Cover Story

Psychologist Andrés Consoli, PhD, hopes to uncover ways to open doors to the many Hispanics who don't seek mental health help by studying those who do.

To do that, he's conducting lengthy, bilingual interviews with low-income Mexicans and Mexican Americans in treatment for depression. So far he's completed nine of the 64 he has planned, and already he has noticed some recurring themes: Many participants lack knowledge about community mental health services, some associate stigma with such services, and often their social networks greatly influence their decision to seek mental health help.

"My hope, particularly with collecting these personal stories, is to construct a voice from the consumers' point of view," says Consoli, an associate professor of counseling at San Francisco State University. "These are people we are intended to serve and who can help us identify what is significant and meaningful to them. We need to study their voice so it can be heard loud and clear."

Accessing care

As such, Consoli is evaluating participants' social networks, values, beliefs and attitudes about outpatient psychotherapy, psychotropic medications and depression.

So far, according to preliminary findings, Hispanic participants most often choose mental health care when they:

  • Feel they need help fulfilling life's responsibilities. For example, the person's lack of energy might be interfering with family and work obligations, Consoli says.

"They become frustrated with themselves because they don't like what they are seeing," he says about their choice to seek care.

  • Receive a mental health referral. Participants mostly learned about mental health services from their physician or a nurse and, otherwise, tended to have limited knowledge about mental health services, Consoli says.

  • Seek to improve relations within their social network. Participants wanted to recover so that their children, parents or peers would no longer be affected by their mental illness, Consoli says.

"They ended up making the decision to follow through based on an interpersonal dimension quite dear to them," he says. "Only secondary do they say it's to 'get better for myself.'"

  • Overcome the stigma many Hispanics associate with mental health services. Consoli found many participants had made multiple attempts at getting mental health services but didn't follow through with treatment--prior to sticking to their current treatment plan--because they viewed psychological services as being for "crazy" people and feared they would be perceived as crazy. Also, they were unsure of what to expect or were concerned about language barriers.

"Most of the people know the word 'psychologist' in English and Spanish, but they don't have a sense of what they do or what they provide," Consoli says. "They will recognize a psychologist as a person who provides psychological help, but what it will be, what it looks like and what it entails is less clear to them."

Moreover, language barriers especially can prevent Hispanics from accessing care, Consoli says. "They didn't feel they could really express themselves well enough in English and worried that the psychologist would not understand them," Consoli explains.

Emerging recommendations

According to Consoli, the preliminary findings suggest psychologists can lead more Hispanics to access care by increasing the number of bilingual psychologists, educating the public about community mental health services and emphasizing how seeking treatment is a sign of strength and a way of "taking care of matters."

"There's a lot that needs to be done," Consoli says. "I hope that we can make changes that resonate for our potential or actual consumers. There are many ways messages about mental health can be con- veyed to be more cultural and relevant, particularly for the Latino community."

Further Reading

In 2000, the National Congress for Hispanic Mental Health developed a national agenda aimed at reducing access gaps for Hispanics with mental illnesses. The report can be found via http://www.mentalhealth.samhsa.gov.