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By Jodie Snyder and Susie Steckner

Luis Ibarra calls Friendly House in Phoenix an institution in the Hispanic community, an agency that offers hope when there is none, and all kinds of services for the needy.

People come in carrying the weight of their worlds, which are complicated by poverty, language barriers and, often times, a host of mental health concerns. Sometimes it's depression or substance abuse or violence.Sometimes it's more than one problem.

"You can't just say, 'I'm just going to deal with your substance abuse' when there are so many things out of balance," said Ibarra, chief executive officer of the 82-year-old social-service agency. "Whatever door they come in, there's an assessment of what all they need."

Across the Valley, there are a few non-profit agencies like Friendly House that focus primarily on human services and mental healthcare for Hispanics.

They face serious challenges: Everything from nitty-gritty financial issues to more abstract ideas about how culture can influence a person's mental health.

The largest minority-focused agencies that provide mental health care are:

• Centro do Amistad in Guadalupe, with an office in Mesa. The center, which serves adults and children, has a range of mental-health services under its umbrella. It offers traditional counseling and substance-abuse therapy, but also programs like anger-management therapy.
• Centro de la Famila in Phoenix, aprogram of the Chicanos por la Causanon-profit organization. The center serves adults and children, and provides counseling to people with mental illness, substance-abuse issues and family problems.
• ·Valle del Sol in Phoenix, with anoffice in Tempe. The agency offers counseling programs to children and families dealing with mental illness, substance abuse and family problems.
• Friendly House, which offers counseling programs to adults and children dealing with mental illness, substance abuse and family problems.

Adequate funding, as well as counselors and staff who speak Spanish, are keys to improving and expanding services.

But those aren't the only considerations, health-care professionals and advocates say.

There must be cultural competency, the recognition of how a people's experiences and their surroundings influence their care. In short, experts say, there must be respect.

"Cultural competency is not about numbers," like how many Spanish speakers are on the staff, said Dr. Elizabeth Valdez, executive director of Concilio de Latino Salud,a non-profit health-care group. "It is about respecting each person who walks through the door."

Non-profit agencies face a daily challenge in providing care: Taking into account a person's ethnic background, gender, education, family status, religion and sexual orientation.

Agencies try to design their behavioral-health programs with that cultural sensitivity in mind. Valle del Sol, for example, has a program in which counselors suggest that children might do better at school if families come in and talk with counselors.

It's a more effective way than outright asking people if there are problems such as domestic violence at home, said Luz Sarmina-Gutierrez, the agency's executive director.

At Friendly House, counselors might go to a client's home to find out why the person isn't coming in for appointments.

Counselors also might have to balance the professional code of not telling a client what to do with the need by a Hispanic client to be told exactly what to do, Ibarra said. Some efforts at cultural competence are very basic when it comes to clients, he said.

"It's how they are greeted, who they are greeted by," he said.

If clients are going to ask for help and then commit to treatment, these kinds of approaches are critical, advocates say.

Ibarra knows that first hand.

"A lot of the time when they come in our doors, they've already been to everyone else," he said.

Copyright 2002, Used with permission from The Arizona Republic.