Research by Deborah Bailey & Bruce Hogan
Research Study Highlights:
- Hispanics face a growing mental health care crisis. Less than 6% of U.S. psychologists can provide services in Spanish even though 18% of Americans are Hispanic.
- In 2018, Hispanic Americans needed $389 million of mental health care services that they did not receive. We project this gap to grow to $485 million by 2030.
- The states with the five largest gaps are: New Mexico, Texas, Arizona, Nevada and California. West Virginia and Vermont have the smallest gaps.
- Online therapy may help close the gap because therapists don’t have to be in the same location as their clients, and it's increasingly covered by insurers.
Table of Contents
- Hispanic Mental Health Crisis
- A $389 Million Gap in Mental Health Services
- Hispanic Mental Health Care Gap by State
- Teletherapy Can Help Close the Gap
- Existing Teletherapy Platforms for Therapists
Hispanic Mental Health Crisis
Hispanic Americans are facing a growing mental health crisis: They’re the fastest growing population, yet there already aren’t enough therapists to meet their needs.
For example, even though about 18% of Americans are Hispanic, only 5.5% of psychologists can provide services in Spanish, according to the American Psychological Association. Moreover, less than 50 percent said they were “quite or extremely knowledgeable” about working with Hispanic individuals.
That’s a large gap, experts say, as it’s vitally important that a therapist know the culture and language of their patients. Research shows that people can better convey their feelings and needs in their primary language, and people may become frustrated or stop therapy altogether if their therapist doesn’t understand their beliefs and values. One analysis found that therapy is twice as effective in clients’ native language, for example.
A $389 Million Gap in 2018 Mental Health Services
Spanish-speaking Americans are less likely to receive the mental health care that they need. In fact, about 33% of Hispanic or Latino people with a mental illness receive treatment, according to the National Alliance for the Mentally Ill, compared to 49% of white Americans. For some needs, the gap is even greater. Hispanics are almost 25% less likely to be treated for depression that non-Hispanic whites, according to USA Today reporting.
That means that almost 2 million Hispanic Americans did not get the care they needed in 2018. The care gap for those 2 million individuals translates to $389 million of mental health services, according to SoftwarePundit.
Moreover, the Hispanic population is projected to grow by 1.9% each year through 2030. As a result, the American Psychological Association predicts that demand for psychologists’ services from Hispanic populations could grow as much as 106% if Hispanic Americans used services at the same rate as white Americans. That means the gap in services could grow to more than $485 million by 2030.
Hispanic Mental Health Care Gap by State
While the Spanish-speaking population is growing everywhere, some states are feeling the need keenly. According to the U.S. Census Bureau, California, Texas and Florida have the largest Hispanic populations. Meanwhile, New Mexico has the 9th largest Hispanic population, but has the highest proportion–almost 50% of residents are Hispanic.
Spanish-speaking therapists are frequently also located in these states. While data aren’t available for all kinds of mental health providers, Psychology Today’s popular therapist directory shows that the states with the highest percentage of Spanish-speaking therapists are California, Florida, New York, Utah and Texas.
The average state has a 12% gap in Spanish-speaking therapists. In states with large Hispanic populations, the gap in Spanish-speaking mental health providers is as high as 39%. The Spanish-speaking therapist gap is largest in New Mexico, Texas and Arizona.
|Therapists who |
speak Spanish (%)
Here's a look at the Spanish-speaking therapist gap for all 50 states.
Teletherapy Can Help Close the Gap
Teletherapy is the online delivery of therapy services. By removing the geographical constraint of traditional therapy, teletherapy increases access to care for people who might not otherwise be able to see a therapist. Many people can’t make it to weekday appointments–people who don’t live near a Spanish-speaking therapist, working parents, those who are homebound with serious health problems, or people working long hours, just to name a few.
General adoption of teletherapy has grown in recent years, and technology providers are working hard to ensure that trend continues. Howard Spector, CEO of practice management software company SimplePractice, is optimistic about teletherapy's future.
"We’ve seen exponential growth in telehealth adoption by our customers and their clients, and are committed to expanding its benefits," Spector says. "Being able to ensure continuity of care regardless of where you are is of utmost importance to us. The more people our customers can reach, the bigger the impact they make in the world. That’s what this is all about."
This geographical constraint is an issue in Hispanic communities that lack Spanish-speaking therapists. In rural areas of Texas, some Spanish speakers drive two to three hours to a therapy appointment, says Karina B. Samaniego Estrada, PhD, a bilingual psychologist in Irving, Texas.
Recent changes in Internet usage among Hispanic Americans, insurance coverage, and consumer behavior have opened the door to teletherapy as a potential solution to the Hispanic mental health care gap.
Growing Internet Usage Among Hispanic Americans
Teletherapy may be one of the best ways to bring care to these people, especially because a growing number of Latino and Hispanic Americans report using the Internet, especially on mobile devices, according to the Pew Research Center.
Increased Acceptance of Teletherapy Among Insurance Providers
Research studies have shown that video conferencing is generally as effective as in-person therapy for a number of mental health concerns, including insomnia and depression, eating disorders, obsessive compulsive disorder, and health problems that involve changing your behavior, such as quitting smoking and managing diabetes. Moreover, people attend about the same number of sessions of online therapy as in person.
Sarah Serrano, a bilingual licensed clinical social worker in South Florida, conducts 100% of her practice's sessions through teletherapy, and about 65% of those are conducted in Spanish. Serrano did six months of personal research into the effectiveness of teletherapy before getting started. “I have had success with teletherapy. I am helping people and they feel like they’ve been helped. The interventions and outcomes are the same,” she says.
