Mental health issues are still not widely shared in many Spanish-speaking communities. For generations, mental health experts and advocates have worked to destigmatize therapy and address the shame of “airing the dirty laundry” so people can experience healing.
Stigma isn’t the only problem. There is another obstacle: the lack of Spanish-language mental health services and providers in the US
According to a 2018 survey by the American Psychological Association, only 5.5% of psychologists in the US can provide services in Spanish. These providers often work in big cities like Los Angeles, New York and Miami. Millions of Spanish speakers who do not live in or near these areas may not have access to a licensed psychologist who can provide personal mentoring in their language.
Teletherapy – therapy sessions held online – has the potential to expand access to care. But overall, the needs of people whose first language is Spanish (as well as other languages besides English) are still not being met.
Mental health problems occur in people of all races, ethnicities, languages and immigration status. But when it comes to treatment, it’s not an even playing field. In addition to stigmatization and language barriers, the obstacles also include legal status, financial income, lack of health insurance and cultural differences with the provider.
Whether in person or through teletherapy, many of these barriers still exist.
“Teletherapy is great because it makes mental health care more convenient. You can join a session from anywhere,” says Patricia Alvarado, MA, a Los Angeles-based licensed professional clinical counselor and advocate for Spanish-speaking mental health care.
Part of the problem is the under-representation of Spanish-speaking clinicians.
“We’re a minority within a minority,” says Alvarado, whose entire team at her Alvarado Therapy practice is fluent in English and Spanish. Another problem, Alvarado says, is that mental health startups are reluctant to invest in meeting the needs of Spanish speakers.
“I sometimes wonder why so many companies try to tie the knot when it comes to mental health,” says Alvarado. “There is a need for this technology, but will it meet those needs? And if so, which churches are they there for?”
Teletherapy has been booming since the start of the COVID-19 pandemic in 2020. In fact, a Time/Harris poll found that 85% of clinical members conducted most of their sessions virtually this year, up from just 2% before the pandemic. The demand for virtual therapies continues, and digital health startups are growing to fill this need.
But while teletherapy has increased access to mental health for millions of people, it hasn’t exactly democratized care. A Time/Harris poll found that only 5% of people were receiving mental health care for the first time during the pandemic, meaning most people using teletherapy have just transitioned from in-person to virtual care. This is largely because teletherapy, like in-person therapy, remains more accessible to a specific demographic: insured and/or affluent English-speaking white US citizens.
None of the top three teletherapy apps – Talkspace, BetterHelp, and Cerebral – offer full Spanish-language in-app services and settings. With all health tech companies, some offer in-app translation while others work with Spanish speaking therapists who can be requested, but matching one is subject to state availability.
However, teletherapy companies are working to close the access gap for Spanish speakers.
In 2021, Ginger, an on-demand mental health app offering behavioral coaching, therapy, psychiatry, and self-care resources, announced that it would be adding Spanish-language features to its mobile app. As of early 2022, the app experience is fully operational in Spanish. Spanish-speaking users can find original mental health content created for them in their language, as well as a team of 45 healthcare providers offering coaching, clinical and psychiatric services via in-app messaging or video calls.
“It’s more than just offering in-app translations. We have a team of Latinos from different countries who are very passionate about making sure we reach out to Spanish speakers and connect with Latinos in general,” said Erika Austin, PhD, Director of Spanish Services at Ginger. “We want to make these services accessible because we get them. We understand what generational trauma is like in our communities, and we know the stigma runs deep. By making this a fully Spanish experience and not just an add-on or translation, we hope this will help destigmatize mental health.”
Ginger’s innovation and eagerness to serve Spanish-speaking communities is contagious. Since the company merged with meditation app Headspace in 2021 (which became Headspace Health), Headspace has originally added Spanish-language mindfulness offerings, including meditation classes and singles, sleepcasts (audio content designed to help you unwind before bed), and Video content Spanish.
“Growing up, I remember my father saying meditation was for rich people. I thought: ‘What?’ So I started teaching this because I wanted to introduce mindfulness and meditation to my people,” says Rosie Acosta, a bilingual mindfulness and meditation teacher at Headspace.
To reach Spanish-speaking communities, Headspace recently launched a campaign with Los Angeles County, offering the mobile app for free to county residents. “While it’s available to everyone in the county, despite the language, the campaign is targeting Spanish speakers,” says Acosta. “It’s important to have that connection and to understand culture and identity in your mindfulness practices.”
Like Ginger and Headspace, Equip, a virtual eating disorder treatment company, has made it a priority to care for Spanish-speaking patients who are often overlooked in eating disorder treatment. Equip provides each client with a dedicated team of five who provide them and their families with tools and resources for recovery. These include therapists, medical providers, nutritionists, family mentors, and peer mentors. There are dozens of Spanish speaking providers in these areas, allowing Equip to match patients with a fully Spanish speaking team.
“Equip believes that it is impossible to treat the ‘whole person’ and their eating disorder without considering their cultural identity, beliefs, behavior and language,” says Dulce Petagara, a family mentor at Equip.
In addition to the Spanish speaking teams, Equip also provides interpreters, written materials and monthly family skills groups in Spanish. By offering virtual treatments, the company is also able to break down physical barriers in caring for people who may live in underserved communities that are not close to Spanish-speaking providers specializing in eating disorders.
Still, it will take more than making talking therapy virtual to serve marginalized communities. It will require rebuilding the entire system.
“To be honest, it’s a complex system,” says Austin. “There is a lot of backend work to be able to provide quality care in different languages and for different cultures, to make that work sustainable for staff and patients, and to build trust and educate. But we must be able to offer Spanish care. We need companies that invest in it. It’s the only way we can destigmatize therapy, normalize the experience, and transform communities.”