Mental Health Issues in Mental Health Issues in Hispanics: A New Challenge for Hispanics: A New Challenge for

North CarolinaNorth CarolinaAntonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.

University of North Carolina at WilmingtonUniversity of North Carolina at Wilmington910.962.3812910.962.3812

puente@uncw.edupuente@uncw.eduwww.uncw.edu/people/puentewww.uncw.edu/people/puente

1508 Military Cutoof Road #3031508 Military Cutoof Road #303www.clinicalneuropsychology.uswww.clinicalneuropsychology.us

New Hanover Regional Medical CenterNew Hanover Regional Medical CenterInterdisciplinary Grand RoundsInterdisciplinary Grand Rounds

January 16, 2003January 16, 2003

DemographicsDemographics

GrowthGrowth• Fastest growing ethnic group in USFastest growing ethnic group in US• Will be or is the largest ethnic group in USWill be or is the largest ethnic group in US• Approximately 15% of the populationApproximately 15% of the population• Could represent the majority group in 2050Could represent the majority group in 2050• Probably undercountedProbably undercounted

North CarolinaNorth Carolina• One of the fastest growing states for HispanicOne of the fastest growing states for Hispanic• Southeastern NC particularly sensitive, Southeastern NC particularly sensitive,

especially rural areas with agriculture and especially rural areas with agriculture and livestocklivestock

Hispanic StatisticsHispanic Statistics

Percentage of PopulationPercentage of Population

- In US = 12.5%- In US = 12.5%• In NC = 4.7%In NC = 4.7%

- 36% are from Latin America- 36% are from Latin America

- 30% are from Mexico- 30% are from Mexico Anticipated GrowthAnticipated Growth

• In US = Births will outpace immigrationIn US = Births will outpace immigration• In NC = 273% growthIn NC = 273% growth

Psychological LiteraturePsychological Literature

PsychologyPsychology• 457,827457,827

HispanicsHispanics• 6,3846,384

Hispanics and Mental HealthHispanics and Mental Health• 731731

Sources of Mental Health ProblemsSources of Mental Health Problems

Language limitationsLanguage limitations Culture and Acculturation issuesCulture and Acculturation issues Family dysfunctionFamily dysfunction Ineffective social supportIneffective social support Low self esteemLow self esteem Limited educationLimited education Financial limitationsFinancial limitations Religious affiliationReligious affiliation DocumentationDocumentation

Language ProblemsLanguage Problems

EnglishEnglish Variations of SpanishVariations of Spanish Spanish as a second languageSpanish as a second language Anxiety associated with learning Anxiety associated with learning

EnglishEnglish Children as translators for parentsChildren as translators for parents Children choosing English over Spanish Children choosing English over Spanish

as primary method of communicatingas primary method of communicating

Culture and AcculturationCulture and Acculturation Understanding the majority group cultureUnderstanding the majority group culture Maintaining culture of originMaintaining culture of origin Being bi-culturalBeing bi-cultural Some basic differencesSome basic differences

• Family above all (and extended family)Family above all (and extended family)• Time to be enjoyed not conqueredTime to be enjoyed not conquered• Cooperation versus competitionCooperation versus competition• Religion as source of support and socializingReligion as source of support and socializing• Keep one’s problems to themselves or familyKeep one’s problems to themselves or family• Less materialLess material• More emotionalMore emotional

FamilyFamily

Defining FamilyDefining Family• NuclearNuclear• ExtendedExtended• DoubleDouble• FunctionalFunctional

Divided FamiliesDivided Families• EconomicsEconomics• GeographyGeography• PoliticsPolitics

Ineffective Social SupportIneffective Social Support

MedicalMedical ReligiousReligious EducationalEducational FinancialFinancial SocialSocial MaritalMarital

Low Self EsteemLow Self Esteem

Productivity and MaterialismProductivity and Materialism ConnectivityConnectivity Self-Effacing PresentationSelf-Effacing Presentation Self-Fulfilling ProphecySelf-Fulfilling Prophecy

EducationEducation

Typical Educational BackgroundTypical Educational Background What it Means to be “Educated”- the What it Means to be “Educated”- the

difference between schooling and difference between schooling and educationeducation

