mental health issues in hispanics: a new challenge for north carolina antonio e. puente, ph.d....
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Mental Health Issues in Mental Health Issues in Hispanics: A New Challenge for Hispanics: A New Challenge for
North CarolinaNorth CarolinaAntonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.
University of North Carolina at WilmingtonUniversity of North Carolina at Wilmington910.962.3812910.962.3812
[email protected]@uncw.eduwww.uncw.edu/people/puentewww.uncw.edu/people/puente
1508 Military Cutoof Road #3031508 Military Cutoof Road #303www.clinicalneuropsychology.uswww.clinicalneuropsychology.us
New Hanover Regional Medical CenterNew Hanover Regional Medical CenterInterdisciplinary Grand RoundsInterdisciplinary Grand Rounds
January 16, 2003January 16, 2003
DemographicsDemographics
GrowthGrowth• Fastest growing ethnic group in USFastest growing ethnic group in US• Will be or is the largest ethnic group in USWill be or is the largest ethnic group in US• Approximately 15% of the populationApproximately 15% of the population• Could represent the majority group in 2050Could represent the majority group in 2050• Probably undercountedProbably undercounted
North CarolinaNorth Carolina• One of the fastest growing states for HispanicOne of the fastest growing states for Hispanic• Southeastern NC particularly sensitive, Southeastern NC particularly sensitive,
especially rural areas with agriculture and especially rural areas with agriculture and livestocklivestock
Hispanic StatisticsHispanic Statistics
Percentage of PopulationPercentage of Population
- In US = 12.5%- In US = 12.5%• In NC = 4.7%In NC = 4.7%
- 36% are from Latin America- 36% are from Latin America
- 30% are from Mexico- 30% are from Mexico Anticipated GrowthAnticipated Growth
• In US = Births will outpace immigrationIn US = Births will outpace immigration• In NC = 273% growthIn NC = 273% growth
Psychological LiteraturePsychological Literature
PsychologyPsychology• 457,827457,827
HispanicsHispanics• 6,3846,384
Hispanics and Mental HealthHispanics and Mental Health• 731731
Sources of Mental Health ProblemsSources of Mental Health Problems
Language limitationsLanguage limitations Culture and Acculturation issuesCulture and Acculturation issues Family dysfunctionFamily dysfunction Ineffective social supportIneffective social support Low self esteemLow self esteem Limited educationLimited education Financial limitationsFinancial limitations Religious affiliationReligious affiliation DocumentationDocumentation
Language ProblemsLanguage Problems
EnglishEnglish Variations of SpanishVariations of Spanish Spanish as a second languageSpanish as a second language Anxiety associated with learning Anxiety associated with learning
EnglishEnglish Children as translators for parentsChildren as translators for parents Children choosing English over Spanish Children choosing English over Spanish
as primary method of communicatingas primary method of communicating
Culture and AcculturationCulture and Acculturation Understanding the majority group cultureUnderstanding the majority group culture Maintaining culture of originMaintaining culture of origin Being bi-culturalBeing bi-cultural Some basic differencesSome basic differences
• Family above all (and extended family)Family above all (and extended family)• Time to be enjoyed not conqueredTime to be enjoyed not conquered• Cooperation versus competitionCooperation versus competition• Religion as source of support and socializingReligion as source of support and socializing• Keep one’s problems to themselves or familyKeep one’s problems to themselves or family• Less materialLess material• More emotionalMore emotional
FamilyFamily
Defining FamilyDefining Family• NuclearNuclear• ExtendedExtended• DoubleDouble• FunctionalFunctional
Divided FamiliesDivided Families• EconomicsEconomics• GeographyGeography• PoliticsPolitics
Ineffective Social SupportIneffective Social Support
MedicalMedical ReligiousReligious EducationalEducational FinancialFinancial SocialSocial MaritalMarital
