22.

Mental Health

v Latinos/Hispanic Americans

The Hispanic/Latino American population is characterized by its rapid growth. Approximately 35.3 million people now self-identify as Hispanic Americans. The number is expected to increase to 97 million by 2050 nearly one-fourth of the U.S. population. Mexican Americans comprise almost two-thirds of Hispanic Americans, with the remainder being of Puerto Rican, Cuban, South American, Central American, Dominican, and Spanish origin.

Latinos are highly concentrated in the U.S. Southwest. 60% live in California, Arizona, New Mexico, Colorado, and Texas. However, from 1990 to 2000, the number of Latinos more than doubled in Arkansas (170%), North Carolina (129%), Georgia (120%), Nebraska (108%), and Tennessee (105%).

Overall, only 56% of Latinos 25 years-of-age and over have graduated from high school, compared to 83% of the total U.S. population. However, academic achievement varies considerably among Hispanic subgroups. 70% of Cuban Americans, 64% of Puerto Ricans, and 50% of Mexican Americans 25 years-of-age and over have graduated from high school.

The economic status of Hispanic Americans parallels their educational status. The poverty rates are 14% respectively for Cuban Americans, 31% for Puerto Ricans, and 27% for Mexican Americans, compared to 13.5% of all Americans.

Refugees. Many refugees from Central America experienced considerable civil war-related trauma in their homelands. Studies have found rates of post-traumatic stress disorder among Central America refugee patients ranging from 33 to 60%.

Individuals with Alcohol and Drug Problems. In general, Hispanic Americans have rates of alcohol use similar to non-Hispanic whites. However, Hispanic women/Latinas have unusually low rates of alcohol and other drug use, while Latino men have relatively high rates. Rates of substance abuse are higher among U.S._born Mexican Americans compared to Mexican-born immigrants. Specifically, substance abuse rates are twice as high for U.S._born Mexican American men than for Mexican-born men, but seven times higher for U.S.-born Mexican American women than for Mexican-born women.

Availability of Mental Health Services

In 1990, about 40% of Hispanics either did not speak English at all or did not speak it well. While the percentage of Spanish-speaking mental health professionals is not known, only about 1% of licensed psychologists who are also members of the American Psychological Association identify themselves as Hispanic. Moreover, 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.

Access to Mental Health Services

Nationally, 37 percent of Hispanics are uninsured, compared to 16% for all Americans. This high number is driven mostly by Hispanics' lack of employer-based coverage only 43% compared to 73% for non-Hispanic whites. Medicaid and other public coverage reaches 18% of Hispanics.

Use of Mental Health Services

Among Hispanic Americans with a mental disorder, fewer than 1 in 11 contact mental health specialists, while fewer than 1 in 5 contact general health care providers. Among Hispanic immigrants with mental disorders, fewer than 1 in 20 use services from mental health specialists, while fewer than 1 in 10 use services from general health care providers.

Precise estimates of the use of complementary therapies by Hispanic Americans do not exist. One study found that only 4% of its Mexican American sample consulted a curandero, herbalista, or other folk medicine practitioner within the past year, while percentages from other studies have ranged from 7 to 44%. The use of folk remedies is more common than consultation with a folk healer, and these remedies are generally used to complement mainstream care.

Appropriateness and Outcomes of Mental Health Services

Few studies on the response of Latinos to mental health care are available. One randomized study found that members of low-income, Spanish-speaking families were more likely to suffer a significant exacerbation of symptoms of schizophrenia in highly structured family therapy than in the less structured case management. Several studies have found that bilingual patients are 
evaluated differently when interviewed in English as opposed to Spanish. One small study found that Hispanic Americans with bipolar disorder are more likely to be misdiagnosed with schizophrenia than are non-Hispanic white Americans.

One national study found that only 24% of Hispanics with depression and anxiety received appropriate care, compared to 34% of whites. Another study found that Latinos who visited a general medical doctor were less than half as likely as whites to receive either a diagnosis of depression or antidepressant medicine.

Culturally Specific Mental Health Resources

n Association of Hispanic Mental Health Professionals
   
P.O. Box 7631, F.D.R. Station
    New York, NY 10150-1913
    Tel: 718-960-0208
    http://www.hispanicfederation.org/agencies/ahmhp.htm

n Centros Para el Control y la Prevencion de Enfermedades
   
(CDC Spanish Language Web Site)
    1600 Clifton Road
    Atlanta, GA 30333
    Tel: 800-311-3435
    http://www.cdc.gov/spanish

n Hispanic Federation
   
(A network of health and human services agencies)
    130 William Street, 9th Floor
    New York, NY 10038
    Tel: 212-233-8955
    http://www.hispanicfederation.org

n Hispanic Health Council
   
175 Main Street, Floor 1-1
    Hartford, CT 06106
    Tel: 860-527-0856
    http://www.hispanichealth.com

n National Alliance for Hispanic Health
   
(formerly COSSMHO)
    1501 16th Street, NW
    Washington, DC 20036-1401
    Tel: 202-387-5000
    http://www.hispanichealth.org

n National Hispanic Medical Association
   
1700 17th Street, NW, Suite 405
    Washington, DC 20009
    Tel: 202-265-4297
    http://home.earthlink.net/~nhma

n National Latina Health Network
   
1680 Wisconsin Avenue, NW, 2nd Floor
    Washington, DC 20007
    Tel: 202-965-9633
    NLHN@erols.com

n National Latina Health Organization
   
P.O. Box 7567
    Oakland, CA 94601
    Tel: 510-534-1362
    Fax:510-534-1364
    http://clnet.ucr.edu/women/nlho