Bilingual Mental Health Providers Spread Thin

The best therapists use the cultural background of their patients as a framework for diagnosis and treatment. No one knows more about Latino cultures than Latinos themselves, which is why there are efforts underway to steer students toward a career in mental health. But the future of a successful scholarship program in Greeley is in doubt once the grant that funds it expires at the end of the month. If someone complains of hearing voices and seeing menacing shadows, a therapist might reasonably think he or she suffers from a serious mental disturbance. But such conditions are common in certain cultures, and when mental health providers don’t share a common language and cultural background with their patients, misunderstandings and even misdiagnoses can result.

“The Latino belief system has more acceptance of hearing your mother’s voice after she is dead, talking to her, having illusions, thinking someone has put a curse on you – these things are very cultural. But someone might misinterpret that as being weird behavior at the least and crazy at the most,” said Becky Marrujo, program coordinator of the Latino Professional Development Program at North Range Behavioral Health in Greeley.

In Colorado and across the nation there is a shortage of Latino, Spanish-speaking mental health providers to counsel the country’s largest and fastest-growing minority population. There is little data to indicate the language skills and ethnicity of mental health professionals. But according to the surgeon general, there are only 29 Hispanic providers per 100,000 Hispanics in the population. For whites, the rate is about 173 mental health providers per 100,000.

To address the problem in Greeley, North Range obtained a grant from the Colorado Trust to educate and train Latino college graduates interested in careers in mental health. The program pays tuition and fees for a master’s program in counseling or social work from either Colorado State University or the University of Northern Colorado. In exchange, each student must spend at least two years working at a North Range clinic.

“We focus on the bicultural as much as the bilingual,” said Wayne Maxwell, executive director of North Range, explaining that only Latinos are eligible for the program. “There is simply no substitute for growing up in the same environment as the people you are treating.”

Nine people have either completed or are currently enrolled in the Latino Professional Development Program, but the grant that funds it runs out at the end of the month, leaving the future of the scholarship in doubt. Mental health experts agree that culturally and linguistically relevant treatment is essential, and the loss of the North Range program would mean fewer qualified providers for an exploding Latino and immigrant population in northern Colorado.

“Not only is cultural understanding a part of the diagnosis, but it is part of the treatment,” said Jane Delgado, president of the National Alliance for Hispanic Health, a nationwide organization of providers focused on serving Latinos. “As we become good at providing services to Hispanics we will become good at providing services to everyone else because being in tune with and understanding a person’s background is key to successful therapy.”

Mauricio Palacio is director of the Office of Health Disparities at the Colorado Department of Public Health and Environment. He says there is a shortage of Latinos in all health professions, not just mental health. Part of his work involves going into local middle schools to try to get Hispanic youngsters excited about science and a career in health care even before they choose their elective courses in high school. The shortage of providers extends beyond the Latino community, Palacio says. African Americans and Native Americans are also underrepresented among health care professionals.

“In mental health care, trust is especially important,” he said. “When you are going to spill your problems it is vital you trust your provider, and when someone comes from your own culture, that rapport is much easier to establish.” 

Carolina Belloso was one of the first graduates of the Latino Professional Development Program and is currently working for North Range doing substance abuse and domestic violence treatment. Belloso, 33, says that although there are significant differences between her native Venezuelan culture and those of her mostly Mexican and Central American patients, there is much that unites them.

“Sometimes at first people are not sure if they trust me because I don’t have dark skin and I don’t have dark eyes like they do,” Belloso said. “But once we start talking about all the things we have in common – the understanding of family and spirituality and the similar struggles that a lot of us immigrants have – that really connects us.”

Belloso says her clients, most of whom are Spanish-speaking, share many of the same stressors. Parents fret about who will take care of them in old age when their children, who grew up in the United States, seem bent on financial independence and moving out as soon as they turn 18. A child’s lack of interest in education or religion can also spark deep sadness among parents, who want their children to both maintain their traditional values and succeed in American society.

“When a kid doesn’t want to continue his education, it is very disturbing and confusing to parents because that was what they wanted and never got and a big reason they came to this country in the first place,” Belloso said.

“Often when kids come here they have friends of different religions or they don’t practice, and for the parents that are seriously Catholic, they can’t understand how their kids don’t want to follow a tradition that has been in the family for generations.”

With her caseload, Belloso describes herself as “spread thin.” But she and her colleagues from the Latino Professional Development Program will likely be even more so if the funds aren’t raised soon to keep the program going.

As it is, Marrujo regularly gets calls from the directors of mental health clinics across the state begging to buy out the contracts and hire program graduates.

“At this point we don’t have enough bilingual therapists to meet the demand, and it would take us a tremendous effort to get up to speed,” Marrujo said. “So there is no way we’re giving them up.”