1. Mental Health Issues in Hispanics: A New Challenge for North Carolina Antonio E. Puente, Ph.D. University of North Carolina at Wilmington 910.962.3812 puente@uncw.edu www.uncw.edu/people/puente 1508 Military Cutoof Road #303 www.clinicalneuropsychology.us New Hanover Regional Medical Center Interdisciplinary Grand Rounds January 16, 2003

2. Demographics Growth Growth 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 Carolina North Carolina One of the fastest growing states for HispanicOne of the fastest growing states for Hispanic Southeastern NC particularly sensitive, especially rural areas with agriculture and livestockSoutheastern NC particularly sensitive, especially rural areas with agriculture and livestock

3. Hispanic Statistics Percentage of Population Percentage of Population - In US = 12.5% - In US = 12.5% In NC = 4.7%In NC = 4.7% - 36% are from Latin America - 30% are from Mexico Anticipated Growth Anticipated Growth In US = Births will outpace immigrationIn US = Births will outpace immigration In NC = 273% growthIn NC = 273% growth

4. Psychological Literature Psychology Psychology 457,827457,827 Hispanics Hispanics 6,3846,384 Hispanics and Mental Health Hispanics and Mental Health 731731

5. Sources of Mental Health Problems Language limitations Language limitations Culture and Acculturation issues Culture and Acculturation issues Family dysfunction Family dysfunction Ineffective social support Ineffective social support Low self esteem Low self esteem Limited education Limited education Financial limitations Financial limitations Religious affiliation Religious affiliation Documentation Documentation

6. Language Problems English English Variations of Spanish Variations of Spanish Spanish as a second language Spanish as a second language Anxiety associated with learning English Anxiety associated with learning English Children as translators for parents Children as translators for parents Children choosing English over Spanish as primary method of communicating Children choosing English over Spanish as primary method of communicating

7. Culture and Acculturation Understanding the majority group culture Understanding the majority group culture Maintaining culture of origin Maintaining culture of origin Being bi-cultural Being bi-cultural Some basic differences Some basic differences Family above all (and extended family)Family above all (and extended family) Time to be enjoyed not conqueredTime to be enjoyed not conquered Cooperation versus competitionCooperation versus competition Religion as source of support and socializingReligion as source of support and socializing Keep ones problems to themselves or familyKeep ones problems to themselves or family Less materialLess material More emotionalMore emotional

8. Family Defining Family Defining Family NuclearNuclear ExtendedExtended DoubleDouble FunctionalFunctional Divided Families Divided Families EconomicsEconomics GeographyGeography PoliticsPolitics

9. Ineffective Social Support Medical Medical Religious Religious Educational Educational Financial Financial Social Social Marital Marital

10. Low Self Esteem Productivity and Materialism Productivity and Materialism Connectivity Connectivity Self-Effacing Presentation Self-Effacing Presentation Self-Fulfilling Prophecy Self-Fulfilling Prophecy

11. Education Typical Educational Background Typical Educational Background What it Means to be Educated- the difference between schooling and education What it Means to be Educated- the difference between schooling and education

12. Financial & Related Limitations The Limits and Hazards of Being Undocumented The Limits and Hazards of Being Undocumented Type of Vocational Opportunities & Corresponding Pay Type of Vocational Opportunities & Corresponding Pay Banking Issues Banking Issues Saving for Retirement Saving for Retirement Drivers License Drivers License

13. Religion Predominantly Catholic, but not Exclusively (fundamental) Predominantly Catholic, but not Exclusively (fundamental) Importance of Religion and Related Social Support Importance of Religion and Related Social Support Church and Related Services in Spanish Church and Related Services in Spanish

14. Documentation Education Education Medical Medical Legal Legal Tax ID NumbersTax ID Numbers Social Security NumbersSocial Security Numbers Drivers LicensesDrivers Licenses Aliases Aliases

15. Outcome of Problems Anxiety13% Anxiety13% Substance abuse 8% Substance abuse 8% Depression 5% Depression 5% Violence ?% Violence ?% Ethnic identity issues Ethnic identity issues Poverty and marginalization Poverty and marginalization

16. Gender Issues Males vs Female Males vs Female Males 27%Males 27% Females 17%Females 17% Heterosexual issues Heterosexual issues Clashing of culturesClashing of cultures Availability of partnersAvailability of partners ProstitutionProstitution Sexual Identity Issues Sexual Identity Issues Childhood Sexuality & Abuse Childhood Sexuality & Abuse

17. A Simple Model for Addressing Mental Health Concerns Communication & Narrative Approach Communication & Narrative Approach Rapport and Trust Rapport and Trust Questioning Questioning Symptom Identification Symptom Identification Empowerment Empowerment Solution Focus Solution Focus Follow-up Follow-up

18. Suggestions for Health Issues Style/Rapport Style/Rapport Translation Translation Family Family Documentation Status Documentation Status Interpretation of Information Interpretation of Information Follow-up Follow-up

19. Personnel and Services in Southeastern NC OAKS & SEMHC & Others OAKS & SEMHC & Others SEMHC (1?)SEMHC (1?) Titleson Clinic (first Wednesday)Titleson Clinic (first Wednesday) Catholic Ministries (1?)Catholic Ministries (1?) Private sector personnel Private sector personnel Psychologist- 1Psychologist- 1 Psychiatrist- 1Psychiatrist- 1 Social Worker- 1 (?)Social Worker- 1 (?)

20. Related Support Radio and Television Radio and Television 1 Program?1 Program? Newspaper Newspaper 1?1? Organizations Organizations Centro Latino/Amigos InternacionalCentro Latino/Amigos Internacional

21. Cultural Matrix ISOLATED VS ACCULTURATED MAINSTREAM VS ASSIMILATED

22. From Isolation to Assimilation IsolationAcculturation Assimilation Income$20,500 $36,100$37,000 Size 3.9 3.6 3.1 Time in US1 st gen. US born 4 th Gen. LocaleInner CitySuburbs ?Suburbs ValuesHispanicPartial HispanicAnglo LanguageSpanishBilingualEnglish

23. The Future Clashing Curves and Cultures Clashing Curves and Cultures Financial & Social Slavery Financial & Social Slavery Pay Now or Pay Later Pay Now or Pay Later What is North Carolina and New Hanover Going to Do? What is North Carolina and New Hanover Going to Do?