latinos come to the United States to seek better economic and educational opportunities (Santiago-Rivera, Arredondo, & Gallardo-Cooper, 2002). Many who began as migrant workers, spending long and laborious days on a job for substandard wages, have settled here permanently and have brought their families to the United States with them. However, with immigration comes increased pressure to acculturate and assimilate, as well as stress from the hardship and poverty that often accompany these difficult transitions, particularly in the current politicized and unfriendly immigration environment (Alegria et al., 2002; Kouyoumdjian, Zamboanga, & Hansen, 2003; Organista, 2000). Because of this, Latinos may be especially vulnerable to marital distress, family problems, depression, and anxiety (Kanel, 2002; Organista, 2000). Yet Latinos remain largely a medically underserved population, with many mental health problems left untreated.
It is important to first note that Latinos are not a homogeneous group. The term Latino refers to persons of Latin America cultural origin (Falicov, 1998). Each Latino cultural group has its own unique history, sociopolitical background, and migration patterns (Lopez, 2003; Romero, 2000; Santiago-Rivera et al., 2002). Wide variations among Latino groups exist, depending on issues such as country of origin, socioeconomic status, education, religion, gender, and generation. Therefore, it is not safe to assume that recommendations for working with Latinos are a "one size fits all" recipe. Rather, comments in this article should be read as broad generalizations about values and characteristics that are often shared among Latinos, but with the understanding that multiple individual differences exist. These recommendations must be seen as what providers should be prepared to do, rather than a set of rules they are obligated to use with every Latino family (Bean, Perry, & Bedell, 2001).
HEALTH DISPARITIES AMONG THE LATINO POPULATION
Latinos may be at higher risk for mental health problems compared with the general population. Research indicates that Latinos are not only more likely to have psychiatric disorders than their Caucasian and African American counterparts, but are least likely to receive care (Alegria et al., 2002). Results from the National Comorbidity Survey (NCS) indicated that compared to non-Latino Whites and African Americans, Latinos had a significantly higher prevalence of diagnosable affective disorders as well as comorbid conditions (Kessler et al., 1994). For example, one study of Latino patients presenting for behavioral health treatment determined that they were more likely to be diagnosed with major depression than other ethnic groups (Minsky, Vega, Miskimen, Gara, & Escobar, 2003). While the prevalence rates may be higher, studies also show that minority clients receive lesser and poorer quality care, increasing the burden of disability from mental health problems (U.S. Public Health Service Office of the Surgeon General, 2001; Institute of Medicine, 2002).
Several explanations exist for the underutilization of mental health services by Latinos. In a recent survey conducted in a Midwestern Latino community, participants indicated the following barriers to utilizing health care: cost of services (52.4%); lack of health insurance (44%); language (37.7%); fear of system (27.8%); transportation (7.9%); lack of knowledge of available services (5.2%); and other (4.1%). Almost half (43.5%) the participants reported that they were diagnosed with a chronic illness and of those, 11.8% had been diagnosed with depression (Sevilla Martir, et al., 2007). This survey shows the dilemma of both a high need for care and the many barriers that impede services.
As early as 1982, the President's Commission on Mental Health found four major reasons for ethnic minority underutilization of mental health services: lack of availability, accessibility, acceptability, and accountability (Parron, 1982). Over the past several decades the mental health field has advanced in developing more culturally sensitive therapy; however, these four issues remain major barriers today. More recently, the issue was reaffirmed in the President's New Freedom Commission on Mental Health (2003) when the elimination of disparities in mental health services was included as a core goal. In the final report of this New Freedom Commission, it states, "the mental health system has not kept pace with the diverse needs of racial and ethnic minorities, often underserving or inappropriately serving them" (2003, p. 49).
With Latinos, the availability barrier refers to the inadequate number of culturally competent and bilingual services available. While more acculturated Latinos may not speak Spanish or may be bilingual, not all family members may have equal proficiency in English (Bean et al., 2001). Clients with limited English proficiency are unlikely to pursue care without access to a bilingual provider (Alegria et al., 2002)....
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