Barriers to Non-U.S. Born Latinos' Use of Mental Healthcare: Are They What We Think?

Background and Purpose: Whether Latinos use mental healthcare depends upon a variety of factors. This study's purposes were to: (1) identify factors that led non-U.S.-born Latinos to use mental health services and (2) assess whether acculturation played a role in access. Objectives included to: 1) assess whether acculturation, gender, or years in the U.S. influence resistance; and 2) compare males and females on resistance. Methods: We used convenience sampling to select sixty-five participants over 18 years who had been referred to or were currently being seen by the clinic's psychiatrist, or were being treated for a mental health disorder. The mean age was 40.6 (SD = 10.6). More than half were females (n= 41, 63.1%). All were born outside of the U.S. The mean length of time living in the U.S. was 13 years (SD = 8.81 years). After Institutional Review Board approval, data were collected over ten weeks. Semi-structured interviews in the participant's preferred language included questions about accessing mental health services; we also administered the Bidimensional Acculturation Scale for Latinos (BAS). An alpha of .05 is customary in social work research, but we used an alpha of .10, because this is more appropriate to detect differences in an exploratory study (Black, 1999). For certain correlations between nominal dichotomous variables and ordinal and continuous variables, point biserial and rank biserial correlation coefficients were appropriate but not available in SPSS. For these, a Pearson's correlation coefficient and Cramer's V were calculated. Results: Regarding personal and familial resistance to accessing mental health services, the majority were not resistant (n= 49, 75.4%). Half of the participants indicated that their family members were supportive in finding mental health assistance (n= 33, 50.8%). For personal resistance to mental health services, there was no correlation to the Spanish dimension (r = -.19, p = .13) of the BAS, gender, and number of years living in the U.S. However, the English dimension was significant indicating a weak, positive relationship. To assess differences in the BAS scores due to gender, we conducted t-tests and did not detect differences (t= 1.198, p=.238; t= -1.192, p=.239). Barriers to services included being unaware they even had a mental health concern (35%) and being unaware of where to access services (32%). Counterintuitively, only one person noted language as a barrier. Conclusions and Implications: Surprisingly, acculturation did not play a mediating role in access. However, factors about the participants' access experiences illustrate how this clinic has succeeded in overcoming barriers. The following conclusions, relevant to social work practice, can be drawn. A main barrier to participants' mental health services utilization was not knowing they had a mental health concern. Utilization of services was enhanced by the clinic being a culturally sensitive, “one-stop shop” with an integrated healthcare strategy worth replicating. These conclusions indicate a need in social work practice to continue to educate the Latino community about mental health concerns and work to develop clinics like the one studied with an integrated healthcare strategy.