Hispanic/Latinx
The Hispanic/Latinx community in the U.S. is very diverse, including people from many different nations and regions of the world. Individuals of Mexican, Puerto Rican, Cuban, Central American and South American descent have been part of the American cultural tapestry for centuries. As with any community, the mental health needs and experiences of Hispanic/Latinx people vary among subgroups.
While there is great diversity within this community, there are some shared cultural factors that connect people regardless of ancestry or national origin. For some, their indigenous roots are a source of pride. A large portion of this community speak Spanish. There is also a shared connection of religious affiliations, strong family bonds, connections to extended networks and a resilient approach to life and work. Another common value in this community is “familismo,” a cultural foundation that emphasizes connectedness and a strong attachment and duty to one’s family.
Identity and Culture
Identity and culture for members of the Hispanic/Latinx community is as complex and rich as the history and trajectory of this population. In other words, there is no one Hispanic/Latinx culture.
It is important to appreciate these differences and understand how community members self-identify based on race, ethnicity, and/or national origin. Those who identify as Latino, Latina, Latine or Latinx may consider themselves of Latin American ancestry (Central America, South America, or the Caribbean). Since the Spanish language is typically gendered, the terms Latine or Latinx are used to eliminate a binary choice (male vs. female) that is limiting and excluding to trans, gender fluid, or non-binary individuals. Those who identify as Hispanic may be referring to ancestors from Spain or other Spanish-speaking countries.
Since cultural identity is a construct shared by groups, recent immigrants may identify by their country of origin instead of as “Hispanic” or “Latinx.” It is also possible that members of this population may use different terms interchangeably.
Barriers to Mental Health Care
Hispanic/Latinx communities show similar vulnerability to mental illness as the general population, but they face disparities in both access to and quality of treatment. More than half of Hispanic young adults ages 18-25 with serious mental illness may not receive treatment. This inequality puts these communities at a higher risk for more severe and persistent forms of mental health conditions, because without treatment, mental health conditions often worsen.
35.1% of Hispanic/Latinx adults with mental illness receive treatment each year compared to the U.S. average of 46.2%. This is due to many unique barriers to care.
Language Barriers
Language barriers can make communicating with providers difficult, or even impossible, particularly when a person is seeking counseling for sensitive or uniquely personal issues. These topics can be difficult for anyone to put into words, but it is especially difficult for those who may not speak the same language as a potential provider.
Although Spanish is the official language in most of Latin America, some Latino/Latinas may speak other languages or dialects, such as Quechua, Nahuatl, or Portuguese. Additionally, Latinx families may be bilingual or mixed-language families; therefore it is helpful for providers to ask what the patient and families’ preferred language is before starting an evaluation and to use interpreters when necessary.
Poverty and Less Health Insurance Coverage
17.0% of Hispanic/Latinx people in the U.S. live in poverty (compared to 8.2% of non-Hispanic whites). Individuals who live in poverty have a higher risk of mental illness and, conversely, individuals with mental illness have a higher risk of living in poverty.
According to the Kaiser Family Foundation, in 2019, 20.0% of non-elderly Hispanic people had no form of health insurance. In addition to facing an already limited pool of providers due to language barriers, people identifying as Hispanic/Latinx have even fewer options when they are uninsured.
Lack of Cultural Competence
Due to cultural differences and/or lack of cultural competency, mental health providers may misunderstand or misdiagnose Hispanic/Latinx patients. For example, an individual may describe feeling “nervios”, fatigue, headaches or other physical ailments. While these symptoms are consistent with depression, a provider without training on how culture influences a person’s interpretation of their symptoms is highly likely to misdiagnose them.
Legal Status
For immigrants who arrive without documentation, the fear of deportation can prevent them from seeking help. Even though millions of children of undocumented immigrants are eligible for health insurance under the Affordable Care Act, many families either may not know about their eligibility or be afraid to register due to fear of separation and deportation.
Acculturation
The level of a person’s acculturation, how thoroughly they have embraced or adopted the predominant culture of the place they live, can play a role in mental health and access to care. Acculturation has been found to predict an increased willingness to use of mental health care services between first and second generation immigrants from various cultural backgrounds.
