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 in the United States of America today. The American family has been impacted upon by the popular media. The powerful medium of the World Wide Web could be argued as a tool bringing awareness about our society directly into the comfort of our homes. Perhaps one could be excused for thinking that equality is the norm in modern USA. Access to quality education, access to jobs and access to effective health care are benchmarks upon which equality may be assessed. Overwhelming numbers of investigations have identified great inequality exists in the USA today between Americans of different socio-economic class, race/ethnicity and gender in the pivotal areas of education, careers and health care (Population Resource Center 1).
The realities of inequality are as prevalent today as they were over thirty years ago (Lopez 1569). Consequences of continued inequality between racial/ethnic minorities are likely to be of enormous social and economic concern as the proportion of the country’s majority white population is changing from 87% in 1950 to a projected 53% by 2050 (Population Resource Center 1).
Inequality across class, race/ethnicity and gender will be addressed in this paper by examining the access to and treatment of mental health issues in the Hispanic American communities. By discussing in detail this example of inequality patterns are identified that are relevant to the wider problem of inequality as it impacts upon the lives of Americans today.
Mental Health Care: Access and Treatment for the Hispanic American Minority Community
In 1975 Padilla, Ruiz and Alvarez, (qtd. in Lopez 1569) reported the underutilization of mental health resources by the Hispanic American community. “The underutilization of mental health resources by Hispanics and the taboos surrounding mental illness remain the elephants in the room,” according to mental health expert Bob Martinez. Mental illness remains “one of the most important issues out there, that no one is talking about,” he stated in 2006 (qtd in Hernandez 1). These almost identical findings were reported over thirty years apart. The Hispanic American minority is projected to make up twenty-five percent 25% of the nation’s population by the year 2050 (Californian Department of Finance, qtd in Aguilar-Gaxiola 1563). If the current situation of limited access and treatment for mental health care problems continues for the Hispanic minority enormous ethical and financial burdens may result.
An identified need for mental health policies for the Hispanic American community
Many reports have identified inequality in the access and treatment for mental health patients across different groups of Americans (Sen 136, Lopez 1570). A Californian report identified that Hispanic Americans received nineteen point five percent of the total outpatient mental health care in a state funded county health system. However, the Hispanic American minority accounted for twenty-nine percent of that county’s population (1,Vega 774). This shows a significant shortfall in the funds utilized by the Hispanic American community as compared to what would have been expected to by used. Even more striking is the finding that ninety percent of Hispanic Americans who have had one or more mental health problems in a one-year period had not received any mental health care from a mental health care specialist (2, Vega 932). With a ninety percent failure rate there is an obvious and dangerous lack of appropriate care illustrated. Another important observation is that Hispanic Americans are less likely to comply long term with treatment once they start a regimen of care compared to white or African Americans (Han 136). The successful management of many mental health disorders relies heavily on long-term drug treatment (Han 137).
Identified barriers that limit mental health care access and treatment of Hispanic Americans.
One of the most prevalent barriers preventing Hispanic American’s access to mental health care is informational. A general lack of knowledge about mental health problems and symptoms coupled with incomplete knowledge of what services are available and the location of those services has been described (Aguilar-Gaxiola 1564, Lopez 1570, Katoka 1549). This suggests that the dissemination of information regarding what signs or symptoms of mental health problems are important to seek medical information for and what services are offered and from where are not reaching the very people they are designed to help. A geographical barrier has been noted. Many Hispanic Americans state a limited ability to travel any distance to attend clinics. This is particularly evident in Hispanic Americans living in rural areas (Aguilar-Gaxiola 1565). Commonly quoted is financial and / or lack of medical insurance as a deterrent for some Hispanic Americans to seek mental health services (Aguilar-Gaxiola 1564). Cultural barriers particularly the desire for consulting with native Spanish speaking practitioners has been documented as a barrier for many Hispanic Americans in seeking mental health care (Leal 1031). Cultural barriers also exist for Hispanic Americans in that 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 mental illness as being crazy but even worse was her cultural traditional healer who told her that mental illness 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 in Hispanic American minorities. A striking result was found. All expected problems facing Hispanic Americans in relation to their under utilization of mental health care services were overcome in individuals belonging to middle income earning families (Feinstein, 281). This study suggests that the effect of socio-economic status or class is strong enough to counteract the effects of race/ethnicity. A higher percentage of Hispanic Americans are burdened with the effects of poverty (Hernandez, 1) than their white American counterparts. An interesting effect of this is that many Hispanic Americans are employed on an hourly basis where they are not provided paid sick leave (Aguliar-Gaxiola 1564). This exacerbates the situation of accessing health care services especially where they operate only within normal work hours. The costs associated with transport to a mental health care facility also formed a barrier to assess to care (Aguilar-Gaxiola 1564).
