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NIDA research director Carlos Blanco-Jerez, MD, PhD, reviews how stigma, language barriers and digital health create disparate outcomes in mentally-ill Hispanic patients.
In the current US health care system, racial and ethnic differences constitute entirely different standards of care and patient outcomes in psychiatry. While many of these disparities have been clearly defined by experts, action toward mitigating them and assuring more equitable mental health care is lagging behind.
In an interview with HCPLive during the American Psychiatric Association (APA) 2022 Annual Meeting in New Orleans last week, Carlos Blanco-Jerez, MD, PhD, director of the Division of Epidemiology, Services, and Preventive Research at the National Institute on Drug Abuse (NIDA), discussed the burden of disparate mental health outcomes among the Hispanic population.
As Blanco-Jerez explained, there are 2 separate but related issues in Hispanic patient mental health rates.
“Hispanics in general have lower prevalence of common psychiatric disorders including depression, anxiety, substance use disorders or behavioral disorders,” he explained. “On the reverse side of that, among Hispanics who have a psychiatric disorder, the rates of treatment are lower. The outcomes of course are worse.”
The driving factors behind lessened Hispanic mental health care use are both culturally and systemically borne. Blanco-Jerez explained that such patients face unique issues compared to the general population, including a potential lack of insurance, limited access to transportation, and “competing demands” in their livelihoods.
“If you have, let’s say a headache, you would want to get rid of the headache,” Blanco-Jerez said. “But if you have to choose between going to the doctor or keeping your job and being able to feed your family, most likely you’re going to your job. This also happens with psychiatric disorders.”
While acknowledging there’s heterogeneity on both sides of the general Hispanic mental health patient-clinician relationship, Blanco-Jerez said cultural and language barriers persist in instances when such patients do begin to receive care. Patients, for example, may be afraid to follow through on treatment or additional visits due to language barriers.
“On the side of the clinicians, I think mostly we do a good job of treating Hispanics—but there’s a non-negligible number of clinicians who tend to see Hispanics as lesser individuals because of language or cultural barriers,” he said. “They may see them as less intelligent or less worthy of attention.”
Regarding opportunities to resolve these issues, Blanco-Jerez pointed to 2 major hurdles at the systemic level: stigma and telemedicine. Speaking to the latter, he explained that as telemedicine is more readily adopted among psychiatry specialists, disparities may be exacerbated among populations that have lesser access to such technology.
Lastly, Blanco-Jerez touched on the need to better differentiate between a person’s need for psychiatric care versus potential legal ramifications after a mental illness-related event that could result in their being imprisoned and shut out from beneficial treatment.