Mental Health Care for Latin Americans Essay

Abstract The Hispanic population in the United States has rapidly increased over the last decade and is underrepresented and cared for in mental health services. By understanding their culture and learning about the environment they live in therapists can better meet the patient’s needs. This paper covers Historical content, Family structure, Education, Rates of Psychiatric Disorders symptoms, and what to do as a therapist for Latino/Hispanic clients. Also discussed will be some research showing patterns of mental health changes between Hispanics that were born in America and those that were born in South America. This paper shouldn’t end your study in this area but serve as a motivator for further education. Mental Health Care for Latin Americans and Hispanic Americans When learning to counsel Latin/Hispanic Americans it is important to know a few facts about their culture and rates of mental illness. There are a few cultural bonds shared be Latin/Hispanic Americans. One of the biggest bonds is the Spanish language. The Spanish language and culture are common bonds for many Hispanic Americans, regardless of whether they trace their ancestry to Africa, Asia, Europe, or the Americas. The immigrant experience is another common bond. Nevertheless, Hispanic Americans are very heterogeneous in the circumstances of their migration and in other characteristics. To understand their mental health needs, it is important to examine both the shared and unique experiences of different groups of Hispanic Americans. One of the most distinguishing characteristics of the Hispanic/ Latin American population is its rapid growth. In the 2000 census the number of Hispanics counted rose to 35. 3 million, roughly equal to the number of African Americans (U. S. Census Bureau, 2001a). In fact, census projections indicate that by 2050, the number of Latinos will increase to 97 million; this number will constitute nearly one-fourth of the U. S. population. Projections for the proportion of Hispanic youth are even higher. It is predicted that nearly one-third of those under 19 years of age will be Hispanic by 2050 (Spencer & Hollmann, 1998). Persons of Mexican origin comprise the largest proportion of Latinos (almost two-thirds), with the remaining third distributed primarily among persons of Puerto Rican, Cuban, and Central American origin, (U.S. Census Bureau, 2001b). It is noteworthy that nearly two-thirds of Hispanics (64 %) were born in the United States (U. S. Census Bureau, 2000c). Another common bond is migration or immigration. Puerto Ricans began arriving in large numbers on the U. S. mainland after World War II as Puerto Rico’s population increased. High unemployment among displaced agricultural workers on the island also led to large-scale emigration to the mainland United States that continued through the 1950s and 1960s. In the 1980s, the migration pattern became more circular as many Puerto Ricans chose to return to the island. One distinctive characteristic of Puerto Rican migration is that the second Organic Act, or Jones Act, of 1917 granted Puerto Ricans U. S. citizenship. Although Cubans came to the United States in the second half of the 19th century and in the early part of the 20th century, the greatest influx of Cuban immigrants began after Fidel Castro overthrew the Fulgencio Batista government in 1959. First, an elite group of Cubans came, but immigration continued with people making the dangerous crossing to the United States by makeshift watercraft (Bernal & Shapiro, 1996). Some of these immigrants, such as the educated professionals who came to the United States during the early phase of Cuban migration, have become well established, where-as others who arrived with few economic resources are less so. Unlike immigrants from several other countries, many Cubans have gained access to citizenship and federal support through their status as political refugees. Central Americans are the newest Latino subgroup in the United States. Many Central Americans fled their countries â€Å"por la situacion†, a phrase that refers to the political terror and atrocities in their homelands. Although the specific social, historical, and political contexts differ in El Salvador, Guatemala, and Nicaragua, conflicts in those countries led to a significant immigration of their citizens. About 21 percent of foreign-born Central Americans arrived in the United States between 1970 and 1979, and the bulk (about 70 %) arrived between 1980 and 1990 (Farias, 1994). The circumstances that caused various Hispanic groups to migrate greatly influence their experience in the United States. Cubans fled a Communist government, and, as a result, the U. S. Government has provided support through refugee or entrant status, work permits (Gil & Vega, 1996), and citizenship. More than half (51 %) of Cuban immigrants have become U. S. citizens, compared to only 15 percent of Mexican immigrants (U. S. Census Bureau, 1998). Puerto Ricans, whether born on the mainland or in Puerto Rico, are by definition U. S. citizens and, as a result, have access to government-sponsored support services. However many Central American immigrants are not recognized as political refugees, despite the fact that the war-related trauma and terror that preceded their immigration may place them at high risk for post-traumatic stress disorder (PTSD) and may make adjustment to their new home more