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Hispanics are within a few years of becoming the largest ethnic minority in the United States. Yet they are sorely underserved by mental health services, and programs that are available often lack the cultural sensitivity needed to address substance abuse and mental disorders in this population.
To redress this failing, the federal government's Substance Abuse and Mental Health Services Administration (SAMHSA) is in the early stages of a 50-step initiative designed to strengthen its responses to mental illness and substance abuse disorders among this fastest-growing segment of the U.S. population.
SAMHSA's effort is part of a wide-ranging initiative titled the Hispanic Agenda for Action: Improving Services to Hispanic Americans, begun in 1996 by the Department of Health and Human Services, of which SAMHSA is a division. In announcing the start of the initiative two years ago, Health and Human Services (HHS) Secretary Donna Shalala emphasized the importance of serving Hispanics and other minority communities "in ways that are culturally sensitive" as well as effective.
The urgency of the need to address the health care requirements of Hispanics stems from several factors that differentiate them from other underserved populations, the obvious ones being language and religion. In addition, they are a relatively young population in the U.S. and are less educated and more economically disadvantaged than some other distinct population segments.
Another factor that puts their health care needs on the critical list is that one-third of Hispanics in the U.S. lack health insurance. This forces a substantial proportion of them to seek health care from emergency rooms and other public facilities that are at best infrequently equipped to navigate language and other cultural differences that could easily have an impact on health care quality. Government statistics reveal the depth of the problem created by cultural barriers-only about 5 percent of physicians and less than 3 percent of registered nurses are of Hispanic origin.
Hispanics living in the U.S. also suffer from some mental and substance abuse problems to a greater degree than do other population groups, according to data from SAMHSA's 1996 National Household Survey on Drug Abuse, the National Institute of Mental Health's National Comorbidity Survey and from the Centers for Disease Control and Prevention. Adding to the urgency of the initiative, for example, are findings showing that 26 percent of Hispanics aged 12 and older have used an illicit drug and 23 percent of adolescents have used such a drug, 9 percent of them within the month preceding the survey.
Research also indicates that nearly one in five Hispanics in the U.S. aged 15 to 54 will suffer from a depressive episode sometime in their lives. Particularly startling is that 21 percent of Hispanic female adolescents in this country have made a suicide attempt, twice the rate for comparable populations of African Americans and non-Hispanic whites.
Overall goals of the initiative are to improve data collection on the health needs of Hispanics, conducting more research on related issues, enhancing collaboration among agencies of the Department of Health and Human Services, improving outreach to Hispanic communities, and eliminating language barriers that make access to services difficult.
In looking at how the project will affect its own programs, SAMHSA Associate Administrator for Minority Health Concerns DeLoris Hunter, Ph.D., commented that the agency wants "to ensure that SAMHSA's activities mirror at the policy level what we urge at the grass-roots level of health care. . . . Making our own agency more culturally responsive should translate into more appropriately attuned assistance to the field, which should result, ultimately, in better services to people affected by mental and addictive disorders."
Among the programs on which the agency will focus are those aimed at reaching Hispanic children, Hunter said, and projects that "encourage older Hispanic youth and young adults to take advantage of special education opportunities, such as agency internships and SAMHSA-supported academic training, to prepare them to work eventually in the mental health and substance abuse fields." These individuals will, Hunter hopes, someday contribute a culturally sensitive perspective to mental health policy formulation and service programs.
Hispanic agenda programs already under way at SAMHSA include grants to states that border Mexico to develop a linguistically and culturally competent array of drug abuse prevention and early intervention efforts, providing guidance to state and county mental health systems to help them assess their cultural competence, and a project at UCLA medical school to train about 200 students, fellows, and residents to become proficient in preventing and treating substance abuse disorders. Thirty percent of the UCLA trainees will be Hispanic.
The agency is also testing a pilot program to teach Spanish to its staff who regularly deal with Hispanic individuals. In addition, it is revamping its data collection procedures to enable it to identify areas in which improved data on Hispanics would allow faster recognition of information gaps and thus improve services to this population.
SAMHSA is also working with other divisions of HHS to examine ways in which primary care providers can better identify elderly Hispanics who have mental or substance abuse disorders.