As a result of this research, more insurance providers are recognizing the value of online therapy, according to data from the American Psychological Association: 36 states plus Washington, D.C., require private insurers to cover telehealth services, and 8 of these require insurers to pay therapists the same rates as in-person services. Medicare also includes several teletherapy services, including psychotherapy and health and behavior assessment, though Part B does specify patients have to be in a rural or underserved area.
Early Adoption of Online Counseling Among Spanish Speaking Therapists
Online searches for telehealth services such as Talkspace and Better Help have increased the last few years as these platforms become more popular. Indeed, many Spanish-speaking therapists are starting to take advantage of this trend. Spanish-speaking therapists in Psychology Today’s therapist directory are 30% more likely to offer counseling online than English-only therapists.
“Teletherapy helps me reach clients that I otherwise would not be able to,” says Samaniego Estrada. “When thinking of people that I’ve been able to provide the online service, many of them did not find other Spanish speaking therapists in their area.” She advertises specifically in west Texas, where there is a shortage of mental health professionals. As a result, about 30% of her practice’s therapy sessions are through telehealth, and of those about a third are conducted in Spanish. “The clients who are taking advantage of teletherapy love it,” she says.
Barriers to Teletherapy
Teletherapy does face some challenges in addressing the Hispanic American mental health gap in addition to the lack of psychologists who speak Spanish. Perhaps the biggest is awareness, say therapists.
In Samaniego Estrada’s practice, monolingual Spanish-speaking clients can be hesitant to engage in telehealth. But after in-person contact, she says they are more open to a video session. “I think there’s an awareness and education gap that we need to address to increase adoption,” she explains.
Moreover, people from some Latin American areas may not seek treatment because they aren’t aware of mental health issues or because they feel shame about having to seek help, says the National Alliance on Mental Illness. Some communities tend to be private and not want to talk about challenges at home.
Finally, Hispanics have a higher uninsured rate compared to white Americans. For example, 19% of Hispanic people have no health insurance, even after the Affordable Care Act.
But not all Hispanic Americans have negative attitudes toward mental health care. A 2009 study in Psychiatric Services found that Hispanics actually may have more positive attitudes toward mental health treatment-seeking than non-Hispanic whites. The study suggested that other structural barriers to care, including language and socioeconomic factors, are what gets in the way of them seeking treatment, according to Mental Health America. Indeed, many Spanish-speaking Americans find success in therapy. Here’s just one example:
Existing Teletherapy Platforms for Therapists
There are a growing number of teletherapy platforms and software services that therapists can use to provide mental and behavioral health care. Therapists will want to start by choosing how much technical investment they want to make in getting started.
- Teletherapy Software Services focus on providing secure, HIPAA-compliant video and audio, but don’t match you with clients or provide electronic health records or practice management functions. SoftwarePundit recommends Doxy.me for therapists looking to expand into telemedicine who cannot do this through their current practice management systems. Doxy.me currently has over 60,000 health care professionals using the platform to provide over 1 million telemedicine minutes per week.
- Practice Management Software. Practice management systems allow therapists to schedule appointments, track insurance payors, and handle billing. Some companies include teletherapy as an add-on feature. SimplePractice is SoftwarePundit’s best overall practice management system for mental health providers, and its telehealth features are used by over 3,000 professionals daily. Samaniego Estrada chose SimplePractice for her own business. Its security measures allied some of the concerns she had about security and confidentiality.
- Online Marketplaces, such as BetterHelp and Talkspace, require the least investment to get started. Usually, you will need a reliable Internet connection and device with a video camera. These marketplaces match you up with potential clients, but also may limit how much you can charge and generally control the end-to-end service.
Therapists who work with Hispanic clients should also consider whether the platform supports Spanish-language content. SimplePractice, for example, allows therapists to send messages in Spanish, but most of the in-product experience is still in English. That creates some logistical challenges, says Samaniego Estrada.
Serrano, who uses Doxy.me for teletherapy, agrees. “What is missing in many of the solutions is the client portal being in Spanish. We have to make it possible for the patients to navigate the tools in their primary language. I’m happy that Doxy.me allows me to offer my Spanish speaking clients a portal in their native language,” she states.
In addition to selecting the right tool for your practice, therapists can also pursue continuing education and other training opportunities to make sure they’re following best practices.
“This is just not something we’re trained on in graduate school,” says Samaniego Estrada. “As you learn more about telehealth, that helps you feel competent in managing the technology and knowing it’s confidential.”
To quantify the size of the Hispanic mental health services gap, we used several data sources and a data model based upon the expected growth of the Hispanic population in the United States. We used data from the Census to project the size of the Hispanic population through 2030. To calculate the number of Hispanic Americans who experience mental illness in a given year, we used data from the National Alliance on Mental Illness. To calculate the number of Hispanic Americans who experience mental illness but do not get care, we used data from the Substance Abuse and Mental Health Services Administration found here. To estimate the dollar amount of the health care services gap, we used data from this study from Psychiatry Online and this article from Counseling.org.
To calculate the size of the mental health gap by state, we compared the percentage of each state's Hispanic population with the percentage of therapists in the state who speak Spanish. We used data from World Population Review on the size of the Hispanic and total populations by state. To calculate the percentage of Spanish-speaking therapists by state, we used data from Psychology Today's online therapist directory.
Sources attributed and products referenced in this article may or may not be partners of SoftwarePundit, but partner status is never used as a basis for selection.
Deborah Bailey is a freelance writer focused on psychology, mental health, health care and education.