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Brief Info Sheet - What is the Ohio Latino Mental Health Network?

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Brief Info Sheet - What is the Ohio Latino Mental Health Network?

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Quick Info Sheet - Ohio Latino Mental Health Network 

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2022 Latino Mental Health Resource Directory (Updated)

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2022 Latino Mental Health Resource Directory (Updated)

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Updated - 2022 Latino Mental Health Resource Directory (1)

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The Hill Article: US youth are in a mental health crisis — we must invest in their care

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The Hill Article: US youth are in a mental health crisis — we must invest in their care

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Mitchell J. Prinstein, opinion contributor

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US youth are in a mental health crisis — we must invest in their care

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To address this crisis, we must acknowledge that our youth mental health system is fundamentally flawed.

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US Surgeon General's Advisory: Protecting Youth Mental Health

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US Surgeon General's Advisory: Protecting Youth Mental Health

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New York Times Article: The Mental Health Crisis Among US Teens

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New York Times Article: The Mental Health Crisis Among US Teens

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Depression, self-harm and suicide are rising among American adolescents. For one 13-year-old, the despair was almost too much to take.

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Why are so many American teenagers feeling anxious, depressed and even suicidal? Our video looks at the science behind the teen mental health crisis. Credit Credit... The New York Times

Matt Richtel spent more than a year interviewing adolescents and their families for this series on the mental health crisis.

One evening last April, an anxious and free-spirited 13-year-old girl in suburban Minneapolis sprang furious from a chair in the living room and ran from the house - out a sliding door, across the patio, through the backyard and into the woods.

Moments earlier, the girl's mother, Linda, had stolen a look at her daughter's smartphone. The teenager, incensed by the intrusion, had grabbed the phone and fled. (The adolescent is being identified by an initial, M, and the parents by first name only, to protect the family's privacy.)

Linda was alarmed by photos she had seen on the phone. Some showed blood on M's ankles from intentional self-harm. Others were close-ups of M's romantic obsession, the anime character Genocide Jack - a brunette girl with a long red tongue who, in a video series, kills high school classmates with scissors.

In the preceding two years, Linda had watched M spiral downward: severe depression, self-harm, a suicide attempt. Now, she followed M into the woods, frantic. "Please tell me where u r," she texted. "I'm not mad."

American adolescence is undergoing a drastic change. Three decades ago, the gravest public health threats to teenagers in the United States came from binge drinking, drunken driving, teenage pregnancy and smoking. These have since fallen sharply, replaced by a new public health concern: soaring rates of mental health disorders.

In 2019, 13 percent of adolescents reported having a major depressive episode, a 60 percent increase from 2007. Emergency room visits by children and adolescents in that period also rose sharply for anxiety, mood disorders and self-harm. And for people ages 10 to 24, suicide rates, stable from 2000 to 2007, leaped nearly 60 percent by 2018, according to the Centers for Disease Control and Prevention.

The decline in mental health among teenagers was intensified by the Covid pandemic but predated it, spanning racial and ethnic groups, urban and rural areas and the socioeconomic divide. In December, in a rare public advisory, the U.S. surgeon general warned of a "devastating" mental health crisis among adolescents. Numerous hospital and doctor groups have called it a national emergency, citing rising levels of mental illness, a severe shortage of therapists and treatment options, and insufficient research to explain the trend.

"Young people are more educated; less likely to get pregnant, use drugs; less likely to die of accident or injury," said Candice Odgers, a psychologist at the University of California, Irvine. "By many markers, kids are doing fantastic and thriving. But there are these really important trends in anxiety, depression and suicide that stop us in our tracks."

"We need to figure it out," she said. "Because it's life or death for these kids."
Read about how Matt Richtel reported this series.
The crisis is often attributed to the rise of social media, but solid data on the issue is limited, the findings are nuanced and often contradictory and some adolescents appear to be more vulnerable than others to the effects of screen time. Federal research shows that teenagers as a group are also getting less sleep and exercise and spending less in-person time with friends - all crucial for healthy development - at a period in life when it is typical to test boundaries and explore one's identity. The combined result for some adolescents is a kind of cognitive implosion: anxiety, depression, compulsive behaviors, self-harm and even suicide.

