Good afternoon and welcome everyone to the American Psychiatric Association's Mental Health Equity Fireside Chat. My name is Dr. Regina James, and I'm the Deputy Medical Director and Chief for the Division of Diversity and Health Equity here at the APA, and I will serve as your moderator this evening. So, or this afternoon. So today we have a very interesting and I think intriguing discussion and a wonderful group of panelists, and we're going to have a discussion about the impact of COVID-19 on the Latino community. But before we get started, I'd actually like for us just to take a moment to recognize I think approximately 700,000 lives that have been lost to COVID-19 to date, and the many families and friends who have been impacted by this devastating pandemic. Okay. So, you know, we're all experiencing heightened mental health issues, anxiety, depression, trauma. But unfortunately, certain communities, in particular communities of color, have been disproportionately, as you know, impacted by not only the disease, but associated mental health issues, etc. So what I'd like to do tonight is to have a conversation around COVID-19 and some of the things that we need to think about as we're engaging with the Latino community. What we do need, I think, to take into consideration is factors such as social, cultural, linguistic, and economic factors. And I think these really help play into the inequities that we see. Just sharing a little bit of data. This is based on information about two weeks ago, September 20th, taken from the Center for Disease Control. As of September 20th, they looked at about 43 states of those individuals who received at least one dose of the COVID-19 vaccine. And for Hispanics, that was 49%. So if we look at the glass half full, that's a good number, 49%. But if you look at the flip side, that's 51% who have not received the first dose of COVID-19. And as the Delta variant continues to spread, you know, there's risks that are increasing, particularly among people who remain unvaccinated. So again, this afternoon, we are going to have a discussion of how can we do a better job of understanding concerns about the community, addressing misinformation and fears about the vaccine, mental health issues that they have been experiencing along with the pandemic, and encouraging and providing information so that individuals could make an educated decision about their health issues, physical health, mental health, etc. So I'd like to start off by introducing our distinguished panelists. First, we have Dr. Margarita Alegria. Dr. Alegria is the Chief of the Disparities Research Unit in the Department of Medicine at Massachusetts General Hospital. She's a professor in the Departments of Medicine and Psychiatry at Harvard Medical School, and a member of the National Academy of Medicine. Welcome, Dr. Alegria. Thank you. We also have Dr. Ruby Castillas-Puentes. Dr. Ruby Castillas-Puentes is the President of the American Society of Hispanic Psychiatrists, a Distinguished Fellow of the American Psychiatric Association, and Director of Clinical Development in Mood Disorders and Alzheimer's at Janssen Pharmaceuticals of Johnson & Johnson. Welcome, Dr. Castillas-Puentes. Thank you. And Dr. Omar Contreras. Dr. Contreras is the founder of Contrias Policy Associates, where he brings a wealth of knowledge and experience around health policy. He has approximately two decades of public health experience in the areas of community engagement through coalition building, health policy, and evidence-based research. And of note, he is the 2020 American Public Health Association Young Professional Public Health Innovation Award recipient. Welcome, Dr. Contreras. Thank you. It's a pleasure to be here. Thank you all. So before we get started with the questions, let me take a moment to thank our APA leadership for the support in programs and initiatives around mental health equity. I'll start with our president, Dr. Vivian Pender. Our CEO and the medical director, Dr. Saul Levin. The Board of Trustees, Assembly, Council, Committee, and Caucuses of the organization. Thank you all for your continued support and work in this important area. Now, if the audience has any questions, please put your questions in the chat box and we'll address them as we see them. So let's get started with the first question, and I'll direct it to you, Dr. Alegria. As many are aware, vaccines have become quite controversial among the public. As we continue with vaccine development and dissemination, what do you feel is the ideal approach in discussing the benefits of vaccinations? Well, I think, first of all, that, you know, we know a lot now about vaccines. One of the very important aspects to do now is keep the public informed. I think we're doing that better, but with the Latino community, there were lags in getting information, and especially in going to our Latino communities and also communities of color, to actually approach people by trusted members and really talk a little bit about, you know, that the vaccine had taken a long time to develop, that it was not as people thought, that it was something that was done, you know, in a couple of months. I also think it's very important to bring, you know, the information to their homes. I think that people were very confused by so much misinformation, as you mentioned, that came across, and therefore, you know, we should be bringing people that they trust, like primary care providers or faith community people that can come and really talk about it. And then I think one thing that is changing dramatically is this issue about access. It was very hard to get the vaccines. You had to do so many things in the web. You know, they made it really hard for people to actually get the appointments and get an appointment, understanding what you had to do, how to fill in the information, have it in different languages. I think that's improving by having, you know, pharmacies be able to dispense the vaccines. But we need to talk more to people. We really need to make sure prominent members of the community to go and canvas these areas of low vaccination, go to their homes, and really access those Latino