When Mercedes Mora talks with Latinos about seeking mental health care, she often compares it to a toothache.
“When you're sick you see a doctor and when you have a toothache you see a dentist,” said Mora, a clinical supervisor and counselor at Guadalupe Centers’ outpatient treatment program. “But when we're feeling emotional unpleasantness, we do nothing.”
It’s a useful analogy because Mora thinks the biggest hurdle for Latinos seeking mental health or addiction counseling is the stigma that goes along with it.
“It's still taboo,” she said. “We're attempting as a community to reassure all people — but especially Latinos — that to seek counseling is not a failure.”
That social imputation is just one factor keeping Latinos from getting the mental health care they need under normal circumstances. Over the course of the last year, the coronavirus pandemic has only served to make the situation worse.
According to analysis from the National Center for Health Statistics and the Centers for Disease Control and Prevention, more than a third of Latinos nationwide have reported frequent symptoms of anxiety or depressive disorder.
In July of last year, the federal Substance Abuse and Mental Health Services Administration described uncontrolled opioid use in the Latino community as a "matter of urgency."
And while their rates of behavioral health disorders don’t significantly differ from the rest of the population, Latinos have substantially lower access to mental health and substance-use treatment services.
Local providers are watching the situation play out in their offices everyday, and are preparing for a surge of folks seeking treatment.
In some cases, the surge has already begun.
“Typically, our small program, if someone called today, they're probably in by next week at the very latest,” said Mora, who has worked at Guadalupe Centers for three decades. “There was a point in, I want to say January or December, where it was a month away for admission.”
Last year 187 people received some type of substance abuse treatment at Guadalupe Centers, according to Mora. About 60% were Latino, and most were men.
Many of them, she said, have been — and still are — anxious about the country’s political climate.
“They were fearful of the future, and so we saw, unfortunately, lots of relapses,” Mora said.
Add the loneliness and stress of being separated from, and having to financially support family in different countries, and the temptation to use can become unbearable.
“They have so much weight on their shoulders,” she said.
Clinics offering more generalized mental health care to Latino clients are facing similar factors.
Not only has the pandemic changed why some patients seek treatment, said Tristen Winston, but it has exacerbated and complicated more familiar stressors.
Winston is the director of behavioral health at Health Partnership Clinic, which operates in Johnson, Miami and Franklin counties in Kansas. She’s also a licensed clinical psychologist and clinical addiction counselor. More than half of her clinic’s patients are Latino.
Prior to the pandemic, many of Winston’s patients worried about losing a job, and the income that comes with it. But analysis from the Pew Research Center shows unemployment rates for Latinos in the U.S. rose sharply during the coronavirus pandemic, particularly among women — peaking at 20.5% in April 2020 — and remains higher for them than for U.S. workers overall.
And while people who were deemed essential workers might have avoided the financial stress of unemployment, they encounter other dilemmas.
“A lot of … our Hispanic patients were continuing to work on the front line during the pandemic, which created a huge child care issue for their children that were home remote learning,” Winston said. “And also a fear for them spreading COVID to their families, coming home after working out in the public during the day.”
During a year when the public was encouraged to stay home as much as possible, many lower-income Latinos had to deal with less than optimal living situations — a tiny apartment shared among multiple families, for instance, or a lack of privacy and alone time, Winston said.
Members of multigenerational households worried about infecting their more vulnerable, elderly family members. And Latinos who were fortunate enough to work from home and could avoid going out had to worry about not seeing family and friends for long stretches.
That’s not to mention the general fear around contracting the coronavirus itself, and the grief that comes with mourning loved ones who passed because of it.
According to a University of Southern California study published in March, Latino immigrants from 20 to 54 years old are more than 11 times as likely to die of COVID-19 than U.S.-born people who are not Latino. CDC numbers show Latinos are more than three times as likely to be hospitalized, and more than twice as likely to die from the disease than white non-Latinos.
Meanwhile, Latinos without proper documentation to be in the country had to make ends meet without the aid of federal coronavirus stimulus money and other kinds of governmental support.
“During the pandemic, all of that (stress) just exponentially grew for those patients,” Winston said, “and their most important recovery tools … their access to their positive social supports — whether it's their family, their friends, their community — all of those were taken away.”
At Winston’s Health Partnership Clinic, that translated into a 60% increase in the number of total patients seeking substance abuse services.
This suite of cultural and social factors is why access to culturally sensitive mental health care is so important, providers agreed, especially for Latinos who speak predominantly Spanish.
“It really helps decrease the stigma around mental health services,” said Winston. “Having staff that's accessible and bilingual and bicultural can really empower patients to collaborate in their treatment planning.”
Andrea Perdomo-Morales’ experience as chief program officer at Vibrant Health in Kansas City, Kansas, reflects the same.
“We have found over the years, especially working with the Latino community, that if people can come to a clinic and see others that look like them, talk like them, that there is an increased sense of trust, and hopefully that they would return for ongoing services if they are needed,” she said.
Three of Vibrant Health’s four behavioral health specialists are bilingual and bicultural, Winston said.
Despite the services these and other clinics offer Latino patients, most providers agree it’s not enough.
“Oh goodness,” Perdomo-Morales said. “I would say we (as a region) are not poised very well at all to keep up with the demand.”
Programs like Adelante Kansas City, supported by Children’s Mercy, have helped increase the number of providers who speak Spanish, but Perdomo-Morales said it’s not uncommon that job openings for bilingual counselors go unfilled in recent years.
Then there’s the cost: Mental health and substance abuse treatment can, for some, be prohibitively expensive, even with insurance.
For now, providers in the area are bracing for another wave of patients.
“The major school districts on the Kansas side are now all open for in-person, and so I anticipate that we will be seeing more and more referrals,” Perdomo-Morales said. “Whether that's through the school social workers that are in place — they will be noticing that families are struggling with a variety of different things — or we will see families themselves reach out to us.”
One thing she doesn’t expect to see is diminishing demand as life starts to more resemble pre-pandemic days.
“Kids and families are going to be adjusting to being back in-person,” she said, “but that feels different, it looks different and there's going to be some anxiety.”
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