This surge has raised vexing questions. Are these issues inherent to adolescence that merely went unrecognized before - or are they being overdiagnosed now? Historical comparisons are difficult, as some data around certain issues, like teen anxiety and depression, began to be collected relatively recently. But the rising rates of emergency-room visits for suicide and self-harm leave little doubt that the physical nature of the threat has changed significantly.

As M descended, Linda and her husband realized they were part of an unenviable club: bewildered parents of an adolescent in profound distress. Linda talked with parents of other struggling teenagers; not long before the night M fled into the forest, Linda was jolted by the news that a local girl had died by suicide.

"You have no control over what they're thinking," Linda said. "I just want to tell people what can happen."

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M at home in Minnesota last fall.

M is one of dozens of teenagers who spoke to The New York Times for a yearlong project exploring the changing nature of adolescence in the United States. The Times was given permission by M and the family to speak with M's school counselor; M's medical records were shared with The Times and, with the family's permission, reviewed by outside experts not involved in M's care.

"This is a typical outpatient," said Emily Pluhar, a child and adolescent psychologist at Harvard University, describing M as "an internalizer."

M, now 14, is tall, with red hair and blue eyes, and has a younger sister and older half brother. By turns shy and outspoken, M has thought extensively about pronouns and currently prefers "they." At the beginning of seventh grade, M also asked to be called by the name of a popular Japanese anime character, whose first name starts with M. "I think we're similar in that she's, like, quiet and smart and plays electric bass, and I really like bass and guitars," M said.

When M was 4, a psychologist the family consulted to assess M's school readiness concluded that their "intellectual ability is in the very superior range," according to the report. M enrolled in kindergarten as one of the younger class members.

At 10, M got a smartphone. Linda and her husband, Tony, both of whom had busy work schedules, worried that the device might lead to heavy screen time, but they felt it was necessary to stay in touch. At 11, M hit another adolescent milestone: puberty.

Over the last century, the age of puberty onset has dropped markedly for girls, to 12 years old today from 14 years old in 1990; the age of onset for boys has followed a similar path. Experts say this shift probably now plays a role in the adolescent mental health crisis, although it is just one of many factors that researchers are still working to understand.

When puberty hits, the brain becomes hypersensitive to social and hierarchical information, even as media flood it with opportunities to explore one's identity and gauge self-worth. Laurence Steinberg, a psychologist at Temple University, said that ability to maturely grapple with the resulting questions - Who am I? Who are my friends? Where do I fit in? - typically lags behind.

The falling age of puberty, he said, has created a "widening gap" between incoming stimulation and what the young brain can process:

"They're being exposed to this deluge at a much earlier age."

M's first hint of trouble came in sixth grade, with challenges focusing in class. The school called a meeting with M's parents. One teacher suggested testing M for attention deficit hyperactivity disorder, but Linda and Tony were skeptical. The number of A.D.H.D. diagnoses in the United States rose 39 percent from 2003 to 2016, according to the C.D.C., and M's parents, both scientists in biomedical fields, were concerned that consulting an A.D.H.D. specialist would tilt the scales toward that diagnosis.

Instead, Linda tried to help M stay organized with an app that parents and students used to track assignments, test scores and grades. M felt put under a microscope.

"She would say, 'Can you bring me your iPad so we can check Schoology?'" M recalled about Linda. "I would literally have an anxiety attack because I was so scared."

By the fall of 2019 - seventh grade - M was struggling socially, too. A close friend got popular, while M often came home from school and got into bed. "I felt like a plus one," M said. "I just wanted to be unconscious." Other times, M said, "I just sat in my room and cried."

The behavior seemed alien to Tony, who had lived a different childhood. As an adolescent in Vermont in the 1980s, he fished and played outdoors. By 15, he had his first serious girlfriend; in 1990, the summer before their senior year, he got her pregnant. Their son was born that December, and Tony and the mother shared custody.

Times have changed. Federal research shows that 38 percent of high-school-age teenagers report having had sex at least once, compared with roughly 50 percent in 1990. The teen birthrate has plummeted.

So has cigarette and alcohol use. In 2019, 4 percent of high school seniors reported having a cigarette in the last 30 days, down from 26.5 percent in 1997. Alcohol use by high schoolers hit 30-year lows at the same time. Use of OxyContin and other illicit drugs among high schoolers is down sharply over the last 20 years. Vaping of both nicotine and marijuana has risen in recent years, although both dropped sharply during the pandemic.