neighborhoods and make sure that we can provide transportation, have it in very easy hours for people to go before work or after work, and then even messaging in WhatsApp to make sure that people know what are the risks, who should do it, how they should do it, and get the information very close to them. That's really necessary. Thank you. Thank you so much for sharing that. And let's expand upon that a little bit. And I'm going to go to you, Dr. Contreras. So Dr. Alegria has already mentioned and talked about this issue of mistrust and misinformation and various partners that we really need to work closely with. So given your experience with communities and with galvanizing communities and working together, what community partners would you suggest that we would engage? She's mentioned some, but given your experience, what community partners should we engage to really effectively connect with the Latino community? Sure. I think it's a multi-pronged approach, actually. It's a collective effort. But I think we need to include religious organizations, clergy. I think for many of the Latino community, we're very religious. And I think we see members of the religion community as trusted members of the community. But I also believe that with nonprofit organizations, including like the APA, I think we could be great key messengers of accurate and also evidence-based information in relation to how COVID impact has impacted the Latino health. But also, I think I want to highlight a bit of, Dr. Alegria mentioned community trusted members. And I think we could also tap in the community health worker or the promotores de salud, who for many years have done great critical work in the community by raising awareness of certain issues, not only in chronic disease, but also in health promotion, infectious disease, and including vaccinations. So they are trusted members who really have that bond and relationships in the community that could build trust and also could be those who dispel those myths and disinformation of vaccines. So that's a really great model to tap into if there are community health workers. I understand that some community clinics do hire community health workers to partake in community outreach events and other efforts to expand reach. But I think that's also a model to look into how you integrate more of that patient navigator in the clinics if those who do have access to care are able to come into the community setting and are able to get that vaccine. But there's still potential hesitancy or inquisitiveness regarding how the administration and what could be that misinformation about long-term effects of the vaccine, which there are none. But I think there's still so much misinformation that is out in the community. Great. Great. And let me just sort of ask a follow-up question. So you mentioned patient navigators, promotores, and there's been a number of research activity and papers around the benefits of having these individuals or liaisons within the community. Do you think that we've actually leveraged those key stakeholders in this vaccine delivery in the last year or so? I think we have to some extent. But I think we also have to understand on the capacity that they're working under. So I think when we are talking about even messaging and the messaging in Spanish for primarily monolingual Spanish speakers, I think community health workers have work within their means. And oftentimes, we also have to protect that workforce because I think as much as we can depend on them, they can get taxed a little bit and overwhelmed with the information that it's also overwhelmed and coming down the pipeline. But you talked about also mistrust and the messaging itself. But there has been an increase in misinformation specifically around those areas of hardest hit, not only by radio shows, social media. I understand that certain community health workers have also built some networks within WhatsApp groups or Facebook or other social media platforms so they could combat that misinformation that is coming across from various sources. And I want to point out to a resource, Dr. James, that Voto Latino, which is a nonprofit organization that not only is involved in grassroots advocacy efforts to increase voting, they have actually launched a Latino anti-disinformation lab where COVID-19 is part of that to combat misinformation. So that's also, I think, an arm and tool that could help those trusted members in the community. Thank you. Thank you for that. And we will provide all resources that are discussed today as well as additional resources by the APA for all of our listeners. Thank you so much. Dr. Castillo-Puente, so telehealth has become more prominent for delivery of mental health services during the pandemic. Do you think telepsychiatry has been a key component for reaching the Latino community, particularly now? Very good question. This is why telehealth technology has been used. This is not new. It has been adopted more for healthcare professionals and patients. Now that we have this situation, before the COVID pandemic, trends show more increased interest in use of telehealth services, both the healthcare professionals and the patients. However, recent policies changed during the COVID-19 pandemic and have reduced the barriers of telehealth access and have removed the use of this tool as a way to deliver services. Many professional medical societies also endorse telehealth services and provide guidance for medical practice in this evolving landscape. We have to recognize, unfortunately, that there are multiple barriers in accessing mental health care, including system fragmentation, episodic care, long wait times, insufficient support for health system navigation. There are also additional stigmas that may further reduce an individual's likelihood to seek support, mental health support. I think that these technologies can present exciting opportunities to bridge significant gaps in mental health, in mental health care services, and reduce the barriers related with the stigma or improve the health outcomes. I think that they are coming to stay with us and to support the communities and support the