Mental Health Issues in Hispanics:Mental Health Issues in Hispanics: A New & Pressing Challenge A New & Pressing Challenge

for North Carolina & the Cape Fear Regionfor North Carolina & the Cape Fear Region

Antonio E. Puente, Ph.D.Antonio E. Puente, Ph.D.

University of North Carolina at WilmingtonUniversity of North Carolina at Wilmington910.962.3812910.962.3812

puente@uncw.edupuente@uncw.eduwww.uncw.edu/people/puentewww.uncw.edu/people/puente

1508 Military Cutoff Road #3031508 Military Cutoff Road #303www.clinicalneuropsychology.uswww.clinicalneuropsychology.us

New Hanover Health DepartmentNew Hanover Health DepartmentJuly 14, 2004July 14, 2004

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

Demographics:Demographics:Hispanic PanoramaHispanic Panorama

United State StatsUnited State Stats• Overall = 12.5% (vs 12.1% for AA)Overall = 12.5% (vs 12.1% for AA)• Before 18 = 35%Before 18 = 35%• 18-65 = 60%18-65 = 60%• 65 + = 5%65 + = 5%• Less Educated than counterpartsLess Educated than counterparts

North Carolina StatsNorth Carolina Stats• Overall = 4.7%Overall = 4.7%• Migration for Foreign Born = 50%Migration for Foreign Born = 50%

Primarily from California (also from the NE)Primarily from California (also from the NE) Comparison (ND = 282% decrease) Comparison (ND = 282% decrease)

• From 1990 to 2000 = 57.9% increaseFrom 1990 to 2000 = 57.9% increase New Hanover Stats ???New Hanover Stats ???

• Total Population = 147,642 (22.7% increase)Total Population = 147,642 (22.7% increase)• 1980 = 788; 1990 = 747; 2000 =1,8281980 = 788; 1990 = 747; 2000 =1,828

Additional Hispanic StatisticsAdditional Hispanic 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(from PsyInfo, 07.14..04)(from PsyInfo, 07.14..04)

PsychologyPsychology

464,5888464,5888 HispanicsHispanics

• 7,4627,462 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

English and losing cultureEnglish and losing culture 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 culture and Understanding the majority group culture and

vice versavice versa Maintaining culture of origin (e.g., southern Eng.)Maintaining culture of origin (e.g., southern Eng.) Being bi-cultural (it’s more than language)Being bi-cultural (it’s more than language) Some basic differencesSome basic differences

• Family above all (and extended family)Family above all (and extended family)• Friends and social groups are criticalFriends and social groups are critical• Time to be enjoyed not conqueredTime to be enjoyed not conquered• Cooperation versus competitionCooperation versus competition• Religion as source of support and socializationReligion as source of support and socialization• Keep one’s problems to themselves or familyKeep one’s problems to themselves or family• Less material & consumer focusedLess material & consumer focused• More emotionalMore emotional• More spiritual and religiousMore spiritual and religious

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 License (the TN solution)Driver’s License (the TN solution)

ReligionReligion

Predominantly Catholic, but not Predominantly Catholic, but not Exclusively (fundamental alternative)Exclusively (fundamental alternative)

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• Language at home; Language for childrenLanguage at home; Language for children

Poverty and marginalizationPoverty and marginalization• Higher Education as an exampleHigher Education as an example

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• STDsSTDs

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

Personnel and ServicesPersonnel and Servicesin Southeastern NCin Southeastern NC

Mental Health Public SectorMental Health Public Sector• Catholic Ministries-Catholic Ministries- (?) (?)• SEMHC-SEMHC- (?) (?)• Titleson Clinic (first Wednesday)Titleson Clinic (first Wednesday)

Mental Health Private Sector Mental Health Private Sector • Psychologist-Psychologist- 11

Health Public SectorHealth Public Sector• New Hanover County-New Hanover County- 1 1

Related SupportRelated Support

Radio and TelevisionRadio and Television• 1 - AM Religious Station1 - AM Religious Station• 1 - WHQR Sunday Night1 - WHQR Sunday Night

NewspaperNewspaper• 11

OrganizationsOrganizations• Centro Latino/Amigos InternacionalCentro Latino/Amigos Internacional

Intra-Cultural ConflictIntra-Cultural Conflict

Pertinent GroupsPertinent Groups• OlaOla• Titleson ClinicTitleson Clinic• Centro LatinoCentro Latino• Hispanic Chamber of CommerceHispanic Chamber of Commerce• Hispanic Development Corporation (?)Hispanic Development Corporation (?)• Others (?)Others (?)

Intra-Cultural Conflicts & A Intra-Cultural Conflicts & A Leadership VoidLeadership Void

Cultural MatrixCultural Matrix

ISOLATED ISOLATED VS VS ACCULTURATED ACCULTURATED

MAINSTREAM MAINSTREAM VS VS ASSIMILATEDASSIMILATED

From Isolation to AssimilationFrom Isolation to Assimilation(from (from Hispanic BusinessHispanic Business, December 2003), December 2003)

IsolationIsolation Acculturation Acculturation AssimilationAssimilation

IncomeIncome$20,500 $20,500 $36,100$36,100 $37,000$37,000

SizeSize 3.9 3.6 3.1 3.9 3.6 3.1

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

• Social Welfare ProgramsSocial Welfare Programs• Social Security DisabilitySocial Security Disability• Penal SystemPenal System

What is North Carolina and the Cape What is North Carolina and the Cape Fear Region Going to Do?Fear Region Going to Do?