Hispanic/Latinx

The Hispanic/Latinx community in the U.S. is very diverse, including people from many different nations and regions of the world. Individuals of Mexican, Puerto Rican, Cuban, Central American and South American descent have been part of the American cultural tapestry for centuries. As with any community, the mental health needs and experiences of Hispanic/Latinx people varies among subgroups.

While there is great diversity within this community, there are some shared cultural factors that connect people regardless of ancestry or national origin. For some, their indigenous roots are a source of pride. A large portion of this community speaks the Spanish language. There is also a shared connection of religious affiliations, strong family bonds, connections to extended networks and a resilient approach to life and work. Another common value in this community is “familismo,” a cultural foundation that emphasizes connectedness and a strong attachment and duty to one’s family.

 

Identity and Culture

Identity and culture for members of the Hispanic/Latinx community is as complex and rich as the history and trajectory of this population. In other words, there is no one Hispanic/Latinx culture.

It is important to appreciate these differences and understand how community members self-identify based on race, ethnicity, or national origin. Those who identify as Latino, Latina or Latinx may consider themselves of Latin American ancestry (Central America, South America or the Caribbean). Since the Spanish language is typically gendered, the term Latinx is used to eliminate a binary choice (male vs. female) that is limiting and excluding to trans individuals and others who identity as fluid or non-binary. Those who identify as Hispanic may be referring to ancestors from Spain or other Spanish-speaking countries.

Since cultural identity is a construct shared by groups, recent immigrants may identify by their country of origin instead of as “Hispanic” or “Latinx.” It is also possible that members of this population may use different terms interchangeably.

 

Barriers to Mental Health Care

Hispanic/Latinx communities show similar vulnerability to mental illness as the general population, but they face disparities in both access to and quality of treatment. More than half of Hispanic young adults ages 18-25 with serious mental illness may not receive treatment. This inequality puts these communities at a higher risk for more severe and persistent forms of mental health conditions, because without treatment, mental health conditions often worsen.

Approximately 34% of Hispanic/Latinx adults with mental illness receive treatment each year compared to the U.S. average of 45%. This is due to many unique barriers to care.

Language Barriers
Language barriers can make communicating with providers difficult, or even impossible, particularly when a person is seeking counseling for sensitive or uniquely personal issues. These topics can be difficult for anyone to put into words, but it is especially difficult for those who may not speak the same language as a potential provider.

Although Spanish is the official language in most of Latin America, some Latino/Latinas may speak other languages or dialects, such as Quechua, Nahuatl or Portuguese. Additionally, Latinx families may be bilingual or mixed-language families; therefore it is helpful for providers to ask what the patient and families’ preferred language is before starting an evaluation and to use interpreters when necessary.

Poverty and Less Health Insurance Coverage
15.7% of Hispanic/Latinx people in the U.S. live in poverty (compared to 7.3% of non-Hispanic whites). Individuals who live in poverty have a higher risk of mental illness and, conversely, individuals with mental illness have a higher risk of living in poverty.

According to the Kaiser Family Foundation, in 2018, 19% of Hispanic people had no form of health insurance. In addition to facing an already limited pool of providers due to language barriers, people identifying as Hispanic/Latinx have even fewer options when they are uninsured.

Lack of Cultural Competence
Cultural differences may lead mental health providers to misunderstand and misdiagnose members of the Hispanic/Latinx community. For instance, an individual may describe symptoms of depression as “nervios” (nervousness), tiredness or as a physical ailment. These symptoms are consistent with depression, but doctors who are not trained about how culture influences a person’s interpretation of their symptoms may assume it’s a different issue.

Legal Status
For immigrants who arrive without documentation, the fear of deportation can prevent them from seeking help. Even though millions of children of undocumented immigrants are eligible for health insurance under the Affordable Care Act, many families either may not know about the eligibility or be afraid to register due to fear of separation.

Acculturation
The level of a person’s acculturation, how thoroughly they have embraced or adopted the predominant culture of the place they live, can play a role in mental health and access to care. Acculturation has been found to predict use of health care services, with a higher level of acculturation resulting in higher utilization.

Hispanic/Latinx communities have an added risk of experiencing mental health issues because of the stress of facing discrimination while also trying to navigate between different cultures.

Stigma
Hispanic/Latinx individuals may not seek treatment because they may not recognize the signs and symptoms of mental health conditions or know where to find help.

