The Healthcare Needs of Latinos with Serious Mental Illness and the Potential of Peer Navigators

Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services

BACKGROUND

Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present.

METHODS

We undertook a rapid systematic review of the literature (01/01/2011 - 09/03/2022) on seeking and/or providing mental health services in linguistically discordant settings. Quality appraisal was performed, data was extracted, and evidence was reviewed and synthesised qualitatively.

RESULTS

58/5,650 papers met the inclusion criteria. Both TCNs (and their carers) and HSCPs experience difficulties when seeking or providing mental health services and language barriers are present. TCNs and HSCPs prefer linguistically and culturally concordant provision of mental health services but professional interpreters are often required. However, their use is not always preferred, nor is it without problems.

CONCLUSIONS

Language barriers impede TCNs' access to mental health services. Improving language support options and cultural competency in mental health services is crucial to ensure that individuals from diverse linguistic and cultural backgrounds can access and/or provide high-quality mental health services.

Participatory Action Research Among People With Serious Mental Illness: A Scoping Review

Participatory action research (PAR) is a research approach that creates spaces for marginalized individuals and communities to be co-researchers to guide relevant social change. While working toward social transformation, all members of the PAR team often experience personal transformation. Engaging people with serious mental illness (PSMI) in PAR helps them to develop skills and build relationships with stakeholders in their communities. It supports positive changes that persist after the completion of the formal research project. With the increasing recognition of PAR's value in PSMI, it is helpful to consider the challenges and advantages of this approach to research with this population. This review aimed at determining how PAR has been conducted with PSMI and at summarizing strategies used to empower PSMI as co-researchers by engaging them in research. This scoping review followed five steps Arkesy and O'Malley (2005) outlined. We charted, collated, and summarized relevant information from 87 studies that met the inclusion criteria. We identified five strategies to empower PSMI through PAR. These are to build capacity, balance power distribution, create collaborative environments, promote peer support, and enhance their engagement as co-researchers. In conclusion, PAR is an efficient research approach to engage PSMI. Further, PSMI who engage in PAR may benefit from strategies for empowerment that meet their unique needs as co-researchers.

Stigma and the Intersection of Ethnicity, Gender, Romantic Relationships, and Serious Mental Illness: Perspectives from Latinxs with Schizophrenia and Their Family Members

Romantic relationships are a fundamental part of the human experience and contribute to quality of life and recovery of people with serious mental illness (SMI). However, few psychosocial interventions exist to address this issue among people with schizophrenia, and no existing intervention focuses on Latinxs. The intersectionality of being Latinx and having schizophrenia can create a unique experience regarding stigma, romantic relationships, and gender. Guided by intersectionality theory, this study used qualitative content analysis and an intersectionality template analysis to examine data from interviews with 22 participants-11 people with diagnosed schizophrenia and their identified primary family member. Overall, findings illustrate perspectives about romantic relationships in a sample of Latinxs with schizophrenia and highlight the stigma that people with schizophrenia and their families can experience. Five key themes emerged from the data: obstacles to romantic relationships, advantages of romantic relationships, disadvantages of romantic relationships, gender-role issues and satisfaction with life, and hope for the future. Participants reported that stigma related to schizophrenia and the lack of employment were the main obstacles to establishing and maintaining romantic relationships. These findings provide an insider perspective on romantic relationships in a sample of Latinxs with schizophrenia and elucidate the importance of using an intersectionality lens to guide culturally responsive approaches.

Clients' Perspectives Regarding Peer Support Providers' Roles and Support for Client Access to and Use of Publicly Funded Mental Health Programs Serving Transition-Age Youth in Two Southern California Counties

Peer providers are increasingly used by mental health programs to engage transition age youth (TAY, age 16-24) living with serious mental illness. This study elicited TAY clients’ perspectives on peer providers’ roles, responsibilities, and contribution to TAYs’ use of mental health services. In 2019, six focus groups were conducted with TAY clients (n=24) receiving publicly funded mental health services in Southern California. Results from this analysis included four themes that illustrated the role of peers as perceived by TAY clients, including: 1) building client–peer provider relationships, 2) engaging with mental health services, 3) role-modelling recovery and supporting skill acquisition to instill hope and empowerment, and 4) peer roles and experiences specific to racial/ethnic concordance. These findings provide needed perspectives on the evolving role of peer providers in mental health services programming for TAY clients.

