Wendy, cooking tamales at Christmastime last year, said the culturally informed therapy she received through Catholic Charities of Oregon’s Intercultural Counseling Center changed her life. An immigrant from Mexico with childhood trauma, the devout Catholic searched for years to find effective, bilingual mental health care she could afford. (Courtesy photo)
Wendy, cooking tamales at Christmastime last year, said the culturally informed therapy she received through Catholic Charities of Oregon’s Intercultural Counseling Center changed her life. An immigrant from Mexico with childhood trauma, the devout Catholic searched for years to find effective, bilingual mental health care she could afford. (Courtesy photo)
Anxiety and fear are pervasive during the coronavirus pandemic. Yet some populations are undergoing even greater psychological trauma — and Hispanics are among them.

“All of us have been experiencing stress; for Latino communities it’s double,” said Olivia Quiroz, executive director of the Oregon Latino Health Coalition.

Latinos are about twice as likely as white people to view the coronavirus as a major threat to their health, according to a recent Pew Research Center survey. Another Pew survey found around half of Hispanics said they or someone in their household has taken a pay cut or lost a job, or both, because of the COVID-19 outbreak, compared with 33% of all U.S. adults.

But when it comes to obtaining effective mental health support to cope with these intense strains, Oregon Hispanics will encounter a longtime deficit.

“The gap is pretty enormous in terms of Latinos having access to linguistically and culturally appropriate care,” said Kat Kelly, who’s worked as a therapist and now serves as director of strategic initiatives at Catholic Charities of Oregon. The Catholic nonprofit’s counseling center is one of a limited number of programs in the state offering bilingual, culturally informed therapy.

As coronavirus cases increase, “it’s triggering a lot in our Latino communities,” said Quiroz, and the psychological repercussions “are bubbling up at a rate that we are not prepared to respond to.”

Underserved pre-pandemic

The National Alliance on Mental Illness (NAMI) found Hispanics typically struggle with common mental health disorders such as major depression, generalized anxiety disorder and post-traumatic stress disorder at rates similar to the general population, but they are at higher risk for severe mental health problems. That’s in part due to the poor quality — or lack — of care they tend to receive. According to the U.S. Department of Health and Human Services’ Office of Minority Health, Hispanics obtain mental health treatment half as often as non-Hispanic whites.

“We’ve completely underserved all people with mental health needs,” said Chris Bouneff, executive director of NAMI Oregon, the state chapter of the national alliance. “When it comes to people from cultures or backgrounds that are marginalized it’s even worse.”

Meanwhile the Oregon Hispanic population is growing faster than the state as a whole, with Hispanics now about 13% of the total population. Hispanics account for approximately 50% of western Oregon’s Catholics and 40% of Catholics nationwide.

Quiroz, who worked for the Multnomah County Health Department for more than a decade, said many Hispanics in the state simply are not able to afford mental health care.

Census data from 2018 shows nearly 18% of Latinos lack health insurance coverage nationally, compared to less than 6% of whites, less than 7% of Asians and around 10% of blacks.

Although Latino Oregonians participate in the labor force at a higher rate than white Oregonians, almost a third of all Latinos live in poverty.

Quiroz believes that along with financial barriers, fears around possible arrests or deportations may cause Latinos to hesitate when in need of mental health services. While most of Oregon’s Latinos are U.S.-born, a sizable minority were born elsewhere, many in Mexico, and more than 90,000 U.S. citizens in the state live with at least one family member without legal documentation.

As in most cultures, there also continues to be a stigma and shame around mental illness, added Quiroz.

Lucrecia Suárez is the manager of Catholic Charities’ Intercultural Counseling Center. She said the diversity among Latinos results in a range of perspectives related to emotional health, which in turn informs how individuals pursue help.

Some have developed a trust in psychotherapy while many have not been exposed to the idea of mental health services, she said. Most Latino clients have told her she’s the first counselor they have spoken to. But she’s observed younger, U.S.-born Latinos more frequently seeking services.

Suárez explained that for new immigrants, socioeconomic status plays a part in how they view the American mental health system. Psychological services, however, most likely were not part of their own or their parents’ experience, she said. Immigrant populations may first turn to their spiritual leaders, or curandera, for healing. They also may believe that speaking about problems they’re having at home dishonors the family.

Those who do seek help face a significant shortage of providers who are bilingual and culturally informed.

Simply having an interpreter in a therapy session is insufficient “in such a personal and complex situation,” Quiroz said.

Suárez noted that culturally informed resources slowly have increased over the last 30 years, but they lag far behind the needs of the growing Latino community.

