Lahi Moheno holds what some would call health retreats for farmworkers in the San Joaquin Valley. There, she pulls workers aside for a forum on health education – mental health, really – without ever using such loaded terms as las enfermedades mentales, Spanish for "mental illness."
Moheno, an activist who holds a master's degree from the University of Texas, knows well her audience and how to reach it. As a girl, she and her eight siblings worked each summer in Modesto, picking grapes at a Gallo vineyard. Later, while at the university, she harvested oranges daily after classes. She managed to avoid student debt and reinforced her education in the lexicon of Latino farmworkers, to boot.
"When I talk to them in forums, or out in the fields, I don't use words like 'mental health,' " Moheno said Monday. "I say, 'Are you interested in having a better life, a life of tranquility?' I had to change my wording in order to reach people."
Moheno's story nicely illustrates lessons learned in a landmark, two-year research study conducted in 13 cities throughout California and unveiled Monday by the UC Davis Center for Reducing Health Disparities. The study, released at UC Davis' Mind Institute in Sacramento, takes a long, hard look at current best practices, based on evidence, and how well they translate in California's growing Latino communities, projected to comprise 52 percent of the state's population by 2050.
The short answer: Western medicine's best doesn't seem well tailored to reduce mental health care disparities in Latino communities, a stubborn problem in which the population has been underserved and lacking quality care for decades.
According to Sergio Aguilar-Gaxiola, the study's lead author and director of the health disparities center, up to 75 percent of Latinos who do seek mental health services opt not to return for a second appointment. Cultural, social and language barriers are too high to surmount.
The report, based on input from more than 550 Latinos, including some in Sacramento, found that the current workforce of psychologists and psychiatrists is ill-equipped to penetrate the disparities and bridge the cultural gulf.
Though the law says mental health services must be provided in native languages of major immigrant groups, the study's authors found Spanish-speaking professionals few and far between within Latino communities.
More needs to be done to reach out to communities on their terms, including recruiting and training more Latino mental health professionals.
Stigma and shame over mental health issues are enough to stop some Latinos from seeking assistance, the study's authors said. And without someone to speak to in a shared language, reticence can become more acute.
Moheno, for example, said two or three people in her large family experienced mental health issues.
"However, we couldn't always find doctors. The family was a little embarrassed in this situation," Moheno said.
"My mother said, 'No espanol, no sabe nada,' or 'If they don't know Spanish, they don't know how to take care of him,' " Moheno said of an ailing sibling.
Indeed, the report recommends that since Latinos do access health care through primary-care facilities, primary- care doctors should consider taking on the task of mending the mental health care gap.
The report, called Community-Defined Solutions for Latino Mental Health Care Disparities, provides a catalog of sorts for what works in reaching Latinos. The list highlights a smattering of programs throughout California, such as those using schools, churches, community centers and other grass-roots gathering places to talk to Latinos about what can help reduce the disparities.
The key is in getting feedback and suggestions from the ground level up vs. from a top-down Western medical model.
One successful program used throughout the state recruits promotores, or women health advisers, to work with residents in the community – using their language and tapping into the culture for solutions.
Without a new model for change, trying to reach Latinos in need of mental health assistance is likely to remain a frustrating enterprise, said Rachel Guerrero, former chief of the California Department of Mental Health's office of multicultural services.
"I am really sick and tired of seeing those statistics of mental health care disparities not change. Latinos are not accessing the services they are entitled to," Guerrero said. "This project is the largest single national investment in this kind of prevention – where we go back to the communities and ask, 'What can help?' "
Aguilar-Gaxiola said the findings and recommendations are timely, given that Latinos in California represent about 40 percent of the population, and that nearly 60 percent of California's children are of Latino origin.
In addition, the state Department of Finance's estimate that Latinos will make up 52 percent of California's projected population by 2050 makes the blueprint for community-based solutions particularly relevant, he said.
The study was funded by California's Mental Health Services Act, a voter-approved ballot measure in 2004 that dedicated a 1 percent tax on millionaires toward improvements in prevention of mental health illness.