Effective Peer Employment Within Multidisciplinary Organizations: Model for Best Practice

This study sought a clearer understanding of organizational mechanisms reinforcing effective peer employment and organizational change from the perspectives of peer workers, non-peer staff and management in multidisciplinary mental health and substance use recovery services. Findings were used to develop a model for organizational best practice for peer employment and associated organizational change to promote recovery-oriented and person-directed services. Qualitative research was undertaken, involving 132 people participating in 14 focus groups and eight individual interviews. These people were employed across five U.S. multidisciplinary organizations providing mental health and substance use recovery services and deemed by a panel of experts to provide effective employment of peer workers. Study findings include the articulation of an interactive working model of best practice, comprising organizational commitment, organizational culture and effective organizational strategies necessary for a "whole-of-organization" approach to support authentic peer work and enable organizational transformation, to actualize recovery-oriented values and person-driven services. Strategies include Human Resources engagement, peers in positions of senior organizational authority, recurring whole of workforce training, along with peer training and peer-led supervision. Findings suggest whole-of-organization commitment, culture and practice are essential for the organizational transformation needed to support effective employment of peers in multidisciplinary environments.

Peer Support in Behavioral Health care: why it can work in the Latinx context

Las personas de origenes latinoamericanos son menos propensas a comprometerse con el cuidado de salud mental y la participación en servicios de salud mental, comparado a otros grupos raciales y étnicos. Las bajas tasas de participación en servicios de salud mental en parte de la comunidad Latinx en los Estados Unidos (EE. UU.) se puede atribuir parcialmente alfuncionamiento de los sistemas de cuidado, los cuales no son sensibles a la cultura Latinx o al español como lengua. Las Investigaciones han demostrado que intervenciones centradas en la cultura, que promueven los valores culturales de la comunidad Latinx, informan una mayor participación y satisfacción en el tratamiento y los servicios de salud mental. Un enfoque efectivo, informado por la cultura, que puede mejorar la participación de la comunidad Latinx en servicios de salud mental es el apoyo de compañerxs. En el enfoque de apoyo de pares, se contrata a personas con experiencias vividas en salud mental y adicciones como compañeros de apoyo para ayudar a quienes han vivido experiencias similares. Los estudios de investigación que miden la efectividad de los enfoques de apoyo entre pares han mostrado mejoras en las vidas de quienes reciben el apoyo, ayudando con el sentido de esperanza, calidad de vida, y bienestar. Los resultados también han demostrado disminución de hospitalizaciones, visitas a la sala de emergencia y menor uso de sustancias y participación en actividades criminales. El apoyo entre compañerxs en el contexto Latinx parece un ajuste natural dados sus valores colectivos compartidos (p. ej., simpatía, personalismo, respeto, confianza, familismo). Este articulo discute como los valores de apoyo entre compañerxs se relacionan con los valores colectivistas; y como se pueden infundir más los valores Latinx en el entrenamiento, desarrollo y supervisión de los compañerxs de apoyo para mejorar el cuidado de salud mental informado por la cultura.   

Mentes Positivas en Acción: A Randomized Feasibility Study of a Promotor-Delivered Cognitive Behavioral Stress Management Program for Low-Income Spanish-Speaking Latinos

Purpose: Although psychological distress is common among Latinos in the United States, they underutilize mental health services. We describe a community-based program to manage stress and reduce depressive symptoms among low-income Spanish-speaking Latinos. Methods: Mentes Positivas en Acción (MPA) (Positive Minds in Action) is an 8-week group program, delivered by trained promotores in community settings and evaluated through a randomized feasibility study. Participants were randomly assigned to an immediate MPA treatment group or a delayed-intervention control group. Outcomes assessed at baseline and 8 weeks included stress (Perceived Stress Scale [PSS]) and depressive symptoms (PHQ-9); higher scores indicate worse health. Repeated-measures analysis of variance examined group×time interaction effects for group differences in change from baseline to 8 weeks. The control group offered the program after the 8-week assessment, completed an additional assessment at the end of the program (16 weeks); t-tests assessed within-group changes. Results: Most participants were female, born in Mexico, and spoke only Spanish. Group×time interaction effects were significant for both outcomes. Mean PSS scores improved in the treatment group but not the control group (-0.80 vs. +0.10; p<0.014). Mean PHQ-9 scores improved more in the treatment group than the control group (-5.7 vs. -0.3; p<0.011). Within-group analyses of the control group found significant improvements in stress (-0.8; p<0.000) and depressive symptoms (-3.9; p<0.002). Conclusions: This study provides preliminary evidence of the effectiveness of a community-based promotor-delivered program to manage stress and reduce depressive symptoms among vulnerable underserved Latinos in the United States.

