El cuidado de la salud mental es el mayor reto de la pandemia en Texas

In partnership with The National Institute for Health Care Management Foundation, The Texas Tribune is producing a limited series of Spanish podcast episodes focused on providing accurate information about the pandemic.

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Según un informe de Mental Health América, Texas ocupa uno de los últimos lugares en cuanto a acceso a servicios en salud mental. Teniendo esto en cuenta y la necesidad evidente de los ciudadanos, nos preguntamos cuáles son los servicios que están disponibles para la población de habla hispana.

Escuche el quinto episodio de esta serie de podcasts.

English translation

The pandemic has affected us in different ways. Millions of people have lost loved ones. Others have lost jobs and homes. The effects of the pandemic are physical and emotional. For this reason, now more than ever, a key aspect to our well-being is taking care of one's mental health.

Listen to the fifth episode of this podcast series.

María Isabel Gonzales: In this episode, we take a look at the mental health landscape in Texas by talking with the people who work in this field. Their experiences will draw us closer to the daily realities in the state.

Alfonso Padilla, a bilingual therapist licensed in the state of Texas who works for Integral Care in Travis County, shares his experience.

Alfonso Padilla: I think, really, that the situation is very threatening, right? And an unknown for all of us. So, this affects us in many ways, including a lot of uncertainty — psychologically, socially and emotionally. We have seen a lot of people who come to our clinics who have a lot of stress, a lot of worry, a lot of anxiety and depression, and a lot of isolation and fear of getting out of their houses. We’ve seen an increase in the use of substances and drugs during the pandemic, during this time.

This has also changed our lives in many ways because our plans are continuing to be canceled. I know our source of income has changed drastically, and this has triggered feelings of pain, and a lot of stress and anxiety.

Gonzales: Although Padilla talks about his experience in Travis County, the scenario is similar in the rest of Texas. At the start of the pandemic, Meadows Mental Health Institute issued one of the most worrying predictions. According to the institute, for each 5% increase in the unemployment rate, 4,000 people in the United States would die by suicide (300 of those in Texas), and 5,500 people would die of drug overdose (425 of those in Texas).

Organizations such as the Houston Methodist Hospital have reported a substantial increase in the number of people with depression and other mental health conditions.

In fact, 2,100 young people in Dallas and Plano were admitted into the emergency room exhibiting suicidal thoughts and behaviors, according to a recent report by Children’s Health in Dallas. In light of these numbers and the need for mental health services among the population, we wonder how accessible these services are to the people.

Isidro Torres, executive director of the National Alliance on Mental Illness of El Paso (NAMI), tells us about what he went through in 2020.

Isidro Torres: Because there are not enough mental health experts here in Texas, the people who were looking for a therapist would have to wait a long time. I was looking for a therapist during the pandemic and I started to do so in May 2020, and it was until December that I could see a therapist. We would have to wait like six months and that is a long, long time. A lot of things can happen during that time.

Gonzales: Isidro Torres’ experience illustrates the reason why Texas ranks second to last in a recent Mental Health America report. The report looks into accessibility of mental health services in each state.

The ranking took the following factors into consideration: access to health insurance, treatment, quality and cost of insurance, access to special education and availability of qualified personnel.

In fact, according to Isidro Torres, 185 of the 254 counties in Texas don’t have a practicing psychiatrist.

The landscape is less encouraging when it comes to mental health experts who speak Spanish. Therapist Alfonso Padilla weighs in on the issue.

Padilla: I think I’m one of the only bilingual therapists in Travis County. And I’m a man. There’s a lot of people, for example, teenagers and adults, who want to see only a man and they don’t want to see a woman. There aren’t many male experts, and we are noticing that we don’t have that many licensed professionals to see patients. I don’t think this just happens in Travis County; I think this is happening all over the country.

Gonzales: After our interview with Padilla, we asked Integral Care to confirm the number of mental health specialists who speak Spanish within their organization and in Travis County. Integral Care said it has 133 employees who speak Spanish and interpreters who are medically trained and who provide translation services for free if there’s no available personnel.

Integral Care said that after a first visit without an appointment, a follow-up visit for each patient can take a week to be scheduled.

However, demand for mental health services among the Hispanic population is increasing. In the fiscal year that goes from Sept. 1, 2019, to Aug. 31, 2020, 8.074 people who self-identified as Hispanic were seen at the center.

On the other hand, Padilla says there are other barriers that the Hispanic population faces when it comes to accessing mental health services.

