The Problem – The debate over the repeal of the Affordable Care Act, known as the ACA or Obamacare, has led to increased emotional strain on the Latino community. Many members of Latino families traditionally have not received adequate health care services, including mental health care, because they work at jobs that do not provide health insurance, or because they are illegal and do not qualify for insurance, or because language barriers make it difficult for them to access or communicate effectively. Those Latinos who qualify for Medicaid often present only a portion of an extended Latino family.
Demographics – Nonetheless, millions of Latinos have benefited from the ACA. According to the Commonwealth Fund (January, 2017), “Since passage of the ACA Latinos have experienced the largest decline in the uninsured rate of any ethnic group,” going from 43% in 2010 to 25% in 2016. Latinos benefitted in those states that expanded Medicaid under the ACA, including Minnesota. Furthermore, the Obama administration, under the ACA, allowed Minnesota to broaden the coverage provided by Minnesota Care (MNsure), which resulted in 96% of MN residents receiving heath insurance. The continuing controversy among Minnesota physicians about the MNsure tax presents a threat to the viability of MNsure. If the ACA is repealed and/or replaced by a law that undercuts Medicaid or MNsure in any way, Latinos will be among those most hurt.
Population History – Latino culture’s perspective on mental illness and resources are major problems for consideration in the Twin Cities. The community has long underutilized professional mental health services. Ambivalent about the stigma associated with mental health and lacking good information on resources, the Latino culture has long relied on strong family ties, spiritual sensibility, and a fundamental communal generosity (“Mi Casa Su Casa”) as the pillars of strength and resilience that protect their mental health. Many Latinos in our community have thrived professionally in law and medicine, in small business, construction, maintenance service, along with local politics. Latinos frequently reside in residential areas, like the west side of St. Paul and sections of north and south Minneapolis, proximate to a Catholic Church with bilingual services. The growth in population and acculturation, however, may lead some Latinos to pursue self-reliance and isolate themselves from their community, including the extended family support needed for early intervention and care.
The need for mental health services has never been greater. The increased number of deportations, beginning under Obama and increasing under the Trump presidency, has increased the stress levels of families that touches almost every member of the Latino community directly or indirectly. A friend, relative, parent, a DACA (Deferred Action for Childhood Arrivals) student or asylum refugee, all carry the burden of anxiety and depression not knowing if or when they may be apprehended and deported. The children of parents at risk and young adults (especially Latinas) have been reported to be at risk for self harm, suicide, and increased drug and alcohol abuse to cope with this constant threat.
Recommendations – Physicians wishing to learn more about mental health resources can access a regularly updated guide produced by the Hennepin County Spanish-speaking Provider Consortium (www.washburn.org/Spanish clinical guide) for accessible, affordable care. Twin City providers, CLUES, Washburn Center for Children, and Hamm Clinic, are examples of mental health agencies with decades of experience in special services for Latinos.
Finally, the website understandingdepression.org includes a video series in English focusing on conversations with men and women who sought professional help for mental illness. They talk openly about depression signs and symptoms, detection across the life cycle, and the treatments that enabled them to recover and lead a healthy life of work and family. A second series on the risk of suicide for untreated major depression is available on the same website in both English and Spanish (entendiendodepresion.org). This series focuses on the risk of suicide when mental health treatment is not available or accessed. It also provides resources for Spanish speakers.