Latinos' preferred language may be more important than ethnicity in their use of mental health services. An examination of the usage of publicly sponsored mental health services by Spanish-speaking Latinos in San Diego revealed significant differences from use patterns by either English-speaking Latinos or Caucasians.

The study, conducted by researchers from the USC School of Social Work, UC San Diego School of Medicine and the University of New Mexico looked at more than 6,000 patients who used San Diego County's Adult Mental Health Services over a five-year period. The findings are reported in the August issue of The American Journal of Psychiatry, the official journal of the American Psychiatric Association.

"In their use of mental health services, English-speaking Latinos resembled Caucasians more than they resemble Spanish-speaking Latinos," said the study's senior author, David P. Folsom, assistant professor of family medicine at UCSD and Veterans Affairs San Diego Healthcare System.

The researchers found a higher proportion of Spanish-speaking Latino patients in the San Diego County mental health system with major depression, but a lower proportion of bipolar disorder, schizophrenia and substance use disorders.

Hospitalization rates were similar in the three groups, but the Spanish-speaking Latinos were least likely to initially seek mental health care through jail or emergency rooms. The Spanish speakers were more likely to receive initial treatment for severe mental illness in outpatient facilities than were English-speaking Latinos or Caucasians.

Although they had the highest proportion of patients receiving outpatient services, Spanish speakers had the lowest number of visits overall. They were also more likely to be living independently or with family members than homeless or living in nursing homes.

"This article is a fascinating snapshot of the process of integrating Hispanic people into the culture of the United States," said Robert Freedman, editor-in-chief of The American Journal of Psychiatry. "Preserving their native language – either because of recent immigration or due to a family decision – appears to be a better predictor of their use of mental health care services than is ethnicity."

Concepcion Barrio, associate professor of social work at USC, was primary co-author and contributed to the interpretation of the study's data.

"The findings suggest there are great cultural strengths and resources particularly within Spanish-speaking Latino communities that remain largely untapped in the design and delivery of mental health services to persons with severe mental illness," she said.

Thomas Insel, director of the National Institute of Mental Health, added: "Disparate health care for racial and ethnic minorities is a major public health concern. Studies such as this will help to better define the needs of these groups with the aim of providing them with better care."

The researchers mentioned the possibility that the San Diego County mental health system is particularly effective in providing care to Spanish speakers and noted these findings need to be confirmed in other U.S. public mental health systems.

San Diego County's Public Adult Mental Health System serves people with Medi-Cal or no health insurance. During the period 2000 to 2005, treatment for schizophrenia, bipolar disorder, or major depression was initiated for 4,638 Caucasians, 1,144 English-speaking Latinos and 539 Spanish-speaking Latinos. In the analysis, mental health services were consolidated into four categories: hospital, emergency room, jail and outpatient settings.

This study was supported in part by grants from the National Institute of Mental Health and the Mental Illness Research, Education, and Clinical Center of Veterans Integrated Service Network 22, Department of Veterans Affairs.

Additional contributors include principal investigator Dilip V. Jeste, distinguished professor of psychiatry and neurosciences at UCSD and the VA San Diego Healthcare System; Todd Gilmer, UCSD; David J. Moore, Jesus Bucardo and Laurie A. Lindamer, UCSD; Piedad Garcia, San Diego County; William Hawthorne, Community Research Foundation, San Diego; Richard Hough, University of New Mexico; and Thomas Patterson, UCSD.