difficult. Many Latinos who arrive without proper documentation have difficulty obtaining jobs or advancing in them and live with the chronic fear of deportation. Finally, many Mexicans, Puerto Ricans, Central Americans, and recent Cuban immigrants come as unskilled laborers or displaced agricultural workers who lack the social and economic resources to ease their adjustment. Hispanics are highly concentrated in the U. S. Southwest In 2000, 60 percent lived in five Southwestern States (California, Arizona, New Mexico, Colorado, and Texas). Approximately half of all Hispanic Americans live in two States, California and Texas (U. S. Census Bureau, 2001b). While many Southwestern Latinos are recent immigrants, others are descendants of Mexican and Spanish settlers who lived in the territory before it belonged to the United States. Some of these descendants, particularly those in New Mexico and Colorado, refer to themselves as â€Å"Hispanos. † More recent immigrants from Mexico and Central America are drawn to the Southwest because of its proximity to their home countries, its employment opportunities, and its established Latino communities, which can help them, find jobs. Outside the Southwest, New York, Florida, and Illinois are home to the largest concentrations of Hispanics. New York has 8. 1 percent, Florida, 7. 6 percent, and Illinois, 4. 3 percent of all the Latinos estimated to reside in the United States in 2000 (U. S. Census Bureau, 2001b). Two-thirds of Puerto Ricans on the mainland live in New York and New Jersey, and two-thirds of Cuban Americans live in Florida (Population Reference Bureau, 2000). Although specific subgroups of Latinos are associated with specific geographical regions, important demographic shifts have resulted in the increased visibility of Latinos throughout the United States. From 1990 to 2000, Latinos more than doubled in number in the following six states: Arkansas (170 %), Nevada (145 %), North Carolina (129 %), Georgia (120 %), Nebraska (108 %), and Tennessee (105 %) (U. S. Census Bureau, 2000c). Of the six States, Nevada is the only one located in a region with traditionally high concentrations of Latinos. Thus, in addition to growing in numbers, Hispanic Americans are spreading throughout the United States. Latinos are often referred to as family oriented (Sabogal et al. , 1987). It is important to note that familism is as much a reflection of social processes as of cultural practice (Lopez & Guarnaccia, 2000). Specifically, the shared experience of immigrating to a new land or of experiencing difficult social conditions in one’s homeland can promote adherence to family ties. In many cases, family connections facilitate survival and adjustment. The importance of family can be seen in Hispanic living arrangements. Although family characteristics vary by Latino subgroups, as a whole, Latinos, like Asian Americans and Pacific Islanders, are most likely to live in family households and least likely to live alone. In addition, children (especially the females) tend to remain in the family until they marry Overall, Hispanics have less formal education than the national average. Of Latinos over 25 years of age, only 56 percent have graduated from high school, and only 11 percent have graduated from college. Nationally, 83 percent and 25 percent of the same age group have graduated from high school and college respectively (U. S. Census Bureau, 2000b). Hispanics’ educational attainment is related to their place of birth. In 1999, only 44 percent of foreign-born Hispanic adults 25 years and older were high school graduates, compared to 70 percent of U. S. -born Hispanic adults (U. S. Census Bureau, 2000b). The dropout rate for foreign-born Hispanics ages 16 to 24 is more than twice the dropout rate for U. S. -born Hispanics in the same age range (Kaufman et al. , 1999). A recent study of middle school Latino students questions why foreign-born adolescents and adults have the worst educational outcomes (C. Suarez-Orozco & M. Suarez-Orozco, 1995). The study concluded that recent immigrants from Mexico and El Salvador had at least the same, or in some cases greater motivation to achieve than white or U. S. -born Mexican American students. The educational achievement of three of the main Hispanic subgroups reveals further variability. Cubans have the highest percentage of formally educated people. Of persons over 25 years of age, 70 percent of Cuban Americans have graduated from high school, whereas 64 percent of Puerto Ricans and 50 percent of Mexican Americans have graduated from high school (U. S.Census Bureau, 2000d). Moreover, one-fourth of Cuban Americans have graduated from college, which is identical to the college graduation rate of Americans overall. In contrast, Puerto Rican and Mexican-origin adults have lower college graduation rates, 11 percent and 7 percent respectively. Although Latinos as a group have poorer educational outcomes than other ethnic groups, there is sufficient variability to offer hope for them to catch up. Another shared area is income. The economic status of three of the main subgroups parallels their educational status. Cuban Americans are more affluent in standing than Puerto Ricans and Mexican Americans, as reflected in median family incomes (Cubans, $39,530; Puerto Ricans, $28,953; Mexicans, $27,883), the percentage of persons below the poverty line (Puerto Ricans, 31 %; Mexicans, 27 %; Cubans, 14 %) and the unemployment