There are 62 million Hispanic and Latino people living in the United States—and in 2020, an estimated 7.7 million Hispanic and Latino adults reported experiencing mental illness, per a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Comprised of people with roots in over 20 Latin American countries, the Hispanic and Latino communities in the U.S. are a diverse demographic, ethnically, culturally and economically. Yet they face an overlapping array of obstacles when it comes to getting the help they need, says Ruby Castilla, M.D., Director of Clinical Development, Mood Disorders, at the Janssen Pharmaceutical Companies of Johnson & Johnson.
The reason for this access gap is an intersection of many factors that prevent people from making mental health a priority, says Dr. Castilla, who served as president of the American Society of Hispanic Psychiatry from 2020 to 2022. For some, lack of insurance coverage is a problem. For those who emigrated from another country, communication with non-Spanish speaking healthcare professionals is a challenge and if they’re among the roughly 8 million who are undocumented, fear of seeking help is another factor.
“They also may be dealing with traumatic events that occurred in the country they arrived here from,” Dr. Castilla adds. Ultimately, “they have no opportunities to say, ‘I’m suffering; can I receive some support?’”
Johnson & Johnson has made it a mission to create such necessary opportunities to improve mental health for Spanish-speaking people in this country and worldwide. In honor of Mental Health Awareness Month, Dr. Castilla shares more insights into the unique mental healthcare needs Hispanic and Latino people face—and how Johnson & Johnson is actively working to help meet them.
1.
Supporting research into mental healthcare gaps
Stigma remains a pervasive barrier to accessing mental healthcare across the entire Hispanic and Latino population, including people who are U.S.-born native English speakers, regardless of their education and income level. A study co-written by Dr. Castilla and supported by Janssen Scientific Affairs, published this summer, confirmed this.
The study used artificial intelligence (AI) to analyze millions of digital conversations about depression in ethnic and racial groups including Hispanic, non-Hispanic whites, Black and Asian-American people.
The result?
“We learned that, even if you have insurance, you’re well-educated and have every opportunity to go to the doctor, you don’t go to the psychiatrist if you’re Hispanic,” Dr. Castilla says. Indeed, Hispanics in the study had the highest rates of conversations showing what she calls an “avoidant mindset” toward their depression.
“People who fell into the other groups tended know when they were depressed, and they reached out for help because they considered depression a disease that can be treated,” she explains. “But in our research, Hispanics and Latinos tend to believe that depression is just part of life that you have to pass through, like going from childhood to adolescence.”
The problem to solve was clear to Dr. Castilla and her colleagues. “If there’s a huge intrinsic cultural barrier unrelated to education, how can we overcome that?”
While researchers start to work on the answer and to develop culturally competent depression treatments for the Hispanic and Latino population, the study’s innovative AI approach is already creating potential for new ways to assess unmet healthcare needs.
“We’re creating awareness that this type of research can be done,” Dr. Castilla says. “We’re opening the doors for more projects and possibilities with other groups in the company as well.”
2.
Helping Spanish speakers get the resources they need
Given the high stigma associated with getting help for mental health issues in Hispanic and Latino communities, the wealth of medically vetted, free-of-cost information online can be a powerful tool for breaking down misconceptions. “The American Psychiatric Association (APA) has very good resources—but they’re in English,” Dr. Castilla says. “Our goal has been to develop these same resources for Spanish-speaking patients.”
And that goal will be realized this month, with the launch of La Salud Mental, an APA website dedicated to Spanish-language information and resources on mental health and substance-use disorders that are culturally competent and evidence-based. It’ll largely mirror the content of the APA’s English site, with content chiefly focused on five main topics: depression, mental health stigma, suicide risk, substance abuse and women’s health.
In weekly meetings organized by the APA, a group of Johnson & Johnson experts in Hispanic-focused psychiatry work as a review board, auditing translated material that includes text, videos and captioned images.
“The tricky part of creating educational resources across cultures is that some terminology and contexts don’t directly translate,” says Dr. Castilla. “Sometimes when we review a web page that’s been directly translated into Spanish, we find it doesn’t make sense.” Staying conscious of those differences, while maintaining the nuances of empathy, is a main focus of the project.
You can’t imagine how difficult is to find mental health professionals that speak Spanish. We need to create a brilliant new generation of physicians, clinicians, nurses and psychologists who are interested in the mental health of the Hispanic community.
The process of retaining meaning and relevance across cultures goes beyond comparing Spanish to English. “Sometimes we have very good discussions in those meetings about regional differences, for example: ‘For Colombians, this is different than in Brazil or Argentina or Puerto Rico,’” Dr. Castilla says. “Or, ‘We don’t say that in Mexico.’ So we have to consider those contexts too.”
Considering how cultural differences can impact the treatment pipeline is also important.
“We recently evaluated the case of a woman who was a victim of domestic violence. She was afraid to reach out to the doctor because she was undocumented and worried that she and her family could be deported,” Dr. Castilla says. “On La Salud Mental we’re trying to include resources where a person in those circumstances can reach out for help—particularly in states with high Spanish-speaking populations like Florida, California and Texas.”
3.
Mentoring students in medical fields
Hispanic and Latino people are vastly underrepresented in the medical field. And when they do attend medical school, research shows that they’re less likely to graduate than their white non-Hispanic counterparts, particularly when students come from underprivileged backgrounds prior to enrolling.
“Many abandon school because they don’t have a network, and they have no models to follow,” Dr. Castilla says. “They need a guide.”
Enter Johnson & Johnson, which has committed $100 million to investing and promoting health equity in healthcare. Helping to create a more diverse medical workforce is a crucial part of this mission. Working alongside the National Hispanic Medical Association, the company is connecting five medical students a year to working healthcare professionals in monthly one-on-one mentorship sessions to ensure they get the information and connections they need to thrive in their program—and graduate.
If a medical student is a native Spanish speaker, they’re paired with a mentor they can easily converse with. “You can’t imagine how difficult it is to find mental health professionals that speak Spanish,” says Dr. Castilla. Other challenges the mentors advise on include financial-aid concerns, housing and childcare.
“We need to create a brilliant new generation of physicians, clinicians, nurses and psychologists who are interested in the mental health of the Hispanic community,” Dr. Castilla says. “They need someone to show them that there’s more than one way to navigate the school of medicine and the residential training program.”
4.
Reaching out to local communities
As an active member of the Hispanic Organization of Leadership and Achievement (HOLA), the company’s Hispanic and Latino employee resource group, Dr. Castilla is currently leading the group’s Hispanic medical initiatives, 50% of which aim to create awareness around mental health. These initiatives typically involve partnering with nongovernment organizations that support Hispanic and Latino populations. “At HOLA we have been privileged to have a leader like Joaquin Duato, who has made possible projects that greatly impact Hispanic communities,” says Dr. Castilla.
One example: A free Spanish-language speaker series about mental health, created by HOLA in partnership with the American Society of Hispanic Psychiatry and held monthly at Newark, New Jersey-based organization La Casa de Don Pedro, not far from Johnson & Johnson’s world headquarters in New Brunswick. The first half hour features a healthcare professional presenting in Spanish, such as a psychiatrist talking about anxiety. The second half hour is an open space in which attendees can ask questions, which Dr. Castilla says often include concerns about family members.
“It’s been one of the most rewarding programs we have,” she says.
