The Future of Health Care for Hispanics - Research Paper Example

The Future of Health Care for Hispanics According to the U.S. Census Bureau, the estimated population of Hispanics in the United States in 2008 was 46.9 million. This makes them the largest ethnic and racial minority. By the year 2050, it is estimated by the Census Bureau that there will be 132.8 million Hispanic people in the United States (U.S. Census Bureau, 2009). In many cities across the Nation, it has become more important to understand how to work with Hispanic clients so that they can get the best treatment possible. Multicultural counseling skills are important for every counselor to develop in order to understand what to do in certain situations. Most therapists have an understanding of their own cultures but they must learn about people who are outside their culture. Since the Hispanic population continues to grow, there is also a need for counseling of new immigrants. It is important to understand that that although the government has created the word "Hispanic" to cover all people who speak Spanish in the United States, there are many types of people that make-up the population referred to as Hispanic. Paniagua (2001) points out this fact and tells the clinician that not only should they be aware that Hispanic has many uses, but that it has different meaning to people who are Spanish speaking (p. 3). In the Hispanic community this term can mean "individuals from Spanish speaking Latin American nations including Central American Countries (Mexico, Panama, Costa Rica etc.), South American countries (Venezuela, Colombia, etc.) and the Caribbean (Puerto Rico, Cuba, Dominican Republic" (Paniagua, p. 4). These terms are just the tip of the iceberg because there are many other terms like Latina, Latino and more that are all a part of the Hispanic community. There are also many differences in family structures, relationships. The fact that the family is of major importance to Hispanics which is very different from some other cultures. Because of these differences, it is important to realize that a counselor must understand how the Hispanic families see the world. The Importance Of Family Family is important to traditional Hispanic families. This means that the entire family, including the extended family, it is important. When a Hispanic family member needs to talk to someone, they will turn to someone in their family. This fact is important for the counselor to understand because when an individual comes to counseling, they may bring family members. The extended family may also include the minister, close friends to the family or other members of their church (Paniagua, p. 5P. There is a strong level of respect for older family members because they are seen as the wise aspects of the lineage. Cultural Values Within many Hispanic families, the oldest male is seen as the head of the family. Often this is the father, but in the absence of a father, the oldest male could be an uncle, cousin or brother. The word for this is "machismo" and it usually suggests specific roles for the head male (Paniagua, p. 5). In this situation, the wife is to take care of the home and the children, and must teach the children to follow the rules that the father sets; in many cases the wife may also have to follow these rules. The opposite of machismo is "marianismo" which is the cultural value that means women must be "submissive, obedient, dependent, timid, docile, sentimental, gentle, and to remain [a] virgin until they marry" (Paniagua, p.6). Counselors should note these two values as important, especially when counseling Hispanic women. The effects of machismo may make it difficult for them to make their own decisions without consulting boyfriends, husbands or fathers. Religious Beliefs Many Hispanic Americans are very religious and often Catholic. The priest or minister is important for counseling with their families and if an individual has to come to counseling, the priest or minister may be important to consult. Some Hispanic people may believe that the mental health problems are coming from a supernatural or cause or a result of "evil spirits" (Paniagua, p. 7). Counselors may find that the curandero(a) or the bruya(o) have been consulted in these situations before coming to counseling. Counselors must understand this information within the cultural context. Acculturation Although many counselors may think that every person who comes to America strives to let go of their culture to become an American, this may not be totally the case. Some Hispanic people strive to live in two cultures. They want to preserve their language and culture and learn to adapt into the dominant culture without losing themselves. In families, acculturation may be different in each generation. Also, there may be different levels of acculturation in each family which may have an impact on their treatment. The level of acculturation is important to assess when someone comes into treatment because it may have an effect on symptoms or treatment (Panigua, p. 8). As an example, an individual experiencing depression may be influenced by their inability to make friends at