rates of persons 16 years and older (Puerto Ricans, 7 %; Mexicans, 7 %; Cubans, 5 %) (U. S. Census Bureau, 2000d). The current income levels of the Latino subgroups are also related to the political and historical circumstances of their immigration. Elite Cuban immigrants have contributed in part to the relatively strong economic status of Cuban Americans. Their experience, however, stands in stark contrast to that of Mexican Americans, Puerto Ricans, and Central Americans, most of who came to the United States as unskilled laborers. Historical and Sociocultural Factors That Relate to Mental Health Historical and sociocultural factors suggest that, as a group, Latinos are in great need of mental health services. Latinos, on average, have relatively low educational and economic status. In addition, historical and social subgroup differences create differential needs within Latino groups. Central Americans may be in particular need of mental health services given the trauma experienced in their home countries. Puerto Rican and Mexican American children and adults may be at a higher risk than Cuban Americans for mental health problems, given their lower educational and economic resources. Recent immigrants of all backgrounds, who are adapting to the United States, are likely to experience a different set of stressors than long-term Hispanic residents. Key Issues for Understanding the Research Much of our current understanding of the mental health status of Latinos, particularly among adult populations, is derived from epidemiological studies of prevalence rates of mental disorders, diagnostic entities established by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 1994). The advantage of focusing on rates of disorders is that such findings can be compared with and contrasted to findings from studies in other domains (e. g. , clinical studies) using the same diagnostic criteria. Although there are several advantages to examining DSM-based clinical data, there are at least three disadvantages. One limitation is that individuals may experience considerable distress-a level of distress that disrupts their daily functioning-but the symptoms associated with the distress fall short of a given diagnostic threshold. So, if only disorder criteria are used, some individuals’ need for mental health care may not be recognized. A second disadvantage is that the current definitions of the diagnostic entities have little flexibility to take into account culturally patterned forms of distress and disorder. As a result, disorders in need of treatment may not be recognized or may be mislabeled. A third limitation is that most of the epidemiological studies using the disorder-based definitions are conducted in community household surveys. They fail to include nonhousehold members, such as persons without homes or those who reside in institutions. Because of these limitations, it is important to broaden the review of research on mental health needs to include not only studies that report on disorders but include high-need populations not usually included in household-based surveys. Mental Disorders Adults A study found that Mexican Americans and white Americans had very similar rates of psychiatric disorders (Robins & Regier, 1991). However, when the Mexican American group was separated into two sub-groups, those born in Mexico and those born in the United States, it was found that those born in the United States had higher rates of depression and phobias than those born in Mexico (Burnam et al. , 1987). The study found that relative to whites, Mexican Americans had fewer lifetime disorders overall and fewer anxiety and substance use disorders. Like some other findings, Mexican Americans born outside the United States were found to have lower prevalence rates of any lifetime disorders than Mexican Americans born in the United States. Relative to whites, the lifetime prevalence rates did not differ for Puerto Ricans, or for â€Å"Other Hispanics. † However, the sample sizes of the latter two subgroups were quite small, thus limiting the statistical power to detect group differences (Ortega et al. , 2000). A third study examined rates of psychiatric disorders in a large sample of Mexican Americans residing in Fresno County, California (Vega et al. , 1998). This study found that the lifetime rates of mental disorders among Mexican American immigrants born in Mexico were remarkably lower than the rates of mental disorders among Mexican Americans born in the United States. Overall, approximately 25 percent of the Mexican immigrants had some disorder (including both mental disorders and substance abuse), whereas 48 percent of the U. S. -born Mexican Americans had a disorder (Vega et al. , 1998). Furthermore, the length of time that these Latinos had spent in the United States appeared to be an important factor in the development of mental disorders. Immigrants who had lived in the United States for at least 13 years had higher prevalence rates of disorders than those who had lived in the United States fewer than 13 years (Vega et al. , 1998). It is interesting to note that the mental disorder prevalence rates of U. S. -born Mexican Americans closely resembled the rates among the general U.S. population. In contrast, the Mexican-born Fresno residents’ lower prevalence rates were similar to those found in a Mexico City study (e. g. , for any affective disorder: Fresno, 8 %, Mexico City, 9 %) (Caraveo-Anduaga