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By
Jodie Snyder and Susie Steckner

Last winter, after two local Spanish-language stations ran public service announcements about mental illness, desperate listeners flooded phone lines and overwhelmed agencies hoping to help.

The outpouring shouldn't come as a surprise. Experts agree that one in five people need mental health services in a year and 25 percent ofthe Valley's 3.2 million residents are Hispanic.

Yet existing services for Hispanics with mental health needs wouldn't even begin to cover as many as the 160,000 people who may need help. For example, there are just 12 Spanish speakers among the 380 members of the Arizona Psychiatric Society.

This lack of treatment strains systems as well as individuals: Hispanics are jailed or put in substance-abuse programs at higher-than-expected rates because that's the only way they can get mental health services, according to national studies.

Inadequate care can have even more extreme results. For three years, Oscar de la Cruz, 28, sat unclaimed at the state's mental hospital because no one understood his schizophrenic-induced Spanish gibberish to catch the name of his hometown in Mexico.

"There is so much need in the community," said Juan Guevara,CEO of the People of Color Network, a group of agencies that primarily servesminority clients. "I'm afraid of going on the radio again."

The situation has been bleak for years, advocates say; but there may be hope ahead. Demographics demand greater attention to Hispanicmental health, and advocates have seized on that.

"People realize if we unify, we will have a bigger voice and a better voice," said Maria Jose-Carrasco, program manager at the Multicultural and International Outreach Center of the National Alliance for the Mentally Ill in Virginia.

The emphasis is national as well as local, everything from a presidential commission calling minority mental health a top priority to South Mountain Community College classes to train Spanish-speaking behavioral health workers.

The new Institute for Mental Health Research, based in Phoenix and Tucson, will host a national forum about the subject next year.

The institute, funded with public and private money, is a collaboration of state universities and health care and research centers.

Changes in funds

Of the many improvements needed, increased funding should be at the top of the list, mental health advocates say. It's a lack of funding, not a lack of interest, that has caused the scarcity of programs.

Tucson's La Frontera Center was recognized by the former U.S. surgeon general for its mental health programs. The agency no longer recruits newpatients.

"They just show up," CEO Dr. Daniel Ranierisaid.

Centro de Amistad, a non-profitin Guadalupe, doesn't do outreach anymore either.

More than a decade ago, volunteers went door to door, trying to find people who needed treatment.

Now, the agency doesn't even hold annual depression screenings; there's no money to treat people in need, CEO Santos Bernasconi says.

Arizona's system

Advocates say the biggest changes should come in the public mental health system. Of the adults in Maricopa County's public system classified as seriously mentally ill, 12.1 percent are Hispanic, while a quarter of the county's population is Hispanic.

Some government dollars will be focused on enrolling more Hispanic children, who are eligible for Medicaid, in the public system. Less than 30 percent of the kids in the system are Hispanic; officials want to boost that to 40 percent, said Michael Zent, CEO of ValueOptions, the company that contracts with the state to provide mental health services for the poor.

Among the other efforts: new computer and phone systems for minority-focused agencies, pay differentials for Spanish speakers employed by ValueOptions, and $500 incentives for hiring bilingual staff members at agencies.

Government assistance

The agencies under Guevara's People of color Network want a larger share of government funding to improve culturally relevant care and bring in more clients.

"You have to change where the dollars go," Guevara said.

"We need to have an understanding of the culture, we need to have an understanding of the culture, we need to have an understanding of the language, before we can provide the clinically appropriate care," he said.

That kind of approach is critically needed, said a Hispanic mother in Phoenix, who asked to remain anonymous.

Her son was an ambitious college sophomore when his life came to a screeching halt.

He was suddenly diagnosed with bipolar and schizo effective disorders-sterile terms applied to a bright and handsome young man.

"Prior to my son being afflicted, I had never heard about a lot of mental illness," she said. "When someone said 'mental illness,' I thought of someone insane."

When the family members did seek help, they didn't think enough was available.

Support groups

Some advocates are pushing for changes outside the public mental health system.

For instance, the non-profit agency MKID, Mentally IllKids in Distress, is training 10 Hispanic families to provide a support system for families in the far west Valley. South Mountain Community College is starting classes to certify bilingual students to be family advocates or go on to advanced training.

Providing culturally relevant and sensitive mental healthcare starts with speaking the language, a basic need that is not close to being met, advocates say. This is key because it can reduce the chance of misdiagnosis and increase the patient's compliance with treatment.

But it takes more than the ability to speak Spanish.

Serving Hispanics, advocates say, means serving an incredible array of people who speak Spanish, from Cuban refugees to Indo-Latinos of Guadalupe to middle-class Mexican-American teens.

"When people say 'Hispanic population,' I don't even know what that means," said Luis Ibarra, CEO of the non-profit agency Friendly House.

Facing challenges

The differences extend beyond where people are born, tohow long they have lived in the United States.

Studies say that recent immigrants have fewer mental health problems than Whites and second-generation Hispanics. Experts are at a loss to explain the difference.

Still, recent immigrants do face challenges, said Dr.Elizabeth Valdez, director of Concilio Latino de Salud, a Hispanic health agency.

"They walk into the stores and there are 25 brands of flour," she said. "You know the saying 'around the world in 80 days?' they encounter 80 different worlds in one day."

Spirituality is another issue. Where an Anglo patient ma ybelieve "I'm empowered," a Latino patient may believe "siDios quiere" or "if God wants," said Maria Restrepo-Toro, who oversees Latino initiatives at Boston University's Center for Psychiatric Rehabilitation. But professionals "can't assume that everyone's spiritual," she said.

As experts debate how best to reach patients and treat them, others push for culturally relevant ways to rehabilitate them.

"The crisis of mental health is devastating but there's hope," Restrepo-Toro said.