A Mental Health Issue And Its Solutions Through Social Determinants

As of 2017, there are 36. 3 million people of Mexican origin in the United States and of this population, 11. 6 million are Mexican immigrants. Due to the unique circumstances of immigration, often involving diverse experiences of hardship, immigrants have been found to be especially vulnerable to adverse mental health outcomes. Depression in particular has been linked to the complex nature and severity of acculturative stress, or the psychological impact of adaptation to a new culture, experienced by immigrants. Over the past two decades, hundreds of thousands of Mexican immigrants have entered into metropolitan Atlanta, initially due to the construction boom following the 1996 Olympics. As a new home for Mexican immigrants, Atlanta has presented a variety of opportunities but also significant restrictions to foreign-born Mexicans. Poor social determinants of health such as unstable housing, low wages, social isolation, inadequate healthcare access and lack of insurance coverage have contributed to the burdens of acculturation. The difficulties of migration and adaptation to life in Atlanta for Mexican immigrants have led to emerging local mental health struggles, with rising rates of depression, and conflicting global cultural values.

Mexicans who migrate to the United States are far more likely to experience significant depression than individuals who do not immigrate. Among migrants, individuals between 18 and 25 were found to have a five times greater risk of experiencing a depressive disorder, compared to their same-age Mexican peers who did not immigrate. Additionally, depressive symptoms increase the risk of suicidal ideology in Mexican immigrants. These findings are due to the complexity and severity of acculturative stress factors. In order to deconstruct depression within Mexican immigrants in metropolitan Atlanta, the following must be taken into consideration: accessibility to services and problems that arise within cultural and religious contexts. Mexican immigrants in metro Atlanta are faced with a multitude of barriers that have made it difficult to access mental health services. These can be explained on the macro level by systemic oppression, the meso level by the lack of culturally-sensitive services and on the micro level by cultural stigmas. Immigrant Mexican families experience a gap between their culture and American ideology. The American value of meritocracy assumes that Mexican immigrants can easily integrate into dominant, White society. Inherently presuming an individual’s ability to conform to a foreign culture, health systems can be highly oppressive and perpetuate the probability of depression in Mexican immigrants.

While a large number of Mexican immigrants are living in poverty, accessibility to mental health resources, such as therapy and medications, is slim. To make matters worse, nearly three quarters of foreign-born Mexicans in Georgia have been reported to not have health insurance. Additionally, language barriers, legal status issues, literacy rates and absence of validated measures to determine mental health needs in Spanish-speaking populations impact the access of services. While the above barriers may contribute to underutilization of mental health services, it is critical to understand the impact cultural and religious beliefs have on the mental health of Mexican immigrants. Foreign-born Mexicans follow cultural values that challenge their acknowledgement of mental health needs once they arrive to America. The value of “machismo” views mental disorders as weaknesses that must be hidden from the rest of society. Those who suffer from mental disorders are stigmatized as “loco”, or crazy. Symptoms of depression are defined as “nervios” (nervousness) or “susto” (fright) and are perceived as short-term feelings that disappear on their own. In both local and global Mexican communities, seeking mental health treatment is viewed as an escape for the weak.

Mexican populations often turn to their family, community and religious affiliations for support and stability. “Familismo”, the value of family cohesion and interdependence, serves as an important foundation. However, this can act as a stressor and risk factor for depression among Mexican immigrants. The family may not support the mental health needs of an individual, creating a greater burden on the individual seeking treatment. Alternatively, the family unit may be broken down due to immigration, generating a lack of familial support and increased isolation.

The role of religion and the Catholic church plays a pivotal role in shaping perceptions around Mexican immigrant mental health. The cultural value of “fatalismo” refers to the idea that life circumstances are preordained and there is little one can do to change life events. This ideology guides religious Mexican populations to believe that they cannot control their own destiny and instead must leave it up to God’s will. Seeking mental health care becomes a faithful disobedience. Recognizing this cultural belief is imperative as metropolitan Atlanta contains a large, rapidly growing number of devote Mexican Catholic immigrants. As the above factors contribute to the rising rates of depression among Mexican immigrants living in metro Atlanta, a culturally-appropriate intervention is necessary. Currently, there are two religious organizations that offer various immigrant groups counseling services to assist with the impacts of acculturation. The Episcopal Diocese of Atlanta offers free, group mental health support for immigrants through the care of a licensed counselor. Catholic Charities of Atlanta offers therapy on a sliding scale basis provided by a professional therapist. However, in order to alleviate depression within Mexican immigrants, it is important to provide culturally sensitive, anti-oppressive, community approaches that are deeply rooted in Mexican cultural and religious values. Without access and engagement in mental health services, this population is at risk of homelessness, substance use and self-neglect. In order to address the barriers present for this population, I propose an intervention that considers and targets the Mexican values of “fatalismo”, “familismo” and machismo”, using narrative theory tools. Narrative theory honors the lesser-told story, examining the cultural values and beliefs held within a person and recognizing the dominant systemic forces that might negatively influence a person’s view of their own life. It accounts for cultural differences, such as language, family structures and patterns of thinking, social injustices, immigration and acculturation issues. Narrative theory views the individual as the expert on his or her life, with a plethora of multifaceted stories that can establish new perspectives on identity and mental health. It provides a culturally sensitive framework, as it recognizes that culture is the most influential determinant in a person’s life. The intervention will develop free, community support groups at two local Catholic churches, co-facilitated by a Spanish-speaking mental health practitioner and a religious community member from the Atlanta Catholic diocese. Narrative theory will require the co-facilitators to take a critical stance in providing individuals with skills that will deconstruct dominant norms. This will aim to normalize mental health and move from the labeling of “loco” to recognizing the resilience that Mexican immigrants foster during their transition to America. Utilizing narrative theory, Spanish-speaking therapists can help individuals reframe their stigmatized narratives while breaking language barriers. At the same time, the co-facilitation from religious leaders will have a meaningful impact on increasing acceptance and encouraging involvement, thus shifting the “fatalismo” ideology.

In order to successfully engage the Mexican immigrant community and prevent negative perceptions around mental health, community support groups will not be labeled as “therapy”, but as “spiritual counseling. ” Groups will not highlight depression and its afflictions. Instead, they will aid in combating and normalizing symptoms by promoting overall wellness through community rituals with faith, food, music, craft-making, and storytelling. Bilingual informational signs and brochures will be circulated within both Catholic churches, with intention to increase awareness and access to the program’s services. Culturally, discussing feelings with a stranger has not been an effective way to reduce depression symptoms among global and local Mexican populations. Thus, strengthening “familismo” by encouraging individuals to share personal narratives with other members of the group may help break down the stigma surrounding mental health. Connecting individuals to others who may have similar experiences may help individuals alter the “machismo” mentality, build social supports and re-author a new narrative, alleviating the burdens of depression.

Research has proposed that creating cultural groups within religious settings that support personal identity formulation can be critical to alleviate depression in Mexican immigrants. Constructing faith-based community support groups which utilize narrative theory tools could appropriately counter depression by fostering mental health awareness through creative expression in a population that is under resourced.