Despite similar or higher rates of psychiatric disorders, most Latinxs are less likely to seek mental health care than ethnic majority group members (Alegría et al., 2008; SAMHSA, 2020; Young et al., 2001). Even when care is sought, Latinxs are less likely to remain in treatment and, consequently, to obtain good therapeutic outcomes (Cabassa et al., 2006; Olfson et al., 2009). However, engaging fully in treatment results in comparably beneficial outcomes for Latinxs and non-Latinxs alike (e.g., Horrell, 2008; Miranda et al., 2005; Sue, 1988; Tonigan, 2003). Inequities in mental health care use create or exacerbate mental health disparities in Latinxs. Here, I provide a framework for understanding the barriers Latinxs face when accessing needed mental health care, illustrating the application of this framework in two Latinx-serving behavioral health clinics.
Health Disparities
A health disparity is defined as significant differences in disease incidence, prevalence, or burden (e.g., mortality rates) in a particular subgroup as compared to the general population (US Public Law 106-525, 2000). A health disparity is not the same as a health difference. To illustrate this distinction using a somewhat ridiculous example, one can accurate note that men experience prostate problems at a much higher rate than women. However, this difference in disease prevalence rate would not be seen as evidence of a health disparity among men and women, given women lack a prostate. Instead, what is concerning is a difference born of avoidable health inequities (Graham, 2004). Health status inequities are variations in the disease prevalence and burden between population sub-groups, while health care inequities are differences in access to or availability of healthcare services (National Academies of Sciences, Engineering, and Medicine, 2017).
According to the World Health Organization (WHO, 2018), avoidable inequities in health status and healthcare access between groups of people arise from inequalities in social and economic conditions. These conditions and their effects on people’s lives determine a group’s risk of illness. For instance, children living in older housing units with lead paint are at elevated risk of brain damage, learning, and behavior problems (CDC, 2022), while migrant farmworkers working in close proximity to fertilizers, pesticides, and chemicals are at increased risk of infectious diseases, respiratory conditions, and cancer (Hansen & Donohoe, 2003). Social and economic conditions also are related to the actions people take to prevent or treat illness when it occurs. Are preventive medical services easily accessible? Does the person have access to health insurance or affordable medications? Is the community supportive of help-seeking (St. Arnault & Woo, 2018)? The National Institutes of Health (HealthyPeople.gov, 2022) notes health disparities adversely affect groups of people who have systematically experienced discrimination or exclusion. These characteristics include race or ethnicity, as well as other aspects of social identity (gender, gender identity, sexual orientation, religion), socioeconomic status (educational attainment, employment status, income, health insurance), ability (cognitive, sensory, physical), and geographic region. The conditions that give rise to unequal social and economic conditions between groups are called social determinants of health (US Department of Health and Human Services, 2022).
Across many social determinants of health, Latinxs show a disadvantage (Figure 1). For instance, Latinxs are less likely to have completed high school, more likely to be unemployed, living in poverty, and uninsured, less likely to own two or more vehicles per household, and less likely to have basic health literacy skills compared to non-Latinx Whites1. Although differences in health equity appear to be largely born out of economic differences among groups (and certainly increased personal wealth improves health), even when comparing within income brackets, Latinxs show poorer self-rated health status (Robert Wood Johnson Foundation, 2008).