Experts cite multiple factors: public awareness campaigns, antismoking laws, parental oversight and a changing social lifestyle that is no longer strictly in-person.

Dr. Nora Volkow, director for the National Institute on Drug Abuse, described drug and alcohol use as "very much of a group dynamic." She added: "To the extent that kids are not in the same place, one would expect a decrease in the behavior."

In the spring of 2020, M retreated further. Bewildered by online classes, M lied about participating, felt guilty and watched YouTube instead, devouring an anime series called "Danganronpa." It is set in a high school where students learn from the evil headmaster, a bear, that the only way to graduate is to kill a peer.

M became enamored of one of the characters, Genocide Jack (sometimes known as Genocide Jill), who is described on one fan site as a witty "murderous fiend" who "kills handsome men" using scissors.

One night after dinner, M was upstairs and used scissors to cut both ankles. "I was mad at myself for not doing homework," M said. "I was kind of thinking, 'Oh, the pain feels good,' like it was better than being stressed." M couldn't recall where the idea came from: "I wanted to hurt myself with anything."

M's parents noticed superficial scratches on M's thighs that resembled cuts but did not raise the subject. Linda worried about the screen time but "it was pandemic," she said.

When school ended for summer break, M's mood improved. Over the summer, M discovered the mobile version of the "Danganronpa" video game and how to override the parental screen limits. M played all day.

"I was in front of my screen staring at Jack," M said. "Then I was playing 'Trigger Happy Havoc,' and I was, like, more in love."

"I was kind of just lonely," M said. M fantasized about the future with Jack: "I'd want her to almost kill me but not, and then we could spend the rest of our lives together."

An obsession with a virtual character is not uncommon, experts said. "This is a kid who is a bit lonely, a bit caught up in these narratives," said Nick Allen, a psychologist at the University of Oregon. "There's nothing new in coming up with stuff that freaks out their parents."

Nonetheless, he added, "extremely powerful" online experiences like these can encourage users to think, "That is going to be my identity, my sense of the future, my sense of where I belong socially," at a time when one's identity is a work in progress.

Dr. Pluhar of Harvard noted that "the challenge and the progress" of modern adolescence "is there are so many types of identity" - more choices and possibilities, which in turn could be overwhelming. Among the factors shaping mental health, Dr. Pluhar said, is the mind's churning and obsessing: "Rumination is a big piece of it."

M had a name for the main source of their mental health challenges: "Loneliness."

Health experts note that, for all its weight, the adolescent crisis at least is unfolding in a more accepting environment. Mental health issues have shed much of the stigma they carried three decades ago, and parents and adolescents alike are more at ease when discussing the subject among themselves and seeking help.

Indeed, Linda had begun having conversations with other parents who wondered whether the challenges their adolescents were facing represented typical moody teen behavior or something pathological. A colleague told Linda about her daughter's eating disorder. A mother named Sarah confided that her middle-school-age daughter was in therapy for anxiety and depression. "I told her, 'I understand where you're at way better than you think,'" Sarah recalled.

How to Help Teens Struggling With Mental Health

Card 1 of 6

In a nearby suburb, the parents of Elaniv Burnett were struggling to understand their daughter's desperation. As a young child, Elaniv had been joyful, an eager student and graceful gymnast, her father, Dr. Tatnai Burnett, a gynecological surgeon at the Mayo Clinic, recalled: "The kind of kid where you go, 'Huh, we should have more kids.'"

But in 2014, when Elaniv was 9, her parents' marriage began to fracture, and Elaniv injured her ankle; she developed chronic pain, which sidelined her from gymnastics, and she went through a dark period. Then, in 2016, Dr. Burnett, who is Black, was held at gunpoint at home by the police, in full view of the family, after officers responded to a call of a possible intruder.

Recent research has found that wealth, education and opportunity do not shield Black families from mental health issues to the same degree they do for white families. From 1991 to 2017, suicide attempts by Black adolescents rose 73 percent, compared with an 18 percent rise among white adolescents. (The overall suicide rate remains higher among white adolescents.) The suicide rate leaped particularly for Black girls, up 6.6 percent per year on average from 2003 to 2017, new research shows.

In the fall of 2019, Elaniv was diagnosed with major depressive disorder. In a poem in her journal, she wrote: "Thoughts like racecars zoom constant in my head/ Self-hate and worthlessness/ Perpetual, they speed ahead."