Low Self EsteemLow Self Esteem
Productivity and MaterialismProductivity and Materialism ConnectivityConnectivity Self-Effacing PresentationSelf-Effacing Presentation Self-Fulfilling ProphecySelf-Fulfilling Prophecy
EducationEducation
Typical Educational BackgroundTypical Educational Background What it Means to be “Educated”- the What it Means to be “Educated”- the
difference between schooling and difference between schooling and educationeducation
Financial & Related LimitationsFinancial & Related Limitations
The Limits and Hazards of Being The Limits and Hazards of Being UndocumentedUndocumented
Type of Vocational Opportunities & Type of Vocational Opportunities & Corresponding PayCorresponding Pay
Banking IssuesBanking Issues Saving for RetirementSaving for Retirement Driver’s LicenseDriver’s License
ReligionReligion
Predominantly Catholic, but not Predominantly Catholic, but not Exclusively (fundamental)Exclusively (fundamental)
Importance of Religion and Related Importance of Religion and Related Social SupportSocial Support
Church and Related Services in Church and Related Services in SpanishSpanish
DocumentationDocumentation
EducationEducation MedicalMedical LegalLegal
• Tax ID NumbersTax ID Numbers• Social Security NumbersSocial Security Numbers• Driver’s LicensesDriver’s Licenses
AliasesAliases
Outcome of ProblemsOutcome of Problems
AnxietyAnxiety 13%13% Substance abuseSubstance abuse 8% 8% DepressionDepression 5% 5% Violence Violence ?% ?%
Ethnic identity issuesEthnic identity issues Poverty and marginalizationPoverty and marginalization
Gender IssuesGender Issues
Males vs Female Males vs Female • Males Males 27%27%• Females Females 17%17%
Heterosexual issuesHeterosexual issues• Clashing of culturesClashing of cultures• Availability of partnersAvailability of partners• ProstitutionProstitution
Sexual Identity IssuesSexual Identity Issues Childhood Sexuality & AbuseChildhood Sexuality & Abuse
A Simple Model for Addressing A Simple Model for Addressing Mental Health ConcernsMental Health Concerns
Communication & Narrative Communication & Narrative ApproachApproach
Rapport and TrustRapport and Trust QuestioningQuestioning Symptom IdentificationSymptom Identification EmpowermentEmpowerment Solution Focus Solution Focus Follow-upFollow-up
Suggestions for Health IssuesSuggestions for Health Issues
Style/RapportStyle/Rapport TranslationTranslation FamilyFamily Documentation StatusDocumentation Status Interpretation of InformationInterpretation of Information Follow-upFollow-up
Personnel and ServicesPersonnel and Servicesin Southeastern NCin Southeastern NC
OAKS & SEMHC & OthersOAKS & SEMHC & Others• SEMHC (1?)SEMHC (1?)• Titleson Clinic (first Wednesday)Titleson Clinic (first Wednesday)• Catholic Ministries (1?)Catholic Ministries (1?)
Private sector personnelPrivate sector personnel• Psychologist- 1Psychologist- 1• Psychiatrist- 1Psychiatrist- 1• Social Worker- 1 (?)Social Worker- 1 (?)
Related SupportRelated Support
Radio and TelevisionRadio and Television• 1 Program?1 Program?
NewspaperNewspaper• 1?1?
OrganizationsOrganizations• Centro Latino/Amigos InternacionalCentro Latino/Amigos Internacional
Cultural MatrixCultural Matrix
ISOLATED ISOLATED VS VS ACCULTURATED ACCULTURATED
MAINSTREAM MAINSTREAM VS VS ASSIMILATEDASSIMILATED
From Isolation to AssimilationFrom Isolation to Assimilation
IsolationIsolation AcculturationAcculturationAssimilationAssimilation
IncomeIncome$20,500 $20,500 $36,100$36,100 $37,000$37,000
SizeSize 3.9 3.6 3.9 3.6 3.13.1
Time in USTime in US11stst gen. US born gen. US born 44thth Gen. Gen.
LocaleLocale Inner CityInner City Suburbs ?Suburbs ? SuburbsSuburbs
ValuesValues HispanicHispanic Partial HispanicPartial Hispanic AngloAnglo
LanguageLanguage SpanishSpanish BilingualBilingual EnglishEnglish
The Future The Future
Clashing Curves and CulturesClashing Curves and Cultures Financial & Social “Slavery”Financial & Social “Slavery” Pay Now or Pay LaterPay Now or Pay Later What is North Carolina and New What is North Carolina and New
Hanover Going to Do?Hanover Going to Do?