Introduction.
We live in enlightened times. Like no other era in the history of human civilization has the ethos of all people being equal been as widely accepted as it is today in the United States of America. The American family has been impacted by popular media, and the powerful medium of the World Wide Web could be argued as a tool that brings awareness about our society directly into our homes. Perhaps one could be excused for thinking that equality is the norm in modern USA. Access to quality education, jobs, and effective healthcare are benchmarks upon which equality may be assessed. However, overwhelming numbers of investigations have identified great inequality that exists in the USA today between Americans of different socio-economic classes, races/ethnicities, and genders in pivotal areas such as education, careers, and healthcare (Population Resource Center 1).
The realities of inequality are still prevalent today, as they were over thirty years ago (Lopez 1569). The consequences of continued inequality between racial and ethnic minorities are likely to be of enormous social and economic concern. This is because the proportion of the country’s majority white population has changed from 87% in 1950 to a projected 53% by 2050 (Population Resource Center, 1).
In this paper, we will address inequality across class, race/ethnicity, and gender by examining the access to and treatment of mental health issues in Hispanic American communities. By discussing this example in detail, we can identify patterns of inequality that are relevant to the wider problem as it impacts the lives of Americans today.
Mental health care access and treatment for the Hispanic American minority community.
In 1975, Padilla, Ruiz, and Alvarez reported the underutilization of mental health resources by the Hispanic American community (qtd. in Lopez 1569). According to mental health expert Bob Martinez, the underutilization of mental health resources by Hispanics and the taboos surrounding mental illness remain the elephants in the room” (qtd. in Hernandez 1). Martinez stated in 2006 that mental illness remains “one of the most important issues out there that no one is talking about” (qtd. in Hernandez 1). These almost identical findings were reported over thirty years apart. The Hispanic American minority is projected to make up 25% of the nation’s population by the year 2050 (California Department of Finance, qtd. in Aguilar-Gaxiola 1563). If limited access and treatment for mental health care problems continue for this minority group, enormous ethical and financial burdens may result.
There is an identified need for mental health policies that specifically address the needs of the Hispanic American community.
Many reports have identified inequality in access to and treatment for mental health patients across different groups of Americans (Sen 136, Lopez 1570). A report from California found that Hispanic Americans received only 19.5% of the total outpatient mental health care in a state-funded county health system, despite accounting for 29% of the county’s population (1, Vega 774). This represents a significant shortfall in funding allocated to the Hispanic American community. Even more concerning is the fact that 90% of Hispanic Americans who experienced one or more mental health problems within a one-year period did not receive any care from a specialist (2, Vega 932), highlighting an obvious and dangerous lack of appropriate care. Additionally, studies show that Hispanic Americans are less likely than white or African Americans to comply long-term with treatment once they begin receiving care (Han 136). Given that successful management of many mental health disorders relies heavily on long-term drug treatment (Han 137), this finding is particularly important.
We have identified the barriers that limit access to mental health care and treatment for Hispanic Americans.
One of the most prevalent barriers preventing Hispanic Americans’ access to mental health care is informational. There is a general lack of knowledge about mental health problems and symptoms, coupled with incomplete knowledge of available services and their locations (Aguilar-Gaxiola 1564, Lopez 1570, Katoka 1549). This suggests that the dissemination of information regarding signs or symptoms of mental health problems that require medical attention and what services are offered and where they are located is not reaching the people who need it. A geographical barrier has also been noted. Many Hispanic Americans have limited ability to travel long distances to attend clinics, especially those living in rural areas (Aguilar-Gaxiola 1565). Financial constraints and lack of medical insurance are commonly cited as deterrents for some Hispanic Americans seeking mental health services (Aguilar-Gaxiola 1564). Cultural barriers exist as well; many Hispanic Americans prefer consulting with native Spanish-speaking practitioners when seeking mental health care (Leal 1031). Additionally, their culture does not recognize mental illness as a true illness (Hernandez 1). Ana Lazu (qtd. in Hernandez 1) described being marginalized by her own family who dismissed her struggles with mental illness as crazy,” but even worse was her cultural traditional healer who told her that her condition was derived from witchcraft.
The Effect of Class
Feinstein (1993) studied the effect of socio-economic status or class in relation to the utilization of existing mental health care facilities among Hispanic American minorities. A striking result was found: individuals belonging to middle-income earning families overcame all expected problems facing Hispanic Americans related to their underutilization of mental health care services (Feinstein, 281). This study suggests that socio-economic status or class is strong enough to counteract the effects of race/ethnicity.
A higher percentage of Hispanic Americans are burdened with poverty’s effects (Hernandez, 1) than their white American counterparts. An interesting effect is that many Hispanic Americans work hourly jobs where they lack paid sick leave (Aguliar-Gaxiola 1564). This exacerbates accessing healthcare services, especially when they operate only within normal work hours. The costs associated with transport to a mental health care facility also form a barrier to access care (Aguilar-Gaxiola 1564).
The Effect of Gender
Hispanic women are more likely than men to suffer from mental health issues, particularly depressive mood (Su 141). However, culture has a stronger effect on Hispanic males, who are at higher risk of not seeking medical treatment and being less likely to comply with long-term treatment (Su 142). This observation highlights significant gender differences within the same racial/ethnic and socioeconomic groups.
A policy that has worked.
Despite many studies continuing to show persistent inequalities in access to and treatment of mental health care in Hispanic American communities, one dynamic group has developed a model of positive change. The formation of a task force called the Latino Mental Health Task Force led to the development of an evidence-based policy that focused on action (Aguilar-Gaxiola 1565). Adopting a three-phase approach of community education and mobilization, translating data for multiple stakeholders, and effecting policy, Aguilar-Gaxiola (1567) brought tangible changes to the Hispanic American mental health care system in Fresno, California.