Examining How Health Navigation Affects Mental Health Among Gay, Bisexual, and Other Men Who Have Sex with Men Living with Human Immunodeficiency Virus in Guatemala

Gay, bisexual, and other men who have sex with men (GBMSM) are disproportionately affected by mental health problems and human immunodeficiency virus (HIV). Health navigation has the potential to improve both HIV and mental health outcomes; however, few studies have measured the impact of navigation on mental health among people living with HIV. We analyzed longitudinal data from a sociobehavioral survey and navigation monitoring system with GBMSM living with HIV in Guatemala (n = 346) that participated in a 12-month differentiated care intervention. We examined relationships between navigation characteristics (frequency, duration, mode of interactions, and level of emotional, instrumental, and informational navigation support) and anxiety and depression using fixed-effects regression. We also examined if these relationships were moderated by baseline social support. We found that as navigation interactions increased, anxiety significantly improved [B = -0.03, standard error (SE) = 0.01 p = 0.05]. Participants who received high levels of informational navigator support also experienced a significant improvement in anxiety compared with those receiving low levels of informational support (B = -0.81, SE = 0.40, p = 0.04). Unexpectedly, we found that as the proportion of in-person navigation interactions increased, anxiety worsened (B = 1.12, SE = 0.54, p = 0.04). No aspects of navigation were significantly associated with depression and baseline social support did not moderate the relationship between navigation and anxiety and depression. To improve the mental health of key populations affected by HIV, health navigation programs should prioritize frequent interaction and informational navigation support for clients with anxiety while considering other strategies that specifically target reducing depressive symptoms, including other cost-effective modalities, such as mobile apps.

The critical importance of community health workers as first responders to COVID-19 in USA

COVID-19 has served to exacerbate existing health disparities and inequities, most—if not all—of which can be traced to the social determinants of health (SDOH) that affect specific populations and communities. Essential to health and health systems long before, community health workers are experts in addressing SDOH in community-based settings; however, they have yet to be mobilized as part of the COVID-19 response both in the US and internationally. We use data from our mixed-methods study with supervisors (n=6), Executive Directors (EDs) (n=7), and CHWs (n=90) to describe the critical role that CHWs can play to assist in response to COVID-19 using New York State's (NYS) as a case example. Building on these findings, we raise specific CHW workforce issues and propose recommendations for how to mobilize this workforce in national pandemic response efforts.

Integrating Stakeholder Engagement With Claims-Based Research on Health Insurance Design and Bipolar Disorder

Researchers increasingly recognize that stakeholder involvement enhances research relevance and validity. However, reports of patient engagement in research that relies on administrative records data are rare. The authors' collaborative project combined quantitative and qualitative studies of costs and access to care among U.S. adults with employer-sponsored insurance. The authors analyzed insurance claims to estimate the impacts on enrollee costs and utilization after patients with bipolar disorder were switched from traditional coverage to high-deductible health plans. In parallel, in-depth interviews explored people's experiences accessing treatment for bipolar disorder. Academic investigators on the research team partnered with the Depression and Bipolar Support Alliance (DBSA), a national advocacy organization for people with mood disorders. Detailed personal stories from DBSA-recruited volunteers informed and complemented the claims analyses. Several DBSA audience forums and a stakeholder advisor panel contributed regular feedback on study issues. These multiple engagement modes drew inputs of varying intensity from diverse community segments. Efforts to include new voices must acknowledge individuals' distinct interests and barriers to research participation. Strong engagement leadership roles ensure productive communication between researchers and stakeholders. The involvement of people with direct experience of care is especially necessary in research that uses secondary data. Longitudinal, adaptable partnerships enable colearning and higher-quality research that captures the manifold dimensions of patient experiences.