psychiatry, all the support that we need in mental health. I think that we are going to keep this system. Thank you so much, Dr. Castillo-Puentes. Please, both Dr. Alegria and Dr. Contreras, if you'd like to comment on any question that's not directed to you, please feel free to jump in and provide additional comments as well. This is an open forum discussion, but just want to make sure that everyone is getting an opportunity to share their knowledge. I just wanted to say, with regards to Dr. Castillo-Puentes' point, that I definitely think that telehealth is here to stay because it really gives us access to a lot of clientele that needs it, and it could be a way of reducing disparities for communities of color. But I should say that we're finding, in our experience working with the Latino community and also with the Black and Asian community, especially with the Latino and Black community, that the issues of bandwidth, the issues of really good communication through Zoom, learning how to download programs, learning how to follow the steps, is something that we have to provide. So IT support for our populations and tablets or iPads that they can connect is going to be vital. Sure. I'd like to add to the telehealth piece, too, from more of a policy context. I think it has proven, of course, to minimize the gap, but I think it's important to highlight also that most of the Latino communities that are of low income, potentially they have access on the Medicaid side of things. And when it comes to statewide policy, Medicaid has also different modalities of reimbursement mechanisms for telehealth. So it varies by state. And I think it's important here when we're talking about how to increase access to telehealth as well. We need to mobilize potentially grassroots organizations or coalitions that can help raise awareness of the different reimbursement mechanisms that exist state by state because they're not all standardized across the nation. So that's also a key important factor to understand that as much as telehealth has helped, there's still the policy gap that exists regarding state-level Medicaid programs. Go ahead. I just want to say that, Dr. Contreras and Dr. Alegria, I really agree with all of these comments. And also, I think that the point of the challenges that we have on the regulatory side that may change with the state by state. And also, the fact that not all the people, they have access to the smartphone, tablet, computer, and they need this is a limitation. But what the system that provides to us is we have a tool, a new tool that has been developed more during the COVID. And I think that we need to improve the system. I'm sorry. So we need to improve the system in order to use in the minority population. Wonderful. Thank you all. My next question is actually directed to you, Dr. Castillo-Puentes. You mentioned previously in a conversation that we had, what we're going through right now is only the first pandemic. And the second pandemic is going to be psychological. Can you expand upon that? Very good question. And thank you for the opportunity to talk about this. Because what I talk is the mental health pandemic. This is the second wave of the COVID-19. This is not just for U.S., but it's for other countries as well. We are facing something that probably is going to continue for years and years to come. Historically, the increase in the rates of mental or severe mental illness have often followed after months of crisis. And there are many examples, but I don't want to deal with the example, but after the Great Depression in the 20s and 30s, the suicide rate rose from 14% to 19% or 20%. So traumatic memories, they are coming through those years. And it's very hard. So the COVID-19 pandemic is causing a lot of suffering in a huge, huge magnitude that is unprecedented in living memory. Millions have lost their incomes, and they are struggling financially, especially the minorities, especially the Latinos. We are seeing how have been devastating in terms of they lost, they have just few people that they are working in the house now with the pandemic. 10,000 have lost loved ones and hundreds of thousands who have been infected with the virus, they face very real perspective of serious illness or death. So the health and also the financial cause of the COVID-19 have resulted in extensive feeling of helplessness, overwhelming anxiety, chronic exposure to severe stress, including increased rates of depression, mood, post-traumatic stress disorder. So I think that this is, I was referring to that, the second wave of the pandemic is the mental health and we need to be aware of that, that is impacting the well-being and the productivity of billions of people. Thank you. Thank you for sharing that. Dr. Alan Grillo or Dr. Contreras, any additional comments? Well, I really think that it has been very, very tough, like Dr. Contreras was, you know, Dr. Castillo was saying. I think, however, I'm quite optimistic that we have really learned from this about the importance of mental health, about the importance of really putting money in the underfunded resources that we have, you know, for children in school mental health that we had in terms of community colleges that we had, underfunding that we had in public health, in the sense of how we need to also reinforce the safety net. I completely agree with Dr. Contreras on policies. Now we know that there are some policies like this supplemental funding that was given. It shows how it lowered dramatically the poverty rate that we would have, you know, gone into for both our Latino and Black communities. It really made a big difference in studies that have been made and how that transfers to, you know, mental health issues. So I think we have to, like, it's a multi-pronged approach of really reinforcing the system of mental health and substance abuse care, doing policies that make sure that our families thrive, and then make sure that we have the workforce ready to provide the services. Exactly, exactly. Thank you. And one of the things you mentioned, Dr. Alegria, was, you know, putting more money into schools and mental health, right? So let me ask you