Latino Trends and Health Policy: From Walking on Eggshells to Commitment

  • Silvia L. Mazzula
  • Aileen TorresEmail author


This chapter provides an overview of major challenges faced by Latina/o clients in need of mental health services. First, an overview of the research on barriers to access (e.g., culture, language, medical insurance, etc.) and service utilization (e.g., poor service quality, improper screening and diagnosis) are presented. Important cultural issues related to Latina/os engaging in treatment are integrated, including issues of citizenship status, cultural values, stigma, and discriminating. Second, recommendations are offered for policy- and decision-makers to implement, re-design, and assess the effectiveness of integrated care with Latino populations. Special attention is given to the need for more clearly outlined, and enforced, policies that improve language accessibility and screening practices, support training, funding and development of culturally competent research, scholarships, and workforce. Medical providers, mental health professionals, and social workers, all bring significant areas of expertise, and must all be directly involved in the development, planning, and execution of policies, guidelines, and protocols. Infused throughout the chapter is the importance of advocating for policies that promote social justice, equity, and equality in all systems of care to help us move toward active commitment to culturally responsive treatment, research, and policies.


Latina/o Mental health policy Service use Healthcare integration 


  1. Acosta, H. (2006). The current status of Latino mental health in the United States. Paper session at National Association for Mental Illness’ Eliminating Disparities: Multicultural Strategic Summit, Washington, DC.Google Scholar
  2. Agency for Healthcare Research and Quality. (2009). Program brief: Mental health research findings. Rockville, MD: Author.Google Scholar
  3. Alegria, M., Mulvaney-Day, N., Torres, M., Polo, A., Cao, Z., & Canino, G. (2007). Prevalence of psychiatric disorders across Latino subgroups in the United States. American Journal of Public Health, 97, 68–75.CrossRefPubMedPubMedCentralGoogle Scholar
  4. American Psychological Association (2001). Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologists.Google Scholar
  5. American Psychological Association. (2014). 2014 Mental health parity survey. Washington, DC: Author.Google Scholar
  6. American Psychological Association. (2015). Consumer guide: What you need to know about mental health coverage. Washington, DC: Author.Google Scholar
  7. Anda, R. F., Brown, D. W., Dube, S. R., Bremner, J. D., Felitti, V. J., & Giles, W. H. (2008). Adverse childhood experiences and chronic obstructive pulmonary disease in adults. American Journal of Preventive Medicine, 34(5), 396–403.CrossRefPubMedGoogle Scholar
  8. Anda, R., Tietjen, G., Schulman, E., Felitti, V., & Croft, J. (2010). Adverse childhood experiences and frequent headaches in adults. Headache, 50(9), 1473–1481.CrossRefPubMedGoogle Scholar
  9. Arredondo, P., Gallardo-Cooper, M., Delgado-Romero, E. A., & Zapata, A. L. (2014). Culturally responsive counseling with Latinas/os. Alexandria, VA: American Counseling Association.Google Scholar
  10. Barreto, M., & Sanchez, G. (2013). New national Latino health care survey results. Latino Decisions. Retrieved from
  11. Benish SG, Quintana S, & Wampold BE. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of Counseling Psycholy V58(3):279–89. doi: 10.1037/a0023626.Google Scholar
  12. Bower P,& Gilbody S. (2005). Managing common mental health disorders in primary care: conceptual models and evidence base. BMJ;330(7495):839–42.Google Scholar
  13. Bustamante, A. V., Fang, H., Rizzo, J. A., & Ortega, A. N. (2009). Heterogeneity in health insurance coverage among US Latino adults. Journal of General Internal Medicine, 24(3), 561–566. doi: 10.1007/s11606-009-10697.CrossRefPubMedGoogle Scholar
  14. Cabassa, L. J., Zayas, L. H., & Hansen, H. C. (2006). Latino adults’ access to mental health: A review of epidemiological studies. Administration and Policy in Mental Health, 33(3), 316–330. doi: 10.1007/s10488-006-0040-8.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Campón, R. R., & Carter, R. T. (2015). The appropriated racial oppression scale: Development and validation. Cultural Diversity & Ethnic Minority Psychology, 21(4), 497–506.CrossRefGoogle Scholar