Hispanic/Latinx communities have an added risk of experiencing mental health issues because of the stress of facing discrimination while also trying to navigate between different cultures.
Stigma
People in the Hispanic/Latinx community can be very private and may not want to publicly talk about challenges at home or in their lives. This can continue the cycle of stigma about mental health within the community, as talking about it can be viewed as taboo. Many in the Latinx community are familiar with the phrase “la ropa sucia se lava en casa” (similar to: “don’t air your dirty laundry in public”. The direct translation is: “clean dirty clothes at home”.). Some people do not seek treatment for mental illness out of fear of being labeled as “locos” (crazy) or bringing shame and unwanted attention to their families. Additionally, faith communities may be a source of distress if they are not well informed and do not know how to support families dealing with mental health conditions.
Stigma within the Hispanic/Latinx community can also lead to a lack of information as individuals may not recognize the symptoms of mental health conditions or know where to seek help. In turn, this may cause individuals to not seek treatment.
When mental health is not commonly or openly talked about, people seeking treatment may have limited knowledge and comfort with the different types of therapy and psychiatric medications available. Providers should use a compassionate and collaborative approach to engage individuals in treatment planning. Incorporating education, symptom monitoring and engagement with community resources can be important ways to support a person’s decision to start therapy or psychiatric medication.
How to Seek Culturally Competent Care
For mental health providers working with Hispanic/Latinx clients or patients, exploring cultural identity may offer important information to tailor their mental health treatment. Cultural humility is necessary to provide quality care. This refers to the ability to recognize that culture plays a large role in a person’s health and well-being and may sometimes affect the provider’s ability to best serve their patient’s needs.
A provider who understands a patient’s culture and needs will know culturally specific information. For example, someone might describe what they are feeling with a phrase like “Me duele el corazón.” While this literally means “my heart hurts,” it is an expression of emotional distress — not a sign of chest pain. A culturally sensitive doctor would be aware of this interpretation and would ask for more information instead of assuming the problem is purely physical.
While we recommend going directly to a mental health professional, a primary care doctor can be a great place to start for an initial assessment or to get a referral for a recommended mental health professional. Community and faith organizations may also have a list of available mental health providers in your area.
When meeting with a provider, it can be helpful to ask questions to get a sense of their level of cultural awareness. Providers expect and welcome questions from their patients or clients, since this helps them better understand what is important in their treatment. Here are some sample questions:
- Have you treated other Hispanic/Latinx people?
- Have you received training in cultural competence or on Hispanic/Latinx mental health?
- How do you see our cultural backgrounds influencing our communication and my treatment?
Whether you seek help from a primary care doctor or a mental health professional, you should finish your sessions with health professionals feeling heard and respected. You may want to ask yourself:
- Did I feel heard? Did I feel my provider understood my concerns?
- Did my provider communicate effectively with me?
- Is my provider willing to integrate my beliefs, practices, identity, and cultural background into my treatment plan?
- Did I feel like I was treated with respect and dignity?
- Do I feel like my provider understands and relates well with me?
If your preferred language is not English, let the office staff know when you schedule your appointment; this will allow them to schedule an interpreter before your visit. When using an interpreter, your mental health provider should:
- Look at you directly when speaking — not communicate only with the interpreter.
- Ask short questions and communicate short messages to promote effective interpretation and reduce errors.
- Allow enough time for the interpreter to finish the statement and for you to ask questions when you need to.
If you believe that language barriers are negatively affecting your mental health treatment, consider bringing it up to your mental health provider. They may be able to schedule more frequent or longer appointments to allow adequate time for the use of the interpreter.
The relationship and communication between a person and their mental health provider is a key aspect of treatment. It’s very important for a person to feel that their identity is understood by their provider to receive the best possible support and care.
Although it has declined in the past decade, the highest percentage of immigration to the U.S. comes from Mexico. Additionally, rates of migration from Central American countries including Guatemala, Honduras and El Salvador have increased in recent years due to systemic challenges of poverty, political persecution and organized crime, and large-scale destabilization from hurricanes, floods, earthquakes, and volcanic eruptions.
