• by Beatriz Mallory , Columnist, April 19, 2018

“La ropa sucia se lava en casa.”

“Dirty laundry is washed at home.” 

There are few challenges more vexing in health care marketing than the therapeutic areas of behavioral and mental health. Some would argue that chief among them is the social stigma associated with mental health — the cultural imperative to keep a patient and their problems under wraps, both literally and figuratively.

Marketing strategy for Latinos related to mental health is particularly thorny due to a variety of factors, but at least two of them — ignorance and social stigma — can be overcome by astute health care marketers. 

First, we must understand how critical this issue has become within the Hispanic population.

The magnitude of the problem

One in four American adults experiences mental health issues. The prevalence among Hispanic adults is nearly the same, but among Latinos with a mental health disorder, fewer than one in 11 contacts a mental health specialist, and fewer than one in five contacts a general health care provider, according to the American Psychiatric Association's Office of Minority and National Affairs. 

In a recent study by the Colorado Health Institute, Latinos who reported having an unmet mental health need were asked why they hadn’t seen a mental health professional. They said they did not feel comfortable talking with a health professional about personal problems.

Specifically, about 40% Hispanics in this study reported lack of comfort as a barrier, compared with 25% for non-Hispanic whites.

Nationwide, a combination of factors — including lack of access to treatment and broad inconsistencies in the quality of treatment — continue to negatively impact efforts to reverse this trend.

These and other health disparities put Latinos at higher risk for more severe and persistent forms of mental health conditions. The most common of them are generalized anxiety disorder, major depression, post-traumatic stress disorder (PTSD) and alcoholism. 

The problem is reaching even more disturbing proportions as the Hispanic population skews younger and younger. Latina high school girls now have the highest rates of suicide attempts in the country. Nearly 25% of them have contemplated suicide, and 15% have attempted it.

It is imperative marketers address the fact that Latinos won’t seek help if we don’t directly address in our communications efforts the stigma around mental health care.

Addressing stigma head on

The Hispanic community doesn’t speak about mental health problems, largely because they don’t know enough and what they do know is not grounded in current science and treatment interventions. Elements of the problem are issues we deal with in every therapeutic area but are exacerbated in the context of mental illness.

• There is a dearth of information available in Spanish about how to recognize symptoms of mental health and where to go for help.

• What exists is translated vs. written from a culturally relevant context and doesn’t address concerns and misperceptions common within Latino culture and community.

• In both Spanish and English, information is largely written at too high a literacy level.

• Information isn’t delivered in the modality patients may prefer (e.g., video vs. print materials).

• Information is not placed in their preferred channels and physical locations within their communities (e.g., churches).

They can’t comprehend health conditions about which they haven’t been educated. So, they can’t identify the problem well enough to seek the right help.

The absence of information breeds ignorance and increases stigma. No one wants to be catalogued as “un loco,” a source of deep shame within the community. Stigma is usually subconscious, but within Hispanic culture, it is firmly planted in the collective perception.

There is widespread belief that people with schizophrenia are violent, untrustworthy, and unpredictable for reasons that can include demonic possession. Mental illness means you can’t hold a job and, thus, cannot leave the house or institution. People suffering from depression have a weak character. Mental health issues are incurable and impossible to deal with except via prayer. 

Finally, there is a significant fact that culturally competent Hispanic health care marketing should take into account. Many of the countries from which the U.S. Hispanic population emanate still rely on state-run institutional systems still referred to as “manicomios” (“places for crazy people”). Physically, there may not be institutional walls in the U.S., but figuratively, they still exist in the collective consciousness of Hispanic patients and their caregivers.

It is incumbent upon marketing strategists to take into account the fact that Hispanic families will continue to believe “no se sacan los trapos al sol” (“keep rags out of the sun”) until we change up our communications approaches to incorporate more education. Our efforts to tear down the internal walls should help end the continued suffering of Latinos with mental illness.