1. Mental Health Issues in Hispanics: A New Concern for Our Region CSM Leadership Development September, 2005 UNCW

2. Antonio E. Puente University of North Carolina Wilmington

3. Contact Information: Antonio E. Puente, Ph.D. Department of Psychology University of North Carolina at Wilmington 910.962.3812 puente@uncw.edu www.uncw.edu/people/puente

4. Background Information Information is Based on: Information is Based on: Reseach- PsyInfo data base Reseach- PsyInfo data base Clinical- Titleson Clinic Clinical- Titleson Clinic Social- Centro Latino Social- Centro Latino

5. Hispanics in the United States: Overview United States Trends United States Trends Is the largest ethnic minority group in US Is the largest ethnic minority group in US Is the fastest growing ethnic group in US Is the fastest growing ethnic group in US Approximating 15% of the population Approximating 15% of the population Will represent the majority group in 2040 Will represent the majority group in 2040 Probably undercounted (hence projections are probably off with a wide margin of error) Probably undercounted (hence projections are probably off with a wide margin of error)

6. Demographics: Hispanics in the United States United States Statistics United States Statistics 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 counterparts Less Educated than counterparts More Fertile than counterparts More Fertile than counterparts

7. Demographics: Hispanics in North Carolina North Carolina Statistics North Carolina Statistics 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 = 394% increase From 1990 to 2000 = 394% increase

8. Demographics: Hispanics in New Hanover County New Hanover Statistics Estimates New Hanover Statistics Estimates Total Population = 147,642 (22.7% increase) Total Population = 147,642 (22.7% increase) 1980 = 788; 1980 = 788; 1990 = 747; 1990 = 747; 2000 =1,828 2000 =1,828 Estimate = severe undercounting Estimate = severe undercounting

9. Additional 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 immigration In US = Births will outpace immigration In NC = Over 500% growth In NC = Over 500% growth

10. Glance (continued) High School Students High School Students One third of all high school graduates by the year 2013 will be Hispanic One third of all high school graduates by the year 2013 will be Hispanic Graduation rate for Hispanics nationally = 54% Graduation rate for Hispanics nationally = 54% Graduation rate for Hispanics in North Carolina = 38% Graduation rate for Hispanics in North Carolina = 38%

11. Glance (continued) Language Ability (about 30 million speak Spanish) Language Ability (about 30 million speak Spanish) US = 22% speak English “poorly” US = 22% speak English “poorly” NC =34% speak English “poorly” NC =34% speak English “poorly” Governmental Representation Governmental Representation Two Elected Officials Two Elected Officials No High Ranking Judges No High Ranking Judges One Executive Level Office One Executive Level Office

12. Glance (continued) Health Insurance Health Insurance 37% lack insurance nationally 37% lack insurance nationally 54% lack insurance in North Carolina 54% lack insurance in North Carolina Increases to 64% if non-documented Increases to 64% if non-documented Income Income 27% live in poverty 27% live in poverty Median family income = $30,529 Median family income = $30,529 National MFI = $ 44,468 National MFI = $ 44,468 MFI for whites = $51,951 MFI for whites = $51,951 National MFI = $61,587 National MFI = $61,587

13. What Does Being “Hispanic” Mean? Speaking Spanish Speaking Spanish Being Catholic (or Christian) Being Catholic (or Christian) Family above all (and extended family) Family above all (and extended family) Children are highly desired and valued Children are highly desired and valued Friends and social groups are critical Friends and social groups are critical Time to be enjoyed not conquered Time to be enjoyed not conquered Cooperation versus competition Cooperation versus competition Modesty Modesty Religion as source of support and socialization Religion as source of support and socialization Keep one’s problems to themselves or family Keep one’s problems to themselves or family Less material & consumer focused Less material & consumer focused More emotional More emotional Personalismo Personalismo Fatalismo (chance and God explain just about everything) Fatalismo (chance and God explain just about everything) Respect and formality Respect and formality The important use and knowledge of a name (and title) The important use and knowledge of a name (and title) Hospitality through gifts, food, and drink Hospitality through gifts, food, and drink Smooth interpersonal relations are critical (amabilidad) Smooth interpersonal relations are critical (amabilidad)

14. Sources of Mental Health Problems Culture and Acculturation Issues Culture and Acculturation Issues Language Limitations Language Limitations 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 Health Status Health Status Gender Issues Gender Issues Interpretation of Efficiency Interpretation of Efficiency

15. Cultural Issues Misunderstanding of the Majority Culture’s Unwritten Social Rules and Agendas Misunderstanding of the Majority Culture’s Unwritten Social Rules and Agendas Isolation to Mainstreaming Isolation to Mainstreaming