Diary of a Mental Health Peer Worker: Findings From a Diary Study Into the Role of Peer Work in a Clinical Mental Health Setting

Introduction: The importance of peer support workers in mental health care delivery has been extensively advocated for in mental health policy frameworks. However, there has been limited research examining the implementation of paid peer workers in clinical settings. This study explores the experience of paid peer support workers integrated within a clinically-operated community-based residential rehabilitation service for people diagnosed with a mental health disorder experiencing challenges living independently in the community. Methods: A general inductive approach was taken in the analysis of diaries completed by a newly employed peer workforce. These diaries focussed on what they viewed as significant interactions in fulfilling their role. Composite vignettes were generated to illustrate key themes. Findings: Thirty-six diaries were provided; these reported unplanned and spontaneously occurring interactions. Peer workers emphasized the importance of connecting with people while they were engaging in everyday activities as an opportunity for personal growth of the residents. The diaries also focussed on the peer workers' ability to connect and establish trust by sharing similar experiences with residents or family members. Peer workers also believed that they brought a different perspective than clinical staff and were able to refocus attention from clinical diagnoses and symptoms to other aspects of the resident's lives. Discussion: Peer support workers described their work as flexible, responsive, and adaptable to the resident's needs. They believed that their roles brought a different lens to interactions on the unit and fostered a more inclusive and personal way of working for the team. Conclusion: To ensure that peer workers can engage authentically with residents and family members, it is critical that the role and principles of peer work are valued and understood by all.

Peer delivery of a brief cognitive-behavioral treatment for posttraumatic stress disorder: A hybrid effectiveness-implementation pilot study

OBJECTIVE

Posttraumatic stress disorder (PTSD) treatment delivery by peer specialist providers could increase access to and engagement with PTSD treatment in low resource settings. The current pilot study tested the feasibility, acceptability, and initial effectiveness of a peer-delivered, brief cognitive-behavioral therapy for PTSD.

METHOD

Four certified peer specialists delivered the intervention to 18 participants with probable PTSD. We assessed PTSD symptoms weekly and administered surveys and interviews at baseline and posttreatment.

RESULTS

Our mixed-methods approach suggests that the intervention was feasible and acceptable, demonstrating high client satisfaction. We also found significant improvements in PTSD, depressive, anxiety, and general stress symptoms.

CONCLUSIONS

Peer-delivered interventions may be a good fit for addressing posttraumatic stress symptoms for people accessing care in low resource settings. Future research should evaluate peer-delivered PTSD treatment as a strategy for both reducing symptoms and improving access and engagement in professional care.

The Availability of Peer Support and Disparities in Outpatient Mental Health Service Use Among Minority Youth with Serious Mental Illness

We examine whether the availability of peer support reduces disparities in service use among minority youth ages 16–24 with serious mental illness in Los Angeles and San Diego Counties. Administrative data from 2015–2018 was used to summarize service use among 13,363 transition age youth age 16–24 with serious mental illness who received services from 183 outpatient public mental health programs; 17.2% were Black, 67.4% were Latinx, and 15.4% were non-Latinx white. The availability of peer support was assessed via a program survey. Generalized linear models were used to assess the relationship between availability of peer support, defined as having a peer specialist on staff, and the annual number of outpatient mental health visits. We also examined the relationship between racial/ethnic concordance of youth and peer specialists and use of outpatient services. Forty-six percent of youth received services from programs that employed peer specialists. Among youth in both counties, the availability of peer support was associated with an increase in annual outpatient visits (P ≤ .05 each). Peer support was associated with reductions in service use disparities among Black and Latinx youth in Los Angeles County (P < .001 each). Peer concordance was associated with an increase in outpatient service use among Latinx youth in both counties (P < .05 each). Peer support was associated with increases in use of outpatient mental health services. Detailed examination of the context for youth peer support implementation is merited to identify the specific pathways that improve outcomes.

Developing a Strategy to Embed Peer Support into Mental Health Systems

Globally, health care systems stakeholders have encouraged health systems change that reflects recovery oriented practice. The implementation and integration of Peer Support Workers is one such strategy. Yet, what factors should be considered in the implementation of these roles? How can services be integrated effectively? Recent literature will be reviewed to explore current knowledge about peer support, and offer considerations for effective implementation of peer supports into current health care systems.

"That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness

BACKGROUND

People living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals.

METHODS

We investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data.

RESULTS

Following a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context.

CONCLUSIONS

These findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.

