Suffering from a mental health or substance abuse disorder is not uncommon. In the U.S., approximately 1 in 5 adults, or 18.5% of the adult population—experiences mental illness or a substance abuse problem in a given year. Given their complex nature, successful treatment for a behavioral health issue often requires regular access to services and support. But for many, especially underserved populations, these services are unavailable or underutilized. Immigrant populations in particular, who possess unique risk factors attributed to their migration experience, face many barriers to this type of care because of their cultural and linguistic differences.
COE, a program of the Foundation for Health Leadership & Innovation, works to help to connect these underserved patients with the primary care and behavioral health services they need –and also identifies and trains medical practices on how to provide integrated behavioral health services. One of the sites they work with, as part of an effort led by the Cone Health Foundation, is the Center for New North Carolinians at the University of North Carolina at Greensboro (CCNC). CCNC specifically helps to serve immigrant and refugees families’ healthcare needs in Greater Greensboro through the Immigrant Health Access Project (IHAP), which aims to eliminate language and cultural barriers, two of the main issues that prevent the immigrant community from receiving health care. From coordinating outreach efforts to providing interpretation and translation services to running workshops on how to navigate the health system, the IHAP helps to ensure that this underserved population receives the quality care they need and deserve.
However, overcoming these barriers does not come without its challenges. Holly Sienkiewicz, the Director of the Center for New North Carolinians (CNNC), tells us from experience that just getting this population to admit they need treatment can be difficult, as mental healthcare is often stigmatized, especially in other parts of the world. “In some cultures, if a certain individual has a mental health or substance abuse problem, it is seen as a bad omen, and the entire family is avoided,” she says. “Because of this, many people do not want to admit their problems in fear that their families will be ostracized from the community.” Many cultures are also much more collective than we are here in the U.S., meaning it’s common to put others first and do what’s best for either the community or your family. It can be difficult to convince people to get treatment for their own problems when cultural norms encourage prioritizing the needs of others.
Language can be another significant barrier to behavioral health for immigrants and refugees, but simply translating is not always enough. A deeper understanding of the culture that patients come from is important, because even simple words that we use every day can have different meanings in other cultures.
“When discussing mental health with a doctor, most of us would have no problem telling a doctor that we feel stressed,” Holly says. “However, some cultures associate the word stress with crazy, and will interpret it that way if you ask.” She notes financial barriers as well- especially with mental health. “These populations often have no insurance or low quality insurance,” she says. “It’s difficult to find insurance for this population that will cover mental health, and finding someone who is willing to work with an interpreter is even more challenging.” It is important to note that these financial barriers also affect many other low-income residents of NC who do not have access to quality insurance coverage.
Overall, the members of the IHAP work hard every day to ensure that immigrants and refugees receive culturally and linguistically appropriate services, as this is critical to addressing their behavioral and general healthcare needs. Holly expressed that she is personally impressed with the resilience of immigrants and refugees, who come with a lot of trauma in their lives, yet are still so resilient and hopeful for the future. “I wish there was more understanding and cultural empathy for this population. Working for immigrants and refugees is in no way easy, and people often understandably get frustrated with language barriers and cultural differences,” she says. “But if you just take the time to get to know them and the circumstances they come from, your perception will change dramatically.”