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COVID-19 has exposed mental health needs within Philadelphia’s Latino communities

"There’s a lot of acute anxiety and not knowing and uncertainty that we’re all dealing with, but for recent immigrants and refugees, the things that were already difficult are 100% more difficult now," said Cathi Tillman, executive director and founder of La Puerta Abierta.

La Puerta Abierta is an organization that provides behavioral health resources to immigrants and refugees in the Philadelphia area.
La Puerta Abierta is an organization that provides behavioral health resources to immigrants and refugees in the Philadelphia area.Read moreCourtesy of La Puerta Abierta

In recent weeks of the COVID-19 pandemic, Latino Americans, like African Americans, have emerged as a group struck disproportionately by the virus because many have continued working in essential jobs while the virus infected thousands of people in cities across the country.

One study found that only 16% of Latinos were able to work from home — most work in retail and service industries, making them more likely to be exposed to the virus or face unemployment because of shutdowns.

Now, physicians and community leaders are worried about what those effects may have on Latino mental health, especially in a community often already lacking access to resources due to language and cultural barriers.

“In Latino communities, like in other communities of color, there are continued gaps in folks having access to behavioral health services,” said Michael Consuelos, the senior medical adviser for NeuroFlow, a behavioral-health platform. “There aren’t as many providers in the community, and there are continued issues around stigma. There’s good evidence to show that all that was happening before COVID.”

The pandemic has created a twofold problem for Latinos: “They’re experiencing anxiety from losing income and being in harm’s way,” Consuelos, of Allentown, said.

‘Things that were already difficult are 100% more difficult now’

For many linguistic minorities, especially Latinos, access to mental health or substance abuse resources is already scarce, said Margarita Alegria, the chief of the disparities research unit at Massachusetts General Hospital and a professor in psychiatry at Harvard Medical School. But now, “the isolation, fear about the future, and economic uncertainty is all going to magnify the sense of catastrophe. We also know that serious psychological distress happens in groups that are underinsured in a pandemic, and Latinos are the group with the highest uninsured rates.”

As of June 3, the U.S. Centers for Disease Control and Prevention’s National Center for Health Statistics shows that in Pennsylvania, 11% of COVID-19 deaths were among Latinos, who make up 7.6% of the state population. Experts have cautioned that this number may not be accurate because the data are based on death certificates, which can be delayed. Plus, data on race are still not available for tens of thousands of cases.

Before the pandemic, Cathi Tillman already had her hands full as the executive director and founder of La Puerta Abierta, a nonprofit that provides trauma-informed and culturally sensitive mental health support to the immigrant and refugee population in Philadelphia. Tillman spent her days training mental health-care providers to better serve those communities and supporting undocumented families.

When the coronavirus came to Philadelphia, it immediately affected the communities Tillman works with.

“People who were supporting themselves on some level now can’t,” she said. “They’ve lost their jobs. They can’t congregate socially, or go to church, which is a big part of the community for many people. They can’t come into the office for therapy. … For recent immigrants and refugees, the things that were already difficult are 100% more difficult now.”

Multiple studies have shown that unemployment and economic recessions are linked to worse mental health outcomes — a 2012 study done after the Great Recession found that people who were unemployed for longer than a year had significantly worse mental health compared to people voluntarily out of the labor force.

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Since the pandemic hit the U.S., data have shown that Hispanics are the hardest-hit group. The Bureau of Labor Statistics reported this month that the unemployment rate among Hispanics was 18.9%, compared to 14.2% for white Americans, 14.5% for Asian Americans and 16.7% for black Americans. A survey by the Pew Research Center conducted in March also found that Hispanics were more likely to say that they or someone in their household has experienced a pay cut or lost a job because of the pandemic, compared to other adult Americans.

Consuelos said accessing treatment will likely become even more difficult for Latinos since many mental health services for their community are dependent on federal and state funding.

“Those are the programs that will take a hit when there are low state revenues,” he said. “And that’s when disparities between communities that are more vulnerable and other communities widen, compounding the problem.”

Adding resources and increasing collaboration

When Sayre Health Center opened its testing site in the Cobbs Creek section of West Philadelphia last month, Kent Bream’s goal was to provide medical care to black and Hispanic individuals — groups that have been disproportionately affected by the pandemic. During the five-minute window between test ordering and swabbing, Bream, the center’s medical director, also screens each person for anxiety and depression. Patients who show symptoms are referred to behavioral health consultants for treatment.

“We noticed from the beginning of all this the anxiety from the stay-at-home order was causing more problems than COVID-19 was causing, directly,” Bream said. That’s why they decided to screen for the virus, "and what we’re calling the ‘fear virus,’ which causes anxiety and depression.”

At first, most of the people who came for screenings were black, but as word spread that Bream speaks Spanish, the number of Spanish-speaking patients has increased.

He said that many Latinos are worried about how a positive test result will affect their family members.

“They’re experiencing what I call benevolent anxiety about working, not being able to work and support their families,” Bream said. “Demographically, many Latino families live in multigenerational homes with extended family members. They have family meals together. So there’s more risk of exposure there.”

Bream, who is also a physician at Penn Medicine, has been impressed by the strong social networks within the community — oftentimes, if someone tests positive for COVID-19, most of the individuals they have had contact with get tested the next day.

“There are still individuals reporting feelings of hopelessness or nervousness every day, but it’s a much smaller portion than in the first two weeks,” Bream said. “Having knowledge eases the anxiety, and this group is becoming more confident as well in navigating the testing system.”

As the mental health system grapples with the pandemic, Tillman said that it’s important for there to be as much collaboration as possible between different behavioral health providers. Before the pandemic, La Puerta Abierta launched a collaborative in February to teach providers how to help immigrants and refugees. The hope is that collaboration will result in more sensitivity, cultural humility and understanding.

“Our mental health system, even in the best of circumstances, is inadequate,” Tillman said. “For other language speakers, it’s even worse. We have to invest in the issue of mental health in these communities, plain and simple, like anything else that really matters.”