Translating a stress management intervention for rural Latina breast cancer survivors: The Nuevo Amanecer-II

Objectives

Adapt a cognitive-behavioral stress management program (Nuevo Amanecer or NA) to be generalizable to rural, low literacy Spanish-speaking Latinas with breast cancer survivors at all phases of survivorship.

Methods

Apply the Transcreation Framework, a community-engaged translational model, to develop the adapted program (Nuevo Amanecer or NA-II), design a randomized controlled trial for community settings, identify recruiters and interventionists, and recruit participants into the trial.

Results

Adaptations included expanding the program from eight to ten weeks, simplifying materials, and increasing skills practice. We added stress management videos, healthy lifestyles information, and survivorship information. Interventionists were trained Latina breast cancer survivors. All core components of NA were retained in NA-II including managing the impact of cancer, information on breast cancer and its treatment, finding cancer information, getting support, managing thoughts, stress management techniques, and setting goals. Participants receive a program manual. Each session includes a review of that week’s content using the manual, practicing a stress-management skill, setting a specific goal, and reviewing videos. Spanish-speaking Latinas with non-metastatic breast cancer were recruited by community recruiters. Of 231 women approached, 24% refused, 10% were ineligible, and 153 (66%) were randomized to the intervention or a wait-list control group. The sample was vulnerable: 69% had < high school education, more than half had only Medicaid or no insurance, 91% was foreign born, and 48% reported financial hardship in the past year.

Conclusions

Applying the Transcreation Framework to engage stakeholders in designing community-based RCTs enhanced congruence with community contexts and recruitment of this vulnerable population.

Increasing Mental Health Engagement From Primary Care: The Potential Role of Family Navigation

Early engagement in mental health intervention is critical, yet the vast majority of children who are experiencing mental health concerns are not receiving needed services. Pediatric primary care clinics have been recognized as an ideal setting in which to identify and address mental health problems early, although engagement in mental health services within primary care and in community-based settings remains low. Navigators, or individuals with experience in navigating the mental health system, have been highlighted as promising partners in efforts to improve engagement in mental health services. Navigation has a growing body of research support among adults and in targeting medical concerns, but there has been limited research on integrating family navigators into pediatric primary care settings to address mental health concerns. Despite this gap in the evidence base, we believe there is significant promise for the use of this model in addressing children's mental health needs. In this report, we discuss factors contributing to high levels of unmet mental health needs and low levels of engagement in mental health services, the role that navigators can play in increasing engagement in mental health care, and implications and recommendations related to integrating mental health-focused family navigators into pediatric primary care settings.

Barriers And Facilitators To Community-Based Participatory Mental Health Care Research For Racial And Ethnic Minorities

People with serious mental illnesses, particularly members of racial and ethnic minority groups, are rarely included in prioritizing research topics or developing the tools and measures important for improving their care. Community-based participatory research holds promise toward reducing mental health disparities. However, initiating research partnerships with community stakeholders is challenging and does not always lead to sustainable community health improvements. Using lessons learned from a project to improve understanding of patients' preferences and discrimination in depression and diabetes treatment, we describe barriers and facilitators to initiating a meaningful partnership with disenfranchised groups. Barriers fell within four domains: trepidation of community stakeholders, complex research methods, uncertainty among academic partners, and unclear partnership decision-making protocols. Primary facilitators included the meaningfulness of the research topic to the community, the presence of a well-established community-based organization, academic financial investment, co-learning activities, and flexibility. Successful initiation of these partnerships holds significant potential for addressing health care disparities.

Prioritizing the healthcare needs of Latinos with mental illness

Latinos with serious mental illness have higher morbidity and mortality rates than same age peers. In this paper, we review findings of a community based participatory research project meant to identify important health needs of this group, barriers to these needs, solutions to the barriers and the promise of peer navigators as a solution. Findings from a prior qualitative study yielded 84 themes related to needs, barriers and solutions. These findings were transposed into individual items, to which 122 Latino participants with mental illness responded using a 7-point importance scale. Results showed item importance means ranging from 4.34 to 5.47, with counseling/therapy services and mental health treatment topping the list for healthcare needs. Analyses also examined differences between those born in the USA versus those born elsewhere. Latinos who were native to the USA differed significantly from those born abroad in over one quarter of importance ratings. Implications of these findings for integrated care of Latinos with serious mental illness are discussed.