COVID-19 Pandemic and Its Impact Among Latinx Communities Living in the United States
Due to the current COVID-19 pandemic, Latinos are more likely to experience individual and environmental stressors, which can often exacerbate their clinical presentation of mental illness compared to other individuals with mild stressors. As of April 25, 2020, the CDC has reported 895,766 cases in the US; 24% were identified as Hispanics. In about 64.5% of reported cases, ethnicity was not specified, reflecting the possibility that Hispanic positive cases may be underrepresented in the current data.
Knowing the situation varies across regions within the United States, we started gathering observations from experts and providers from the field. The purpose of this initiative is to illustrate, using four core questions, the effect of the pandemic among Latino populations with mental health disorders.
We asked the following questions:
- Describe your experiences and observations working with the Latino population during this pandemic.
- How the COVID-19 pandemic and social distancing have evidenced mental health inequalities for Latino communities?
- In what way has the provision of mental health services been affected for Hispanics and Latinos in your region?
- Provide recommendations for mental health professionals serving Hispanic and Latinos to facilitate access and reduce service disparities for mental health services.
Manuel Paris, Psy.D., Michelle A. Silva, Psy.D., Andrea Mendiola Iparraguirre, MD, Luis Añez-Nava, Psy.D.,
Sarah Finke, LCSW, Eric Frazer, Psy.D., Jomary Sepulveda, Psy.D., & Esperanza Diaz, MD
La Clínica Hispana/The Hispanic Clinic-Connecticut Mental Health Center
Connecticut Latino Behavioral Health System,2
Yale University School of Medicine-Department of Psychiatry
Describe your experiences working with Latinx communities during this pandemic.
In the state of Connecticut, about 16.5% of the population is of Hispanic or Latinx descent (U.S. Census Bureau, 2019). As of June 21, 2020, about 18.5% of confirmed cases and 8.5% of deaths related to COVID-19 were among individuals of Hispanic or Latinx descent (Connecticut Department of Public Health, 2020). The Latinx clients we serve are incredibly resilient; nevertheless, we must be aware of their vulnerabilities as a minority and underserved population in order to be prepared to meet their needs. As many providers across the country, those in the Northeast quickly transitioned to a telehealth platform, and the fears and trepidations we had as mental health providers concerning how our clients would negatively react have not materialized. With that said, our clients are experiencing:
• Increased mental health distress due to social isolation (particularly from family and faith-based communities)
• Growing concerns regarding health and safety among those with designated essential job duties
• Compounded stress for parents managing childcare and remote schooling responsibilities
• Increased case management needs due to unemployment
• Food insecurity and other basic needs not being met
• Fear of losing housing due to unemployment and even with the postponement of rental payment, fear that due to job loss, they will not be able to pay back missed payments
• Even with telehealth, engagement varies depending on the living situation, access to space/privacy at home, and access to internet data, WiFi, or a reliable telephone
• Ambivalence among providers and clients on how to maintain continuity in therapy
• Ongoing mixed reaction to a telehealth option
• Limited training among providers in the provision of telehealth
Describe how the COVID-19 pandemic and social distancing has evidenced mental health inequalities for Latinx communities in your region.
The inequalities experienced by different communities are varied and complex. Reports suggest that most impoverished neighborhoods have experienced COVID-19 infection rates that are twice as high as the nation’s wealthiest zip codes. A practical example related to disparities impacting health and access to care is the access and availability of technology required for telehealth services. Smartphones and the internet have become essential during the COVID-19 pandemic. Clients with simple cellphones without a camera or the capacity to hold a videoconference, suffer under the disparity gap of not being able to fully access telehealth services. In an effort to increase and support communication, some telecommunication companies have opened WiFi “hot spots” with free internet access. However, not everyone has access to these “hot spots” from home, and so it requires people to leave their homes and increases their exposure to COVID-19. The lack of access and continuation of primary care visits due to social distancing measures and cancellation of elective procedures have impacted mental health indirectly and contributed to increased anxiety. The Latinx communities, already suffering higher levels of comorbidities such as hypertension, diabetes, and asthma, are at elevated risk of complications from COVID-19, and consequently increased mortality due to barriers to accessing services and receiving appropriate and timely treatment (Bibbins-Domingo, 2020). Additionally, issues surrounding food and housing instability and limited access to quality health care are a reality for many of the underserved and marginalized across the country. There is limited/varied access to the technology necessary to engage in telehealth and support children in remote learning. For those relying on public transportation, COVID-19 has put people at increased risk for infection or increased their social/geographic isolation and reliable access to resources.
Describe in what way has the provision of mental health services been affected for Latinx communities in your region.
From our experience, the most obvious effect has been the shift to a mostly telehealth format, with face to face encounters reserved for crises. Mental health systems have adapted, expanded, and transformed to provide services during this challenging time. The introduction of telehealth as a standard procedure has pushed institutions and organizations to shift almost all encounters to videoconferences or phone interactions. A forced and abrupt transition to telehealth has brought multiple challenges and opportunities for growth.