Elaniv began therapy, took medications and enrolled in an outdoor inpatient program in Utah. "We worked on ourselves, worked on our parenting, we changed so many things to try to help meet Elaniv where she was," Dr. Burnett said. "We controlled electronics, monitored friendships."

Elaniv's mother, Tania Gainza, a clinical social worker, saw a generational trend. She had counseled an adolescent for years who was terrified of not meeting expectations. She heard about a local boy who killed himself seemingly without warning.

"There's something different about this era or generation that makes them much more susceptible or vulnerable," Ms. Gainza said. "There's not that community, I guess."

A rise in loneliness is a key factor, experts said. Recent studies have shown that teenagers in the United States and worldwide increasingly report feeling lonely, even in a period when their internet use has exploded.

"They're hanging out with friends, but no friends are there," said Bonnie Nagel, a psychologist at the Oregon Health & Science University. "It's not the same social connectedness we need and not the kind that prevents one from feeling lonely."

Often, she said, online social connections amount to seeing "pictures of people hanging out, flaunting it, as if to say, 'Hey, I'm very socially connected,' and 'Hey, look at you by yourself.'"

One day in the autumn of 2020, with the pandemic in full swing and eighth grade having gone fully remote, Linda found M sobbing in bed. M confessed to wanting to die.

Linda found an online therapist. After several sessions, "the therapist broke confidentiality," Linda said. "She said, 'You need to know about the knife.'"

In M's night stand, Tony found a pocketknife and a box knife with a cat's paw image on the handle that M had surreptitiously bought on Amazon and was using to self-harm. One night, M went further, tightening a red hair tie around their neck. "I was trying to see how far I could take it," M said.

The following February, M entered full-day group therapy. A psychiatrist at the clinic notified the family that M had admitted to being unable to stop cutting, medical records show. Linda "de-knived the house," she said, and hid all the pills. Then M engaged in a different kind of self-harm: hitting their head with an eight-pound workout barbell.

Linda recalled feeling stunned: "Oh, now I have to get rid of the blunt objects, too."

M was discharged with a diagnosis of depression and a prescription for antidepressants. From 2015 to 2019, prescriptions for antidepressants rose 38 percent for teenagers compared with 15 percent for adults, according to Express Scripts, a major mail-order pharmacy.

Subsequently, M also received a diagnosis of attention deficit disorder, not A.D.H.D., and given a prescription for methylphenidate, the generic name for medications including Ritalin and Concerta. "I'm still not sure I believe it," Linda said.

M's middle school has a trained mental health counselor. In March 2021, M visited him for the first time. During that visit, on a scale of 0 to 10, M ranked hopelessness and anxiety at 9, expressing terror at returning to school, a fear of falling behind and a wish to die.

But M's mood improved; at a meeting a month later, M ranked hopelessness and sadness at 5 and anxiousness at 2. M felt therapy was crucial but wasn't sure the medications helped; the school counselor credited M's improvement to family support and getting back to school. He cautioned the parents, though, that the pendulum could swing back.

Around that time, Linda heard through the grapevine that a girl named Elaniv Burnett had died following an overdose. "I'm sorry, I can't take it anymore," Elaniv wrote in a note. Her mother rushed her, still conscious, to the hospital, where Elaniv expressed regret at the overdose and described her terror. She died four days later, at age 15.

The news was still on Linda's mind a few weeks later when M fled into the forest.

M's family had recently returned from visiting both sets of grandparents. One set criticized M's pronouns, the other M's heavy screen use. Linda said she felt judged. She stole a look at M's phone and saw the troubling photos.

"Let's go for a walk," she said to M and went upstairs briefly. When she returned, M had vanished, so she followed them into the woods, texting as she frantically looked for flashes of M's white dress.

Finally M texted back: "I don't want to talk to you."

Linda returned home, and Tony went out. He found M along a commonly used trail. They walked, mostly in silence. "Then they were ready to come home," he recalled.

The school year ended, and M improved, the anxiety ebbing. M took joy spending time with a friend, in person, walking home, strolling the forest.

But a few weeks later, a hurtful text from the friend plunged M into despair again, "like I was back to having no friends."

M used an exfoliating blade to cut both ankles. "I don't know how to stop it," M said. "I can bet $20 that I'll be in the hospital next year."

