An estimated 14% of the U.S. population speaks Spanish at home, and 16 million Spanish speakers have limited English proficiency(1). In addition to the potential barrier of lack of language services, recent research has identified other factors contributing to inequities in access and outcomes for Spanish-speaking patients, including perceived discrimination, and mistrust and privacy concerns.(2)

Accessing Services

A new study looks at current challenges in accessing mental health services in Spanish.(2) Researchers worked with simulated patients seeking depression care to contact more than 386 safety-net clinics in California in English and Spanish. Nearly 1 in 5 Spanish calls ended with the scheduler hanging up on the caller or informing them that no one was available to assist them in Spanish. When a Spanish-speaking caller was able to get through and schedule an appointment, the wait times were similar for English and Spanish-speaking patients, with an average wait of 36 days. About half of the clinics examined had Spanish-speaking clinicians, including 50% for telehealth and 46% for in-person visits.

The study also looked at the availability of in-person and telehealth visits. Following the pandemic, use of telehealth services has dropped significantly for most medical care but has remained high for behavioral health services. Nearly two-thirds (64%) of the clinics offered both telehealth and in-person visits, 22% offered only telehealth visits, and 14% offered only in-person visits.

Another study published last year in the APA journal Psychiatric Services looked at the trend over time and found declining availability of mental health services in Spanish.(3) Between 2014 and 2019, the proportion of facilities in the U.S. offering mental health treatment in Spanish declined about 18%. Over the same time period, the Hispanic population in the U.S. increased by 4.5% or 5.2 million people.

Stigma

Stigma surrounding mental illness and treatment is a significant barrier to care in the Hispanic/Latino community. A recent study assessed mental health stigma, specifically toward depression, among Spanish-speaking Latino adults in Baltimore.(4)

The primary stigmatizing beliefs held among participants had to do with the extent to which a person could control their depression, that depression is a personal weakness, and that depression causes people to be dangerous or unpredictable. Men, people who reported that religion was highly important in their lives, and those who didn’t know much about depression had higher personal stigma.

Importantly, though, there was little stigma expressed with respect to talking about personal experiences with depression with clinicians or seeking medical care for depression. The most significant factor associated with lower stigma beliefs was knowledge of depression. Overall, the authors conclude, that the research “supports simultaneous and ongoing efforts to address mental health stigma and expand access to mental health care.”

Expanding Spanish-Language Resources

• The Crisis Text Line recently added a Spanish language version along with a WhatsApp version. An estimated one in five people reaching out to the service are Hispanic and/or Spanish speakers.(5)
• In July 2023, the 988 Suicide & Crisis Lifeline added Spanish language text and chat services.
• The American Psychiatric Association has recently expanded its Spanish-language mental health information at La Salud Mental.
• APA Foundation is reaching out to Spanish-speaking audiences in its Mental Health Care Works Campaign, an effort to grow awareness about and encourage those who need it to take the first step towards mental health treatment.
• Spanish language resources are also available from NAMI (National Alliance on Mental Illness) and Mental Health America.