Below we share some reflections through the collective voices of our consumers:
“I prefer to see you in person at the clinic.”
“Personalismo," one of the core values in Latinx communities, describes the preference for one on one interactions, valuing the warm interpersonal relationship between people. Phone calls or videoconferences lack this sense of intimate therapeutic relationship and might be an obstacle when trying to establish care via telehealth. However, we do want to acknowledge that in some cases where a client may have high levels of shame or self-consciousness, phone-only sessions create an increased sense of privacy, allowing for some sense of anonymity thereby helping clients to risk greater vulnerability with self-reporting – an experience akin to the “dashboard effect” or the “confessional.”
“Who is this other person on the line?”
The scarcity of Spanish speaking clinicians demands the use of interpreters during encounters with Spanish-speaking only clients. The use of interpreters in telehealth encounters adds a layer of complexity to the client-clinician interaction. Some clinicians do not feel comfortable utilizing a language line for interpretation, and clients may prefer to express their concerns and emotions in their native language.
“I am driving, who is this?”
The therapeutic encounter at home has different characteristics than in the office. There are often more distractions, and some clients struggle to find a private space that is necessary to speak about their concerns. Some clients take the videoconference call in a common area with relatives sitting around them, or while doing different activities such as driving, cooking, or being in bed. Alternatively, some clients do not disclose that others are present during the session. This latter scenario raises the concern in abusive dynamics or homes with power-imbalances that a partner might obligate the client to let them “monitor” the session, something that would not be possible in a clinic office.
“I am less anxious now that we have to stay at home.”
Some clients, with severe anxiety or agoraphobia, report to prefer isolation and say that they feel less anxious or calmer because they do not need to leave the house.
“I cannot stay at home one more day!”
For many, family (Familismo) is an essential component of their community and wellbeing, and the lack of human interaction has taken a significant toll during the quarantine. Anger, frustration, and sadness are common reactions expressed during therapy or medication management sessions. These common reactions to the quarantine raise the issue of grief and bereavement (loss of way of life), as well as radical acceptance, more so than in a typical clinic setting. Focusing on topics related to COVID-19 might disrupt the progress already made in therapy.
For some providers and clients who are tech-savvy, the transition has been a relatively smooth one. Clients learning how to log-on to new technology has created a unique opportunity to draw their awareness to their ability to adapt and learn new things. From a cognitive-behavioral approach, this has been a great resource for insight and personal growth. For the majority, it has been a steep learning curve compounded by the initial confusion around the myriad platforms and whether or not they were HIPAA compliant. Additionally, for those clients working with trainees who frequently end their academic year on June 30th, they will likely not have the opportunity to terminate their work together in a traditional way.
It is essential to highlight the incredible work community providers have done in rallying together to provide the needed support for those they serve. The concerted effort by mental health and substance use providers, shelters, food pantries, visiting nurses, hospital personnel, just to name a few, demonstrates the indomitable spirit of the human condition.
Provide recommendations for mental health professionals serving Latinx communities to facilitate access and reduce service disparities for mental health services.
During the pandemic, we have received, developed, and shared countless practical and clinical resources for working with Latinx populations. Whereas enterprise organizations have knowledge platforms (Basecamp, Slack, Microsoft Teams, etc.) to harness the collective intelligence and talent of its professionals, we have continued to be restricted to email and public domain knowledge dissemination. Ideally, professional resources can be shared in real-time with spontaneous collaboration that directly impacts decisions for systems of care, agile-changes within and between agencies serving our clients, and immediate client services. The availability of these technologies can provide immediate benefit to behavioral health professionals serving our clients with greater efficiency, clinical precision, and, by democratizing knowledge and professional collaboration.
To further facilitate access and reduce service disparities for mental health services in Latinx communities, mental health professionals should:
• Gain familiarity with the provision of telehealth
• Be mindful that it may take more time than anticipated to conduct a telehealth session. In some cases, the time estimates allotted by governing systems are incongruent with the reality of providing services • Provide psychoeducation and encourage ways to decrease the risk of COVID-19 transmission (e.g., the use of masks, social distancing)
• Collaborate with Spanish public radio and social media platforms to disseminate relevant information to the community
• Assess needs/available resources and connect clients to community resources
• Be aware of available resources • Identify and address racial and ethnic disparities
• Advocate and respond to the new challenges faced by Latinx communities
• Maintain a flexible and professional role
• Be willing to advocate for community needs and promote multidisciplinary collaborations
• Utilize interventions such as Motivational Interviewing to promote engagement and combine with Cognitive Behavioral Therapy skills training
• Engage in self-care
• Share knowledge with other health care professionals and increase research or academic work that will help increase awareness, reduce the gap of culturally relevant treatments, and improve overall care.
