It’s a typical Tuesday at the Latin American Community Center (LACC) in Wilmington, the place many Hispanics in New Castle County turn to when they have a problem.
Today and every day, the list of challenges is long and often complex. Landing a job. Navigating the maze of paperwork associated with various levels of documentation. Getting a GED. Finding a lawyer. And, in a number of cases, obtaining help for a mental health issue.
Community at high risk for mental health issues
Hispanics are at high risk for depression, substance abuse and anxiety, according to the National Resource Center for Hispanic Mental Health. Many are burdened with the crushing stresses of immigration and adjusting to a new culture.
[audio:http://www.wdde.org/wp-content/uploads/2014/01/TheGreen01312014_LatinoMentalHealth.mp3|titles= WDDE News Director Tom Byrne's interview with the Latin American Community Center's Denise Ziya Berte.]
Yet among Hispanics with mental health issues, fewer than one in 11 contact a mental health specialist, according to a report by the U.S. Surgeon General. Fewer than one in five sees a primary care practitioner.
“Providers who are bilingual and bicultural are practically nonexistent in Delaware,” says Denise Ziya Berte, a licensed clinical psychologist and the LACC’s vice president of life empowerment services. “It is very difficult for people to get help if they can’t find someone who understands their language and their culture.”
Experts predict the challenge to grow with the population. Like much of the United States, Hispanics represent the fastest-growing segment of the population in Delaware.
The state’s Hispanic population first leapt in the 1990s, from 15,820 people in 1990 to 37,277 persons in 2000, a 136 percent jump.
In the following decade, the state’s Hispanic population nearly doubled again, from 37,277 in 2000 to 73,221 in 2010, according to the U.S. Census. More than 32,000 are undocumented.
That year, Hispanics accounted for 8.2 percent of the state's population, up from 4.8 percent in 2000. Delaware’s overall population grew 14.6 percent during that period, from 783,600 residents to 897,934 residents. Hispanics accounted for 31.4 percent of the increase.
Yet Hispanics are underrepresented when it comes to mental health care. A national study published in Psychiatric Services, a professional journal, reports that 36 percent of Hispanics with depression received care, compared to 60 percent of non-Hispanic whites.
Barriers to care include poverty, lack of insurance, language, the stigma associated with mental illness and a shortage of qualified mental health professionals, the study says.
At LACC, there is a waiting list for mental health services, which include counseling for children, a support group for victims of domestic violence and a state-mandated program for drivers who have been charged with driving under the influence.
“We don’t have to go out and talk people into getting help,” Berte says. “Everybody knows us and trusts us because we have been around forever.”
Center is a lifeline for migrant community
The Latin American Community Center or El Centro Latino was created in 1969, founded by a group of Puerto Rican migrants who had been meeting in a nearby church basement for several years.
In the beginning, programs focused on finding housing and jobs for people in the Latino community. Since then, the organization has added more than 50 programs, including La Fiesta, a day care center, and Los Jardines, a 24-unit apartment complex for low-income seniors.
Each week, a support group for women who are victims of domestic violence meets. The group has been active for 16 years and provides a safe and secure environment where women can share their feelings, learn about their legal rights and encourage one another in establishing a better life.
“Often, the women talk to relatives at home who tell them that they can’t make it on their own, that they need to sacrifice themselves for the good of the children and the family,” says Letycia Figueroa, who coordinates the program. “Being part of a group helps them to feel less isolated and depressed.”
Currently, LACC funds positions for five licensed mental health professionals. Five additional staffers also are going to school with that goal, including Figueroa, who is enrolled at Drexel University and plans to become a marriage and family counselor.
To pay for programs, the center stitches together a patchwork of resources, including state grants, Medicaid, private insurance, philanthropic donations and fees based on the client’s ability to pay.
Helping a vulnerable population
Under the Affordable Care Act (ACA), treatment for mental illnesses and substance abuse now receive parity with physical health, providing behavioral health services for 62 million Americans.
Under the law, health plans must now cover preventive services at no cost, including depression screening for adults and behavioral assessments for children.
As U.S. citizens, Puerto Ricans have access to those benefits, as do naturalized citizens. But an estimated 11.5 million unauthorized aliens in the U.S. are not eligible for coverage under the ACA.
Undocumented immigrants with a Social Security number can apply for private insurance or obtain coverage through an employer. Otherwise, community health centers and hospital emergency departments will continue to provide care for immigrants, regardless of their documentation.
Patricia Arredondo is a licensed bilingual psychologist and campus president of the Chicago School of Professional Psychology. She and three co-authors wrote “Culturally Responsive Counseling With Latinas/os,” a book that provides insights and intervention strategies for mental health professionals focused on the Latin community.
It’s not a one-size-fits-all strategy. There are significant cultural differences among a diverse population of immigrants from the Caribbean, Mexico, Puerto Rico, and South and Central America.
“You have to know where you are and the history of the community if you are going to be effective in serving people in need,” she says.
Berte says immigrants are especially vulnerable because they often don’t use banks and rely on cash. Many live in poor neighborhoods where crime is a constant danger.
“They aren’t going to call the police if something bad happens to them,” she says.
Many Latino immigrants bear the psychological scars of being tortured in wars and political uprisings in their native lands.
“Most immigrants have had some level of trauma,” she says. “They did not leave their homes and come to the United States for no good reason.”
Among the immigrant community, mental health services are a relatively new concept, Berte notes.
“In their country of origin, mental health issues were treated inside the family or the church,” she says. “When you come to a new country, you don’t have your father to keep your husband in line. You don’t have your mother’s shoulder to cry on.”
Gender also plays a significant role in who gets help in Latin culture, says William Vega, executive director of the Edward R. Roybal Institute on Aging at the University Of Southern California School Of Social Work.
“The majority of women will see a doctor because of reproductive health,” he says. “But they are not going to the doctor for mental issues so it’s up to the primary care provider to recognize it.”
Vega, who has written widely on mental illness and substance abuse in the Hispanic community, says alcoholism and DUI are prevalent among men, especially those from Mexico and Central America.
“Getting help is a complex prospect because people are fearful of cost, fearful of stigma, fearful of documentation problems,” he says. “Meanwhile, people are suffering.”