By Dr. Manny J. Gonzalez, Assistant Professor/Research faculty Associate, Fordham University Graduate School of Social Service/Center for Hispanic Mental Health Research, Member of Committee on Inquiry
(October 2000)

Hispanics constitute the largest minority group in this nation. According to the U.S. Bureau of the Census (1993), there are currently 25 million Hispanics living in the mainland. This number does not include Puerto Rico's population and undocumented Hispanic immigrants living in the United States. 60% of Hispanics living in the U.S. are of Mexican origin, 14% of Puerto Rican origin, 7% of Cuban origin, and close to 19% are of Central and South American origin. Hispanics comprise over 24% of the NYC population and 12% of the population of New York State. Immigrants from the Dominican Republic represent one of the fastest growing Hispanic ethnic groups in the United States. It is estimated that 520,000 Dominicans are living in the United States with the largest concentration found in New York and Florida.

Hispanics are a diverse and heterogeneous group with noted differences in socioeconomic status, nationality, race, use of the English language, worldview and religion. These differences must be carefully incorporated into the planning and implementation of mental health services. For example, although many Hispanic clients may be proficient in both English and Spanish, during periods of emotional crisis bilingual clients may prefer to discuss their mental health concerns in their native tongue. Language is a significant variable in the underutilization of mental health services by Hispanics. Treatment agencies, therefore, must ensure that Hispanics have accessibility to competent bilingual and bicultural mental health practitioners.

Another area of importance in the provision of mental health services to Hispanics is the understanding of the individual's worldview. A world-view includes an individual's philosophy of life, belief systems, and ways of interacting with the world. Assessing a Hispanic client's worldview (e.g., level of acculturation/assimilation, degree of adherence to traditional cultural values, level of biculturalism) will assist clinical practitioners in the selection of appropriate mental health interventions. Highly acculturated or bicultural clients may, through conventional psychotherapy or existing therapies, find alleviation for their mental health symptoms. However, modification of existing treatments will be necessary for Hispanic clients who maintain a strong adherence to traditional cultural values. The techniques, structure, and procedures of modified treatments should mirror the cultural and individual characteristics of native-oriented/ traditional Hispanic clients.

Given that the mental health problems of Hispanics living in poverty and undocumented Hispanic immigrants are often exacerbated by socioeconomic stressors, racism, and political oppression, effective mental health treatment for this segment of the Hispanic population must encompass case advocacy, community outreach, and the mediating of complex social systems. Mental health clinicians who treat poor and/or undocumented Hispanics should be skilled in the implementation of multiple interventive roles such as that of advocate, mediator, broker, and teacher.

Provision of mental health services to Hispanics is both a challenging and rewarding professional endeavor. It requires skill, empathy, and an awareness of the socioeconomic and political reality currently impacting the lives of many Hispanics in the United States. The mental health problems of this population must be addressed at an individual, community, and political level. In addition, the planning and implementation of mental health services must take into serious account the differences that exist in class, level of education, citizenship or resident status, nationality, and worldview between and within Hispanic groups.