Problems in designing and implementing culturally relevant mental health services for Latinos in the U.S.

Abstract

Passage of the Community Mental Health Centers Act in 1963 by the U.S. Congress reflected a new concern with providing mental health services to previously underserved communities, many of them minority communities in the inner cities, and a new goal of primary prevention through social change. It has been assumed that utilization by non-white, non-middle class patients will increase when services are “culturally relevant”. One group which has consistently underutilized mental health services is Latinos, who comprise the second largest—and fastest growing—minority in the U.S. Three constituencies active in planning mental health services for Latino populations are: (1) governmental funding agencies, (2) social scientists, and (3) Latino activists. They have each approached the issue of cultural relevance in mental health service delivery from different perspectives: governmental funding agencies stressed geographic proximity to services; social scientists pointed out the need to recognize indigenous. folk belief systems and practitioners; Latino activists saw the key to cultural relevance in staffing patterns providing bilingual, bicultural staff. While many would uncritically accept these assumptions, the three constituencies involved in planning and delivering mental health services have frequently clashed and actual changes in service delivery have been difficult to implement. A case study which illustrates the difficulty of implementing—and defining—culturally relevant services in a Mexican/Chicano community mental health center is presented. Directions for future research to develop and evaluate culture-specific treatment modalities are suggested.