For those with insurance or ability to pay, there’s a small group of skilled, culturally informed clinicians in private practice in the state. Some might be able to find affordable therapy through the Oregon Health Plan, which pays for low-income Oregonians’ health care, “but unfortunately, people may lose their clinician as there’s typically high turnover in participating mental health programs,” said Suárez.

To help address the lack of access to affordable, quality care, Kelly and Suárez co-founded the Latino Emotional Health Collaborative a few years ago. The collaborative is sustained financially by the Oregon Latino Health Coalition, the nonprofit headed by Quiroz that’s working to advance health equity across the state.

The purpose of the relatively new collaborative “is to align providers across three priorities — policy, advocacy and access to culturally appropriate services and clinicians,” said Kelly.

This past year it developed a statewide strategic plan. The first priority is to strengthen the mental health work force, and the collaborative hopes to act on its priority even while navigating coronavirus-related hurdles.

‘It’s changed my life’

For Wendy, a Latino Catholic living in Vancouver, Washington, culturally and trauma-informed care in her native language may have saved her life. She said it’s undoubtedly helped her remain grounded during the COVID-19 crisis.

Born in Mexico, Wendy was sent as a teenager to live in Oregon, where she confronted an unknown language and culture. “Nothing made sense and I felt very lonely,” said Wendy, now 41. Underneath her sadness was also a deep trauma — childhood sexual abuse by a family member.

Over the years her depression intensified, and after marrying, Wendy sought help. But because she lacked legal status at the time, she was unable to obtain medical insurance and had to pay out of pocket.

“There was no way I could afford it for long,” said Wendy. Referred to a therapist who spoke choppy Spanish, Wendy had trouble conveying her thoughts or feeling understood.

As the depression escalated, she made one of several suicide attempts and spent two weeks in a psychiatric unit.

“When I left it was the same thing: I was trying to find somebody, but I couldn’t find someone who could help, who I could feel connected to, or who spoke Spanish and that I could afford,” she said. “I had to pay for our house and food.”

She recalls feeling compounded shame about needing therapy. “When you talk about mental health in my culture, it means you are weak, maybe crazy and not in control of your life,” she said. “And then there’s the stigma from the American culture about people coming into the country just to take advantage of assistance.”

Through a relentless search, Wendy finally found Suárez, now at Catholic Charities. The agency’s counseling center offers services in several languages, including Spanish, Somali and Arabic, and provides care that recognizes how culture and trauma affect clients’ mental health needs, said Suárez, who teaches a class at Portland State University on how to provide counseling for Latinos. She’s considered one of the top trauma experts for Latinos in Oregon.

“She was totally different,” said Wendy of Suárez. “She had the language and cultural understanding to help. I’m empowered, more confident and more present. It’s changed my life.”

Understanding culture, trauma

Though there’s a significant lack of the culturally informed care Wendy eventually received, it’s an approach that’s far more effective in mental health treatment, say public health experts and seasoned therapists.

Therapy conventions used in the dominant population have benefits for all, said Kelly, but “there are so many cultural nuances around family, spirituality, identity and trauma” that should be taken into account when working with Latinos.

Suárez explained that a therapist who’s been educated in culturally sensitive therapy knows Latinos often conceptualize emotional wellness and distress differently. They may express emotions using words or they may communicate their bodily discomforts or tell stories. A client may say, “I have pain in my body,” which he or she may not view as anxiety, sadness or grief. Or clients might use stories or metaphors to convey a mental state.

Suárez said it’s been a privilege to hear stories not only about suffering but also about transformation. “They are beautiful,” she said.

No population is adequately served without an understanding of trauma, according to clinicians, but this is especially true when it comes to working with immigrant communities.

Quiroz described the two main Hispanic groups who face different kinds of trauma. There are those who’ve had trauma in their native country and in their immigration experience, and there are second-generation immigrants, many of them young. “They are navigating the cultural context of being in their home and in the broader culture,” said Quiroz. “It’s hard enough for teens to grow up in our society but adapting to two worlds can impact their mental health.”

Many first- and second-generation immigrants grapple with the possibility or reality of family separation.

If a family member is going into or out of a detention center, “there’s going to need to be generations of care to break through the trauma that causes in a family,” said Kelly.

Even in subsequent generations, Latinos are “surviving racist attacks,” Kelly said. Hate crimes in Oregon grew 125% between 2013 and 2017, a study by SafeHome.org found last year, making it the state with the sixth biggest increase in the country. The study used FBI data.

Because of language and cultural barriers, immigrants are regularly misdiagnosed, causing additional trauma, said Kelly, pointing out that Latinos are the group most commonly misdiagnosed with psychosis. That’s in part because therapists working in the framework of the dominant culture don’t understand Latino spirituality, she said. “Latinos often have an active relationship with santos, the saints, or with elders who have passed away.”