When Linda saw the cuts, she confronted M, who handed over the blade. M let Linda examine the wounds.

"I think that's good," Linda said. "They let me look."

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'It's Life or Death': The Mental Health Crisis Among U.S. Teens

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Depression, self-harm and suicide are rising among American adolescents. For one 13-year-old, the despair was almost too much to take. Matt Richtel spent more than a year interviewing adolescents and their families for this series on the mental health crisis.

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The resources and information on this page are designed to help states, territories, tribes, mental health and substance use disorder professionals, and others looking for information on understanding the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services.

Need Support Now?
If you or someone you know is struggling or in crisis, help is available. Call or text 988 or chat 988lifeline.org.

In 2020, Congress designated the new 988 dialing code to be operated through the existing National Suicide Prevention Lifeline. SAMHSA sees 988 as a first step towards a transformed crisis care system in America.

The 988 Partner Toolkit is intended to facilitate partner efforts for collaborative and aligned 988 communication planning.

In 2020, the U.S. had one death by suicide every 11 minutes. Suicide is a leading cause of death for people aged 10-34 years.

There is hope. Providing 24/7, free and confidential support to people in suicidal crisis or emotional distress works. The Lifeline helps thousands of people overcome crisis situations every day.

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The resources and information on this page are designed to help states, territories, tribes, mental health and substance use disorder professionals, and others looking for information on understanding the background, history, funding opportunities, and implementation resources for strengthening suicide prevention and mental health crisis services.

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PBS Wisconsin: Not Enough Apologies -Trauma Stories

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PBS Wisconsin: Not Enough Apologies -Trauma Stories

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Explore how adverse childhood experiences can result in changes to the brain, leading to cascading behavioral and mental health problems. Discover how service providers across Wisconsin are working to be responsive to trauma in efforts to change the trajectory for affected children

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REEL TO REAL SCREENING RESOURCES

Reel to Real Screening Request - Use this online form to host a free film, or a film series, with your local library, favorite nonprofit, or school with this free, high quality selection of local and national programs. We will send you a DVD of the film, a PDF flyer for use in promoting the event, and we can assist you in finding a discussion leader.

Event Planner (PDF) - This tool was created as a helpful primer to using this documentary as a community or group activity and conversation starter. It contains tips for hosting a dialogue around such a sensitive and complex topic, including suggestions on finding local experts and local community groups to help build a useful resource for your community.

Promotional Event Flyer (PDF) - Your organization can use this handy pre-designed PDF template with customizable areas you can fill in with the details of YOUR own event to help with promotion. The final product can be emailed, printed, posted online and used in social channels.

Discussion Guide (PDF) - Watch the doc, then use this helpful guide to help frame a discussion about the complex subject of trauma with your group or community. This guide is designed to help facilitate conversations that ask participants to reflect on their own experiences, and to delve further into the many layers of this topic.

Impact Survey (PDF) - We are heavily invested in our communities. When we do critical work like this we want to know if it made a positive difference, so we ask all of our community partners and friends who host screening events/discussions around Not Enough Apologies to use this survey tool with their participants, then collect and share the responses with us.

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Explore how adverse childhood experiences can result in changes to the brain, leading to cascading behavioral and mental health problems. Discover how service providers across Wisconsin are working to be responsive to trauma in efforts to change the trajectory for affected children.

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American Psychiatric Association: Stress & Trauma Toolkit for Treating Hispanics in a Changing Political and Social Environment

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American Psychiatric Association: Stress & Trauma Toolkit for Treating Hispanics in a Changing Political and Social Environment

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Anti-Hispanic sentiment has been present throughout American history, and it has resulted in historical trauma for Hispanic populations. Overt and covert racism directed at Hispanic Americans has resulted in not only verbal insults, but also acts of violence and structural racism. Recent events, such as immigration raids on food processing plants, have had devastating impacts on the wellbeing of Hispanics because they incite fear and erode public trust in institutions designed to care for the public, including fear of deportation for legal immigrants.