  16. Carter, R. T., Forsyth, J., Mazzula, S. L., & Williams, B. (2005). Racial discrimination and race-based traumatic stress. In Carter R. T. (Vol. Ed.), Handbook of racial-cultural psychology and counseling: Practice and training Vol. 2 (pp. 447–476). New York, NY: Wiley & Sons, Inc.Google Scholar
  17. Carter, R.T., Mazzula, S. L., Victoria, R., Vazquez, R., Hall, S., Smith, S., … Williams, B. (2013). Initial development of the race-based traumatic stress symptom scale: Assessing the emotional impact of racism. Psychological Trauma: Theory, Research, Practice, and Policy, 5(1), 1–9.Google Scholar
  18. Carter, R. T., Yeh, C. J., & Mazzula, S. L. (2008). Cultural values and racial identity statuses among Latino students: An exploratory investigation. Hispanic Journal of Behavioral Sciences, 30(5), 5–23. doi: 10.1177/0739986307310505.CrossRefGoogle Scholar
  19. Chapa, T. (2004). Mental health services in primary care settings for racial and ethnic minority populations. Rockville, MD: U.S. Department of Health and Human Services, Office of Minority Health.Google Scholar
  20. Cofresí, N., & Gorman, A. (2004). Testing and assessment issues with Spanish-English bilingual Latinos. Journal of Counseling & Development, 82, 99–106.CrossRefGoogle Scholar
  21. Corso, P. S., Edwards, V. J., Fang, X., & Mercy, J. A. (2008). Health-related quality of life among adults who experienced maltreatment during childhood. American Journal of Public Health, 98, 1094–1100.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Delgado-Romero, E. A., Glavan, N., Maschino, P., & Rowland, M. (2005). Race and ethnicity: Ten years of counseling research. The Counseling Psychologist, 33, 419–448.CrossRefGoogle Scholar
  23. Dong, M., Giles, W. H., Felitti, V. J., Dube, S. R., Williams, J. E., Chapman, D. P., & Anda, R. F. (2004). Insights into causal pathways for ischemic heart disease: Adverse childhood experiences study. Circulation, 110, 1761–1766.Google Scholar
  24. Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune disease. Psychomatic Medicine, 71, 243–250.CrossRefGoogle Scholar
  25. Ell, K., Katon, W., Cabassa, L. J., Xie, B., Lee, P. J., Kapetanovic, S., & Guterman, J. (2009). Depression and diabetes among low-income Hispanics: Design elements of a socio-culturally adapted collaborative care model randomized controlled trial. International Journal of Psychiatry in Medicine, 39(2), 113–132.Google Scholar
  26. Ell, K., Katon, W., Xie, B., Lee, P. J., Kapetanovic, S., Guterman, J., & Chou, C. P. (2010). Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes. A randomized controlled trial. Diabetes Care, 33(4), 706–713.Google Scholar
  27. Ell, K., Xie, B., Kapetanovic, S., Quinn, D. I., Lee, P. J., Wells, A., & Chou, C. P. (2011). One-year follow-up of collaborative depression care for low-income, predominantly Hispanic patients with cancer. Psychiatric Services, 62(2), 162–170.Google Scholar
  28. Hugo Lopez, M., & Gonzalez, A. (2013). What is the future of Spanish in the United States? Pew Research Center. Retrieved from
  29. Humensky, J., Santiago, B., Gill, R., Mazzula, S. L., & Lewis-Fernández, R. (2014). Life is precious: Reducing suicidal behavior in Latinas. Ethnicity and Inequalities in Health and Social Care, 6(2), 54. doi: 10.1108/EIHSC-10-2013-0027.Google Scholar
  30. Institute of Medicine. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.Google Scholar
  31. Leyro, S. (2015). Legal violence: Crimmigration and the violent effects of deportation. Paper session at the 32nd annual Winter Roundtable, Teachers College, NYGoogle Scholar
  32. Linenkugel, N. (2001). Integrated health networks are not created equal. Frontiers of Health Services Management, 17, 41–44.PubMedGoogle Scholar
  33. Marin, G., & Marin, B. V. O. (1991). Research with Hispanic populations. Newbury Park, CA: SAGE Publications.CrossRefGoogle Scholar
  34. Mazzula, S. L., (2013, August). Chair. Race and culture in psychology publications: A call to action in research, theory and practice. Symposium at the American Psychological Association 121st Annual Convention, Honolulu, HI.Google Scholar
  35. Mental Health America (YR). Position statement 15: Mental health parity in health insurance.Google Scholar
  36. Nadal, K., Mazzula, S. L., Rivera, D. R., & Fujii-Doe, W. (2014). Racial microaggressions and Latina/o Americans: An analysis of nativity, gender, and ethnicity. Journal of Latina/o Psychology, 2(2), 67–78. doi: 10.1037/lat0000013.CrossRefGoogle Scholar
  37. National Alliance on Mental Illness. (2009). Grading the states. Arlington, VA: Author.Google Scholar
  38. National Alliance on Mental Illness. (2013). New mental health coverage for Latino families. Arlington, VA: National Latino Behavioral Health Association.Google Scholar
