1. Mental Health Issues in Hispanics: A New & Pressing Challenge for North Carolina & the Cape Fear Region Antonio E. Puente, Ph.D. University of North Carolina at Wilmington 910.962.3812 puente@uncw.edu www.uncw.edu/people/puente 1508 Military Cutoff Road #303 www.clinicalneuropsychology.us New Hanover Health Department July 14, 2004

2. Demographics Growth Growth Fastest growing ethnic group in USFastest growing ethnic group in US Will be or is the largest ethnic group in USWill be or is the largest ethnic group in US Approximately 15% of the populationApproximately 15% of the population Could represent the majority group in 2050Could represent the majority group in 2050 Probably undercountedProbably undercounted North Carolina North Carolina One of the fastest growing states for HispanicOne of the fastest growing states for Hispanic Southeastern NC particularly sensitive, especially rural areas with agriculture and livestockSoutheastern NC particularly sensitive, especially rural areas with agriculture and livestock

3. Demographics: Hispanic Panorama United State Stats United State Stats Overall = 12.5% (vs 12.1% for AA)Overall = 12.5% (vs 12.1% for AA) Before 18 = 35%Before 18 = 35% 18-65 = 60%18-65 = 60% 65 + = 5%65 + = 5% Less Educated than counterpartsLess Educated than counterparts North Carolina Stats North Carolina Stats Overall = 4.7%Overall = 4.7% Migration for Foreign Born = 50%Migration for Foreign Born = 50% Primarily from California (also from the NE) Primarily from California (also from the NE) Comparison (ND = 282% decrease) Comparison (ND = 282% decrease) From 1990 to 2000 = 57.9% increaseFrom 1990 to 2000 = 57.9% increase New Hanover Stats ??? New Hanover Stats ??? Total Population = 147,642 (22.7% increase)Total Population = 147,642 (22.7% increase) 1980 = 788; 1990 = 747; 2000 =1,8281980 = 788; 1990 = 747; 2000 =1,828

4. Additional Hispanic Statistics Percentage of Population Percentage of Population - In US = 12.5% - In US = 12.5% In NC = 4.7%In NC = 4.7% - 36% are from Latin America - 30% are from Mexico Anticipated Growth Anticipated Growth In US = Births will outpace immigrationIn US = Births will outpace immigration In NC = 273% growthIn NC = 273% growth

5. Psychological Literature (from PsyInfo, 07.14..04) Psychology Psychology464,5888 Hispanics Hispanics 7,4627,462 Hispanics and Mental Health Hispanics and Mental Health 731731

6. Sources of Mental Health Problems Language limitations Language limitations Culture and Acculturation issues Culture and Acculturation issues Family dysfunction Family dysfunction Ineffective social support Ineffective social support Low self esteem Low self esteem Limited education Limited education Financial limitations Financial limitations Religious affiliation Religious affiliation Documentation Documentation

7. Language Problems English English Variations of Spanish Variations of Spanish Spanish as a second language Spanish as a second language Anxiety associated with learning English and losing culture Anxiety associated with learning English and losing culture Children as translators for parents Children as translators for parents Children choosing English over Spanish as primary method of communicating Children choosing English over Spanish as primary method of communicating

8. Culture and Acculturation Understanding the majority group culture and vice versa Understanding the majority group culture and vice versa Maintaining culture of origin (e.g., southern Eng.) Maintaining culture of origin (e.g., southern Eng.) Being bi-cultural (it’s more than language) Being bi-cultural (it’s more than language) Some basic differences Some basic differences Family above all (and extended family)Family above all (and extended family) Friends and social groups are criticalFriends and social groups are critical Time to be enjoyed not conqueredTime to be enjoyed not conquered Cooperation versus competitionCooperation versus competition Religion as source of support and socializationReligion as source of support and socialization Keep one’s problems to themselves or familyKeep one’s problems to themselves or family Less material & consumer focusedLess material & consumer focused More emotionalMore emotional More spiritual and religiousMore spiritual and religious

9. Family Defining Family Defining Family NuclearNuclear ExtendedExtended DoubleDouble FunctionalFunctional Divided Families Divided Families EconomicsEconomics GeographyGeography PoliticsPolitics

10. Ineffective Social Support Medical Medical Religious Religious Educational Educational Financial Financial Social Social Marital Marital