Although Hispanics are the largest ethnic minority group living in the United States, anti-Hispanic discrimination is still prevalent-and on the rise, especially with the controversies surrounding undocumented immigrants from Latino countries. Stereotyping of Hispanics in the current sociopolitical climate continues to affect Hispanics negatively. Discrimination is a contributing factor in social inequality and health disparities and is associated with adverse mental health outcomes in Hispanics. Discriminatory experiences for Hispanics are specifically associated with an increase in emotional stress, social isolation, and symptoms of depression and anxiety. Additionally, research suggests that everyday discrimination increases the probability of Hispanics reporting suicidal thoughts and behaviors.

The Hispanic American population consists of a diverse range of ethnicities, cultures, and experiences that require and benefit from a knowledgeable and thoughtful practice of psychiatry. Significant gaps already exist between patient demand for mental health services and the availability of appropriate resources for Hispanics, particularly for those with limited English-language proficiency. Language barriers and lack of culturally appropriate mental health services also keep many Hispanics with mental illness from seeking services.

Doña Carmen, middle-aged

Doña Carmen, a middle-aged woman from South America who has lived in the U.S. for more than 20 years, has been in treatment for depression. She describes herself as "stable" with the ability to engage in her preferred daily activities. She identifies psychotherapy and antidepressant medication as being important to her recovery. Beginning in summer 2016, Doña Carmen's therapist noticed an increase in symptoms: depressed mood, restlessness, and a growing obsession of being watched by certain clinic staff members whom she had known for a decade.

A psychiatric evaluation reveals the onset of new psychotic symptoms. Doña Carmen is mistrustful and paranoid. She thinks the U.S. government is out to get her and that her therapist and certain staff members are in a plot to harm her. She now refuses to see her therapist. In conversation with her psychiatrist, Doña Carmen shares that she is worried about her fate since the government announced policy changes related to certain immigrant groups. She believes her safety in this country is no longer assured and has repeatedly stated, "I just don't know who I can trust anymore."

Factors that Put Hispanics at Risk for Mental Health Problems

Acculturation difficulties: These include language barriers, trauma history, cultural stigma against seeking mental health care, and lack of health insurance, particularly among people whose immigration status is undocumented.

Social determinants of mental health: As a group, Hispanic Americans are more likely to experience unstable housing, underemployment, unemployment, and poverty, all of which are associated with poorer physical and mental health.

Unfavorable government policies: Policies that promote mistrust and separate families challenge core Hispanic cultural values of familism (shared understanding and responsibility to identify a solution) and the Hispanic concept of confianza (trust in the experience, knowledge, and mission of each partner). Perceived anti-immigrant rhetoric and legislation, including efforts to rescind the Deferred Action for Childhood Arrivals (DACA) program , have affected health care utilization among vulnerable communities that feel targeted and persecuted by the government.

Reluctance to access mental health services: Given the multiple risk factors already experienced among Hispanic immigrants, refusal to access needed care due to fear and efforts to remain "invisible" may only lead to worsened health outcomes.

Racism, racial bias, and discrimination: Negative social factors such as racism, racial bias, and discrimination contribute to poor physical and mental health, including depression, anxiety, or suicidal thoughts, among other health concerns.

Racial profiling: Data have shown that Hispanics are disproportionately stopped and searched by law enforcement. Exposure to unfair law enforcement reduces trust in the government and increases the risk of health issues. Data has also shown that anti-immigration policies, which can sometimes result in racial profiling, exacerbate perceived discrimination among Hispanics--including U.S.-born Hispanics.

Suggested Assessment and Treatment Recommendations

1. Please see Suggested Assessment and Treatment Recommendations for Marginalized Populations

2. Consider cultural and structural issues: Include consideration of cultural and structural issues in the psychiatric evaluation. Identify the social determinants of mental health such as poverty, transportation difficulties, lack of insurance, lifestyle options and choices, unemployment, and domestic violence, among others. These risk factors should be considered when creating a treatment plan for Hispanic patients. Promoting services capable of effectively addressing these issues can help improve treatment outcomes.

3. Facilitate access to mental health services: Consider screening for mental health disorders in places where people are most likely to visit for health problems such as primary care clinics, women's clinics, and pediatric clinics. Providing patients with a mental health consultation at convenient locations can ease cultural stigma against mental health care and facilitate treatment.

4. Promote understanding of cultural differences in the clinical presentation of mental illness: Providers must consider the different cultural presentations of mental illness in Hispanics, as they may express depression, anxiety, trauma, and psychosis with somatic symptoms. Given these common clinical presentations, primary care providers are most likely to interact with these patients. Therefore, both mental health providers and primary care providers should receive cultural competency and sensitivity training.