this. With the reopening of the schools, how do you feel the psychiatric community can best support teachers and students during this time? Let me start by students. I mean, the first thing I think is it would be super useful to help schools have a healthy, safe, supportive school climate. And that might be like giving support to teachers that are really stressed out, are getting all of these children that have been out for a while and are anxious, and some of them feel that they have an uncertain future. So I think this is where the psychiatric, you know, resources and staff can make a big difference. Also in training and social-emotional learning in core curriculum to actually reinforce what is being done in the school, but also identifying where are the resources to deal with any mental health problems. We know that school mental health services are great and they offer so much support, but when it goes to more moderate and severe cases, we need to be connected to clinics and to the psychiatric workforce. And then I wanted to say, you know, one area that we in this area, we don't really touch so much upon is the value of sleep routines and connectedness across children, parents, and staff. I think we need to help connect them. And so having bringing experts in mental health to the school, both to work with staff, but also to bring on parents so they learn more about health literacy. They lower expectations about how fast we have to do all of this academic catching up, that we communicate more with the teachers, that the children learn how to communicate with the teachers more, the signs and symptoms of how they're not feeling well. And then I think this is where also we could do a role in teaching about health literacy and strategies that are very targeted of how teachers can work with families, especially families that are having more problems. Thank you. Thank you. And you've mentioned three sort of simple, but yet not so simple components, sleep routines and connectedness. And I think, you know, we kind of forget about those things, particularly when we're going through something so, you know, dramatic as we are, but yes, extremely important, particularly in the lives of children and their families. So would anyone else like to comment on? Yes, I would like just to mention, and I fully agree with Dr. Alegria, but when I was listening to her comments, I was thinking that we really need to support our teachers, the Latino, Hispanic teachers, that they are in front of all of these situations. And although there are many programs, they are really developed for population in general, for people that they are not culturally sensitive, you know, about those programs. So I think that we really need more of this program, but they are really dedicated to the Hispanic Latino communities. We have recently an experience where we were trying to provide some services to the American Society of Hispanic Psychiatry, to an NGO in New Jersey, and we put together a program with monthly meetings where we talk to the communities about mental health, one topic psychosis, one month depression, so far so good. And we discovered that with the first conference, that we didn't listen to the community. As soon as we listened what they were looking for, there were all the conferences in Spanish, not in English, nothing related with all the nice slides I would prepare. No, they want this type of conversations, the Latino, the Hispanics, they really love to be close to the source of information, close to the health care professional. So we developed a second program, and it's this program that has been very successful, where we provide all the support, not only to the families, but also it's open for, we have people that they are connected from different countries as well, the Spanish-speaking from Argentina, Mexico, so have been very successful, but we need to listen to the community, we need to listen to what they need. Thank you, thank you. Listening, definitely very key. Dr. Contreras, cultural sensitivity. We know that it plays a significant role in fostering relationships, right, you know, whether it's like an organization like the APA and different communities, etc. In the context of cultural sensitivity, what mental health policy changes do you think we need to focus on during the pandemic? Oh, I think we need like four hours for that question. But I'll try to, it gave you a couple of points from the mental health policy perspective. So I think one, definitely access to health care coverage that is equitable, affordable, including the parity for mental health, that everyone reserves the right to have, you know, mental health services. So I think we need to start with that. But I like to point to that, back to the messaging piece, I think, you know, early in the onset of the pandemic, we did see that if you have cough, if you have these symptoms, call your doctor, right, but they didn't give you information on insurance, didn't give information where to call, there was no consistent messaging. So I think we need to do a better job on that perspective. And to Dr. Legria's point earlier about the workforce, I think increasing the pipeline of Latinos and Latinas in the health care system, it's important and even encourage them to serve in areas of greatest needs. Just to put some statistics out there, approximately 130 million Americans are living in mental health professional shortage areas. And that will approximately require 6600 mental health and behavioral professionals to alleviate those shortage areas. So let that marinate for a little bit. According to the American Medical Association, though, only 5.8% of those active physicians identify as Latino, Latino, Hispanic, of those 4% only specialize in psychiatry. So what does that number mean? That means there's only 2192 individuals that identified as psychiatrists who were Latino or Latina or Hispanic. So that means when we're trying to reach that 6600 mental health behavioral professionals to eliminate those shortage areas, we're only a third way there. And that number is going to keep increasing and increasing. So we need to do a better effort in increasing that