People in the Hispanic/Latinx community can often be very private and may not want to talk publicly about challenges at home. This can lead to a lack of information and continued stigma about mental health within the community, as talking about it can be viewed as taboo. Many in the Latinx community are familiar with the phrase “la ropa sucia se lava en casa” (similar to “don’t air your dirty laundry in public”). Some people do not seek treatment for mental illness out of fear of being labeled as “locos” (crazy) or bringing shame or unwanted attention to their families. Additionally, faith communities may be a source of distress if they are not well informed and do not know how to support families dealing with mental health conditions.

When mental health is not commonly or openly talked about, people seeking treatment may have limited knowledge and comfort with different types of therapy and psychiatric medications. Providers should use a compassionate and collaborative approach to engage individuals in treatment planning. Incorporating education, symptom monitoring and engagement with community resources can be important to support a person’s decision to start therapy or psychiatric medication.

 

How to Seek Culturally and Linguistically Competent Care

For mental health providers working with Hispanic/Latinx clients or patients, exploring cultural identity may offer important information to tailor their mental health treatment. Cultural humility is necessary to provide quality care. This refers to the ability to recognize that culture plays a large role in a person’s health and well-being and may sometimes affect the provider’s ability to best serve their patient’s needs.

A provider who understands a patient’s culture and needs will know culturally specific information. For example, someone might describe what they are feeling with a phrase like “Me duele el corazón.” While this literally means “my heart hurts,” it is an expression of emotional distress — not a sign of chest pain. A culturally sensitive doctor would be aware of this interpretation and would ask for more information instead of assuming the problem is purely physical.

While we recommend going directly to a mental health professional, a primary care doctor can be a great place to start for an initial assessment or to get a referral for a recommended mental health professional. Community and faith organizations may also have a list of available mental health providers in your area.

When meeting with a provider, it can be helpful to ask questions to get a sense of their level of cultural awareness. Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. Here are some sample questions:

  • Have you treated other Hispanic/Latinx people?
  • Have you received training in cultural competence or on Hispanic/Latinx mental health?
  • How do you see our cultural backgrounds influencing our communication and my treatment?

Whether you seek help from a primary care doctor or a mental health professional, you should finish your sessions with health professionals feeling heard and respected. You may want to ask yourself:

  • Did I feel heard? Did I feel my provider understood my concerns?
  • Did my provider communicate effectively with me?
  • Is my provider willing to integrate my beliefs, practices, identity and cultural background into my treatment plan?
  • Did I feel like I was treated with respect and dignity?
  • Do I feel like my provider understands and relates well with me?

If your preferred language is not English, let the office staff know when you schedule your appointment; this will allow them to schedule an interpreter before your visit. When using an interpreter, your mental health provider should:

  • Look at you directly when speaking — not communicate only with the interpreter.
  • Ask short questions and communicate short messages to promote effective interpretation and reduce errors.
  • Allow enough time for the interpreter to finish the statement and for you to ask questions when you need to.

If you believe that language barriers are negatively affecting your mental health treatment, consider bringing it up to your mental health provider. They may be able to schedule more frequent or longer appointments to allow adequate time for the use of the interpreter.

The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s very important for a person to feel that their identity is understood by their provider to receive the best possible support and care.

 

More Information

  • If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).
  • If you or your loved one does not speak English, or are not comfortably fluent, you have the right to receive language-access services at institutions that receive funding from the federal government as well as the right to request a trained interpreter and to receive forms or information in your preferred language.
  • If you do not have legal documentation, seek out clinics and resources that care for all members of the community. Latinx-based organizations often provide services regardless of legal status.
 

Resources

NAMI’s Compartiendo Esperanza
A 90-minute program to increase mental health awareness in Latino communities by sharing the presenters’ journeys to recovery and exploring signs and symptoms of mental health conditions. The program also highlights how and where to find help.

Compartiendo Esperanza: No Hay Salud Sin Salud Mental
Through stories and quotes, this booklet provides mental health information in a sensitive manner. Recovery is possible, and this booklet tells you where to find more information, seek help and be supportive. You can preview the booklet for free or buy hard copies through the NAMI Bookstore.

Please note: The resources included here are not endorsed by NAMI, and NAMI is not responsible for the content of or service provided by any of these resources.

American Society of Hispanic Psychiatry
Promotes the research, education, advocacy and support for those in the Hispanic community. Offers a “Find a Physician” feature on their website.

Therapy for Latinx
A database of therapists who either identify as Latinx or has worked closely with and understands the unique needs of the Latinx community. The website is also offered in Spanish.

Mental Health America’s Resources for Latinx/Hispanic Communities
General mental health Spanish-speaking resources, including a list of Spanish-language materials and Spanish-language screening tools.

Psychology Today
A directory of Hispanic/Latinx therapists.