Magazine article Clinical Psychiatry News

Access 'Critical' for Hispanic Patients

Magazine article Clinical Psychiatry News

Access 'Critical' for Hispanic Patients

Article excerpt

JoEllen Brainin-Rodriguez, M.D., speaks Spanish fluently, yet even she frequently faces language barriers when trying to help her Spanish-speaking psychiatric patients.

One problem is the dearth of Spanish-speaking psychiatrists, nurses, psychologists, social workers, pharmacists, translators, clerks, technicians, and other members of the health care field.

Dr. Brainin-Rodriguez is one of two Spanish-speaking psychiatrists at A Bridge to Wellness, a partial hospitalization and intensive day-care program in San Francisco for people with psychiatric illness. The program's support groups, however, are run in English.

She searched high and low for a community-based support group that could help a recent patient--an employed, insured Hispanic woman--who spoke a little English but primarily Spanish. Even in multicultural San Francisco, she could find only one, and it met in the evening, when her patient worked.

More Spanish speakers are needed in all sectors of health care, said Dr. Brainin-Rodriguez, also of the University of California, San Francisco. "A translator popping in for 10 minutes during an assessment is not enough to deliver good care."

Hispanics are the fastest-growing ethnic population in the United States. The prevalence of mental illness is approximately the same among Hispanics as in other ethnic populations, but Hispanics are much less likely to get treatment. Approximately 28 million U.S. residents speak Spanish at home, and 14 million of these speak English "less than very well," according to the United States Census 2000.

Recent studies have shown that language barriers make it difficult for Spanish-speaking people with mental illness to schedule medical appointments, to understand a physician's instructions, to take the appropriate doses of medication on time, and to communicate with social workers.

Language isn't the only barrier to care, but it's a big one. In interviews with this newspaper, experts in the field identified several key problems that need to be addressed to improve mental health care for Hispanics. Among the problems cited:

* Lack of Spanish-speaking providers. Only 5% of physicians, 2% of nurses, and 3% of dentists in the United States are Hispanic, said Elena Rios, M.D., director of the National Hispanic Medical Association. The only major program that aims to groom minority grammar school and high school students for careers in health care--the federal Health Careers Opportunity Program--is threatened with closure, as the White House and Congress have proposed eliminating its budget, she said.

* Lack of cultural competence among non-Hispanic providers and little understanding of Hispanic subgroups. The Spanish spoken by people who hail from Puerto Rico, Peru, or Mexico may not be the same, and cultural components can differ. Immigrants face particular mental health problems, such as a higher rate of posttraumatic stress disorder.

"As a practitioner, you need to be aware of these special needs in the Hispanic population," said Ana E. Campo, M.D., chair of the American Psychiatric Association's Committee of Hispanic Psychiatrists.

* Stigma and discrimination related to mental illness. This makes some people reluctant to seek care.

* Distrust of the government. "Hispanics sometimes tend to distrust big institutions and that includes hospitals," added Dr. Campo of the University of Miami. This can be true particularly for immigrants.

* Lack of health insurance among Hispanics. In a 2004 survey, 28% of Hispanics lacked health insurance for more than 1 year, compared with 11% of non-Hispanic blacks and 6% of non-Hispanic whites, according to the National Center for Health Statistics. …

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