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To Talk is to Change

By Caroline Clauss-Ehlers

Reprinted with permission, Salud Mental, Winter 2005,

Stigma refers to the negative attitudes and perceptions that make people fearful about those with mental health problems. Stigma also relates to those who suspect that they have a mental health problem and don't go for help because they fear being labeled. Poor outcomes abound when stigma is part of the mental health equation. Avoiding treatment, being secretive about one's problems, and denial are a few possible stigma-related outcomes.

Mental health stigma among the Latino community is especially relevant when we consider research that indicates mental health problems among Latino families are going undetected, untreated, and unresolved. A study published by Vega and colleagues in 1999 found that, of Mexican Americans residing in Fresno County in California, only 9% of those with a mental disorder during the twelve month period prior to being interviewed contacted a mental health provider. The Surgeon General's report entitled Culture, Race, and Ethnicity estimated that less than 1 in 11 Latinos with a mental health problem seek help from a mental health professional. Lack of access and utilization is compounded by the Center for Mental Health Service finding that for every 100,000 Latinos in the United States there are only 29 Latino mental health professionals.

Research shows that stigma must be considered when planning mental health interventions. It appears, however we have little scientific knowledge about the role of stigma in help seeking patterns among Latinos. The Surgeon General's report, for instance, did not find any current studies that examined the impact of stigma on the access and utilization of mental health services for Latinos.

Where to Turn for Help

Perhaps one starting point is to explore who people turn to when they need help. "When people need help they go to the doctor," said Karla Garcia, a mother of a newborn. "Any questions I have, I would ask an expert. What I tell my friends who have problems is to look for resources. In the Latino community people usually go to family and friends. Not asking for professional help when you have a mental health problem is something that goes from generation to generation. It's about stigma and not having the resources. If you don't have access to a computer, for instance, you have less information about what you're experiencing."

"It is important to go for help, to desahogar, and to talk about your feelings rather than keep them in and stay angry," said Melinda Olavarria. Melinda, who suffers from seizures, has a newborn baby. She has found that when she does not talk to someone about her problems the seizures get worse. "My medical doctor told me to talk it out," Melinda said. "He is my confidant. I tell him everything."

"Some people don't accept that they have a problem. They put it behind their minds and don't want to think that anything is wrong," said Karla Garcia. "Or people feel that they are the only one going through the problem. They feel isolated and alone-not knowing that others could be going through the exact same thing that they are."

When Business as Usual Doesn't Work

Perhaps this commentary suggests that business as usual is not always effective when it comes to thinking about the provision of mental health services across the Hispanic culture. Dr. Vincent Ramos, Campus Dean of Psychology and Behavioral Sciences at Argosy University's The Texas School of Professional Psychology, said, "Latinos tend to stay within the community and tell their problems to religious leaders or family members. Latinos are not necessarily socialized to the community mental health model so they don't understand that there are resources for their problems."

In addition, Latinos may not think of stressors in terms of mental health. "A mental health problem may be somaticized," Dr. Ramos said. "If someone has high blood pressure, they immediately go to their physician." Certainly Melinda's relationship with her doctor highlights the importance of the mind-body connection.

Talk is Change

Melinda and Karla's stories are ripe with implications of what can be done. The enterprise of therapy is based on the view that talking about one's problems promotes healthy change. If to talk is to change, perhaps the mental health system has some conversations to continue to engage in. One such conversation concerns implementing culturally relevant change in the provision of mental health services for the Latino community. As somatization and turning to one's medical doctor are common phenomenon, educating primary care physicians (PCP's) in mental health issues seems critical. If PCP's know the screening questions to ask for depression, for instance, then they are in a better position to make an appropriate referral.

A second possibility is to incorporate religious leaders into the treatment process. If the individual seeking treatment is religious, for instance, greater integration of one's faith and mental health treatment prevents the person from having to choose between the religious leader and the mental health professional.

Education is a third area of change. "Education is the main problem," Karla Garcia said.

"We need to develop intentional outreach and educational programs to help Latinos identify what mental health issues are," Dr. Ramos said. "An educational program, for instance, could let the community know what depression is and how it manifests itself."

Finally, it is important that mental health services incorporate the role of culture in all aspects of the treatment process. "We need to educate mental health practitioners to be culturally competent, to decrease language barriers, and to increase resources to support infrastructure and policies," Dr. Ramos said. Required courses in cultural competence and a language requirement for graduate students may be one way to start changes at the beginning of professional development.

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