pipeline of Latinos and Latinas in, you know, in the behavioral health and psychiatry fields. And then I think when we were talking about federal policies, I think oftentimes we also forget that in the Latino community, there's also the undocumented community. And despite the American Rescue Plan, and some of the initiatives that were put forth to by the prior administration, that those policies to alleviate poverty, the undocumented communities, unfortunately, are not able to benefit from those services. So I think when we're talking about how to change that, I think we need to do a better effort in how the federal administration or the current administration can include undocumented communities into those stimulus and into those programs, because financial hardships and poverty, poverty is the number one indicator of poor health outcomes. So we need to do a best job in how to increase, you know, the sustainability of those individuals that are facing hardship, especially during the culture of the pandemic. Thank you. And given you're almost two decades in this health policy arena, you know, and I know that both Dr. Castillo-Puentes and Dr. Eldree as well have been doing research around equity forever, you know, we've been having these conversations and we sort of know what works. What do we need to focus on from a policy standpoint? You know, I think it really starts off with how, I think we all have a voice. And I think when earlier on when I described about the power of coalition building and mobilization, they are very key. And I think sometimes coalitions are underutilized and they are your key stakeholders on raising awareness and educating the importance of mental health, and also the importance of de-stigmatizing mental health. And one thing that I want to bring to light is that coalitions do also have an important role in keeping our elected officials accountable and how they could best serve their constituencies. So even going back to the case example on the shortage areas, you know, we need to best educate our elected officials on how best to alleviate that burden. And so I think when we're having these data and statistics, we need to make sure that they're palatable to those who are making these decisions for us. So then that brings me to the dissemination implementation of research. I think it's important that it informs policy, but it's also relatable to those who are making the decisions for us. And that's where those coalitions come back into play to help really build or be that nexus between those who are building the research and then those who are making our laws and decisions for communities across the country. I also think I completely agree with Dr. Contreras, but I think we also have to have more accountability of our elected officials in what are the decisions they're making to make sure that our communities thrive. You know, what are the policies that they're doing and the resources that they're doing? I think we also could do more academic research community partnerships to really bring, like you were saying, what is the evidence that we have, what has been tried and shows that it worked? Because I think there is a gap between the evidence out there and the use of that evidence by not only our policymakers, but people in communities that could benefit. And they also telling our academic and research partnerships, what are other pieces of information that would be useful for them to empower them in taking action? So I think we could do more on those two dimensions to really, you know, accelerate what we know to make it work now. And I would like to add to Dr. Alegria's point. I also agree with Dr. Contreras. And the role of our role with the new generations of Hispanics that they are looking for positions in mental health, how we are doing in that sense, how we are coaching them, mentoring them, helping them to move forward in their careers. And I think that is an important role that we need to play here in the education, improving the education of people, improving the possibility to move forward in their careers, to create those groups of support for students in the School of Medicine and other residency training in psychiatry. For example, we have groups, monthly groups with people that they have issues, but they are Hispanic, the Hispanic community, they're facing specific issues that they are really different from other minorities. And we need to consider those, the possibility to get together and to discuss this and to be able to mentor them. And so this piece of mentorship is something important that we need to consider for the future generations. Thank you, Dr. Castillo-Puentes. And let me ask you a question now. So I believe that you had the quote, Hispanics generally don't talk about depression as a disease, but something that is just part of our lives. And thinking about this in the context of COVID and the rise of mental health issues, the need to access services, you know, to get help, treatment works, et cetera. Do you see this perspective as a barrier to addressing the rise of mental health in the Latino community? Very good question. And yes, it's a big barrier. Depression doesn't discriminate race, color, gender, ethnicity. However, the experience and how the people understand and cope with this condition may be impacted by the cultural beliefs. And we have been searching in the electronic health records, big data, but always focusing the healthcare system about what the barriers are for the Hispanics to access to the treatment of conditions as a depression. We use recently, we have in the 2019 before the COVID, the opportunity to analyze a half a million of unique online digital conversations about depression. And we have the opportunity also to analyze through the new machine learning techniques, the artificial intelligence. And we learned, you know, that they are really different between Hispanics and not Hispanics. And the quote that you mentioned at the beginning, it was based in that study. Basically the Hispanic belief that there is no solution. They have to go through the depression without treatment. So that is part of the life of our life to pass