From documenting to eliminating disparities in mental health care for Latinos.

Abstract

The U.S. Surgeon General's report Mental Health: Culture, Race and Ethnicity--A Supplement to Mental Health: A Report of the Surgeon General (U.S. Department of Health and Human Services, 2001) identified significant disparities in mental health care for Latinos and recommended directions for future research and mental health services. We update that report by reviewing five groundbreaking research projects on the mental health of Latinos that were published since 2001. National studies of adults and children, longitudinal designs, and analyses of Latino subgroups characterize these investigations. Despite the increasing sophistication of disparities research, these landmark studies, as well as the research in the supplemental report, can be characterized as documenting disparities in care. We argue that the next wave of research should give greater attention to reducing and eliminating disparities. Accordingly, we apply Rogler and Cortes's (1993) framework of pathways to care to the study of Latinos with schizophrenia. Specifically, we draw on research regarding the recognition of illness, social networks (families) and their association with the course of illness, and interventions. We illustrate examples at each pathway that have the potential to reduce disparities. We argue that implementing interventions synchronously across multiple pathways has considerable potential to reduce and eventually eliminate disparities in mental health care.

Mental Health Care for Latino Immigrants in the U.S.A. and the Quest for Global Health Equities*

“…This recommendation is consistent with the finding that a large portion of Latinos in the general population have reported that they first sought help from a primary care physician for a mental health problem (e.g., Vega et al, 1999). Accordingly, the integration of mental health care with primary health care has been identified as one of the priorities in Latino mental health in the U.S.A (López et al, 2012).…”

“…For example, large-scale epidemiological studies have revealed that immigrant Latinos in the U.S.A. have a lower prevalence of mental health problems than Latinos born in the U.S.A., that is, second and later generation Latinos (Alegría et al, 2008;López, Barrio, Kopelowicz, & Vega 2012;Vega et al, 1998). In other words, the rates of mental health problems of immigrants are lower than average than those of the general population.…”

“…However, in the U.S.A. immigrants and vulnerable populations are less likely to use Empirically Suppor-ted Treatments (ESTs), that is, problem (or illness) focused programs that have been shown empirically to reduce the levels of symptoms and psychological distress (USDHHS, 2001). The lower usage of mental health services and ESTs applies to immigrant Latinos (Alegría et al, 2008;López et al, 2012;Vega et al, 1999).…”

“…There are data showing that when ESTs are modified during their implementation with ethnic minorities, including Spanish speaking Latinos, they are more effective than when those ESTs implemented without modifications (Benish, Quintana, & Wampold, 2011;Griner & Smith, 2006;Smith, Domenech-Rodriguez, & Bernal, 2011). Certainly, there is much more work to be done by Latino mental health researchers in order to understand better how to improve the efficacy and reach of interventions for Latino immigrants (López et al, 2012).…”

“If You Build It, They Will Come”: Attitudes of Medical Residents and Fellows About Seeking Services in a Resident Wellness Program

“…18 Educational outreach in the general population, publicizing the benefits of counseling and countering perceived risks, has increased willingness to seek help. 16,19 To date few studies have assessed whether educational campaigns lead to changes in physicians' attitudes and Intervention A resident wellness program (RWP) was designed to lower known barriers limiting resident access to services.…”