et al. , 1999). Together, the results from the ECA, the NCS, and the Fresno studies suggest that Mexican-born Latinos have better mental health than do U. S. -born Mexican Americans and the national sample overall. A similar pattern has been found in other sets of studies. One study examined the mental health of Mexicans and Mexican Americans who were seen in family practice settings in two towns equidistant from the Mexican border (Hoppe et al. , 1991). This investigation found that 8 percent of the Mexican American participants had experienced a lifetime episode of depression, whereas only 4 percent of Mexican participants had experienced depression. The most striking finding from the set of adult epidemiological studies using diagnostic measures is that Mexican immigrants, Mexican immigrants who lived fewer than 13 years in the United States, or Puerto. Ricans who resided on the island of Puerto Rico had lower prevalence rates of depression and other disorders than did Mexican Americans who were born in the United States, Mexican immigrants who lived in the United States 13 years or more, or Puerto Ricans who lived on the mainland. This consistent pattern of findings across independent investigators, different sites, and two Latino subgroups (Mexican Americans and Puerto Ricans) suggests that factors associated with living in the United States are related to an increased risk of mental disorders. Some authors have interpreted these findings as suggesting that acculturation may lead to an increased risk of mental disorders e. g. , Vega et al. , 1998. The limitation of this explanation is that none of the noted epidemiological studies directly tested whether acculturation and prevalence rates are indeed related. At best, place of birth and numbers of years living in the United States are proxy measures of acculturation. However, acculturation is a complex process (LaFromboise et al. , 1993); it is not clear what aspect or aspects of acculturation could be related to higher rates of disorders. Is it the changing cultural values and practices, the stressors associated with such changes, or negative encounters with American institutions (e. g. , schools or employers) that cause some of the different prevalence rates (Betancourt & Lopez, 1993)? Before acculturation can be accepted as an explanation for this observed pattern of findings, it is important that direct tests of specific acculturation processes be carried out and that alternative explanations for these findings be ruled out. More research would be especially helpful in identifying the key predictors of Latinos’ mental health and mental illness. Older Adults Few studies have examined the mental health status of older Hispanic American adults. A study of 703 Los Angeles area Hispanics age 60 or above found over 26 percent had major depression or dysphoria. Depression was related to physical health; only 5. 5 percent of those without physical health complications reported depression (Kemp et al. , 1987). Similar findings associated chronic health conditions and disability with depressive symptoms in a sample of 2,823 older community-dwelling Mexican Americans (Black et al. , 1998). The findings from in-home interviews of 2,723 Mexican Americans age 65 or older in Southwestern communities revealed a relationship between low blood pressure and higher levels of depressive symptomatology (Stroup-Benham et al. , 2000). These data are somewhat difficult to interpret. Given the fact that somatic symptoms (e. g. , difficulty sleeping and loss of appetite) are related to poor health, these studies could simply document that these somatic symptoms are elevated among older Hispanics who are ill. On the other hand, presence of physical illness is also related to depression. Taken together, these findings indicate that older Latin/Hispanics who have health problems may be at risk for depression. Furthermore, a recent study suggests that the risk for Alzheimer’s disease may be higher among Latin/Hispanic Americans than among white Americans (Tang et al. , 1998). Symptoms The early epidemiological studies of Latinos/Hispanics examined the number of symptoms, not the number of mental disorders, reported by groups of Latin/ Hispanic Americans, and in some cases compared them to the number of symptoms reported by white Americans. Much of this research found that Latinos/Hispanics had higher rates of depression or distress than whites Frerichs et al. , 1981. In a large-scale study of Latin/ Hispanics Americans, Cuban Americans (Narrow et al. , 1990) and Mexican Americans (Moscicki et al. , 1989) were found to have lower rates of depressive symptoms than Puerto Ricans from the New York City metropolitan area Moscicki et al. , 1987; Potter et al. , 1995. In another line of inquiry, Latin/Hispanic American mothers who have children with mental retardation were found to report high levels of depressive symptomatology. It is important to note that measures of symptoms may reflect actual disorders that may not be measured in a given study, as well as general distress associated with social stressors but not necessarily associated with disorders. Two studies provide evidence that depressive symptom indices used with Latinos tend to measure distress more than disorder. In one study, rates of depressive symptoms were found to be similar among poor Puerto Ricans living in New York City and in Puerto Rico (Vera et al. , 1991), even though