N.J. Latinos said to receive poor mental health care
Experts say language barrier and stigma are largely to blame
BY KAREN E. BOWES
Staff Writer

FREEHOLD - Compared to whites, Latinos in New Jersey continue to receive inferior mental health care.

While social stigma and a language barrier are thought to be the main reasons, a myriad of others exist for the discrepancy, according to Henry Acosta, deputy director of the New Jersey Mental Health Institute.

On Aug. 30, Acosta spoke about the problem at a forum in Freehold. Sponsored by the Latino Outreach Group of Monmouth County, the event was held at the county's Human Services Building on Kozloski Road.

The statistics are daunting. According to a 1999 Surgeon General's report, 78 percent of Latinos requiring mental health care do not receive the help they need. Of those Latinos who do seek treatment, between 63 and 90 percent fail to return after one visit.

Hispanics also have a higher tendency of being misdiagnosed and "prescribed older medications," Acosta told the audience, a mix of health-care providers, teachers and social workers.

Prejudice aside, there are also social, religious and cultural issues at play. For example, Acosta told the story of a Mexican woman thought to be psychotic by her boss but was actually quite sane. The misunderstanding arose when the woman erected a small shrine on her desk at work. The shrine was decorated with skulls and skeletons and included a plate of fruit. The woman apparently talked to the shrine, which her boss found disturbing. Unaware that in Mexico similar shrines are built each November in honor of the Day of the Dead - a holiday that celebrates the life of those who have died over the past year - the boss called Acosta's office, asking to have the woman classified as mentally ill, he said.

There are other cultural barriers, Acosta explained.

The use of "folk healers," those who concoct teas, herbs and other over-the-counter remedies, can sometimes interfere with psychological medications. However, Acosta noted most are harmless and considered a cultural tradition.

His mother, for example, recently asked him to mail her "cream of crab," for a folk remedy she was making.

"They come up with the weirdest, weirdest things," Acosta joked.

Religion and "machismo" can also be blockades. Machismo, the belief that men should be tough, can keep men away from mental assistance, even when they need it. Traumatic events such as many experience when crossing the border, struggling to keep ends meet or simply being separated from home and family can be cause for mental distress.

Women have special mental health needs. Horrifically, many Latina immigrants are prone to sexual slavery and can be raped or tortured for years "as payment" for their passage to the United States, Acosta said. Post-traumatic stress disorder is often the result and is usually left undiagnosed.

Religion plays a large role in mental health's negative image.

While visiting various Latino churches throughout the United States and abroad, general disapproval of the mental health field was quite noticeable, Acosta said

"This is your medicine," Acosta said, holding up an imaginary Bible, re-enacting a sermon he heard at a Latino church in Passaic.

For many Latinos, cost is the greatest obstacle. Health insurance remains elusive for most immigrants, especially those working per diem.

And while there are almost 2 million Latinos currently living in the Garden State, and about 42 million nationwide, most have no medical coverage.

"We're the No. 1 group in America without insurance," Acosta said.

"There's a disconnect there," he said. "The state, even though they think they meet everyone's needs, they don't."

Acosta has been asked to work for the state as a mental health adviser by the last three governors, he said. He's turned them all down.

"It's not about the money," he said, adding he believes he can make a bigger difference in his current role as director of the mental health institute, a nongovernment agency. Keeping his job means Acosta can participate in mental health studies, such as the one he recently led with Rutgers University, concerning Latino views on mental health.

Meeting with focus groups throughout the state in places like New Brunswick and Jersey City, Acosta listened and learned, making note of what specifically can be done to remedy the situation.

"They had no clue about mental health," Acosta said. "Every group said mental health meant you were crazy."

What was keeping them away? Firstly, poor signage. Mental health facilities rarely offer bilingual signage, Acosta said. Simply hanging up a few signs in Spanish could help tremendously.

"Make it feel like a place where they belong," he said.

Another point, most suburban health facilities are only accessible by car. Problematic for those without a vehicle; this point is easily solved by placing facilities near bus and train routes, Acosta suggested.

Because many Latinos have more than one job, work day to day or cannot miss a day without being fired, the hours of operation should be convenient, going beyond the standard Monday through Friday, 9 a.m. to 5 p.m. regimen.

Facilities looking to attract Latinos should participate in Hispanic parades and festivals, hand out T-shirts or fliers, anything to get the attention of the public.

"You can't wait for a Latino to come knocking on your door saying I have a mental health problem," Acosta said. "It ain't going to happen."

Sometimes, outreach is simply a matter of semantics.

Acosta gave the example of a struggling facility in Arizona. In hopes of removing the stigma associated with mental illness, the facility changed its name, replacing the words "mental health" with "learning and growth." Since the change, the facility has seen a steady spike in patients, including Latinos.

Perhaps the greatest need is in translation. Too often, New Jersey hospitals must rely on maids and janitors to act as interpreters, Acosta said. Health professionals who are bilingual are likely to burn out under the current system, Acosta said. Expected to perform both a regular job and act as an impromptu translator whenever needed, a bilingual employee can easily be overworked and encouraged to seek work elsewhere.

More Spanish-speaking people are needed in the mental health field, not only to act as interpreters but as cultural liaisons as well, Acosta said. While others working in the facility might speak Spanish, they may not understand the cultural background of say, a Honduran family, or a recently immigrated Mexican woman.

As one woman attendee pointed out, "The fact that we speak Spanish, we are not all the same."

Acosta said he is working to promote Latino employment in the mental health field but that it hasn't been an easy task.

In 1993, the national Latino high school drop-out rate was 46 percent; compared to whites, Latinos are more than twice as likely to leave high school, according to a Manhattan Institute study. Because of this, an unfortunate paradox exists.

"I can't even get you to graduate high school, how am I going to get you to get a master's?" Acosta said, noting social workers are usually required to get the higher degree to work in the mental health field.

Acosta himself has three master's degrees in social work and the mental health field. Still, he complained he was not taught much in regards to race or ethnicity in college, an omission he found troubling.

"Culture counts," he told the audience. And although strides have been made toward improved services for Latinos, a cultural barrier still exists that often sabotages such efforts. When the county recently published a Latino directory, for example, Acosta learned there were more complaints from callers than extensions of gratitude or interest in the directory.

"And that's sad," Acosta said. "How dare we use taxpayer money to create a directory for Latinos? They have no problem going to our restaurants where we work and staying at our hotels where we make the beds, but they don't want us to get the services we need."

For more information on this topic, visit the New Jersey Mental Health Institute's Web site at www.njmhi.org. For county government inquiries, or to find a Spanish-speaking individual regarding government issues, call the Monmouth County Hispanic Affairs Office in Asbury Park at (732) 774-3282.