Mental health issues are still not widely talked about in many Spanish-speaking communities. For generations, mental health experts and advocates have worked to destigmatize treatment and counter the shame of “airing dirty laundry” so that people can experience healing.
Stigma is not the only issue. Another obstacle: the paucity of Spanish-language mental health care services and providers in the United States
Only 5.5% of psychologists in the United States can provide services in Spanish, according to a 2018 survey by the American Psychological Association. These providers often work in major cities like Los Angeles, New York, and Miami. Tens of millions of Spanish speakers who do not live in or around these areas may not have access to a licensed psychologist who can personally provide care in their language.
Is remote treatment the solution?
Telemedicine – therapy sessions that take place online – have the potential to expand access to care. But in general, the needs of people whose first language is Spanish (as well as languages other than English) remain unmet.
Mental health problems happen to people of all races, ethnicities, languages, and immigration status. But when it comes to treatment, it’s not an equal playing field. In addition to stigma and language barriers, obstacles include legal status, financial income, lack of health insurance, and cultural differences with the provider.
Whether in person or through telemedicine, many of these barriers still exist.
“Telemedicine is great because it makes receiving mental health care more convenient. You can get a session from wherever you are,” says Patricia Alvarado, Massachusetts, a licensed clinical professional counselor in Los Angeles and a mental health advocate in Spanish.
Part of the problem is the underrepresentation of Spanish-speaking doctors.
“We are a minority within a minority,” says Alvarado, whose entire team at her clinic, Alvarado Therapy, is fluent in both English and Spanish. Another problem, says Alvarado, is that mental health startups aren’t willing to invest in meeting the needs of Spanish speakers.
“I sometimes wonder why so many companies try to get their hands on the bowl when it comes to mental health,” Alvarado says. “There is a need for this technology, but does it meet those needs? And if they are, what communities do they serve?”
Since the COVID-19 pandemic began in 2020, telemedicine has thrived. In fact, a Time/Harris survey found that 85% of clinicians had nearly the majority of their sessions that year, up from just 2% before the pandemic. The demand for virtual therapy has continued, and digital health startups are growing to meet this need.
But while telemedicine has improved access to mental health services for millions of people, it has not democratized care. A Time/Harris survey showed that only 5% of people received mental health care for the first time during the pandemic, which means that most people who have used telemedicine have just switched from in-person care to virtual care. This is largely because telemedicine, like in-person therapy, remains more accessible to a certain demographic: insured and/or insured white, English-speaking US citizens.
Application gap
None of the top three telemedicine apps — Talkspace, BetterHelp, and Cerebral — offer complete Spanish-language services and preferences within the app. Across health tech companies, some offer in-app translations while others work with Spanish-speaking therapists who can be requested, but compatibility with one depends on in-country availability.
However, telemedicine companies are working to close the access gap for Spanish speakers.
In 2021 Ginger, an on-demand mental health app that offers training in behavioral health, therapy, psychiatry, and self-care resources, announced that it would add Spanish language capabilities to its mobile app. Since the beginning of 2022, the app experience has been fully functional in Spanish. Spanish-speaking users can find original mental health content created for them in their language as well as a team of 45 caregivers providing training, clinical and psychological services through in-app messaging or video calls.
“It’s more than just offering in-app translations. We have a team of all Latinos from different countries who are very passionate about making sure we reach out to Spanish speakers and communicate with Latinos in general,” says Erica Austin, Ph.D., Director of Spanish Services at Ginger. To make these services available because we get them. We understand what generational trauma looks like in our societies and know that stigma runs deep. By making this an all-Spanish experience, not just an add-on or translation, we hope this helps remove the stigma of mental health.”
Ginger’s innovation and dedication to serving Spanish-speaking communities is infectious. Since the company merged with the meditation app Headspace (which became Headspace Health) in 2021, Headspace has added original mindfulness offerings in Spanish, including meditation courses and singles, sleep podcasts (audio content designed to help you relax before bed), and video content in Spanish.
“Growing up, I remember my dad said meditation was for the wealthy. So I said, ‘What?’ So I started teaching this because I wanted to bring mindfulness and meditation to my people,” says Rosie Acosta, a bilingual mindfulness and meditation teacher with Headspace.
In an effort to reach Hispanic-speaking communities, Headspace recently launched a campaign with Los Angeles County offering the mobile app free to people who reside in the county. “While it’s available to anyone, despite the language, in the county, the campaign is aimed at Spanish speakers,” Acosta says. “It’s important to have that connection and to understand the culture and identity in your mindfulness practices.”
Like Ginger and Headspace, Equip, a virtual eating disorder treatment company, has made it a priority to serve Hispanic patients who are often overlooked in the treatment of eating disorders. Equip provides each client with a dedicated team of five that provides them and their families with the tools and resources they need to recover. This includes therapists, medical providers, dietitians, family mentors, and peer mentors. There are dozens of Spanish-speaking providers across these areas that allow Equip to pair patients with a fully Spanish-speaking team.
“Equip believes that it is impossible to treat the ‘whole person’ and their eating disorder without taking into account their cultural identity, beliefs, behaviors and languages,” says Dulce Petagara, family counselor at Equip.
In addition to the Spanish language teams, Equip also provides interpreters, written materials, and monthly family skill sets provided in Spanish. By offering virtual therapy, the company is also able to overcome physical barriers to caring for people who may live in underserved communities and not near Hispanic-speaking providers who specialize in eating disorders.
However, it will take more than just making speech therapy virtual to serve marginalized communities. It will require rebuilding the entire system.
“Truthfully, it’s a complex system,” Austin says. “There is a lot of work on the back end to be able to offer quality care in different languages and for different cultures, to make this work sustainable for staff and patients, and to educate and build trust. But we have to be able to provide Hispanic care. We need companies that invest in this. It’s the way Only we can remove the stigma of treatment, normalize experience, and transform societies.”
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