school. They may perceive this as the other kid's being mean to them. This could mean that the individual must learn how to make friends or it could be that they must learn to cope with racism. In other words, there may be more than one reason for their depression. Gonzalez and Gonzalez-Ramos reported that studies show that those Hispanic Americans who do a total acculturation to American values and behaviors are negatively affected; those who retain their traditional culture are affected more positively (p. 90). Attitudes Towards Mental Health Mental health in the Hispanic community is perceived as something to do with forces outside the individual. Many people believe it is the result of evil forces or sin. They go to their healers inside the community because they feel it is a sign of weakness, which results in a stigma about the use of mental health services (Maldonado-Schullo, 2009, p. 1). To this end, they may feel that the mental illness is something that will pass if the individual prays about it and the family will help (Maldonado-Schullo, p. 2). Common Mental Health Challenges The literature supports several issues that seem to occur within the Hispanic community that are important for the counselor to understand. Some are related to culture and other are based in the challenges with coming to a new country. Depression Depression is a major issue for many men and women. According to NAMI (2001), "Latinos are identified as a high risk group for depression, anxiety and substance abuse" (p. 1). Forty six percent of Latina women experience depression and this is higher in the U.S. born who are long-term residents than for those who are new immigrants (NAMI, p. 1). Cabassa (2007) states that approximately six million men suffer from depression each year (p. 492). He suggests that immigrant Latino men are more vulnerable than other males and they do not seek mental health care for it. Many Hispanic men become depressed when they cannot ;provide for their families (Cabassa, p. 493). Risk factors for depression There is no single cause of depression but there are many conflicts and pressures that affect many new and old immigrants. In most situations Hispanic people come to the United States and leave behind their families. They maintain their strong ties at home which helps some deal with the pressures in the U.S. (Maldanado-Schull, p. 1). Many older Hispanics deal with the isolation that can come as family members leave or move away (Gonzalez and Gonzalez-Ramos, p. 71). Also, Hispanic youth are prone to depression and statistically, they are at higher risk for psychological distress than Caucasian youth I(Gonzalez and Gonzalez-Ramos, p. 8). Counselors must be aware that suicide is another risk factor that can be present in the Hispanic community. SPAN USA has starling statistics in this area for the years 1999-2004: 1. The highest suicide rate was found in adult males 85 and older; 30.69 per 100,000. 2. Suicide ranked as the 11th leading cause of death for Hispanics over all races and ages. 3. Suicide was the third leading cause of death for youth 15-24 years old. 4. High school student also have their own statistics: A Youth Risk Behavior Survey done in 2005 by the Center for Disease Control showed the following statistics: 1. 11.3% of youth said they had made a suicide attempt versus 8.4% in the entire U.S. 2. 14.5% said they had a plan for suicide versus 13% for the rest of the U.S. 3. More female students reported thoughts of suicide than males or other non-Hispanic Youth (SPAN USA, 2001, p. 1). From these statistics is clear that suicide is an important issue to consider when Hispanic youth and Adults come to counseling. Davis (1991) found through her study that the degree of acculturation that an individual had would influence how they appeared in counseling. The stressors that come from acculturation "may combine to result in high rates of depression" (p. 79). Loss and separation are also stressors that can lead to depression. For many Hispanic immigrant children, being uprooted from what they know and being taken away from their social and cultural world, many children suffer depression or other mental health problems. Some of the reasons this happens is because "these events place enormous demands on the individual for personal change and adaptation" (Serafica, Schwebel, Russel et al, 1990, p. 38). Children not only have to adapt to the new environment, but they have to adapt to a different social environment, a new culture and climate and there are linguistic changes. They will also have to adapt to a new school where many teachers and children mistreat them because they are different. These issues can make problems in school become larger for the child (Serafica, Schwebel, Russell et al, p. 40). Since depression is a major challenge for Hispanic people, it is important to understand the cultural challenges that bring it into fruition. Mental Health Assessment With Hispanics NAMI (2009) states that "mental illness reach does not adequately include Latinos" (p. 3). Children and youth also get less treatment than adults. NAMI also quotes a 1998 study on mental health that said that most