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The stress of family, health and employment in the wake of the pandemic has created a high demand for mental health services in Connecticut. But for Spanish-speakers, who represent an ever-growing population in the state, finding mental health professionals who can understand and speak their native language is a particular challenge.
Dr. Michelle Silva, a faculty member at the Yale Department of Psychiatry, clinician at the Hispanic Clinic in New Haven and director of Latino Behavioral Health Services, said that the clinic where she works is seeing more clients coming in from Central America — many who have been through traumatic events.
“These are individuals often that have fled very dangerous situations and have had significant experiences of trauma and violence,” she said. “And particularly we’re seeing a larger number of women affected by gender-based violence.”
Silva said that while the Hispanic Center doesn’t have a waitlist, they are always in need of more Spanish-speaking clinicians.
“When you have a staff member that comes on, they get to capacity very quickly because there is such a demand,” said Silva.
Rebeca Vergara Greeno, executive director of Haven Free Clinic, a Yale student-run clinic a clinic that serves uninsured patients, said her organization has seen an increase in cases of domestic violence, job loss and need for mental health services. For the domestic violence cases, she said, there was a particular need for – and lack of — competent services in Spanish.
“From reporting to the police to going through the courts to searching for mental health services, there’s a large lack of experts and capacity in this area,” said Greeno.
The number of Spanish-speakers seeking help for domestic violence has increased across the state. According to statistics from the Connecticut Coalition Against Domestic Violence, the 18 agencies they partner with helped provide services to about 5,800 non-English speakers in 2019. In 2021, that number had risen to about 8,900.
Jennifer Lopez, the advocacy program director at the Hartford-based domestic violence shelter Interval House, said that she had seen a change in the mental health needs of her clients during COVID, including anxiety, depression, and some victims saying they had developed PTSD.
“I think some of the isolation brought up, brought out more anxiety,” she said. “We were having more victims talking about just a feeling [that] this was never going to change, the feeling of not knowing what was coming up next.”
Eileen Wilson, clinical director at Hartford Behavioral Health, which partners with Interval House, said that while the center had enough Spanish-speaking staff to provide the necessary services, her organization had “definitely seen an uptick” in need.
“You’re seeing a lot more physical abuse, any types of domestic violence, people who are needing to flee their homes at this point in time. High stress levels. I mean, I think everybody’s sick of COVID and there’s only so much you can take,” said Wilson.
Tamara Nunez del Prado, a community organizer with Unidad Latina en Acción, a New Haven-based nonprofit serving the Spanish-speaking community, said that before the pandemic, her organization would have maybe one case of domestic violence every three months. Since mid- 2020, she said, they have been getting about four cases of domestic violence every month.
Nunez del Prado said that the disparities in services for Spanish-speakers compared with English-speakers was clear. She said that recently, she was helping two cases – one woman who only spoke Spanish and another woman, who was Puerto Rican and also spoke English.
Within three days, she said, the English-speaker had a social worker, and in less than a week she had a place to stay. For the Spanish-speaker, she said, it took two months to find her a place to stay.
Nunez del Prado also said that it took the Spanish-speaker four months to obtain mental health services, which amounted to two sessions – in part, because she lacked a New Haven address, and was not eligible for the Hispanic Clinic.
Meghan Scanlon, president and CEO of Connecticut Coalition Against Domestic Violence, said that housing was a problem in general for domestic violence agencies, regardless of what language the clients speak. During the pandemic, many domestic violence agencies were forced to house clients in hotels because of the need to social distance in the shelters. Holder said this practice has continued.
“I will tell you that it has been really difficult to keep people in the communities they want because the rental prices are really high,” said Holden.
Doris Maldonado Mendez, the statewide bilingual health information specialist at PATH, said that it is difficult to find Spanish-language mental health services in general for people outside the large cities. She said while the larger hospitals like Yale-New Haven Health have translation services or interpreters that they are able to use, it’s much more difficult for smaller community-based clinics.
“You go to Fairfield, you go to rural areas — we have rural areas with Spanish speakers, Windham county. There are various communities that are non-English-native speakers … and they are really at a disadvantage,” she said.
Maldonado Mendez said that she has a list of providers and connections that she can use to find services for people who come to her. She also said that faith-based communities offer support groups and peer groups that people can attend for free.
Wait times to see a mental health provider, she said, can vary based on the person’s needs, and can last up to six months. For monolingual Spanish speakers, she said, the wait times are longer than for English speakers.
“It depends on if that agency or that social worker or that casework or that clinic. Has accessibility to a person that will translate,” she said.
Nunez del Prado said that when she couldn’t arrange mental health services for the people who came to Unidad Latina en Accion, she ended up being the person who listened as they shared their experiences, something that has taken a toll, she said.
“We let people vent their emotions, we listen to them. You generate empathy by telling them about something similar that happened to you so that this person understands that we understand them and understand their feelings,” said Nunez del Prado. “In many cases, we can’t refer them to another organization, nor can we help with their problem because we don’t have the services. But we also can’t deny them the space to have emotional support.”
Greeno said that while the Haven Free Clinic did what they could to support the people who came to them, she felt that students shouldn’t be the primary aid for people in situations of domestic violence. Greeno said that domestic violence cases were also particularly difficult to translate without causing further trauma.
“The patient has to repeat his or her story five or six times without knowing if it’s going to be translated correctly,” said Greeno.
Nunez del Prado added that having a translator accurately convey how someone is feeling to a mental health professional was nearly impossible.
“You are trusting that a person translates emotions — a feeling of abandonment, a feeling of exploitation or a feeling of sexual abuse or a feeling of discrimination. You are relying on a translator so that the professional can attend to you well? No, you can’t,” she said.
Wilson said that having psychiatrists and APRNs – people who prescribe medication – who speak Spanish is also important.
“The clients come in and they want to talk about how they’re doing on the medication and changes they may have seen in mood,” she said.
Greeno and Nunez del Prado also pointed to a general lack of preventative health services. Greeno said that the patients who came to the Haven Free Clinic looking for mental health services were often rejected from the Hispanic Clinic, which only takes severe cases of depression and anxiety, people “at the point of being hospitalized.”
Silva also said that, beyond mental health support, more work was needed so that people could access basic services like housing.
“If somebody does not have access to safe housing or is not sure how they’re going to pay their rent from one month to the next, it’s very challenging to focus on some of the other mental health needs that they may have,” she said.
In a January press conference about the lack of mental health services in the state, Vickiana Gray, a licensed clinical social worker with the Department of Mental Health and Addiction Services who works at the Hispanic Clinic, said that the Latino population needed greater access to telehealth services.
Wilson told CT Examiner that sometimes telehealth needs could be further complicated by a lack of access to smartphones or a stable internet connection.
Gray said at the press conference that the state needed to make sure it invests in public services and staffing, particularly in light of the retirements expected to happen this June.
“We’re not going to get better with less resources,” said Gray.
The Department of Mental Health and Addiction Services did not respond to requests for comment from CT Examiner.