For many, the decision to reach out and seek help for their mental health does not come lightly. Between the vulnerability needed to connect with a trusted mental health professional, and resources needed to maintain access to services in a sustainable way, many folks who may benefit from counseling are unable to receive the care they need.
In general, barriers to mental health treatment among the US population include (Mojtabai et al., 2010):
- Low perceived need for mental health support
- Structural barriers, including:
- Financial barriers
- Unavailability of services
- Lack of reliable transportation
- Lack of reliable access to internet
- Inconvenient hours of services (ex. Family care services)
- Attitudinal barriers, including:
- A desire to handle problems on one’s own
- Perceived ineffectiveness of therapy
- Stigma against mental health services
But, what are the specific barriers faced by different communities within the US?
This blog post hopes to shine a light on the unique barriers experienced by Hispanic & Latinx immigrants – a sizable portion of the population we serve at Family Service of Chester, and an important part of the many communities that make up Chester County.
The Hispanic & Latinx Community in Chester County
Chester County has a rich history of immigration since the county was founded. Data from naturalization records located at the Chester County Archives details the plethora of groups of people immigrating to the area thanks to the religious freedom and other important opportunities provided by Pennsylvania. Early settlers were followed by the ‘Irish Wave’, ‘Southern and Eastern European Waves’, ‘Korean and Vietnamese Waves’, and – most recently – the Central and South American Waves (Chester County Archives).
While Hispanics/Latinxs are a diverse set of interconnected communities, there exist some commonalities between folks regardless of their country of origin. According to the National Alliance of Mental Illness: “…for some, [Latinx/hispanic] 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.” (NAMI, 2021). Recently immigrated families have also been found to be more likely to experience migration-related stress and trauma than other non-immigrant groups. The link between trauma exposure and negative public health outcomes (before migration, during migration, and post-migration) is of particular concern among this population (Mercado et al. 2021).
Hispanics/Latinxs are the fastest growing minority population in the United States in modern times (Grieco et al., 2012). In particular, Southern Chester County is home to many Guatemalan and Mexican immigrant families consisting of both foreign-born and US-born family members (Garcia, 1997). FSSC strives to meet the unique needs of these multi-generational families. Part of our work aims to help dismantle the barriers these families face when considering seeking support for their lives.
Barriers to Mental Health Services
Did you know that more than half of Latinx/Hispanic young adults with a serious mental illness will not receive the mental health services they need? (SAMHSA, 2018).
Aside from being at greater risk for experiencing negative public health outcomes due to migratory trauma, Latinxs/Hispanics also encounter greater barriers to accessing culturally competent care. Culturally competent care is defined as “…attaining the knowledge, skills, and attitudes to enable administrators and practitioners within the system of care to provide effective care for diverse populations, i.e., to work within the person’s values and reality conditions.” (SAMHSA, 2021).
Barriers to this type of care include but are not limited to:
- Attitudinal Barriers – While some of these barriers are shared with the general population such as wanting to handle problems on your own, thinking treatment will not work, etc., a few are unique to Latinxs/Hispanics. This includes receiving treatment before, perhaps from providers who were not culturally competent, and having it not work; concerns about how to afford treatment, especially if undocumented and uninsured; and lastly concerns about the stigma of being in mental health treatment (for example: thinking “what will others like family and friends think if they found out?”). (Falgas et al., 2018). “Familismo” stresses relying on family to resolve problems; religious values also stress the importance of seeking support from the church for similar reasons. The stigma against mental health services experienced by these folks interact with these two family-based and religious-based value systems.
- Structural Barriers – Likewise, some structural barriers are also shared with the general population. These include problems with transportation or scheduling, uncertainty about where to go or who to see, fear of being put in a hospital against your will, etc. (Falgas et al., 2018). However, there are quite a few structural barriers unique to Latinxs/Hisapnics (NAMI, 2021):
- Language barriers
- Counseling is an extremely personal process that requires the establishment of rapport and trust for successful outcomes. Rapport is particularly difficult to achieve when counselors and health care providers are not able to communicate in the language clients are most comfortable speaking in. Imagine trying to communicate your most intimate details to a stranger in another language: Would you be able to do so?
- Poverty & Health Insurance
- According to the US census, 15.7% of Latinx/Hispanic people in the United States live in poverty as compared to 7.3% of non-Hispanic White people (Creamer, 2020). Poverty is associated with higher rates of mental illness. It is also estimated that 19% of Latinx/Hispanics do not have health insurance (Kaiser Family Foundation, 2018). This further limits the pool of affordable providers for this group of immigrants.
- Social Services & Legal Status
- Immigrants who are undocumented navigate a very different reality: the fear of being deported looms over these folks, and can very much deter them from accessing important health services due to this fear. And although millions of undocumented children are eligible to be covered by health insurance under the Affordable Care Act, many folks do not know of these available benefits or – worse – chose not to receive them in fear of the family being separated by immigration authorities.
- Acculturation & Discrimination
- Acculturation is defined as “…how thoroughly [one has] embraced or adopted the predominant culture of the place they live,” (NAMI, 2021). Higher levels of acculturation have been found to predict whether someone begins the process of seeking mental health services. First- and second- generation immigrants are less likely to be as acculturated as their counterparts. This immigrant group is also more likely to experience discrimination, which may further contribute to the stress they are experiencing while navigating the mental health care system.