earlier analyses indicated different rates of major depression for the two samples Canino et al., 1987; Moscicki et al. , 1987. In the second study, symptoms of depression were less related to diagnosis of depression for those Hispanics who were economically disadvantaged than for those Hispanics more socially advantaged (Cho et al. , 1993). If an index of depressive symptoms were an indicator of both general distress and disorder, then that index would have been related to a diagnosis of depression for both economically advantaged and disadvantaged samples. Culture-Bound Syndromes DSM-IV recognizes the existence of culturally related syndromes, referred to in the appendix of DSM as culture-bound syndromes. Relevant examples of these syndromes for Latin/Hispanic Americans are â€Å"susto† (fright), â€Å"nervios† (nerves), and â€Å"mal de ojo† (evil eye). One expression of distress that is most commonly associated with Caribbean Latinos but has been recognized in other Latinos as well is â€Å"ataques de nervios† (Guarnaccia et al. , 1989). Symptoms of an ataque de nervios include screaming uncontrollably, crying, trembling, and verbal or physical aggression. Dissociative experiences, seizure-like or fainting episodes, and suicidal gestures are also prominent in some ataques. In one study carried out in Puerto Rico, researchers found that 14 percent of the population reported having had ataques (Guarnaccia et al. , 1993). Furthermore, in detailed interviews of 121 individuals living in Puerto Rico (78 of who had had an ataque), experiencing these symptoms was related to major life problems and subsequent psychological suffering (Guarnaccia et al. , 1996). There is value in identifying specific culture-bound syndromes such as ataques de nervios because it is critical to recognize the existence of conceptions of distress and illness outside traditional psychiatric classification systems. These are often referred to as popular, lay, or common sense conceptions of illness or illness behavior (Koss-Chioino & Canive, 1993). Some of these popular conceptions may have what appear to be definable boundaries, while others are more fluid and cut across a wide range of symptom clusters. For example, many people of Mexican origin apply the more general concept of nervios to distress that is not associated with DSM disorders, as well as to distress that is associated with anxiety disorders, depressive disorders (Salgado de Snyder et al., 2000), and schizophrenia (Jenkins, 1988). Though it is valuable for researchers and clinicians alike to learn about specific culture-bound syndromes, it is more important that they assess variable local representations of illness and distress. The latter approach casts a wider net around understanding the role of culture in illness and distress. In the following quote, Koss-Chioino (1992) (page 198) points out that a given presenting problem can have multiple levels of interpretation: the mental health view, the folk healing view (in this case, spiritist), and the patient’s view. The same woman, during one episode of illness, may experience â€Å"depression† in terms of hallucinations, poor or excessive appetite, memory problems, and feelings of sadness or depression, if she presents to a mental health clinic; or, alternatively, in terms of â€Å"backaches,† â€Å"leg aches,† and â€Å"fear,† if she attends a Spiritist session. However, she will probably experience headaches, sleep disturbances, and nervousness regardless of the resource she uses. If we encounter her at the mental health clinic, she may explain her distress as due to disordered or out-of-control mind, behavior, or lifestyle. In the Spiritist session she will probably have her distress explained as an â€Å"obsession. † And if we encounter her before she seeks help from either of these treatment resources, she may describe her problems as due to difficulties with her husband or children. Individuals with Alcohol and Drug Problems Studies have consistently shown that rates of substance abuse are linked with rates of mental disorders (Kessler et al. , 1996). Most studies of alcohol use among Hispanics indicate that rates of use are either similar to or slightly below those of whites (Kessler et al. , 1994). However, two factors influence these rates. First, gender differences in rates of Latinos’ use are often greater than the gender differences observed between whites. Latinas are particularly unlikely to use alcohol or drugs (Gilbert, 1987). In some cases, Latino men are more likely to use substances than white men. For example, in the Los Angeles ECA study, Mexican American men (31 %) had significantly higher rates of alcohol abuse and dependence than non-Hispanic white men (21 %). In addition, more alcohol-related problems have been found among Mexican American men than among white men (Cunradi et al., 1999). A second factor associated with Latinos’ rates of substance abuse is place of birth. In the Fresno study (Vega et al. , 1998), rates of substance abuse were much higher among U. S. -born Mexican Americans compared to Mexican immigrants. Specifically, substance abuse rates were seven times higher among U. S. -born women compared to immigrant women. For men, the ratio was 2 to 1. U. S. -born Mexican American youth also had higher rates of substance abuse than Mexican-born youth (Swanson et al. , 1992). The study of mental disorders and substance abuse among Latinos suggests two specific types of