Fronteras Mentales: A Journey into Hispanic Mental Health
EL PASO, Texas (KVIA) — Hispanic culture dominates the Borderland, but does it also influence mental health access for the Hispanic population? That's the question we explore in this ABC-7 special report, Fronteras Mentales: A Journey into Hispanic Mental Health.
Avery Martinez, ABC-7's Be Mindful correspondent, traveled across Spain, Mexico and the U.S. to explore the differences between their health care systems, approaches to mental health, funding challenges and to see first hand the professionals trying to provide support to the Hispanic community.
The project is a collaboration between ABC-7, The Commonwealth Fund and the Association of Healthcare Journalists. Through this report, Martinez and his support hope a better understanding of Hispanic mental health across the globe.
Across the Borderland, there are concerns about a lack of mental health providers, the stigma of Hispanic culture and the challenges of cultural access to care.
In 2021, there were over 60 million Hispanic Americans -- and over 11 million Hispanic Texans. Despite being such a large demographic -- Hispanics are less likely than other groups to get mental support, or admit mental needs.
Research from Counseling Psychology found a lack of mental health professionals in the U.S. El Paso was considered the worst city for Hispanic patients -- because there are so few therapists here. The 2021 Healthy Paso del Norte Systems Assessment notes stigma as a particular challenge for Hispanics.
In fact, health officials wrote the population has "higher rates of perceived stigma" and lower rates of getting "behavioral health services."
Stigma also exists in spain -- the nation that founded El Paso.
Martinez wanted to see if things were different in the historical homelands of El Paso -- in reality, there were many similarities.
In mexico, the impacts of stigma branch out in many directions.
The Juarez mental health organization ROTEMNAS conducted a 2,000 person survey -- results showed serious concerns of misunderstanding mental health in the city.
The Paso del Norte Health Foundation found 11% of adults in Juarez felt depressed or hopeless each day.
UTEP has also studied mental health challenges on the border, resulting in an article in the Frontiers in Public Health. Researchers found "pervasive" stigmas about mental health in Hispanic culture. In the article, the authors wrote that Hispanic adults "with mental health conditions in the United States experience disproportionate access to and utilization of professional mental health treatment. This is believed to be in part due to systemic barriers and challenges, difficulty accessing care, cultural factors, and stigma." The authors also noted a lack of data specifically on the Borderland area. This study found people worry about being seen as "crazy," or being rejected.
The concern extends across Hispanics in general – in 2020, the Substance Abuse and Mental Health Services Administration reported only about 35% of Hispanics with a mental condition received professional treatment – compared to over 50% of non-Hispanic whites.
The UTEP researchers hope understanding where stigma comes from in Hispanic culture can help address it.
Spain faces it's own challenges. The concern about mental health struggles or "locura" in Spanish as been a concern for centuries, even taking center stage in the classic novel Don Quixote by Spanish author Miguel de Cervantes. It was written only a short time after the settlement that would become El Paso was founded. In Spain, the Colegio Oficial de Psicólogos oversees psychologists in the country and has been working to examine the impacts of mental health for many years.
Leaders in the organization tell Martinez this has been a challenge for centuries, and much has changed in the past 70 years in terms of patient treatment and success.
The Spanish phrase, "La ropa sucia se lava en casa" was quoted by Hispanics on both sides of the Atlantic. Roughly translated, it means to wash dirty clothes at home – not in public.
Duke University called the phrase potentially harmful to Hispanics, their website states "phrases like these that dissuade Hispanic youth from reaching out for mental healthcare assistance, feeling as though they need to keep their issues private." The university quotes statistics that less than 1 in 11 Hispanics with a mental disorder get treatment.
Experts, patients and researchers have all noted a lack of providers in the Borderland, Counseling Psychology's research shows that across the country, there's a single therapist for every 1200 Hispanics. In El Paso -- for one therapist -- there are more than 3,000 Hispanics waiting for support.
