Academic journal article Health and Social Work

Pathways to Mental Health Services among Inhabitants of a Mexican Village

Academic journal article Health and Social Work

Pathways to Mental Health Services among Inhabitants of a Mexican Village

Article excerpt

The utilization of mental health services among Mexican Americans is a topic that has been researched extensively during the past three decades (Griffith, 1983; Padilla & Ruiz, 1973; Snowden & Cheung, 1990). Both underutilization and overutilization of mental health services have been reported in available studies (Barrera, 1978; Cuellar & Schnee, 1987). These somewhat contradictory findings are partially the result of the diverse methodological approaches that have been used to study this topic (Cervantes & Castro, 1985; Wells, Golding, Hough, & Burnam, 1988; Yamamoto & Silva, 1987).

Among the identified factors related to low utilization of mental health services among Mexican Americans are the cultural or individual factors and the institutional barriers to access (Rogler, 1983). For instance, Padilla and Keefe (1984) reported that four factors determine the selection of a source of help when Mexican Americans face emotional problems: (1) perceived nature of the problem, (2) perceived qualities of the source of help, (3) language ability and preference, and (4) characteristics of the social network, especially family members. The role played by family members in Mexican culture is of crucial importance to understanding the health-related supportive behaviors among this group. The strong identification with and attachment to family known as "familism" (Sabogal, Marin, Otero-Sabogal, Marin, & Perez-Stable, 1987) is the core of social support among Mexican Americans and consistently has been acknowledged as the most powerful factor affecting the help-seeking behavior of many people of Mexican origin. Family ties, however, can either facilitate or interfere with a family member's seeking health services (Grebler, Moore, & Guzman, 1970).

Most research on service utilization, however, has focused on identifying and describing the barriers to mental health services and has not offered an explanation of the sequential steps an individual goes through before obtaining specialized help. It has been proposed that psychosocial and cultural factors play an important role in how a mental health problem is defined and how severe it is considered, which indirectly influences the direction and duration of the help-seeking pathway (Gater et al., 1991; Rogler, 1983; Rogler & Cortes, 1993). For example, if a pathway to service utilization involves consulting a network of people until a professional is approached, then the more dense the network, the longer it will take to seek out formal services (Birkel & Repucci, 1983). Furthermore, among urban Mexican populations it has been found that if the individuals find their way to obtaining formal services, it is likely that they will seek out the assistance of a medical doctor rather than a psychologist, even if the problem is emotional or psychiatric in nature (Caraveo-Anduaga & Mas-Condes, 1990; Martinez Lanz, Medina-Mora, & Campillo Serrano, 1984). Among rural Mexicans, similar results have been found (Salgado de Snyder, Diaz-Perez, & Maldonado, 1995).

Evidently, earlier research on health service utilization and traditional models of pathways to services for Mexican-origin people has contributed in a substantial way to a partial understanding of the help-seeking behavior of this ethnic group (Barrera, 1978; Keefe, 1978; Yamamoto & Silva, 1987). However, most studies have been conducted with treated patients who have reached and obtained formal or specialized services (Stolp & Warner, 1987), leaving a gap of knowledge about the alternate pathways of those who do not reach formal services. Also, many such studies have neglected addressing the influence of socialization practices and health-related beliefs and behaviors that Mexicans, especially in rural settings, learn in their own cultural context prior to migrating to the United States. Finally, the majority of studies have focused on identifying barriers and describing the components of service utilization but not on providing the socio-cultural context for the understanding of movement along a continuum. …

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