CHAMPAIGN, Ill. - It was an alarming message: A Spanish speaking woman in the Champaign area was on the brink of suicide, and a bilingual mental health professional was urgently needed for crisis intervention, but none could be found. Could anyone help?
"Toward the end of the day, a bilingual social worker was located in the community who was available to see her," said Lydia Buki, a licensed psychologist and a professor in the department of kinesiology and community health, one of the bilingual professionals at the University of Illinois who received the email plea for help. "But it really brought to light the fact that there are so few bilingual mental health providers in town."
The event was a catalyst for Buki and Lissette Piedra, a professor in the U. of I. School of Social Work, to assemble a panel of multidisciplinary experts to examine the issues that lead to service disparities. Their strategies for addressing them are explored in a new book, "Creating Infrastructures for Latino Mental Health" (Springer Science+Business Media, 2011).
One of a number of "new-growth" communities nationwide, Champaign has seen its Latino population increase 104 percent since 2000. Across the U.S., the Latino population has grown in 3,000 of the nation's 3,141 counties, a development that demographers have called perhaps the most important population redistribution of the past 50 years.
However, the number of bilingual service providers has not kept pace, and Latinos with limited or no English proficiency frequently are marginalized by linguistic, structural and organizational barriers in mental health care, Buki and Piedra wrote.
With Latinos expected to account for more than 20 percent of America's workforce by 2050, developing infrastructures that ensure the health and well-being of this growing minority population will become critical in the years ahead, particularly as baby boomers begin retiring, further straining the already shaky Social Security system, Buki and Piedra wrote.
"Because Latino populations play a critical role in labor markets, we must examine the ways things are being done," particularly helping people with limited English proficiency - who are often low income and uninsured - navigate America's English-language dominant and institutionally complex health care system, Piedra said.
Title VI of the Civil Rights Act of 1964 mandates that health care organizations that receive federal funds provide language services to clients who have limited English proficiency. However, the mandate is unfunded, and the problem is compounded by an ongoing shortage of trained interpreters, and a wide variation in language proficiency of office staff members called upon to act as translators, resulting in treatment delays, miscommunication and medication errors with potential clinical consequences.
The influence of language barriers on access to mental health and health care, and the resultant needs for linguistically accessible services and a bilingual workforce that can communicate competently are explored in one chapter by Piedra and her co-authors Flavia C.D. Andrade, a professor in the department of kinesiology and community health, and Christopher R. Larrison, a professor of social work, both at Illinois.
Buki, who studies cancer detection and survivorship in Latina women with breast cancer, predicts that the surge in cancers and mental health disorders that will occur among Latinos as their population soars in coming years will put additional strain on a health care system that does not meet their needs.
"This is an important part of the population whose needs are being ignored, which creates more symptomatology," resulting in unfortunate, sometimes tragic, consequences for individuals, their families and communities, Buki said.
The unmet psychological needs of breast cancer survivors and Latina women in particular are examined in one chapter by Buki and her co-author Jennifer Mayfield, a doctoral student in counseling psychology at Illinois. As a model of culturally competent support services, the authors highlight the work of the nonprofit organization Nueva Vida, meaning "new life," which provides culturally tailored breast cancer support services in Spanish for Latina women living in Washington, D.C.
To ameliorate the shortage of bilingual workers, Annie R. Abbott, a professor of Spanish at Illinois, discusses in another chapter using community service learning programs to train college students studying Spanish to assist people in the community.
In another chapter, Piedra and co-authors Tiffany A. Schiffner, a psychologist in private practice in Orlando, Fla., and Geneva Reynaga-Abiko, a clinical psychologist at the University of California, discuss the intersections of postsecondary education with better health and mental health outcomes as well as the need for legislative policies that will support Latino youth in gaining access to higher education.
Elsewhere in the book, experts examine the treatment disparities and unmet mental health care needs of immigrants in rural communities, Latino youth in the juvenile justice system and undocumented unaccompanied minors, recommending an array of solutions and programs that could expand the availability of quality mental health treatment for Latinos.
The book's final chapter offers practical advice for practitioners on developing and sustaining a clinical practice for Latino clients. It is written by Lillian Comas-Diaz, a psychologist in private practice in Washington, D.C., who is also director of the Transcultural Mental Health Institute and a professor at the George Washington University Medical School.
Public policies on immigration reform and health care that ensure access for everyone in the U.S. - regardless of ability to pay, immigration status, English proficiency or other factors - are vital to eliminating barriers that marginalize Latinos and other groups that play critical roles in the world's economy, wrote Annie G. Toro, a lawyer who is governmental affairs manager of Population Services International, a global health organization that works at improving the health of poor and vulnerable people in the developing world.