Serving The Latino(a,x) Population In Massachusetts

Implications for therapists

Languages in Massachusetts

I imagine that when people think of Massachusetts, their minds go to Salem and the witch trials or Plymouth Rock. But if you were paying attention, you will know that Massachusetts has a strong Native American population that is regaining stolen lands, that Sojourner Truth landed in Florence and made a home, and that abolitionists worked, wrote, and joined forces here. In addition, Massachusetts was a cultural and economic hub for migrant workers from Puerto Rico in the 1950s. This diversity is partially reflected in the 2018 Census Bureau, citing that nearly 25% of Massachusetts residents speak a language other than English, which is higher than the national average. Spanish was the language most spoken, at nearly 10%, followed by Portuguese at 3.14%, and then Mandarin and Cantonese Chinese at 2.8%.

The high percentage of Spanish-speaking people reflects the larger national pattern. By 2060, Latina people will reach 28% of the US population (Smith, 2018). So, with this in mind, let’s look at some barriers to Latino people seeking mental health services.

Language support in health and social services

The 2018 Census Bureau found that 63% of the Latino population reported limited English, with only 12% reporting levels of English proficiency. So, how is mental health keeping pace with this trend? Not so well. According to an APA survey, only 5.5% of psychologists can provide services in Spanish (Smith, 2018). 

Like every state, Massachusetts requires an interpreter in hospitals for non-English speaking patients.  Chapter 6 of the Acts of 2000 states,

“Every acute-care hospital, as defined by 25B, shall provide competent interpreter services in connection with all emergency room services provided to every non-English speaker who is a patient or who seeks appropriate emergency care or treatment “(del Mar Farina & Kirby, 2019).

Although laws require interpreters in health care facilities, in practice, interpretation is not offered or when offered, it is inadequate. 

Opioid use amongst Latinos

SAMHSA reports that an epidemic of opioid use amongst Latinos has increased dramatically in recent years. Some of the reasons are that these drugs ameliorate the pain associated with trauma due to deportation and detention, fleeing from natural disasters and violence, injury from physically taxing service jobs, and psychological and physical injury from serving in the armed forces. Alarmingly,

“In 2018, Massachusetts had the highest opioid-related overdose death rate for Hispanics” (30.4 deaths per 100,000).

Unequal access to adequate drug treatment and diagnosis

Some studies found emergency departments are reluctant to prescribe opioids to Latino and Black patients even when presenting similar levels of pain intensity as white people. This pushes people to other options for pain relief.

Another structural hurdle is for heroin users in treatment. Latino individuals face barriers in receiving a less stigmatizing and more effective treatment such as naltrexone or buprenorphine. They are less likely to elect methadone since it is highly controlled and administered in a public setting and is more stigmatized. SAMHSA states, 

“ ..a two-tiered treatment system exists where buprenorphine is accessed by Whites, higher-income, and privately insured individuals, while methadone is accessed by low-income and publicly insured people of color.”

Cultural competence

Social workers will need to have a firm understanding of the mental health effects related to the above social issues such as detention, immigration, and opioid misuse. In addition, social workers will need to remember the pillars of many Latino families include religion, and maintaining an insular and close-knit family structure. 

Bilingual psychologist Pizzi underscores this point,

“Family is a priority, and one does not offend or put the family values or family unit at risk to pursue one’s own individual happiness” (Smith, 2018).

Final thoughts

Since Latino families tend to leave treatment more quickly than other groups, it is important that social workers continually reevaluate their methods to help Latino people get the best out of their treatment by offering a culturally responsive and a clinically and linguistically informed approach.

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Resources

Census Bureau. (2018). https://datausa.io/profile/geo/massachusetts/demographics/languages#:~:text=24.3%25%20of%20Massachusetts%20citizens%20are,the%20national%20average%20of%2021.9%25.

Del Mar Farina, M. & Kirby, S.M. (2019, September). Use of interpreters in mental health encounters. In IBHC Training Modules. https://www.westfield.ma.edu/interdisciplinary-behavioral-health-collaboration/modules 

Smith, B. (2018, June). Spanish-speaking psychologists in demand. APA. 

https://www.apa.org/monitor/2018/06/spanish-speaking#:~:text=In%20a%20nationwide%20APA%20survey,making%20them%20a%20rare%20commodity.
SAMHSA. (2020). The opioid crisis and the hispanic/population: An urgent issue.