Hogg Foundation for Mental Health

Overcoming Cultural Barriers to Mental Health

January 1, 2009

"I have major depression and generalized anxiety disorder," a 34-year-old South Texas man recently wrote to the foundation. "My anxiety level limited my way of life. I could not participate in any social events. I felt I was living in fear – but yet, there was hope."

That hope came from Tropical Texas Behavioral Health in the Lower Rio Grande Valley. The center received a grant from the foundation to culturally adapt mental health services for treating anxiety disorders among primarily Spanish-speaking clients.

Cultural values, beliefs and language can affect a person's response to treatment for a mental health condition. Evidence-based mental health practices in particular have proven successful for treating white, English-speaking mental health consumers, but remain largely untested with culturally and linguistically diverse communities.

The foundation is working with grantees to identify cultural issues and language differences that may interfere with mental health treatment, adapt and implement services that are culturally appropriate, and evaluate the outcomes of the adaptations.

The foundation has awarded nearly $3 million to five nonprofit community-based organizations in Texas to adapt evidence-based practices for clients of Latino and African American descent. The organizations treat children and adults with a variety of mental health needs, including attention-deficit hyperactivity disorder, anxiety disorders and major depression.

"Ultimately our goal is to help improve the design and delivery of mental health services in Texas. Our grantees are demonstrating that mental health services can and should be adapted to more effectively serve people of diverse backgrounds, cultures and languages," said Rick Ybarra, the foundation's program officer who is leading the initiative.

The Tropical Texas client described how the clinic's services helped him. "I was taught to handle situations that came my way, from socializing, handling large crowds, being able to go shopping and attend certain events. With the help I receive, I have a new way to fight my anxiety. This program is really working and has changed my life," he wrote.

The clinic's adaptations are straightforward yet critical to overcoming cultural and language barriers to treatment. Mental health services and educational materials are available in English and Spanish. Family members may participate in treatment with the client's consent. Clinicians ask about their clients' personal and family cultural histories, beliefs and traditions. They also discuss cultural stereotypes and stigmas about mental illness and share culturally rooted stories of others with similar conditions who have achieved recovery.

"This grant has been a driver for change. We are more creative and perceptive in integrating cultural adaptation and cultural competence throughout our organization," Jim Banks, the clinic's planning and evaluation specialist, told other grantees in October at an annual meeting sponsored by the foundation.

Richard Salcido is executive director of Family Services of El Paso, which also received a grant. Two-thirds of the clinic's clients are Hispanic, largely of Mexican descent, and nearly half prefer to work with a Spanish-speaking therapist. Some clients require mental health services in Spanish or in both English and Spanish to meet family members' language needs.

Salcido said the clinic implemented an agency-wide cultural competency plan and made adaptations at every level of operations, from revising the board's bylaws and appointing board members who reflect the community's diversity, to hiring bilingual clinical and administrative staff and integrating dichos (folk sayings) into therapeutic sessions. The clinic identified 10 characteristics of Hispanic families that can impact therapy and is collecting information about how these characteristics intersect with treatment methods and adaptations.

The program increased staff's understanding of cultural definitions and perceptions, and enabled them to confront personal biases and recognize their comfort levels in working with clients from a wide range of cultures, backgrounds and histories, Salcido said.

"Some staff have chosen to increase their cultural competency by taking Spanish language classes, learning about culturally based health beliefs and practices, participating in Mexican cultural heritage events, and learning Mexican history and the effects of immigration and assimilation," he said.