The co-chairs of APA's Spanish Language Working Group, Amalia Londoño Tobón, MD, and Hector Colón-Rivera, MD, join us to discuss LaSaludMental.org, APA's online home for evidence based information and resources in Spanish. The conversation also covers the unique mental health challenges facing the Hispanic/Latino community in the U.S., and how cultural competency can help physicians from any background better engage with and treat patients from this community.

Transcript for Audio

Erin Connors (0:00 - 1:07): Hello, and welcome to Mental Health Pathfinders. My name is Erin Connors, and I'm Associate Director of Media Relations for the American Psychiatric Association, and I'll be your host. Every month, we'll share a new podcast featuring APA members who are helping to chart a course to the future of mental health care.

Thanks for joining us. For our show today, I have two guests who are helping the APA get important mental health information up to the Latino population through our website, lasaludmantel.org. First, I would like to introduce you to Dr. Hector Colon-Rivera, past president of the APA's Hispanic Caucus and medical director of APM, a nonprofit in Philadelphia. And also Amalia Ladonia Tobon. She is Assistant Professor in the Department of Psychiatry at MedStar Georgetown University Hospital. And both are actually co-chairs of APA's Spanish Language Working Group.

Thank you both for being here today.

Amalia Londoño Tobón (1:07): Thank you so much for inviting us, Erin.

Hector Colón Rivera (1:07): Thank you.

Erin Connors (1:08 - 1:17): Absolutely. I'm going to start with you, Dr. Colon-Rivera. Tell us some of the background on how Lasalud Mantel got started and how you got involved with this.

Hector Colón Rivera (1:17 - 3:33): It's a great question. And everything started with a conversation, an idea, as part of the Council on Communication probably back in 2021. And I think the idea came out from what we saw happening with COVID-19 and all the misinformation, not getting to our Hispanic communities and not translating in Spanish until the end.

But then at the end, it was like, again, miscommunication in Spanish was not culturally competent or humble for our communities. So the idea started like that. And why the APA doesn't have this kind of outreach programs for our Hispanic communities?

I mean, Hispanic communities are increasingly part of our daily life as doctors, as administrators. And I mean, people say it's just probably three out of five people in the future are going to be Hispanic or Hispanic descendant. So we're talking about a lot of people, and we know that only a few of us Hispanic work in the health workforce.

So everything started with an idea. And then we have a new project, it was kind of mentioned, it was kind of like a grant with opportunity of creating resources for Hispanic communities. And in 2022, we created this amazing working group with a lot of our colleagues.

And I think I started texting Amalia to see if she wanted to be part of this, and she wanted to co-share because Amalia is pretty active in social media, and she had her own group created and was pretty amazing. I was a follower and a fan of her work as a doctor and a researcher. And so we connected and we started creating some content products and media outreach opportunities and saludmentar.org was created, which I think is the first product in other language other than English for the APA, which I think is the oldest medical organization out there. So it's pretty amazing. It's pretty amazing the product we have, and we're looking forward to see more.

Erin Connors (3:34 - 3:43): It is amazing. And you know, this is such an important population to reach. Dr. Londonia Tobon, what are some of the biggest barriers to care for the Hispanic community?

Amalia Londoño Tobón (3:44 - 5:23): Yeah, well, first of all, I wanted to respond to Dr. Colon Rivera's nice remarks. I'm also a huge fan of his work and his leadership as the APA Caucus, Hispanic Caucus President, Press President, and all his advocacy, because without his leadership and advocacy, we wouldn't have this amazing resource for families that primarily speak Spanish and also for clinicians who want to get this information in Spanish. So yeah, so what are some of the biggest barriers for the Hispanic community?

Well, we have to understand that the Hispanic community is quite diverse, right? There are some people that speak Spanish. There are some people that do not.

There are some people that speak Spanglish, and there are all their languages that are spoken in the Hispanic community. But a big portion of individuals do speak Spanish, and that is a huge barrier to accessing care. And so that's why we've had, you know, that that's one of the impetus for this program, LasAnimadas.org and this information, right?

The other thing that's really important is the stigma around mental health issues that really often leads to denial, avoidance of treatment. But we also need to think about them in the context of structural factors, right? So there are these barriers that are outside of people's control, like their ability to pay for things, their ability to access health care.

And that is really culturally humble and competent to find clinicians that really not only speak the language, but really understand the cultural aspects. And that's huge in psychiatry. So I would say those are some of the main and biggest barriers.

Erin Connors (5:23 - 5:36): Absolutely. And Dr. Colon-Rivera, what are some of the challenges facing mental health care professionals when they're caring for this population? It seems like we heard about a few there, but are there more things that need to be focused on?

