BROKIN: MENTAL HEALTH SOLUTIONS FOR MEN OF COLOR

OVERCOMING MENTAL HEALTH STIGMA IN LATINO COMMUNITIES

Some Latinos view mental illness as a sign of weakness. Others think it’s a personal issue to be kept quiet. Others fear being labeled “loco,” Spanish for “crazy.”

Mental health disorders are prevalent among Latino ethnic groups in the U.S. The Hispanic Health and Nutrition Examination Survey reported that 28 percent of Puerto Ricans living in the U.S. had depression symptoms. So did 13 percent of Mexican Americans and 10 percent of Cuban Americans.¹

However, only 20 percent of Latinos with a mental disorder talk about it with a primary care physician, according to the U.S. Surgeon General’s report, Mental Health: Culture, Race, and Ethnicity.² And only 10 percent pursue treatment from a mental health provider.

“Mental health issues have a stigma³ in the Latino community,” says psychiatrist Diana Lorenzo, MD, of Cleveland Clinic’s Center for Behavioral Health. “Many Latinos would prefer to ignore these conditions over talking about them openly.”

Originally from Argentina, Dr. Lorenzo completed her psychiatry residency at Cleveland Clinic. She joined the Cleveland Clinic staff in 2016, when she began leading the mental health care of Spanish-speaking patients at the Hispanic Clinic at Cleveland Clinic Lutheran Hospital, located in a Cleveland neighborhood with a large Latino population. In a little over a year, her caseload has increased more than 16-fold.

Dr. Lorenzo credits five factors — outlined below — in helping her improve Cleveland-area Latinos’ access to mental health care.

1) Removing the language barrier

Communication is essential to diagnosing mental disorders, so understanding what patients are expressing is critical. Using an interpreter may help, but a psychiatrist who speaks the patient’s native language — and can interpret cultural nuances and jargon — is often most effective, says Dr. Lorenzo.

2) Collaborating with primary care physicians (PCPs)

Since Latinos with a mental health concern are twice as likely to consult a PCP rather than a mental health provider, collaborating with primary care clinics is vital to reaching this population. “Latinos typically won’t claim they’ve had a panic attack, for example, but they will report the somatic symptoms, like chest pain and shortness of breath,” says Dr. Lorenzo. “PCPs are the ones to identify the psychological root of the symptoms and refer patients for appropriate care.”

3) Encouraging family involvement

Latinos have strong family networks, says Dr. Lorenzo. Family support can help alleviate the stigma of a mental disorder and embolden patients to address it. “I encourage my patients to bring their parent, spouse or child to their appointments,” she says. “Sharing information with family members increases their understanding of the disease and helps them better support the patient.”

4) Offering sensitive, culturally competent treatment

Schizophrenia, bipolar disorder and similar severe mental illnesses are especially stigmatizing — labeled “locura” (Spanish for “craziness”) by many Latinos. More common disorders, such as depression and anxiety, are regarded as merely “nervios” (“nervousness”) and perceived as short-term, easier to treat and not requiring medication. As such, Dr. Lorenzo is cautious about recommending pharmacotherapy to her patients.⁴ “Latinos tend to view psychotherapy as more acceptable,” she says. “If appropriate, I often recommend that first, then add medication later if needed.”

5) Educating about the physiologic roots of mental illness

Lack of information and misunderstanding fuel the stigma. Providing details about diagnoses, discussing treatment options and answering questions may be the best way to eradicate stigma. “Explaining the biological underpinnings of mental health disorders is enlightening to many Latinos,” says Dr. Lorenzo. “When they understand that chemicals in the brain play a primary role, they view the diseases differently.”

Helping Latinos overcome their community’s stigma about mental illness is difficult. But the more that physicians understand Latino culture and work to raise awareness of mental health disorders and symptoms, the better.

“When a Latino patient does disclose information indicating possible depression, anxiety or another mental health concern, we need to address it immediately,” says Dr. Lorenzo. “For them to open up, they must really be struggling.”

Providers in Northeast Ohio can refer Latino patients for mental health appointments or triage at Cleveland Clinic’s Hispanic Clinic by calling 216.444.5812.

References

1. Guarnaccia PJ, Martinez I, Acosta H. Mental health in the Hispanic immigrant community: An overview. In: Gonzalez MJ, Gonzalez-Ramos G, eds. Mental Health Care for New Hispanic Immigrants. Philadelphia: Haworth Press; 2005:21-46.
2. Mental health care for Hispanic Americans. In: Mental Health: Culture, Race, and Ethnicity — A Report of the Surgeon General. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2001.
3. Interian A, Ang A, Gara MA, et al. Stigma and depression treatment utilization among Latinos: utility of four stigma measures. Psychiatr Serv. 2010;61:373-379.
4. Lewis-Fernandez R, Das AK, Alfonso C, et al. Depression in US Hispanics: diagnostic and management considerations in family practice. J Am Board Fam Pract. 2005;18:282-296.