Padilla: The barrier that we’re noticing, unfortunately, is that people simply don’t have the resources. There are people who don’t even have phones, let alone the internet. So, there’s an enormous social disparity that’s manifesting.

I think there are a lot of problems such as these that affect people in a disproportionate manner. Because the people who don’t have access, don’t have health care. We do see people regardless of their having insurance or not. We see anybody — we’re not going to deny them services. But I think this has increased, magnified the social issue we’re seeing now. There are people who simply don’t have health insurance and those who have limited access; for example, those who don’t have Internet and those who live in multifamily households, where there’s no privacy so they can’t attend virtual appointments. I think there are barriers and we’re seeing them.

Gonzales: At this point, we wonder how many Spanish-speaking people have access to mental health services. Isidro Torres, with NAMI El Paso, elaborates.

Torres: I can say, based on a NAMI report with the country’s data and information, that 33% of Latinos or Hispanics have access to or access mental health services. So, there's a lot of people who are not accessing the services, and this could be because there’s a stigma or they don’t know about these services or they don’t want to talk about mental health outside of their homes.

Gonzales: As Torres mentioned, another key aspect to consider is health insurance. Even for those who are insured, it’s not easy to find a mental health provider in their network or to get a treatment plan that’s approved by their health insurance.

So, what can people who don’t have health insurance and who need help now do? Alfonso Padilla tells us how they work in Travis County.

Padilla: In any case, you come to the clinic and talk with someone who’s going to help you. For example, here in Travis County there’s a program called MAP (Medical Access Program) through which the city provides you with insurance so you can see a doctor. We also help people to qualify for this program. So, even if the person doesn’t have MAP, even if that person doesn’t have health insurance, we’re going to help that person no matter what, either to get MAP or to help them to pay a bit less.

Gonzales: Available services will depend on the place where people live. No county is the same. And, regardless of being insured or not, there are nonprofit services and other community networks [that offer help]. Also, the local mental health authorities have official information on their websites.

It’s worth mentioning that beyond the context and times we’re currently living in, it’s essential to take care of each other. For this reason, Padilla tells us the signs to pay attention to at home.

Padilla: When people begin to isolate themselves from their families, when they start to speak in a negative manner, for example, when they speak about suicide. When they lose their appetite, don’t care for themselves, don’t shower themselves. There are plenty of signs, and I think it’s important that we maintain connection.

I’ll tell you about the stigma in our Latino culture, because I think it’s very important. Within our Latino culture there’s a lot of shame in talking about our emotional problems with anybody. We always talk about men not talking about their emotional problems. But there are also a lot of women who don’t like to talk about it or don’t want to or who simply have shame about talking about it openly with someone.

So, these stigmas exist and we have to talk about mental health not only with the people who know us well, but also with professionals.

Gonzales: Mental health experts say it’s important, particularly during these times, to establish and keep a routine. Being constant. Making sure to perform physical activities. Sleeping and eating well. Trying to not spend too many hours in front of a screen, and setting aside time to disconnect.

NAMI’s Isidro Torres reminds us about an important fact on help lines.

Torres: When it comes to the Suicide Hotline or the Crisis Text Line, a lot of people think they have to be going through a huge crisis or something bad. [These help lines] are there to help people.

Gonzales: The representatives from the organizations we have interviewed in this episode call for greater visibility and support for mental health. This will help us overcome the challenges that have stemmed from the pandemic.

Available mental health services vary from county to county for people with insurance and for those without. But in general, the barriers on the path to access mental health services are:

1. The lack of specialists to meet demand
2. The lack of resources to pay for mental health care, and/or Internet or media/devices to access virtual sessions
3. The lack of awareness and understanding of available services

This is why organizations working to boost mental health care, such as NAMI, think it’s so important to emphasize the need to improve access to affordable and quality mental health care through health insurance plans with more ample coverage. It’s also important to bridge the digital gap so there’s improved access in rural areas and a tangible support for the people.

Our final thought for those of you who are listening: Don’t wait till you’re in a crisis to ask for help.

Links to resources and more information:

• Suicide Hotline in Spanish: 1-888-628-9454
• Crisis Text Line: Send a text message with the word AYUDA to 741741
• Find your local NAMI chapter: In TEXAS, call 211
• Find your local mental health authority
• Texas Health and Human Services offers a list of information about mental health en español
• COVID-19 Mental Health Support Line
• Mental Health America
• Therapy for Latinx