states do not have "appropriate health data for minority populations" (NAMI, p. 3). Within this context, many Hispanic people have been over diagnosed, under diagnosed or mis-diagnosed (Paniagua, p. 14) when cultural differences are not taken into consideration. The DSM-IV, the primary diagnostic tool for determining a diagnosis in counseling, did not adequately explain cultural variants for clients. Usually cultural features are discussed within the context of other features or by itself but not within the context of specific illnesses (Paniagua, p. 15). The special considerations that should be considered in assessment include: Acculturation The level of acculturation is important each family member may have a different level of acculturation. There are several scales that can be used to measure acculturation. One scale developed by Paniagua, called The Brief Acculturation Scale "emphasizes three variables: a) generational status, b) the language the client prefers to use and c) a client's preference of social activities with a particular group" (Paniagua, p. 30-31). When scoring this instrument the scores range between 1 and 5, and the higher the score, the more it is assumed that the individual has acculturated. This scale is one of many in this category that was developed to test acculturation. Mental Status The general Mental Status Exam must be modified to take into consideration the variations in cultures. The challenge with this exam is that it assumes that normal behaviors and cognitive processes are "The same" for everyone regardless of culture. By assuming this is the same in every situation, many therapists will misdiagnose the psychopathology of the individual (p. 32). Also, questions on the test may or may not be within the experience of the individual. As an example, some Hispanics may not count forwards and backwards as a matter of course, so "failing" in this area may not be a true test of mental status. They may not understand what is meant by this if they have never had the experience. Another example give by Paniagua is of the question, "What is your last name?" This may cause confusion for some Hispanics who have more than one name. Also, days of the month can be confusing if the individual is not English speaking. There are many other issues to take into consideration when using this exam so it is important for therapists to become familiar with the differences in these exams for Hispanic clients. Self Assessment: Bias and Prejudice Many Hispanics have had difficulty with other races and it may be a good idea to measure their amount of bias with certain groups. Paniagua suggests that this type of scale be used when the clinicians racial background is different from the client's. By suing the Self-Evaluation of Biases and Prejudice Scale, a ten item scale, a clinician can understand where there is bias. There are many instruments to help in this area. Some of them include, the Cross-Cultural Counseling Inventory-Revised, Multicultural Counseling Awareness Scale-Form B: Revised, the Self Assessment or the Multicultural Counseling Inventory (Paniagua, p. 35). Each counselor must seek different instruments that they can use with their Hispanic clients that are unbiased and appropriate for use. Culturally Appropriate Questioning During the first clinical interview the therapist should be mindful of the types of questions they use. As an example, asking a Hispanic woman, "What do you think about yourself?" May be difficult because she may never have had that experience within the context of her home. Also, there may be challenges for the very religious Catholic Hispanic if the therapist asks questions that are perceived to be against the client's religious belief. Treatment For Hispanics Research for this paper consistently showed that it is important for the therapist working with Hispanic clients to be bilingual. The reasons for this is so that any Hispanic person from any country would be able to access services. González from and González-Ramos suggest that treatment should include psychosocial interventions. Particularly, the interventions should "Range from supportive, behavioral approaches, vocational and independent-living programs to family-centered psychoeducational models" (p. 93). These interventions are particularly important to those clients with severe mental illness. Family Participation in Treatment Family involvement is very important for Hispanic clients because of the importance they place with the family. Some authors suggest that family therapy should be one of the first types of counseling used because of the importance of the extended family. Paniagua points out however, that using family therapy will depend on the type of challenge (p. 38). Acculturations would also need to be assessed before family therapy. There are two reasons according to Paniagua, that this assessment is important: 1) when different acculturation levels exist within a family, the therapy can have different results and 2) many clients would want to include their extended family into therapy (Paniagua, p. 38). According to Gonzalez and Gonzalez-Ramos, two other reasons to use family therapy" 