5. Increase provider partnerships: Developing partnerships with community and professional organizations may provide patients with more care offerings while increasing participation in the health care system.

6. Promote interventions tailored to the populations: Service agencies should actively avoid barriers, such as waiting lists, while facilitating access to language-appropriate offerings. Service agencies should also incorporate population-specific, evidence-based recommendations and evaluate outcomes including consumer satisfaction and recovery-oriented services.

7. Engage the family: Families are vital building blocks of the Hispanic community; therefore, incorporate patients' families in the therapeutic process as much as possible.

8. Community and religious engagement: Emphasize available community resources and engage with faith communities, when appropriate, to help create a supportive network.

9. Support the creation of local leadership groups: Such groups may facilitate referrals to appropriate professionals and increase the availability of effective behavioral health services in Spanish. Leadership groups may also help strengthen partnerships with community-based resources such as advocacy organizations, attorneys, schools, and faith-based organizations.

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Learn more about treating Hispanic patients experiencing stress and trauma related to changing political and social environments.

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OACBHA Health, Equity, Diversity and Inclusion Readiness Workbook

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OACBHA Health, Equity, Diversity and Inclusion Readiness Workbook

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SAMHSA National Guideline for Behavioral Health Crisis CareBest Practice Toolkit

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SAMHSA National Guideline for Behavioral Health Crisis CareBest Practice Toolkit

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OCHLA March 2022 Mental Health Newsletter

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OCHLA March 2022 Mental Health Newsletter

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Interesting NPR Article about views of Mental Health within Latino communities

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Interesting NPR Article about views of Mental Health within Latino communities

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If you were raised in a Latinx household, you'll know that when it comes to mental health, we don't grow up talking about it.

Personally, neither of us (Isabeth and Naydeline) talked about it with our parents until college, when we both went to therapy for the first time. It wasn't until we had the right language to discuss mental health that we felt comfortable enough to bring it up at home. So if the thought of admitting to your family that you're struggling makes you tense up, we totally get it.
Explore Life Kit
You're not alone in your fear. A 2019 study found that in the U.S., Latinos access mental health care at nearly half the rate of non-Hispanic white people. Shame and stigma play a huge role in discouraging folks from seeking mental health support in our communities - not to mention talking about it with loved ones.

As hard as it can be to bring up, there's power and freedom that come from feeling safe in your mind and your body, and at home. If you want to explore having a conversation with your loved ones about mental health, we have some tips for you! You'll hear from therapists, young people who have had the conversation and, of course, us.

Work to understand your own mental health

The more aware you are of your specific mental health struggles and needs, the better you will be able to communicate those needs to others. To start, understand that mental health isn't stagnant and can change as your life changes. How you understood your mental health before might not be how you understand it now.

There are several ways you can learn how your emotions show up and interact with your body and mind. Therapy card decks, such as Ebony Butler's My Therapy Cards, made specifically for people of color, can be a great tool for reflection. Journaling, meditation and following licensed mental health professionals on Instagram can also be helpful. Some of our favorite people to follow are Josie Rosario, Lisa Olivera, Nedra Glover Tawwab and Whitney Goodman.

Here are a few book recommendations that speak to mental health-related topics such as intergenerational trauma and attachment styles:

And of course, there's therapy! Therapy can be a scary process, but having the right mental health professional on your side can help you work through things that you might not be able to on your own. Some therapist directories you can look into are Latinx Therapy, Therapy for Latinx, Psychology Today, Therapy for Black Girls and Open Path Psychotherapy Collective.

Reflect on your "why"

After you have a better understanding of your mental health, the next step is to establish why you want to talk about it with your family. You may not feel like sharing this part of your life is important, and that's OK. But for those who do, this step is essential.

For some people we spoke to, like Figgy Baby, 30, a musical artist and co-founder of Bloom Homie, a collective of "homies reimagining masculinity," they want to be able to be their full authentic selves with their family members - that's one "why."

"I want home and family to be a space where I can be my freest self. I'll admit that it's not, but little by little it can be more and more," says Figgy. "And I feel like taking this leap of being vulnerable and shameless with my folks only allows space for deeper connections with my family."