This group increased community education regarding mental illness and available treatment options by bringing Spanish-speaking healthcare providers into the community and encouraging existing mental health care providers to learn Spanish. Translating data for multiple stakeholders meant that study leaders directly showed community leaders what the true costs were of providing more funds for community education, increasing mental health clinic hours of operation, finding Spanish-speaking mental health care providers compared to funding consequences from untreated mental health issues including projected increases in crime and illegal drug use problems (Aguilar-Gaxiola 1567).
Effecting policy meant active and timely review of the effects made or not made with changes being made if necessary. Ongoing critical evaluation was vital part their strategy allowing them a method to show financial responsibility for this study.
Discussion
We need policies to address inequalities in our community services. However, the question remains: are such policies effective? According to the literature reviewed in this paper, past policies have not been effective. To achieve its set goals, a policy needs to be accompanied by dynamic review, evaluation and action procedures. This would enable those charged with implementing the policy to move forward with evidence that confirms if their efforts are working towards correcting the inequality. If the review process shows evidence that the policy is not working, then a change may be made. Without continuous evaluation and policy changes based on evaluation results, any new policy may simply repeat past failures.
The consequences of allowing the current situation of continued underutilization of mental health care services by the Hispanic American community would be enormous. The Hispanic community is expected to grow in percentage of the American population, and there is a correlation between untreated mental health care problems being associated with poverty and crime (Hernandez, 1). Therefore, we cannot afford to ignore the unmet needs of this group.
The study of inequality in access to and treatment of mental health issues within the Hispanic American community provides a detailed example of racial/ethnic, class, and gender inequality affecting our country today. Although this study focused on one specific area of inequality, the pattern of its causes is common to many other examples that affect different racial/ethnic, class or gender groups. These patterns may be identified as: lack of education; ineffective dissemination of information; cultural insensitivity or misunderstanding; unresponsiveness from government services when needs fall outside normal working hours or locations; and a lack of continued review and change-making in response to failed programs.
Perhaps it is naive to imagine that other programs addressing inequalities in access to effective healthcare for at-risk groups within our country, such as low-income families and the African American community, could achieve similar success as the Aguilar-Gaxiola group achieved by following their innovative methods. As the patterns of inequality are basically the same, it could be suggested that the methods of Aguilar-Gaxiola and colleagues (1563-1568) be applied to other areas burdened by continued inequality, such as education and jobs. It is with a policy of active change rather than static apathy that there remains hope for true equality to be achieved.
In an interesting twist of fate, the relatively privileged white majority of today may rely on the racial minority groups of tomorrow as their tax support base in retirement. Statistics show that minorities represent a larger share of U.S. youth, chiefly due to higher fertility rates, while non-Hispanic whites constitute the bulk of the nation’s elderly. About 35% of U.S. children under 18 are minorities, while 84% of those over 65 are non-Hispanic whites. By 2025, almost half (47%) of American children will be African-American, Hispanic or Asian (Population Resource Center 1). This may prove to be a significant incentive for our country to finally resolve continuing inequalities that burden our people.
Works Cited
Aguliar-Gaxiola, S.A., Zeleny, L., Garcia, B., Edmondson C., Alejo-Garcia C., and Vega.
In the article Translating Research into Action: Reducing Disparities in Mental Health Care for Mexican Americans” published in Psychiatric Services in December 2002, W.A. discusses ways to reduce disparities in mental health care for Mexican Americans.
Feinstein J.S. conducted a review of the literature on the relationship between socioeconomic status and health. The findings were published in The Milbank Quarterly, Volume 171, in 1993, spanning from page 279 to page 322.
Han, E. and Liu, G.G. conducted a study on racial disparities in prescription drug use for mental illness.
Among Population in the U.S.,” published in the Journal of Mental Health Policy and Economy in September 2005, explores various mental health issues affecting Americans. The article is a valuable resource for anyone interested in understanding the current state of mental health policy and its impact on society.
Hernandez, J. wrote an article titled The Elephant in the Room: Latinos and Mental Health” in 2006.
http://news.newamericanmedia.org
Kataoka, S.H.; Zhang, L.; and Wells, K.B. conducted a study on the unmet need for mental health care among children in the United States. The study found that there is variation in unmet need based on ethnicity and insurance status.
American Journal of Psychiatry, September 2002: 1548-1555.
Leal, C.C. conducted a study titled Stigmatization of Hispanic Children, Pre-adolescents and Adolescents with Mental Illness: Exploration Using a National Database.
Issues for Mental Health Nursing, December 2005: pages 1025-1041.
Lopez, S.R. (2002). A Research Agenda to Improve the Accessibility and Quality of Mental Health Care to Latinos.” Psychiatric Services, 53(12), 1569-1573.
Population Resource Center’s Executive Summary: A Population Perspective of the United States” was published in 2000. The summary can be found at http://www.prcdc.org/summaries/uspopperspec/uspopperspec.html.
Sen, B. (2004). Adolescent Propensity for Depressed Mood and Help Seeking: Race and Gender Differences.” Journal of Mental Health Policy and Economy, 133-145.
(1) Vega, W.A.; Kolody, B.; Aguilar-Gaxiola, S.A. et al. conducted a study on the lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. The study was published in the Archives of General Psychiatry in 1998 and found that these disorders were prevalent among both urban and rural Mexican Americans.
(2) Vega, W.A.; Kolody, B.; Aguilar-Gaxiola, S.A. et al. Gaps in Service Utilization by Mexican Americans with Mental Health Problems.
American Journal of Psychiatry, 1999, 928-934.