As Hispanic/Latinx people continue to migrate to the U.S. and become a larger and more diverse segment of our population, it is important to understand the internal diversity, experiences, and needs of these communities.
Mental Health Factors for Immigrants
In addition to the wide range in national origin and ethnicity, Hispanic/Latinx immigrants come from diverse socioeconomic and educational backgrounds and have arrived under different documentation statuses. The community includes documented immigrants who have received permanent residency or citizenship status, undocumented immigrants, U.S.-born children of undocumented immigrants, and young people eligible for temporary protected status granted under DACA (Deferred Action for Childhood Arrivals) and the DREAM (Development Relief and Education for Minors) Acts.
Depending on their reasons for migration, and the way in which they migrated to this country, members of this community may experience significant stressors — including severe physical, emotional, and mental health trauma — that can increase their risk of poor mental health, worsen an existing mental illness or result in a new chronic condition.
Trauma Among Refugees and Asylum Seekers
Refugees and asylum seekers are a significantly vulnerable population at risk for worsened mental health outcomes. Many are seeking asylum due to trauma, violence, and other social injustices unaddressed in their home countries. Additionally, the migration journey itself, and the relocation in a new country, can involve physical and emotional trauma.
The process to be granted refugee status is long, usually lasting years, while the individual awaits resettlement at a refugee camp or a secondary country. When it comes to mental health and trauma, unaccompanied minors, children and adolescents who migrate to the U.S. without the company of an adult or a caregiver, or have been separated from their parents at the border, are a specific population of concern.
These children face significant mental health challenges as they often face mistreatment and lack social support. The results of trauma endured by separated families have not been fully measured or reported, but the impact of mental health as a result of adverse childhood experiences is well documented.
Immigration Status
For people who arrived in the U.S. without documentation, or those who are awaiting formal recognition of permanent residence or citizenship, everyday experiences of finding work, housing, and medical care are fraught with uncertainty and risk. Young people eligible for DACA and DREAM Act status may face prolonged stress and anxiety during the application process and while their status is pending renewal. Mixed-status families, those with undocumented parents and U.S.-born children, can face significant stress and many barriers when accessing care. In addition to the challenges of stigma, language barriers, and lack of insurance, family members may not seek care or may not be fully forthcoming about immigration-related stress or status due to fear of deportation.
Undocumented individuals often must navigate systemic challenges with limited social support, placing them at high risk of mistreatment or discrimination in their homes, work environments, and broader society. Mental health providers working with these vulnerable populations benefit greatly from additional education about their mental health needs, as well as from partnerships with community organizations who support the social needs of these individuals.
Assimilation
Immigrants can feel an intense pressure to “assimilate” into U.S. culture, adopting mainstream social and cultural practices at the expense of losing traditional ones. This includes expectations that they learn and primarily speak English, consume mainstream American media, and dress, act, and eat according to mainstream American standards.
The pressure to assimilate into U.S. culture can be a risk factor for poor health. One way to decrease these risks is to promote biculturalism, the understanding and appreciation of belonging to two cultures. Collectively, we can enhance our understanding of intersecting identities — valuing and respecting different cultures and their worldviews as part of a stronger and diverse society.
Mental Health Factors for Second-Generation Immigrants
Although trauma and stress are common in first-generation immigrants, children born in the U.S. to immigrant parents have even higher rates of mental illness than their parents — an experience known as the “immigrant paradox.” This is an area that continues to be studied, but several possible explanations have been explored.
Generational Trauma
People choose to immigrate to the U.S. for many reasons, but undocumented immigrants are often motivated by violence, political or religious persecution, poverty, and other traumatic experiences in their country of origin. These experiences can directly affect mental health, resulting in personal struggles and difficulties for the individual and longer-term impacts that affect the next generation.