strengths that Latinos may have. First, as noted, Latino adults who are immigrants have lower prevalence rates of mental disorders than those born in the United States. Among the competing explanations of these findings is that Latino immigrants may be particularly resilient in the face of the hardships they encounter in settling in a new country. If this is the case, then the identification of what these immigrants do to reduce the likelihood of mental disorders could be of value for all Americans. One of many possible factors that might contribute to their resilience is what Suarez-Orozco and Suarez-Orozco (1995) refer to as a â€Å"dual frame of reference. † Investigators found that Latino immigrants in middle-school frequently used their families back home as reference points in assessing their lives in the United States. Given that the social and economic conditions are often much worse in their homelands than in the United States, they may experience less distress in handling the stressors of their daily lives than those who lack such a basis of comparison. U. S. -born Latinos are more likely to compare themselves with their peers in the United States. Suarez-Orozco and Suarez-Orozco argue that these Latino children are more aware of what they do not have and thus may experience more distress. A second factor noted by the Suarez-Orozcos that might be related to the resilience of Latino immigrants is their high aspiration to succeed. Particularly noteworthy is that many Latinos want to succeed in order to help their families, rather than for their own personal benefit. Because the Suarez-Orozcos did not include measures of mental health, it is not certain whether their observations about school achievement apply to mental health. Nevertheless, a dual frame of reference and collective achievement goals are part of a complex set of psychological, cultural, and social factors that may explain why some Latino immigrants function better than Latinos of later generations. A second type of strength noted in the literature is how Latino families cope with mental illness. Guarnaccia and colleagues (1992) found that some families draw on their spirituality to cope with a relative’s serious mental illness. Strong beliefs in God give some family members a sense of hope. For example, in reference to her brother’s mental illness, one of the informants commented: We all have an invisible doctor that we do not see, no? This doctor is God. Always when we go in search of a medicine, we go to a doctor, but we must keep in mind that this doctor is inspired by God and that he will give us something that will help us. We must also keep in mind that who really does the curing is God, and that God can cure us of anything that we have, material or spiritual. (p. 206) Jenkins (1988) found that many Mexican Americans attributed their relatives’ schizophrenia to nervios, a combination of both physical and emotional ailments. An important point here is that nervios implies that the patient is not blameworthy, and thus family members are less likely to be critical. Previous studies from largely non-Hispanic samples have found that both family criticism and family blame and criticism together (Lopez et al., 1999) are associated with relapse in patients with schizophrenia. Mexican American families living with a relative who has schizophrenia are not only less likely to be critical, but also those who are Spanish-speaking immigrants have been found to be high in warmth. This is important because those patients who returned from a hospital stay to a family high in warmth were less likely to relapse than those who returned to families low in warmth. Thus, Mexican American families’ warmth may help protect the relative with schizophrenia from relapse. The spirituality of Latino families, their conceptions of mental illness and their warmth all contribute to the support they give in coping with serious mental illness. Although limited, the attention given to Latinos’ possible strengths is an important contribution to the study of Latino mental health. Strengths are protective factors against distress and disorder and can be used to develop interventions to prevent mental disorders and to promote well-being. Such interventions could be used to inform interventions for all Americans, not just Latinos. In addition, redirecting attention to strengths helps point out the overemphasis researchers and practitioners give to pathology, clinical entities, and treatment, rather than to health, well-being, and prevention. Availability of Mental Health Services Finding mental health treatment from Spanish-speaking providers is likely to be a problem for many Spanish-speaking Hispanics. In the 1990 census, about 40 percent of Latinos reported that they either didn’t speak English or didn’t speak English well. Thus, a significant proportion of Latinos need. Spanish-speaking mental health care providers. Presently there are no national data to indicate the language skills of the Nation’s mental health professionals. However, a few studies reveal that there are few Spanish-speaking and Latino providers. One survey of 1,507 school psychologists who carry out psychoeducational assessments of bilingual children in the eight States with the highest percentages of Latinos found that 43 percent of the psychologists identified themselves as English-speaking monolinguals (Ochoa et al. , 1996). In other words, a large number of Engli.