The 2021 Systems Analysis also raised another concern - culture. The document notes that in particular, the "largely" Hispanic population and culture have existing attitudes toward mental health and treatment. Historically, it's been difficult to get hispanics connected to treatment.
In Spain, doctors and patients spoke with me about the role that culture, history and cultural norms has on people's minds. Patients were concerned the patriarchal culture in the background of Spain may be a barrier to mental health care, while doctors believe that many Spaniards think their mental health concerns are their own fault. European based initiatives have been monitoring on these concerns in Spain for some time.
Some Spaniards are concerned about the word stigma, and mental health stigma in general. Some even noted the phrase "etiquetta," and it's impact. Some clinics, like the San Juan de Dios Hospital in Spain, tell me demand for service have increased. Community therapists told Avery they're concerned about the impact of stigma on people with intense mental health conditions.
In El Paso, similar concerns. Emergence Health Network, the local mental health authority, told Martinez they're focused on making sure people discuss their mental health, find options for treatment and try to connect to the community – especially with the unique culture of the Borderland. Machismo is a term constantly circling in mental health circles across Hispanic cultures, and are concerning to patients and doctors in each nation.
El Paso from it's Hispanic culture and population, as well as it's military community. Mexico because of cultural norms and beliefs, and Spain from the long history of ideas of manhood. EHN experts working with men, patients in Spain and El Paso residents believe this mental health barrier must be addressed before treatment can continue. "Manly" industries in particular seem to be a concerning area, like construction – both from the tough-guy mentality and the high number of Hispanics in the field. The National Association of Home Builders says Hispanics make up 61% of the construction workforce in Texas -- 834,000 people.
Breaking stigma and concerns starts with cultural competence and treatment, according to El Paso therapists. Spanish experts believe you must address stigma and eliminate it's negative effects. Mexican doctors believe that the stigmatic impacts of culture need to be discussed, and fought with more monetary and institutional support for those needing help.
Courts, the government and organizations try to help with mental needs -- but dr. Bonita suarez says it's sometimes not enough. Many turn to private healthcare for their conditions due to monetary challenges. All aggree that addressing stigma, cultural fears and language barriers can help provide support to anyone, and lower extreme struggles – or even suicide.
And treatment changes are taking place across the globe – like 988, the National Suicide and Crisis Hotline in the U.S. and the 024 Suicide hotline in Spain. Treatment options are expanding more into integrated care, especially in Spain – moving from the more antiquated systems common in the early 20th century.
As part of the 2024 International Health Study Fellowship from the Association of Health Care Journalists. Special thanks to the work of Spainfixer in this report, and the support of the staff of KVIA/ABC-7 in making this report possible.
Funding for the Fellowships is provided in part by The Commonwealth Fund, a private foundation that supports improvements to health care systems. It supports independent research on health care issues, and is based in New York City.
The other recipients of the International Fellowship explored health concerns in Italy, Portugal and in France. Recipients include: Ariel Cohen at CQ Roll Call; Eleanor Klibanoff at the Texas Tribune; and Usha Lee McFarling at STAT.
Data for this report came from mulitple sources across all three nations. Including, the Pew Research Center, the World Health Organization, COP, the Commonwealth Fund, the European Observatory on Health Systems and Policy, Emergence Health Network, San Juan de Dios Hospital, the Community of Madrid, Meadows Mental Health Policy Institute, Doctors Without Borders, UTEP, the State of Texas, Clínica Bienestar y Salud Mental, Vision in Action, Healthy Paseo del Norte, and many other groups investigating mental health across borders.
-------
Avery Martinez covers mental health in the Borderland as part of ABC-7’s Be Mindful initiative. He is also a Report for America corps member. RFA places talented, emerging journalists in newsrooms like ABC-7’s to report on under-covered issues and communities. Report for America is an initiative of The GroundTruth Project, an award-winning nonprofit journalism organization dedicated to rebuilding journalism from the ground up.