through the depression. So it's part of the, like the menopausal transition, like the teenagers passing through the adolescence. So there is really in this digital conversation, when we move from our offices, healthcare records and claims databases, and we move to that, the voice of the people, the digital conversation, we can see that they are a big difference. The Hispanic show, for example, more negative conversation, portrayed conversations, and the attitude towards depression. When we compare Hispanics and non-Hispanics, for example, just to put some numbers, 66 of the conversation in the Hispanics, they are really, really negative. Negative related with depression, treatment, access to treatment versus 35% of non-Hispanics. So it's a huge difference. And also when we compare, when we have the opportunity to compare what is the what, what is the attitude that are until the treatment stage, you know, with that, they are the attitude of the Hispanics remain resigned, hopelessness, with very huge difference when we compare with non-Hispanics. So one of the reasons what we need here, and not only for after COVID, with the COVID, we, we, as Dr. Margarita mentioned at the beginning, we were able to see more of the mental health piece. And we were able to explore more. So we were now exploring what happened before, because we have the conversation in them before the COVID, and now we did COVID. So after COVID or during COVID, so we are able to compare the two scenarios through the digital conversations. And there are some tools that we need to use with, you know, we have been very cautious in the use of this new technology. But I think that this is a good instrument in order to see that kind of thing, cultural specific issues that they are facing the Hispanic communities. So they are really the conversations that they are really the Hispanics they are less concerned about the impact of depression of their life than non-Hispanics and because they believe that there is really part of the life there is no disease no major depressive disorder there is nothing is part of what you have to cope in life if you believe that you never reach out for help for treatment so this is something that we need to work more in that okay thank you really really appreciate that really appreciate that we do have a question i think that can be addressed to all three of you so please feel free to jump in uh what are some ways to increase the mental health practitioners who work with latinos i think there are several incentives that we could do uh loan forgiveness for many of them you know i think uh early internships make a huge difference we've seen it in our all you know in our disparities research unit people that were not so keen in going to the mental health uh route have gotten very excited in seeing what it is like you know what is the uh benefits of seeing how people get better uh i think the other thing is uh the difference omar talked about community health workers i think we could do uh you know a pipeline where we start community health workers you know and and move them throughout give them credits uh for doing you know a lot of the work that they can be trained in structure manualized very good treatments so i think there are ways of adding that but i think we need to incentivize better salaries one of the things we have not done that great is the payment by medicaid for example uh and some of the uh insurance employer insurances paid very little for providers so i think those are a few of the things we could do okay thank thank you so much uh we have another question how can other medical professionals who do not identify as latino act as allies to the latino community regarding mental health advocacy again i'll open it up to all three sure i i think we need champions all across you know uh race ethnicity into you know improving health outcomes so i think it's this is going back to the collective effort i think it's all hands on deck right and it goes across helping communities of color across the country so you know helping medical professionals who do not identify um you know the help is a weekend we take it but bring it to us um you know and and so it's not that we reject um any others who identify maybe not as latino but i think it's it's important for them to also be aware of the cultural norm the sensitivity that comes with working with latino communities so that they could also best understand you know once they go into these communities how to best approach those cultural cultural and sensitive conversations that may often be um may come to light so i would suggest um to to just become part of it okay any other comments for that question i agree that we should bring everyone in uh both because i mean the need is so great and the available resources so limited this is a time uh i could not agree more that this is all hands on deck and i would like to add to that doctor's message is that we need to promote to learn a second level spanish because one of the main barriers to approach the community hispanic communities in general is the barrier of language so we need to really promote the bilingual education in our new future generations because they are really needed you know um um so for specific for the latino hispanic community okay thank you um and so this question is for dr u alegría uh you have a blog conversations with margarita margarita alegría and in one of your recent blogs you wrote as millions in the united states get vaccines we're trying to regain a sense of normal but when it comes to our mental health normal isn't good enough we all deserve better can you expand upon that statement sure absolutely uh you know i think normal sometimes is taking what we have been receiving for many many years in terms of um you know not the best in terms of resources to uh get people to do better we wrote a piece in um i've been writing in especially conversations with margarita about all the things that we have learned that could help us do better things that people didn't even think about like green spaces and blue spaces uh going to for walks the importance of exercise the importance of sleep um how to you know