1) the involvement of the extended family has been sown to work well for severe psychiatric conditions and 2) family and community working together in treatment contexts are important to develop as culturally appropriate approaches (p. 95). Santisteban and Mena (2009) suggest that culturally sensitive interventions are especially important today because there are many young Hispanics in the United States who are exhibiting severe symptoms of mental illness. They report that there is a "disproportionate high rate" of drug abuse in eighth grade youth, a high rate of HIV and depression and suicide ideation (p. 254). These challenges will also show the need for health care for youth. Group Therapy Group therapy is a common technique that is used for many mental illnesses. Paniagua states that "acculturated clients should not be mixed with non-acculturated clients in group therapy sessions' (Panigua, p. 39). The reason he gives for this is the disagreements that can happen. As an example, there may be a difference in cultural values between the two groups: One may have very traditional values and the other group may be more relaxed. The facilitator of the group should also understand that if a group is facilitated in Spanish, some people may not understand other members in the group, because there are different linguistic and grammatical variations between members in the group (Paniagua, p. 39). Other Therapy Options The current trend for Cognitive Behavior Therapy (CBT) and other behavioral therapies may not work well with Hispanic clients if culture is not taken into consideration. As an example, a problem solving training is recommended for Hispanic clients because it "emphasizes a directive, active, and structural approach" to manage emotions (Paniagua, p. 40). The use of drugs with Hispanic clients is sometimes a good idea because they are used to taking medications for things. Paniagua points out that Mexican Americans are one group that would not be resistant to the use of medications (P. 42). Insight interventions or psychodynamic approaches often "blame" the client for their problems. However, many Hispanic clients believe that their problems happen because of external situations. Rational-emotive therapy can be argumentative and go against values and beliefs of this group. When a therapist can understand that there are many ways to work with different types of clients, they become a better therapist. Challenges for Treatment When working with Hispanic clients it is also important to note that there can be other challenges. Figueiredo, Boerstler and Doros (2009) studied the fact that some Hispanic clients drop out of treatment after their first visit with a counselor. In their study they found that there may be no shows of between 10% and 75% (p. 92). When there are no shows this can create problems for the individual and the therapist. As an example, when someone doesn't show for therapy and they decide not to go at all, they may not be able to get past the stigma of mental illness. Staff will reserve time for the individual that could go to someone who really wants to be in treatment. They found that women were more prone to be no shows then men, those who have never married are more prone to not show than those who have been married, and the referral source may be a reason for someone not to go to treatment (p. 99-100). The study found that if the agency tracks no-shows, they can more fully understand what happened. As an example, some find that the individuals decided to seek treatment elsewhere and this is then a case that can be closed. Poverty, Socio-Economic Status Many new immigrants come to the United States and they live in poverty. They are not able to find good healthcare in many cases and they go without many types of treatment. With the crackdown on those immigrants who have "illegal status", many will not receive the benefits they need. Although this is something that many Americans may have a negative voice about, this can be a strong barrier to an individual's need for treatment. Elias (2009) reports that many Hispanic Americans are unable to get healthcare as the economy changes. According to her report, "There were few racial differences, but Hispanics, the nation's largest and fastest growing minority, had the worst emotional health all year long" (p. 29). The article attributes that fact that Hispanics are hit harder to "cultural qualities" and "their economic roles". Both men and women feel shame when they cannot take care of their families. This brings about more depression and they would rather be isolated than let people know that they are suffering (p. 30). Because many Hispanics work in small businesses that rely on other Hispanics to purchase their services and products, many have lost their jobs or their business has folded. Many families that had a good job and a strong future, lost them when they lost their jobs. Although this has happened to many Americans, it can be more difficult for Hispanics because many also work in trades; some trades are seasonal. Alcohol and Other Drugs According to the Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 8.3% of Hispanics