During the COVID-19 pandemic, Latinx workers have stepped up to keep many essential services running. Latinx communities are best described as luchonas, always up for the challenge, relentless and resilient. As such, Latinx essential workers are in many ways the backbone of our economy, yet they are suffering a disproportionally high rate of COVID-19 deaths.
Structural barriers, such as the lack of employer-sponsored insurance in the service and retail industries; barriers to applying for public benefits, such as chilling effects from public charge rule, even for those who qualify; and the lack of linguistically and culturally effective services contribute to this disproportionate effect and have left many basic health needs neglected, including mental health.
A large share of the US Latinx population, which includes any people of Latin American descent, has been historically employed by the service sector, and, because these jobs have been hit the hardest by COVID-19, Latinx workers and their families are among the most afflicted by pay cuts and job losses because of the pandemic. A robust research base connects unemployment and economic insecurity with declining mental health, so, more than ever, it is crucial to shed light on this often unaddressed topic within the Latinx community.
The status of mental health services among the Latinx population
According to the National Alliance on Mental Illness, 1 in 5 adults—47.6 million people—in the US experienced mental illness in 2018. Although not a Latinx-specific issue, the barriers to mental health care are difficult to overcome in the Latinx context. The 2019 Behavioral Risk Factor Surveillance System shows approximately 49 percent of Hispanic people in the US reported having at least one poor mental health day in the previous 30 days, and the average is four poor days, almost a full work week.
Although Latinx and white populations show similar rates of any mental illness, there are disparities when it comes to treatment. According to the 2019 National Survey on Drug Use and Health (NSDUH), only about one-third of Hispanic people experiencing any mental illness receive some sort of mental health treatment, compared with 50 percent of non-Hispanic white people. This gap in mental health services has not significantly narrowed since 2012.
Unmet need, or the share of Latinx people who perceived a need for mental health treatment or counseling and did not receive it, has also increased in the past few years. From 2017 to 2019, the rate of perceived unmet need for mental health services increased by 63 percent among Hispanic people, while increasing 15 percent among non-Hispanic white people. The problem becomes more alarming when we consider that at-risk populations, such as the uninsured, undocumented immigrants, and people experiencing homelessness, are less likely to seek services.
Because these numbers are based on reported mental health issues and because the NSDUH does not include at-risk populations, many are likely suffering in silence. Stigma around mental health is experienced by all communities, and the Latinx community is no different. After cost and insurance, concerns over prejudice and discrimination are more commonly identified among Latinx people than in other communities. In many ways, being part of a community that is luchona may also prevent people from realizing they need help, and our health care system makes it more difficult to access services and treatment.
A comprehensive response is needed to increase access to mental health services
COVID-19 has exacerbated health inequities experienced by the Latinx population in the US, with reports showing this group continues to lack access to adequate health care, including mental health care. Many are experiencing increased stress and depression, and, according to a recent report by the Centers for Disease Control and Prevention, 18.6 percent of Hispanic respondents seriously considered suicide in the 30 days before completing the survey, considerably higher than the 10.7 percent average. If left unattended and unaddressed, the mental health issues faced by the Hispanic community could be dire.
Policy changes are needed to increase health insurance coverage in the service and retail industry, reduce access barriers for public benefits, and increase access to linguistically and culturally appropriate mental health care. But reducing the varied structural barriers to mental health care for the Latinx community requires partnership with the community in research, policy development, and training and implementation to identify barriers and to design policies and programs that address comprehensive needs.
For example, a community-centered, culturally effective outreach and education campaign to address stigma may reduce disparities in mental health service use. Last year, Congresswoman Napolitano, who represents California’s 32nd district, introduced a bill to reduce mental health stigma in the Latinx community. And some local and state educational campaigns have attempted this strategy and have shown promising results, such as increased mental health literacy and increased service use. Community advisory boards, which have been suggested to help address maternal mental health inequities (PDF), would be key to inform such campaigns.
Telehealth also offers a unique opportunity for the Latinx community to access linguistically and culturally responsive mental health services. Because many people feel shame in seeking mental health services, getting care privately and remotely could help and could translate into increased access to mental health services and treatment compliance for the Latinx community.
But regulatory barriers need to be addressed before expanding telehealth infrastructure, and communities of color could face challenges with telehealth similar to those students of color encountered with remote learning, such as linguistic isolation, limited access to a device or internet, or limited options for having a private conversation. Addressing these barriers would require targeted investments and innovative strategies by policymakers and providers, as well as partnership with the Latinx community to ensure barriers to receiving care are addressed in a culturally effective way.
Before the COVID-19 pandemic, there were significant unmet mental health needs across the nation and within the Latinx community. Addressing these needs and eliminating health disparities among all racial and ethnic groups is essential and should be included in policy and community efforts as we recover.
Photo was changed to better align with content (updated 10/22/20).