“Putting in place trauma-informed programs and culturally specific therapy,” said Quiroz, “establishes the safety and environment where Latinos can feel welcome and able to be properly diagnosed.”

Suárez emphasized that to be effective, a therapist need not have the same background as a client. “It’s about having good clinical training, embracing humility and curiosity, learning about others’ culture and of course, speaking the same language,” she said.

Hope shared

Wendy has been seeing Suárez for the past three years; in the age of coronavirus, sessions are held virtually.

Suárez “knows the struggles of immigrant women,” said Wendy. “Not only does she have the knowledge to help professionally, she also knows the challenges you face, how hard it is to find a place to live, a job, enough food to eat.”

Wendy recently enrolled in college, something she’d attempted years ago but dropped because of her depression. She also began attending Mass again before churches were closed in response to the pandemic.

A lifelong Catholic, Wendy said crowds and male leaders gave her anxiety because of the sexual abuse she’d endured. “Now I’m ready to be more active in my faith because I’m not afraid,” she said.

Wendy is sharing her story in an attempt to offer others hope. “We are very thankful and want to give back to this country — to do anything we can to help others,” she said.

Amid the coronavirus, Wendy said she feels especially grateful she’s gained mental stability and has the support of Suárez.

“I’m worried about how we are going to financially deal with it, but I’m feeling positive and have coping skills,” said Wendy, whose husband temporarily lost his job as a welder as a result of COVID-19.

She’s worried about other Latino families, though. She knows many have been affected psychologically and don’t have access to counseling. It’s not just their own health and finances they worry about. “Many are also supporting family in Mexico, so there’s another stress there,” she said.

COVID-19’s toll

U.S. Latinos are more likely than U.S. adults generally to say the coronavirus pandemic has changed their daily lives, disrupted their finances and will threaten their health, according to new surveys by Pew and the Kaiser Family Foundation.

Though so far there’s been spotty government data collection and publication, early data shows the virus already is hitting black and brown Americans especially hard.

It’s thus not surprising that Hispanics say the public health emergency is affecting their mental health at rates higher than whites. About 50% of Hispanics say the pandemic has had a negative impact on their mental health; nearly 25% say it’s had a major impact, compared to 17% of whites.

A number of factors make Latinos more economically and physically vulnerable to COVID-19.

Along with blacks and Native Americans, Latinos frequently have underlying health conditions, including bronchitis and diabetes, that make them more susceptible to complications from the virus.

Many risk exposure in jobs that are impossible to do from home — working as nursing home care aids, construction workers and farm laborers — “the basic workforce the whole society depends on,” said Suárez.

“The majority of our Latino clients inform us that they don’t have a choice,” she said. “They don’t stop because they must continue to support their families.”

At the same time many Hispanics work in areas that have been devastated by virus-induced layoffs, such the restaurant and hospitality industries.

“We don’t know the final impact of the virus yet on Latinos, but we know they are vulnerable, as we all are,” Suárez said. “Many have already lost loved ones through family separation, through policies at the border. The virus adds another layer of fear.”

Efforts to help

The need for more culturally informed, bilingual care has become far more acute during the pandemic and makes those who provide such support all the more valuable to the Latino community.

Foremost among Oregon programs with a Catholic framework is Catholic Charities’ well-established Intercultural Counseling Center. During the coronavirus, therapists have continued to conduct regular sessions virtually.

Northwest Catholic Counseling Center in Portland launched a program last fall called Levantar, which provides low-cost, culturally and linguistically tailored mental health care. It is maintaining services to clients through video chat and telephone.

In addition to such counseling programs, Providence Health and Services has Promotores de Salud de la iglesia, which trains volunteers to build healthier communities within 14 participating Catholic parishes. It’s also meeting mental health care needs via technology, offering events through Facebook Live and creating a series of videos for the Latino community on stress responses and how to speak with youths about COVID-19.

And at St. Andrew Parish in Northeast Portland, a Latino youth minister for several years has focused on deepening teens’ faith while reducing stigma around mental illness. During the outbreak he’s leading youth group meetings on Zoom and staying connected daily to the young people through social media.

Suárez said she’d like to see mental health experts and parishes work more closely together.

“I believe parishes are such an important space for our community, and I’m hoping we will be doing more collaboration in the future.”

Kelsey Bell works in pastoral care for the Portland Archdiocese and for years has listened to Oregon Hispanics’ needs across the region. Bell, who is bilingual, believes faith communities “can go a long way in reducing the overall stigma around mental illness.”

It begins with people understanding that “mental health challenges are real and that support exists, even if it’s very hard to find,” she said.

Suárez tells Latinos not to be alone in their suffering or to give up looking for a therapist who understands their needs.

“Go to those you trust, and we, counselors or therapists, hope to be there to support you, too.”