What Serving My Community Taught Me About Minority Mental Healthcare

As I sat in my eighth grade English class, I looked around and tried to count how many kids surrounding me did not have blond hair and blue eyes. I could count them in one hand, and maybe only one or two actually looked like me, out of the 20+ kids in that classroom. I felt like I was different from most kids in my school, from the moment I entered the building for the first time, since I was not able to understand anything anyone was saying. I had moved to the United States just a couple months earlier and lived in a small suburban town located in the north shore of Massachusetts, which consisted mostly of white upper middle class families; very white, very blond, very blue-eyed families. I remember feeling like I was living in “Barbie land” and I stood out like a sore thumb.

In the upcoming years I would learn to understand what it means to be a Brazilian immigrant living in the U.S. and all of the challenges that came with it. I would learn to “adapt” to my new country by not speaking with an accent, by not overtly showing too much of my own culture, except for the parts that Americans wanted to see or partake in, like food, for instance. I would learn to blend in with the rest of the kids in my community, by talking, dressing and seeming as “Americanized” as possible, at the cost of my own Latin identity, and be repeatedly complimented and thanked by white Americans for doing so. I would learn that in most cases, before I even opened my month, I would be asked “Where are you from?” as if someone with tan complexion, brown hair and brown eyes couldn’t possibly be from here.

I started struggling with my mental health in my teens, and as a young adult was diagnosed with depression. Mental health issues, such as depression can be rooted in a variety of factors, such as childhood trauma, genetics, environmental circumstances, and many more. I’m sure that mine stemmed from a little bit of each of those factors, and I can say with all certainty that the challenges I’ve faced for being a minority definitely haven’t helped. Besides my own experiences, I’ve also been able to learn from working closely with the latin community in my area, and see first hand how their challenges have affected their mental health as well.

For the last five years I’ve worked serving the immigrant community as a medical interpreter. The majority of my patients are latin immigrants, and it became very clear the kinds of issues they face when it comes to mental health. From cultural stigma, to racial bias, to lack of access to proper care, all these factors contribute to poor mental health within the latin community. According to the Center for Medicare and Medicaid Services, Office of Minority Health, it is not uncommon for racial minorities to report worse mental health functioning and more symptoms of depression when compared to white people. These issues can result in inability to work, within a community which is often not employed by companies that offer sick leave. That means, when they can’t work, they may not get paid, or may even lose their jobs, putting them in a situation that contributes to even more stress and worse mental health outcomes.

Another way many minority communities are disadvantaged is through lack of access to mental health care. As mentioned above, many people in minority communities work low-paying jobs that don’t provide sick leave, and also don’t provide them with health insurance, leaving them to depend on government healthcare as their only option. In the state of Massachusetts I worked with low-income patients who were eligible to receive state-paid health insurance, allowing them to seek healthcare when needed. Unfortunately there were many more minority patients who were only eligible for limited coverage, which presented many challenges, including lack of healthcare networks in the area, that accept limited coverage. The state-paid health insurance is a good option for many low-income patients, when they are able to receive full coverage. In my experience working in this field, I learned that the patients that only received limited coverage, were only able to seek healthcare out of one network in the entire greater Boston area. That means fewer hospitals, clinics and providers to assist this section of the population, not to mention longer wait times, especially when it comes to mental healthcare.

Besides all the problems that the lack of full coverage health insurance presents, the minority population still faces several other issues, even when they are able to access mental healthcare. One such issue that I witnessed with many of the patients I’ve worked with over the years is lack of culturally competent care. As a medical interpreter a part of my job is to empower the patient and serve as a conduit for communication between the provider and the patient. When I notice there is a potential for miscommunication due to lack of cultural understanding, especially coming from the provider, I am to intervene and educate the provider on whatever part of the patient’s culture might be affecting the conversation. I noticed that happening in many mental health-related encounters.

When a mental health provider isn’t culturally equipped to properly care for a minority patient, it can have serious effects on the patient’s recovery. While working as a medical interpreter, my job is to facilitate communication for non English-profficient patients, as well as educate providers on culturally-related issues that may arise. However, there are many minority patients whose first language is English or who speak English fluently, and therefore do not require the assistance of an interpreter for communication purposes. Those patients don’t have someone  who can culturally educate providers and may in turn face discrimination, judgement and racial bias from providers who are not culturally equipped to care for them. In my personal experience as a patient, none of the mental healthcare providers who have treated me have ever experienced the challenges I’ve faced as a minority living in the U.S. Not one. I’ve been lucky to have worked with empathetic professionals who, although could not relate to my problems, were understanding and able to provide me with adequate care. Many people of color can’t say the same.

There are countless issues with our broken mental healthcare system and oftentimes the people who are most affected are minority populations. I could write pages and more pages about this subject, and talk about it tirelessly for countless hours as it is one the problems that keeps me up at night. I mean it. I toss and turn, asking myself “How do we solve these issues?”. I don’t yet have all the answers, but recognizing that there is a problem, a huge problem in our society regarding the mental health care of minorities, is a start.

Sources:

https://www.mentalhealthfirstaid.org/external/2018/04/state-minority-mental-health/ https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts https://www.huffpost.com/entry/minority-mental-health-statistics_n_57a4c099e4b021fd98787185 https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/Data-Highlight-Vol11-Dec-2017.pdf