over the age of 12 needed treatment for alcohol or drugs in the past year. Of this 8.3% only about 7.7% actually received the treatment they needed from a special treatment facility (SAMHSA, as quoted in U.S. Department of Health and Human Services). What was particularly interesting was that people who were born in the United States were more likely to be the ones who needed treatment for illicit drugs or alcohol and not those who were born in Spanish speaking countries. Lack of Bilingual Therapists A strong reason why many Hispanics do not receive mental health treatment is because of the lack of bilingual therapists. Many times an individual can more easily define what is happening to them in their own language. When a therapist is bilingual, they have a better chance of understanding what is happening with their Hispanic clients and they are able to build trust. Many Hispanics have had difficulty with non-Spanish speaking agencies and/or clinicians which has created a distrust of the situation. It can be a therapist's obligation to learn Spanish if they are working within a certain area that has a large majority of Spanish speaking people. "The Future of Health Care for Diverse Clients" According to an editorial by Broome (2009), there are many concerns when looking at the needs of diverse clients. In many situations, they are left out of some studies or their representation is limited. The factors of issues of trust, concerned of physical harm or whether a client is valued are some of the factors that clinicians need to understand. She states that language barriers and perceptions by diverse families of mental health and other healthcare systems is important to explore. Hispanic families fall into this category and it is important to make sure that as therapists work with Hispanic families, that they write about their findings. Conclusion Counseling Hispanic people is important and counselors who want to be successful will make sure that they understand the culture. This understanding does not come from reading books, but it comes from getting involved in learning about the culture, perhaps attending special events and about interaction with people within the culture. The more that a therapist can learn, the better they will be when someone comes to the counseling session. References Broome, B.A.(2009). The future of health care for diverse clients. 16(3) p. 91-98 . Journal of Cultural Diversity. Retrieved October 23, 2009 from Academic Search Premier. AN: 44335583. Cabassa, L.J. (2007). Latino immigrant men's perceptions of depression and attitudes toward help seeking. Hispanic Journal of Behavioral Sciences. 29. p. 492-504. Sage Publications. DOI: 10.1177/0739986307307157. Davis, K.A. (1991). Assessment of depression among bilingual adolescent Hispanics. (Doctoral Dissertation). Department of Educational Psychology. University of Utah. Elias, M. (12 March 2009). Mental stress spirals with economy. USA Today Online, p. 29. Retrieved October 24, 2009 from http://www.usatoday.com/news/health/ 2009-03-11-stress-poll_N.htm. Figueireda, J., Boerstler, H. and Doros, G. (2009). Failure of high-risk minority patients to show up for outpatient psychiatric treatment. International Journal of Mental Health. 38(2). P. 91-105. Retrieved October 23, 2009 from Academic Search Premier. AN:39761963. Gonzales, M.J., and Gonzales-Ramos, G.(eds.) (2005). Mental health care for new Hispanic immigrants: Innovative approaches in contemporary clinical practice. NY: The Haworth Social Work Practice Press. Maldonado-Schullo, D. (2009). Latino mental health. Latino News and Opinion. Retrieved October 24, 2009 from http://www.pontealdia.com/health/ mental-health.html. National Multicultural International Outreach Center. (2003). Latino community mental health fact sheet. Retrieved Oct 24, 2009 from http://222.nami.org/Content/ContentGroups/MIO/Fact_Sheets1 /Latino_MH_Dispariti es_2003.pdf. Paniagua, F. A. (2001). Diagnosis in a multicultural context: A casebook for mental health professionals. Multicultural Aspects of Counseling Series 15. CA: Sage Publications. Santisteban, D.A. and Mena, M.P. (2009). Culturally informed and flexible family-based treatment for adolescents: A tailored and integrative treatment for Hispanic youth. Family Process. 48(2). P. 253-268. Retrieved Oct. 24, 2009 from Academic Search Premier. AN: 39881070. Serafica, F.C., Schwebel, A.I., Russell, R.K., Isaacs, P.D., and Myers, L.B. (eds.). (1990). Mental health of ethnic minorities. NY: Praeger. SPAN USA. (2001). Suicide among Hispanic Americans. Retrieved October 24, 2009 from http://www.sprc.org/library/Hispanic.am.facts.pdf. U.S. Census Bureau (2009). Hispanic Heritage month 2009: Sept 15-Octo 15. Press Release Fact Sheet. Retrieved October 24, 2009 from http://www.census.gov/Press-Release/www/releases/archives/ facts_for_features_special_editions/013984.html. U.S. Department of Health and Human Services (2009). National alcohol and drug addiction recovery month. Press Release. Retrieved October 24, 2009 from http://www.recoverymonth.gov/Press-Room/News/2009/SAMHSA-Press- Release-New-National-Study-Reveals-Various-Hispanic.aspx. Read More