do more self-care how for you to really learn how to self-regulate uh issues that we know how trauma and adversity really exposes us to increased risk so i think we have a lot more knowledge that we haven't been using and so the normal to me is not adequate enough to put us to the next level i think the opportunity that we have with the pandemic is to one reimagine what mental health could be uh really rethinking the system we wrote a paper in health affairs about how we could really transform the mental health and addiction service system because we need to get to people earlier one of the things we haven't done is we need to meet people where they are rather than to wait to come to the clinic when they're actually quite sick we need to decriminalize what we people suffering from mental health that have been incarcerated instead of treated we need to recognize how the social context matters how are how we relate in our social context how people treat us in that social context and then how to address social needs so people are not in hardship which just brings a lot more um like poverty like unemployment like you know lack of fixed schedules of work how all of that really takes a toll on our mental health and then i think we know a lot more about you know federal regulations that can have a tremendous impact in terms of mental health issues like we know we have great data now about the affordable care act and how it really had impacts in terms of mental health especially even for people that had not even identified that they had depression uh so i think we we can do a lot more you know to integrate mental health uh you know substance abuse services and infectious disease within a public health infrastructure free of charge free of eligibility requirements especially for children and emerging adults so we make sure that we invest in mental health not only for now but for the future wonderful wonderful and if you can a follow-up question on that you mentioned addressing you know social issues and how that impacts one's mental and physical health etc what are your thoughts on you know the the implementation or the integration of social determinants of health in electronic health records and how that might help move us toward what you're talking about i think it could be very useful but i i think we have to be very careful how it's used i think it should be used for uh identifying people with greater need and the payment and resource allocation be greater for those with more social needs but it should not be used for i mean insurance companies to charge more for certain groups of people it should be more for allocating you know reallocating more resources to those with social needs and also to show that we could do a better system by combining the social with the mental right now in several of our clinical trials we have a community health worker supervised by a clinician giving the the mental assist the mental treatment but we also have a care manager that helps connect that person to resources you know food insecurity risk of evictions and and those are the things we need to do to make sure that people thrive thank you dr castillo puentes do you have any comments in relation to interaction with with patients that you see in terms of having social determinants of health in the electronic health records definitely i think that there is it really have been very well identified that is is very tight the health the poverty with the lack of education the lack of access to the health care all they are together so if we really trigger the poverty you know i think that all the other things they are coming together but this is very important to identify that this is something that we need to work more um as a community you know i'm not just latinos minorities in general because the global globally we need to um to try to work more against poverty when we also uh compare males and females women men the females we are really more in the in the side of poverty compared with males so all of these inequities we need to work more especially for the poverty with all of these consequences that dr alegría mentioned uh that people they are more incarcerated they are really not receiving the treatment that they really need okay thank you so much and we have another question a general question for all three of you uh the question is what about the barrier of culture that sometimes does not believe it you know people don't believe in psychology how do we train providers to tackle this aside from only treating those who seek treatment the culture that tells us to just shake it off i i think to the to the point of i dr lydia and also because the appointments were mentioning earlier in terms of the training competency once uh health care providers are going through their educational training i think it is important to bring that to light that you are going to encounter you know communities across uh various backgrounds various cultures and that sometimes you know you might just say it needs to be shaken off um so i think it's it's important so i think it's it's a piece of the cultural competency that needs to be embedded in in order for us to understand how to best train a competent workforce so i do think that education institutions not just in medicine i think public health nursing across the entire healthcare workforce need to uh tackle on the responsibility on how to best acknowledge when some providers or they encounter patients who don't feel like oh they're just going to shake it off i think the issue of uh we i think the narrative of how we present this strategies needs to change i think we've been very focused on you know severe illness and getting you know and i think we need to focus on the importance of managing stress we all need skills to manage stress we all could benefit from you know doing better in terms of our anxiety of when we get depressed uh even you know teaching that this is a universal phenomenon that it's gonna be everyone's gonna have it at some point in their lives and if we learn early how to manage this uh with certain strategies and then recognizing you know the signs and symptoms of when it's