Financial & Related LimitationsFinancial & Related Limitations

The Limits and Hazards of Being The Limits and Hazards of Being UndocumentedUndocumented

Type of Vocational Opportunities & Type of Vocational Opportunities & Corresponding PayCorresponding Pay

Banking IssuesBanking Issues Saving for RetirementSaving for Retirement Driver’s LicenseDriver’s License

ReligionReligion

Predominantly Catholic, but not Predominantly Catholic, but not Exclusively (fundamental)Exclusively (fundamental)

Importance of Religion and Related Importance of Religion and Related Social SupportSocial Support

Church and Related Services in Church and Related Services in SpanishSpanish

DocumentationDocumentation

EducationEducation MedicalMedical LegalLegal

• Tax ID NumbersTax ID Numbers• Social Security NumbersSocial Security Numbers• Driver’s LicensesDriver’s Licenses

AliasesAliases

Outcome of ProblemsOutcome of Problems

AnxietyAnxiety 13%13% Substance abuseSubstance abuse 8% 8% DepressionDepression 5% 5% Violence Violence ?% ?%

Ethnic identity issuesEthnic identity issues Poverty and marginalizationPoverty and marginalization

Gender IssuesGender Issues

Males vs Female Males vs Female • Males Males 27%27%• Females Females 17%17%

Heterosexual issuesHeterosexual issues• Clashing of culturesClashing of cultures• Availability of partnersAvailability of partners• ProstitutionProstitution

Sexual Identity IssuesSexual Identity Issues Childhood Sexuality & AbuseChildhood Sexuality & Abuse

A Simple Model for Addressing A Simple Model for Addressing Mental Health ConcernsMental Health Concerns

Communication & Narrative Communication & Narrative ApproachApproach

Rapport and TrustRapport and Trust QuestioningQuestioning Symptom IdentificationSymptom Identification EmpowermentEmpowerment Solution Focus Solution Focus Follow-upFollow-up

Suggestions for Health IssuesSuggestions for Health Issues

Style/RapportStyle/Rapport TranslationTranslation FamilyFamily Documentation StatusDocumentation Status Interpretation of InformationInterpretation of Information Follow-upFollow-up

Personnel and ServicesPersonnel and Servicesin Southeastern NCin Southeastern NC

OAKS & SEMHC & OthersOAKS & SEMHC & Others• SEMHC (1?)SEMHC (1?)• Titleson Clinic (first Wednesday)Titleson Clinic (first Wednesday)• Catholic Ministries (1?)Catholic Ministries (1?)

Private sector personnelPrivate sector personnel• Psychologist- 1Psychologist- 1• Psychiatrist- 1Psychiatrist- 1• Social Worker- 1 (?)Social Worker- 1 (?)

Related SupportRelated Support

Radio and TelevisionRadio and Television• 1 Program?1 Program?

NewspaperNewspaper• 1?1?

OrganizationsOrganizations• Centro Latino/Amigos InternacionalCentro Latino/Amigos Internacional

Cultural MatrixCultural Matrix

ISOLATED ISOLATED VS VS ACCULTURATED ACCULTURATED

MAINSTREAM MAINSTREAM VS VS ASSIMILATEDASSIMILATED

From Isolation to AssimilationFrom Isolation to Assimilation

IsolationIsolation AcculturationAcculturationAssimilationAssimilation

IncomeIncome$20,500 $20,500 $36,100$36,100 $37,000$37,000

SizeSize 3.9 3.6 3.9 3.6 3.13.1

Time in USTime in US11stst gen. US born gen. US born 44thth Gen. Gen.

LocaleLocale Inner CityInner City Suburbs ?Suburbs ? SuburbsSuburbs

ValuesValues HispanicHispanic Partial HispanicPartial Hispanic AngloAnglo

LanguageLanguage SpanishSpanish BilingualBilingual EnglishEnglish

The Future The Future

Clashing Curves and CulturesClashing Curves and Cultures Financial & Social “Slavery”Financial & Social “Slavery” Pay Now or Pay LaterPay Now or Pay Later What is North Carolina and New What is North Carolina and New

Hanover Going to Do?Hanover Going to Do?