The effect of gender
Hispanic women were more likely to suffer from mental health issues, particularly depressive mood (Su 141) than men. However, the effect of culture played more strongly on Hispanic males, who were at a higher risk of firstly not seeking medical treatment and secondly were less likely to comply with treatment long-term (Su 142). This observation showed that there are significant gender differences within the same racial/ethnic and class or socioeconomic groups.
A policy that has worked
Despite many studies continuing to show persistent inequalities in access and treatment of mental health care in Hispanic American communities one dynamic group have developed a model of positive change (Aguilar-Gaxiola 1564). The formation of a task force called, The Latino Mental Health Task Force lead to the development of an evidence-based policy that focused on action (Aguilar-Gaxiola 1565). Adopting a three phase approach of: 1) community education and mobilization; 2) translating data for multiple stakeholders and 3) 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 the treatment options that were available by bringing Spanish speaking health care providers into the community and encouraging existing mental health care providers to learn Spanish. Translating data for multiple stakeholders meant that this study leaders showed directly community leaders what the true costs of providing more funds for community education, the increasing of mental health care clinic hours of operation and finding Spanish speaking mental health care providers was compared to the cost of funding the consequences of untreated mental health issues including projected increases in crime and illegal drug use problems (Aguilar-Gaxiola 1567). Effecting policy in this case meant active and timely review of the effects of he changes that were being made or not made and making changes to their strategies that failed. Ongoing critical evaluation of their results was a vital part of their strategy and allowed them a method to show financial responsibility for this study.
We need policies to address inequalities in our community services that plan for improvement but are such policies effective? The literature reviewed in this paper suggests that the policies in the past have not been effective. For a policy to achieve its set goals it needs to be accompanied by dynamic review, evaluation and action procedures. This would enable the people who are charged with implementing the policies to move forward with evidence that confirms if their efforts are working towards correcting the inequality. However if the review process shows evidence that the policy is not working then a change in policy may be made. Without continuous evaluation and policy changes that reflect the evaluation results any new policy may simply repeat the failed policies of the past.
The consequences of allowing the current situation of the continued under utilization of mental health care services by the Hispanic American community would be enormous. With the Hispanic community expected to grow in percentage of the American population and a correlation between untreated mental health care problems being associated with poverty and crime (Hernandez, 1) we can not afford to ignore the unmet needs of this group.
The study of inequality in access and treatment of mental health issues in the Hispanic American community provides a detailed example of racial/ethnicity, class and gender inequality affecting our country today. While this study focused on one specific area of inequality the pattern of its causes are common to many other examples of inequality affecting other racial/ethnic, class or gender groups. The pattern of its causes may be identified as: lack of education; lack of dissemination of information in an effective manner; lack of cultural sensitivity or understanding; lack of responsiveness of government services when the 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 naïve to imagine that other programs addressing inequalities in access to effective heath care for other at risk groups within our country such as low-income families and the African American community could achieve similar success as the Aguliar-Gaxiola (1568) group achieved by following their innovative methods. As the patterns of inequality are basically the same perhaps it could be suggested that the methods of Aguliar-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 that true equality will be achieved.
In an interesting twist of fate the relatively privileged white majority of today are likely to be relying on the racial minority groups of tomorrow to be their tax support base in their retirement. The statistics show that “chiefly because of higher fertility rates, minorities represent a larger share of U.S. youth, while non-Hispanic whites constitute the bulk of the nation’s elderly. About 35 percent of U.S. children under the age of 18 are minorities, while 84 percent of those over 65 are non-Hispanic whites. By 2025, nearly 47 percent of American children will be African-American, Hispanic or Asian” (Population Resource Center 1). This may prove to be the greatest incentive for our country to resolve at long last the continuing inequalities that burden our people.
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(1) Vega, W.A.; Kolody, B.; Aguilar-Gaxiola S.A. et al. “Lifetime prevalence of DSM- III-R psychiatric disorders among urban and rural Mexican Americans in California” Archives of General Psychiatry 1998: 771-778.
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