becoming severe and where can people get help i think we've seen also the presentation that one of the things we're doing is how this is so important not only for you but you know for your children how it's important for relationships how its relationship to avoid absenteeism you know treating yourself and getting help early makes a huge difference in terms of you know how you go about in your daily life we don't have to suffer this is uh dr castillo puentes was saying how people and we see that's exactly what she said people saying you know well you know i'm too old uh you know i i really think there's nothing to be done my child has been incarcerated i'm not happy but we we really stress you know some circumstances you cannot change but you can change how you feel about them and how you feel about yourself and that is something that is uh something we can teach you about or coach you about thank you go ahead very good comment dr alegría because i am going to say that what we really need uh as well is to elevate the conversation about the mental health and physical health you know we need to to save the same you know wars um across why why we differentiate and why we receive more treatment for physical health and not for mental health if we elevate the conversation and we put the sentence to the same level talking about diabetes hypertension other cardiovascular diseases suicidality that cause death sometimes we say we are very focused in the cardiovascular in oncology but listen the depression the suicidality is tied with the depression and if we don't treat the depression the prevention that dr alegria also took at the beginning is there to identify to learn how to identify and the early detection is key in this i think thank you thank you so much so much important information we have another question uh from the audience in your opinions what are two key skills that trainees in public mental health need to master in order to be prepared to meet the needs of the latino community and how and where can they learn those i'm gonna say just one uh to make sure everyone has a chance i think cultural humility is really important that we need to learn who's the other what what is what are their goals and and really we talked i think before and and dr castillo puentes mentioned this listening really being able to listen and see what matters to that person i think we we tend to think we're the expert and don't give enough chance to the person to tell us about their expertise in the in in how they're experiencing their illness i i like to add to that that i think um the integration of family values is very important um as latinos we do take into consideration not just when it's one our own health but how does it impact the entire community or sorry our entire family and i think when decisions are made is made as a family so i think that's one important skill set that needs to be uh included once you're treating a patient you know uh for mental health that how can we integrate the family into the overall decision making of that individual and last but not least the language barrier that you have to be really some of the expressions about mental health they are related with the culture with the language and they are really we really need people that they can speak the same language in order to um to be able to communicate better with with the patient the families and dr alegría mentioned something that is very important the empathy you know how to cultivate also um you know to put in the other people choose as well you know that we um we sometimes we we don't as a health care professionals we are not on the same level and we should put in the same level of humility okay thank you thank you so if i can summarize that that's cultural humility linguistic sensitivity and engaging family members in decision making process three important key skills great so we have one more question before we close out um what responsibility does dc east coast based health policy and advocacy organizations have to represent the latino community two thousand miles separate these minority majority cities states counties from the headquarters of these organizations um well i think we have to recognize that latinos were the fastest and largest growing group in the country and i think that oftentimes we may be forgotten in the way of how to best implement strategies and advocacy efforts that are to promote latino health forward so when you're talking about how to cross the nation i i think we have to have again a collective voice on how what are the the best ways to move uh latino health forward um and that starts with really what is the key messaging in these national policy organizations but also having the voice within those uh organizations to shape policy and i mean you know do we have enough representation within decision making table to help best support these initiatives that are targeted towards latino communities across the country but i just want to say that though base health organizations that are policy and advocacy focus it's not the panacea to eliminate you know mental health disparities but i think it's a a good way to move forward with a collective voice okay what a great way to end the discussion and on behalf of the american psychiatric association i'd like to thank all three of you dr margarita alegría dr ruby castillo puentes and dr omar contreras you have been excellent i have truly enjoyed and learned uh and become aware of other and become aware of other issues and i hope others have too during this conversation and the discussion we all appreciate you sharing your thoughts and your expertise on this very important topic and for those who join the webinar thank you very much for taking the time again to listen to the conversation around covid 19 and the impact on the latino community with a focus on mental health so thank you again thank you so much for having us thank you thank you for the invitation that's a pleasure thank you

COVID-19

Latino community

mental health

disproportionate impact

cultural factors

access to healthcare

telehealth

cultural sensitivity

barriers to treatment

mental health equity