For others, they want to talk about mental health at home because it helps to normalize the conversation as well as break down stigmas. Have you ever heard el dicho, " la ropa sucia se lava en casa" (don't air your dirty laundry in public) or heard a family member shaming a relative with a diagnosis by calling them loco? These are all cultural stigmas prevalent in the Latinx community.

And while it's easy to laugh about - and maybe even bond over - these shared traumas, we can't deny the real-world implications these ideas have on our collective well-being. It's through open and honest conversations with the people around us that we can help shatter these outdated narratives.

Come prepared to have the conversation, and have an after-care plan too

After establishing your "why," then it's time to actually have the conversation. This type of conversation can feel emotionally and mentally daunting, so we suggest entering it with humility and love - and maybe even a plan of action.

Kayla Zapata Fory, 29, scripted out what she wanted to say to her parents before having that conversation with them. Scripting can be a helpful tool if you get nervous during difficult discussions and want to make sure you're laying it all on the table when you have the talk.

Natalie Gutierrez, a licensed marriage and family therapist who specializes in trauma and is based in New York and New Jersey, suggests starting off by saying something along the lines of:

I'm struggling to love me, and I'm struggling to know who I am, and I really want to heal.

You want to be sure to share your struggles with your loved ones in a way they'll understand, so in addition to sharing your medical diagnosis - if you have one and choose to share - it might also be helpful to share your symptoms using simple language. For example, you can say: "When I'm driving, I get really nervous that I might hit something or get into an accident," as a way to describe anxiety.

You might get some pushback from your family, so be prepared to redirect the conversation when you feel your parents or loved ones reacting negatively. Remind them that your mental health journey is about you wanting to be your best self and might have nothing to do with them.

Daniel Olavarría, a licensed clinical social worker who serves clients in New York, California and Florida, says you can say:

No mom, no dad. It's not your fault. The world is moving quickly, things are changing and this is what people are doing now to show up as the healthiest version of themselves. I know that you didn't have time to take care of yourself, but thank you so much for what you did [for me], because now I do.

Nevertheless, we recognize that parents aren't perfect! If your family members may have negatively contributed to your mental health, you can show compassion for their errors while still honoring your reality.

After sharing your diagnosis or struggles with your family, it's important to reflect on what support you might need from them. This is also an opportunity to share where you'd like to set boundaries to create a safer environment for yourself. (There's a whole Life Kit episode on setting boundaries with family.)

After all is said and done, it can be beneficial to have a plan for how you'll take care of yourself afterward. You might want to set some time for a walk, call a friend to debrief or journal - anything that will help you decompress. This may be one of many conversations with loved ones, so it's important to have self-care tools for when things get too heavy.

Put yourself first

Through it all, remember to put yourself and your healing first!

Although family may be super-important to many of us in the Latinx community, your healing journey may or may not include them - it didn't include some family members for Reza Cristián Moreno, 26.

She offers this advice for people whose parents aren't as understanding and might also be going through their own healing journeys: "We grow up understanding that family values are everything. But I think the advice that I've learned from my therapist is that it's OK to put yourself first and your needs first."

Just because you are putting yourself first doesn't mean you don't care deeply about your folks. Gutierrez reminds us, "We may need to disappoint people if it means that we are healing ourselves and tending to what feels right within us." Healing starts by being vulnerable, and that's pretty brave - not selfish.
Have you talked to your Latinx loved ones about mental health or therapy? Share the tips that worked for you. Send us a note to Naydeline Mejia is a freelance writer and editor based in the Bronx, N.Y. If you love Life Kit and want more, subscribe to our newsletter.Isabeth Mendoza is a freelance producer based in Los Angeles. .
The audio portion of this episode was produced by Sylvie Douglis, with engineering support from Gilly Moon.

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4 tips for talking to your Latinx parents about mental health : Life Kit

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Shame and stigma play a huge role in discouraging folks in the Latinx community from seeking mental health care - and talking about it with their families. These steps can help you prepare for the conversation with your loved ones.

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2022 Ohio Department of Insurance Annual Mental Health Parity Report

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2022 Ohio Department of Insurance Annual Mental Health Parity Report

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This report, made available by The Ohio Department of Insurance (ODI), in partnership with the Ohio Department of Mental Health and Addiction Services (OhioMHAS), includes information on consumer and payer outreach activities and identification of trends and barriers to access and coverage in the state of Ohio