Bibbins-Domingo, K. (2020). This time must be different: Disparities during the COVID-19 pandemic. Annals of Internal Medicine. On-line ahead of print. doi: 10.7326/M20-2247
Connecticut Department of Public Health. (2020, June 21). COVID-19 update June 21, 2020. https://portal.ct.gov/-/media/Coronavirus/CTDPHCOVID19summary6212020.pdf
Laurencin, C.T., & McClinton, A. (2020). The COVID-19 pandemic: A call to action to identify and address racial and ethnic disparities. Journal of Racial and Ethnic Health Disparities, 7(3), 398-402. doi: 10.1007/s40615-020-00756-0
U.S. Census Bureau. (2019, July 1). Quick facts, Connecticut. https://www.census.gov/quickfacts/CT
The CT Latino Behavioral Health System is made possible through funding from the CT Department of Mental Health and Addiction Services.
2We would like to acknowledge the CT LBHS team for their commitment to the care of Latinx communities: Sarah Finke, LCSW; Jose Layedra, MA, AADC, MATS; Nydia Massey, LMSW; Vanessa Santiago, LCSW; and Jomary Sepulveda, PsyD.
Michelle Evans, DSW, LCSW, CADC
Bilingual Private Provider
Describe your experiences working with the Latino population during this pandemic.
In the state of Illinois, about 17.4% of the population are Hispanic or Latino (U.S. Census Bureau, 2019). COVID-19 has affected all individuals physically, psychologically, socially, and financially. As of May 20, 2020, about 30.4% confirmed cases, and 18.3% of deaths related to COVID-19 were among Hispanic or Latinos (Illinois Department of Public Health, 2020). COVID-19 transmission among the Latinos living in Chicago is most evident due to the vulnerability of this population's lack of access to quality health services and limited economic resources. Most of them work in jobs that require close contact, including service industries, factories, and agriculture and hospitality staff. Many families do not have adequate health literacy or have language barriers that affect their understanding of how COVID-19 can affect them and protect themselves. In my clinical practice with under-resourced Latino client's part of the session is devoted to talking about COVID-19, how they can protect themselves, and clarifying information that they saw on social media or in the news.
Describe how the COVID-19 pandemic and social distancing has evidenced mental health inequalities for Latino communities.
COVID-19 has exacerbated ongoing trauma that the Hispanic and Latino population has already experienced. Many of the individuals I have worked with have previous food trauma, health care insecurity, and worry about being able to access resources to survive. Due to community resources' closures, the resources that Hispanic and Latino clients typically use for support are not accessible. Churches are also closed for in-person connections and are only reaching out individually or via phone. Many individuals within this population maintain their mental health through community connections and community services, which are less likely to be available due to closures or are overwhelmed due to need. Latino children who have spent time away from their parents have had fears of losing their parents due to immigration. These children are experiencing extreme stress and anxiety at the thought that they might lose their working parents due to COVID-19. Schools are no longer able to connect with anxious children daily as schools have either closed or moved to an online modality.
Describe in what way has the provision of mental health services been affected for Hispanics and Latinos in your region
Mental health services have moved to telehealth. The governor of Illinois approved for telehealth to be offered and paid for by all insurance companies, including Medicaid. However, Hispanics and Latinos are the least likely to be covered by health insurance. Due to an emphasis on providing hospital bed space for COVID-19 patients and increasing social distancing space for psychiatric patients, fewer community-funded psychiatric hospital beds are available. Hospitals are emphasizing discharges faster to keep patients safe from COVID-19. However, this has led to fewer days of psychiatric treatment available.
Many Hispanic and Latinos receive mental health services from schools and religious organizations. These organizations have closed or changed the format of services delivery, to protect staff and clients; this has led to limited availability for new and existing patients. Services that are available require the use of technology, which is difficult for many families. As a therapist, offering telehealth sessions to clients, I have observed that Latino clients have been the least likely to have the technology needed to meet for an online therapy session, and they have limited resources to be able to connect via phone. I have had sessions with individuals on the phone while standing in their apartment stairwells as they lack appropriate space for privacy in their apartments, and they were using the only phone owned by the family. COVID-19 also affects individuals psychologically due to the instability of safety, health, and finances.
Provide recommendations for mental health professionals serving Hispanics and Latinos to facilitate access and reduce service disparities for mental health services.
On a micro level, mental health professionals need to be flexible. They should consider creative ways of staying in contact with their clients through phone, text, or an online meeting platform. Mental health professionals must provide culturally relevant interventions that consider the specific needs of the individual and family. Past trauma must be considered when understanding how the COVID-19 crisis impacts the individual, and previous help-seeking behavior should be explored and adapted to current needs. This may mean that more case management is needed than therapy at times, or it may mean that a more personal approach is required than is the norm.
On a mezzo and macro level, mental health professionals need to advocate for mental health resources for individuals affected by COVID-19. Mental health professionals need to consider the long-term impact on this population and advocate for all workers' safe working conditions. The trauma of the pandemic will continue long after the states are re-opened. Mental health workers will be responsible for managing and advocating for appropriate services to serve this population.
U.S. Census Bureau. (2019, July 1). Quick Facts Illinois. https://www.census.gov/quickfacts/IL
Illinois Department of Public Health. (2020, May 21). COVID-19 Statistics. https://dph.illinois.gov/covid19/covid19-statistics