11. Low Self Esteem Productivity and Materialism Productivity and Materialism Connectivity Connectivity Self-Effacing Presentation Self-Effacing Presentation Self-Fulfilling Prophecy Self-Fulfilling Prophecy

12. Education Typical Educational Background Typical Educational Background What it Means to be “Educated”- the difference between schooling and education What it Means to be “Educated”- the difference between schooling and education

13. Financial & Related Limitations The Limits and Hazards of Being Undocumented The Limits and Hazards of Being Undocumented Type of Vocational Opportunities & Corresponding Pay Type of Vocational Opportunities & Corresponding Pay Banking Issues Banking Issues Saving for Retirement Saving for Retirement Driver’s License (the TN solution) Driver’s License (the TN solution)

14. Religion Predominantly Catholic, but not Exclusively (fundamental alternative) Predominantly Catholic, but not Exclusively (fundamental alternative) Importance of Religion and Related Social Support Importance of Religion and Related Social Support Church and Related Services in Spanish Church and Related Services in Spanish

15. Documentation Education Education Medical Medical Legal Legal Tax ID NumbersTax ID Numbers Social Security NumbersSocial Security Numbers Driver’s LicensesDriver’s Licenses Aliases Aliases

16. Outcome of Problems Anxiety13% Anxiety13% Substance abuse 8% Substance abuse 8% Depression 5% Depression 5% Violence ?% Violence ?% Ethnic identity issues Ethnic identity issues Language at home; Language for childrenLanguage at home; Language for children Poverty and marginalization Poverty and marginalization Higher Education as an exampleHigher Education as an example

17. Gender Issues Males vs Female Males vs Female Males 27%Males 27% Females 17%Females 17% Heterosexual issues Heterosexual issues Clashing of culturesClashing of cultures Availability of partnersAvailability of partners ProstitutionProstitution STDsSTDs Sexual Identity Issues Sexual Identity Issues Childhood Sexuality & Abuse Childhood Sexuality & Abuse

18. A Simple Model for Addressing Mental Health Concerns Communication & Narrative Approach Communication & Narrative Approach Rapport and Trust Rapport and Trust Questioning Questioning Symptom Identification Symptom Identification Empowerment Empowerment Solution Focus Solution Focus Follow-up Follow-up

19. Personnel and Services in Southeastern NC Mental Health Public Sector Mental Health Public Sector Catholic Ministries- (?)Catholic Ministries- (?) SEMHC- (?)SEMHC- (?) Titleson Clinic (first Wednesday)Titleson Clinic (first Wednesday) Mental Health Private Sector Mental Health Private Sector Psychologist-1Psychologist-1 Health Public Sector Health Public Sector New Hanover County-1New Hanover County-1

20. Related Support Radio and Television Radio and Television 1 - AM Religious Station1 - AM Religious Station 1 - WHQR Sunday Night1 - WHQR Sunday Night Newspaper Newspaper 1 Organizations Organizations Centro Latino/Amigos InternacionalCentro Latino/Amigos Internacional

21. Intra-Cultural Conflict Pertinent Groups Pertinent Groups OlaOla Titleson ClinicTitleson Clinic Centro LatinoCentro Latino Hispanic Chamber of CommerceHispanic Chamber of Commerce Hispanic Development Corporation (?)Hispanic Development Corporation (?) Others (?)Others (?) Intra-Cultural Conflicts & A Leadership Void Intra-Cultural Conflicts & A Leadership Void

22. Cultural Matrix ISOLATED VS ACCULTURATED MAINSTREAM VS ASSIMILATED

23. From Isolation to Assimilation (from Hispanic Business, December 2003) IsolationAcculturation Assimilation Income$20,500 $36,100$37,000 Size 3.9 3.6 3.1 Time in US1 st gen. US born 4 th Gen. LocaleInner CitySuburbs ?Suburbs ValuesHispanicPartial HispanicAnglo LanguageSpanishBilingualEnglish

24. The Future Clashing Curves and Cultures Clashing Curves and Cultures Financial & Social “Slavery” Financial & Social “Slavery” Pay Now or Pay Later Pay Now or Pay Later Social Welfare ProgramsSocial Welfare Programs Social Security DisabilitySocial Security Disability Penal SystemPenal System What is North Carolina and the Cape Fear Region Going to Do? What is North Carolina and the Cape Fear Region Going to Do?