Differing Cultural Beliefs
A person born in the U.S. to immigrant parents may experience conflict between the attitudes, beliefs and values of the parents’ culture and those that are more prevalent in the U.S. Parents will often try to preserve their cultural roots through maintaining beliefs and practices from their home country, while their U.S.-born children may separate or dissociate from their parents’ beliefs due to a lack of strong connection to the country of origin or a desire to be “more American.” Because cultural beliefs and practices have deep roots and are often fundamental to a person’s identity, it can be hard to discuss and resolve differing perspectives and viewpoints within the family.
Seeking Mental Health Care
The decision to immigrate and the ensuing experiences of migration and acculturation require great strength and resilience. Although many are able to rely on this personal strength and the protective factors of community and culture, the stress involved in immigration may cause significant challenges.
Differentiating between “natural” or expected responses to the stress of immigration and the presence of a mental health issue that requires treatment and professional support can be difficult, and often requires seeking support from friends, family, and the community. Primary care doctors, counselors, religious leaders, and community organizations supporting immigrants can all be great resources to discuss any concerns about your mental health.
However, if your sleep, eating, daily mood, relationships, and ability to function at work or school are affected, it is likely time to seek the help of a professional. Mental health treatment can include dialogue-based or behavioral therapy, medication, or a combination of both. Increasingly, no cost or low-cost practices like mindfulness and breathing exercises are being used to address mental health conditions such as anxiety and PTSD. A culturally competent mental health provider can help you understand and navigate the specific challenges you may be facing, and determine what type of treatment and support is best for you.
Mental health providers may or may not have additional education or training in working with immigrant patients. It may be helpful for you to prepare ahead of time with information you think is important to discuss with your mental health provider, including:
Concerns about financial cost of treatment, including visits, medications, and therapy.
Concerns about insurance coverage. Your documentation status may affect your ability to receive services, as most mental health providers require insurance coverage. If you do not have insurance, it may be helpful to ask faith leaders or community center workers for mental health providers who may offer free or low-cost mental health services. Be aware that emergency services are generally covered for undocumented immigrants.
Concerns about privacy, especially regarding documentation status. Be aware that your mental health provider is not required by law to share your medical records with government authorities.
Cultural beliefs or practices that may affect your mental health treatment. For example, some families strongly believe that mental illness does not need to be treated with medications. If you or your family believes this, do not hesitate to discuss this with your mental health provider so they can incorporate this important information in your treatment plan.
Concerns about having a bilingual practitioner or the use of interpretation services.
Disclosing Your Status and Migration History
A culturally competent mental health provider will appropriately and respectfully discuss your immigration status and your migration history to determine how to best provide treatment and support. They may ask questions about how long you have lived in the U.S., what led to your decision to migrate and your life experience living in the U.S. — but they should not take up time during appointments to give any opinion or judgment about your experience and choices. Your provider should use open-ended questions and allow you to provide however much information you feel comfortable sharing.
Providers should make it clear that the information you share is confidential and will not affect your access to medical treatment. You should see signs or receive a notice that outlines their confidentiality policy and the measures they will take to protect their records from scrutiny by immigration agencies. If you don’t see a notice, feel free to ask and get assurances that your documentation status information will be protected.
When finding a provider, it may be helpful to inquire about their use of interpreter services. Interpreter services should be available during phone calls when making an appointment, when you are evaluated by the medical provider and by any other staff member who interacts with you at the doctor’s office.
Whether you seek help from a primary care doctor or a mental health professional, you should finish your sessions with health professionals feeling heard and respected.
Additional Resources
If finances are preventing you from finding help, contact a local health or mental health clinic or your local government to see what services you qualify for. You can find contact information online at findtreatment.samhsa.gov or by calling the National Treatment Referral Helpline at 800-662-HELP (4357).
Johns Hopkins Centro Sol promotes equity in health and provides opportunities for Latinos by advancing clinical innovations, diversity in research, education access and exposure, and advocacy in active partnership with the Johns Hopkins Institutions and their Latino neighbors.
If you or your loved one does not speak English, or are not comfortably fluent, you have the right to receive language-access services at institutions that receive funding from the federal government as well as the right to request a trained interpreter and to receive forms or information in your preferred language.
If you do not have legal documentation, seek out clinics and resources that care for all members of the community. Latinx-based organizations often provide services regardless of legal status.
