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Access 'critical' for Hispanic patients.

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.

* Higher poverty rates in Hispanic communities that put health care out of reach.

Solutions to these problems must take many paths. "We know it's not going to happen overnight," Dr. Rios said.

To improve access to health care for Hispanics, cities need to prioritize creating services specific to various languages, Dr. Brainin-Rodriguez suggested. "In the mental health system, it's critical."

Training primary care physicians to be more culturally competent could help get more Hispanics mental health care, Dr. Campo said. Psychiatric illness is more likely to present as somatic symptoms in Hispanics. That, combined with distrust of big institutions, often drives them to primary care clinics rather than to psychiatrists. "We need to train primary care physicians, so they know when to refer" Hispanic patients, she said.

Some strides are being made in finding ways to reduce the language barrier, Dr. Rios noted. The Department of Health and Human Services' Office of Minority Health held a roundtable of experts over the summer on using technology to create affordable language services in hospitals and clinics.

Lessons learned from a $10 million grant program called Hablamos Juntos ("We Speak Together") will be evaluated this winter. The program distributed funding from the Robert Wood Johnson Foundation to medical institutions in 10 U.S. cities with new and fast-growing Hispanic populations to create affordable Spanish-language services.

"A variety of strategies came out of our demonstrations" that will be posted on the program's Web site ( in the next 6 months, said Yolanda Partida, director of Hablamos Juntos at the University of Southern California's School of Policy, Planning and Development.

The APA is planning to soon post on its Web sites new Spanish versions of its ParentsMedGuide ( and "Let's Talk Facts" fact sheets ( The APA's Office of Minority and National Affairs is creating a speakers' bureau of psychiatrists from different ethnic backgrounds and subgroups within ethnicities.

"These are really umbrella groups that are quite heterogeneous," said Annelle Primm, M.D., who serves as director of the office.

The APA also is looking ahead to publication of the DSM-V a few years from now, to lobby for a translation using a form of Spanish that can be comprehended across Hispanic subcultures, and to ensure adequate copies.


San Francisco Bureau

RELATED ARTICLE: Meetings to Focus On Hispanics

Several upcoming meetings will include a focus on mental health services for Hispanics:

November 7-9, 2005: Mental Disorders Among Latinos: Biological and Psychosocial Influences on Diagnosis and Treatment, Princeton, N.J. Sponsored by the National Institute of Mental Health, Robert Wood Johnson Medical School, and the American Society of Hispanic Psychiatry. See

January 9-11, 2006: National Leadership Summit on Eliminating Racial and Ethnic Disparities in Health, Washington. Sponsored by the Department of Health and Human Services and the Office of Minority Health. See

March 23-26, 2006: Somos Unidos: United to Eliminate Health Disparities for Hispanics, Washington. Sponsored by the National Hispanic Medical Association. See
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Author:Boschert, Sherry
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Oct 1, 2005
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