16. Language Limitations English English Variations of Spanish Variations of Spanish Spanish as a Second Language Spanish as a Second Language Anxiety Associated with Learning English and Losing Your Culture Anxiety Associated with Learning English and Losing Your Culture Non-Verbal Communication is Important Non-Verbal Communication is Important Children as Translators Children as Translators Children Choosing English over Spanish Children Choosing English over Spanish

17. Family Defining Family Defining Family Nuclear Nuclear Extended Extended Double (US and abroad) Double (US and abroad) Divided Families Divided Families Economics Economics Geography Geography Politics Politics

18. Limited Social Support Familial Familial Social Social Medical Medical Religious Religious Educational Educational Financial Financial

19. Low Self Esteem Productivity and Materialism = Success in the US Productivity and Materialism = Success in the US Limited Connectivity & Personal Isolation Limited Connectivity & Personal Isolation Self-Effacing Presentation Self-Effacing Presentation Loss of Respect From Others Loss of Respect From Others Self-Fulfilling Prophecies Self-Fulfilling Prophecies

20. Education Typical Educational Background Typical Educational Background Often Limited Often Limited Usually in Spanish Usually in Spanish What it Means to be “Educated”- What it Means to be “Educated”- the difference between schooling and education the difference between schooling and education

21. 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 Driver’s Licenses Driver’s Licenses

22. Religion Predominantly Catholic, but not Exclusively (about 25%) Predominantly Catholic, but not Exclusively (about 25%) Importance of Religion and Related Social Support Importance of Religion and Related Social Support Always Hoping for a “Milagro” Always Hoping for a “Milagro” Church and Related Services in Spanish Church and Related Services in Spanish

23. Documentation Education Education Medical Medical Legal Legal Tax ID Numbers Tax ID Numbers Social Security Numbers Social Security Numbers Driver’s Licenses Driver’s Licenses Aliases Aliases

24. Health Status Increased and Disproportionate Health Problems Increased and Disproportionate Health Problems Higher Low Birth Weights & Infant Mortality Higher Low Birth Weights & Infant Mortality Increased Morbidity Increased Morbidity Under-Utilizaton of Health Services Under-Utilizaton of Health Services Health Viewed as Absence of Pain Health Viewed as Absence of Pain Women as Primary Care Providers in Family Women as Primary Care Providers in Family Disability is a Family Affair Disability is a Family Affair Hospitals as Last Place for Health Care or Possibly a Place One Goes to Die Hospitals as Last Place for Health Care or Possibly a Place One Goes to Die

25. Gender Issues Males vs Female Males vs Female Males 27% Males 27% Females 17% Females 17% Machismo Machismo False = loss of dignity and respect False = loss of dignity and respect True = Protector, supporter True = Protector, supporter Heterosexual issues Heterosexual issues Clashing of cultures Clashing of cultures Availability of partners Availability of partners Prostitution Prostitution STDs STDs Sexual Identity Issues Sexual Identity Issues Childhood Sexuality & Abuse Childhood Sexuality & Abuse

26. Interpretation of Efficiency Time (enjoyment vs. completion) Time (enjoyment vs. completion) Cooperation (vs. competition) Cooperation (vs. competition) Process (vs. outcome) Process (vs. outcome)

27. 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

28. A Simple Model for Addressing Mental Health Concerns Communication, Rapport & Trust Communication, Rapport & Trust Resource Information Resource Information Empowerment Empowerment Solution Focus Solution Focus

29. Model for Integration: Helping People Fit into the Bigger Picture Model for Integration: Helping People Fit into the Bigger Picture 1.Isolation 2. Acculturation 2. Acculturation 3. Assimilation 3. Assimilation 4. Mainstream 4. Mainstream

30. In Three Generations (from Hispanic Business, 2003) IsolationAcculturation Assimilation Income$20,500 $36,100$37,000 Size 3.9 3.6 3.1 Time in US 1 st gen. US born 4 th Gen. LocaleInner CitySuburbs ?Suburbs ValuesHispanicPartial HispanicAnglo LanguageSpanishBilingualEnglish

31. The Future Clashing Demographics and Cultures Clashing Demographics and Cultures 21 st Century Economic “Slavery” 21 st Century Economic “Slavery” Address the Problem Now or Major Problems Later Address the Problem Now or Major Problems Later What is North Carolina and the Cape Fear Region Going to Do Especially with the Changes in the Public Mental Health System? What is North Carolina and the Cape Fear Region Going to Do Especially with the Changes in the Public Mental Health System?

32. Future? Demographic Shifts Are Obvious Demographic Shifts Are Obvious Socio-political Shifts Are Not Socio-political Shifts Are Not The Lack of Integration of These Two Shifts Will Result in Social Misunderstanding & Unrest The Lack of Integration of These Two Shifts Will Result in Social Misunderstanding & Unrest