Hector Colón Rivera (5:37 - 6:57): Yes. And as a medical director for a Hispanic nonprofit here in Philadelphia, we struggle with a lot of these things, which is the cost, also the workforce, finding a workforce that is humble, culturally humble and speak the language and understand the traditions and what people are presented with. Also, we are seeing a lot of these clinics, Hispanic clinics, closing around us and there are less and less resources for our community.

So and I think part of it is retention of what we have, the staff we have. And also training is an issue. And as you might know, Hispanics communities do not tend to participate in research for multiple reasons.

And probably Amalia knows more about this than me. But what we see a really high attrition rate and people not participating due to language importation or to be seen or working or taking care of their parents, illegal or immigration status. I mean, there are a bunch of reasons.

So I would say workforce, retention of staff, training and, of course, access to the social determinants of health.

Erin Connors (6:57 - 7:17): Absolutely. And, you know, although Hispanics make up about 20 percent of the U.S. population, only about 7 percent of psychiatrists identify as Latino. Dr. Londoño-Tobon, what do mental health care professionals who are not Latino need to understand about this population in order to provide care properly for them?

Amalia Londoño Tobón (7:17 - 9:39): Yeah, that's that's a really excellent question. I think, you know, besides all the things that we have been talking up till now, I think, you know, it's really good, important to emphasize that non-Latino professionals really must prioritize cultural humility and cultural competence. And I really like the word humility in particular because the reality is that it's such a diverse community.

No matter if we speak, you know, Spanish as a common language, there is such great diversity even within, you know, the Spanish that we all speak. I have to be culturally humble all the time, even with my Spanish speaking patients and with my Hispanic patients and not assume things. So humility is at the core of what we really need to prioritize and emphasize.

And know that it's OK if you don't know everything. I mean, as a Hispanic patient myself, like I really appreciate when my providers really just even try or are curious about my background, my values, what's important to me in health care and don't assume, but rather see me as an individual and try to understand my particular values, which may be different from another Hispanic person. So I think that's really, really key.

And at the same time, you know, we do know that there are some shared values in the Hispanic community. And, you know, one, actually being humble is one that we really appreciate and warmth and really caring, like that you really, really care for the individual. Right.

That's really important and that sometimes we need to take into consideration the family system. Familismo or the family context is quite important, not for everybody. And that's why I kind of put a pause in that.

But definitely for many Hispanics, family is a huge factor and plays a role in accessing health care and mental health care. And they can play a huge role as well in stigma or destigmatizing mental health. So I would I would say those things are quite important for non-Hispanic clinicians to be aware of.

Erin Connors (9:40 - 9:51): I'd like to ask you both, you know, what are your hopes for LaSaludMental.org? What do you hope to see more of in the future? What do you think the patients and the and the just the people that are reading this site need to see?

Hector Colón Rivera (9:51 - 11:18): Yeah, and I feel like LaSaludMental, I mean, we have a great product. It's still it's still a baby. I think it's still growing up.

We are just feeding it and learning from it. And we are understanding the needs of both our members, the APA members, community and our patients. And we know that we're not we're not trying to only put like a free translation services for what we already have.

But we are trying to understand the and comprehend, fully comprehend the nuances of being a Hispanic. And I understand that we're coming from different places. Languages are not the same.

And health is is not priority for some of them. Right. So we want to make sure that this product is for everyone and includes everyone.

And they are able to to match their need when they come in. I would love to see and this is something that have have been discussed before, a connection with services and see how Hispanic communities can go not only to educate themselves, but also to to get services in the areas they are. I mean, just as easy.

We're in 2024. Technology is going up. Just it will be an easy as just putting your zip code and, you know, all Hispanic members or people that understand the culture or the language, you know, it appears as options for these clients, these patients to see.

Amalia Londoño Tobón (11:18 - 12:18): I love that. I mean, I feel like I agree one hundred percent with what Dr. Rivera said. I would say.

Besides it being a platform for education, you know, that Spanish speaking patients can access and providers can as well and refer patients similar to what Dr. Rivera was saying, Rivera was saying, relief advocacy is what we need. And so hopefully this can be a platform as well to continue to advocate for this population that is really underserved. And we hope to engage more APA members, more future psychiatrists, anybody that is interested in really supporting and advocating for this population so that we really have increased access for Spanish speaking patients and the Hispanic community at large to mental health services.

Erin Connors (12:18 - 12:35): I want to thank you very much for the work that you do every day and the work you do as co-chairs of APA's Spanish Language Working Group. We really appreciate you both being here today. Thanks so much.

And to our listeners, please join us again for our next edition of Mental Health Pathfinders. Find us at all major podcasting platforms.