  39. National Alliance on Mental Illness. (2015). A long road ahead: Achieving true parity in mental health and substance use. Arlington, VA: Author.Google Scholar
  40. National Child Traumatic Stress Network. (2005). Promoting culturally competent trauma-informed practices. NCTSN Culture & Trauma Briefs, 1(1).Google Scholar
  41. National Institute of Health. (2015). Current programs in the Division of Training, Workforce Development, and Diversity (TWD). Rockville, MD: U.S. Department of Health and Human Services, Division of Training, Workforce Development and Diversity. Retrieved from Scholar
  42. New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America, Executive summary. Rockland, MD: Substance Abuse and Mental Health Services Administration. Retrieved from Scholar
  43. Ngo-Metzger, Q., Sorkin, D. H., & Phillips, R. S. (2009). Health care experiences of limited-English proficient Asian Americans. The Patient: Patient-centered Outcomes Research, 2(2), 113–120.Google Scholar
  44. Rios-Ellis, B. (2005). Critical disparities in Latino mental health: Transforming research into action. Retrieved from
  45. Rogers, A., & Sheaff, R. (2000). Formal and informal systems of primary healthcare in an integrated system: Evidence from the United Kingdom. Healthcare Papers, 1, 47–58.CrossRefPubMedGoogle Scholar
  46. Sanders Thompson, V. L., Bazile, A., & Akbar, M. (2004). African-Americans’ perceptions of psychotherapy and psychotherapists. Professional Psychology: Research and Practice, 35, 19–26.CrossRefGoogle Scholar
  47. Satterfield, M., & Dover, M. (2012, January). AAP mental health toolkit addressing mental health concerns in primary care a clinician’s toolkit. Presentation at the NC Center of Excellence for Integrated Care 2010.Google Scholar
  48. Unutzer, J., Schoenbaum, M., Druss, B. G., & Katon, W. J. (2006). Transforming mental health care at the interface with general medicine: Report for the President’s Commission. Psychiatric Services, 57, 37–47.Google Scholar
  49. U.S. Department of Health and Human Services (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.Google Scholar
  50. U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to mental health: A report of the surgeon general. Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services.Google Scholar
  51. U.S. Department of Health and Human Services. (2010). Movilizandonos por Nuestro Futuro: Strategic Development of a Mental Health Workforce for Latinos Consensus Statements and Recommendations. USDHHS Office of Minority Health and the National Resource Center for Hispanic Mental Health.Google Scholar
  52. U.S. Department of Health and Human Services. (2014). Fact sheets: The affordable care act and Latinos., U.S. Department of Health and Human Services. Retrieved from
  53. U.S. Department of Health and Human Services Office of Minority Health & Hogg Foundation for Mental Health. (2012). Eliminating disparities through the integration of behavioral health and primary care services for racial and ethnic minority populations, including individuals with limited english proficiency. A literature review report.Google Scholar
  54. Umaña-Taylor, A. (2003). Language brokering as a stressor for immigrant children and their families. In M. Coleman & L. Ganong (Eds.), Points and counterpoints: Controversial relationship and family issues in the 21st century: An anthology (pp. 157–159). Los Angeles, CA: Roxbury.Google Scholar
  55. Vitullo, M. W., & Taylor, A. K. (2002). Latino adults’ health insurance coverage: An examination of Mexican and Puerto Rican subgroup differences. Journal of Health Care for the Poor and Underserved, 13(4), 504–525. doi: 10.1353/hpu.2010.0653.CrossRefPubMedGoogle Scholar
  56. Weinick, R. M., & Jacobs, E. A. (2000). Hispanic healthcare utilization: The role of ancestry, language, and duration of residence in the United States. Abstract of the Academic Health Services Research Health Policy Meeting. Google Scholar
  57. Yeung, A., Shyu, I., Fisher, L., Wu, S., Yang, H. Y., & Fava, M. (2010). Culturally sensitive collaborative treatment for depressed Chinese Americans in primary care. American Journal of Public Health, 100(12), 23972402.CrossRefGoogle Scholar
  58. Zayas, L. H. (2011). Latinas attempting suicide: When cultures, families and daughters collide. New York, NY: Oxford University Press.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.John Jay College of Criminal JusticeNew YorkUSA
  2. 2.Aileen Torres, Private PracticeLyndhurstUSA

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