Overcoming Behavioral Health Barriers in the Hispanic Community

For Hispanic and Latino communities, mental health care can remain difficult to access—not only because of practical barriers, but also because stigma can make it harder to acknowledge a need for help.

In 2024, Hispanic/Latino adults were 28% less likely than U.S. adults overall to receive mental health treatment, according to the U.S. Department of Health and Human Services Office of Minority Health. Among Hispanic adults with any mental illness in 2023, fewer than half (47.4%) received mental health treatment during the year, according to the Substance Abuse and Mental Health Services Administration.

These disparities underscore the importance of reducing stigma, building trust and making culturally responsive behavioral health care easier to access.  This is especially important work at NYC Health + Hospitals where many of our patients and communities are Hispanic.  Our experienced and compassionate behavioral health teams focus on identifying people in need of care, whether they can admit it and ask for it, or not. 

For more details on identifying and breaking down barriers to mental health care for our Hispanic patients, we turned to Dr. Vladimir Gasca, Chief of Behavioral Health at NYC Health + Hospitals/Elmhurst.  

Dr. Gasca has been at NYC Health + Hospitals/Elmhurst since 1999. Born in Colombia and raised in Venezuela, where he earned his medical degree, his personal journey of migration deeply resonates with the diverse Hispanic and Latino communities he serves. This background gives him firsthand insight into the challenges of acculturation and family separation that many of his patients face. He later lived in Orange County, California, completing substance abuse studies at UCLA, before moving to New York City in 1999 to pursue his residency at the Mount Sinai School of Medicine at Elmhurst.

He has proudly lived in his beloved community of Queens ever since. In his free time, he enjoys exploring the borough’s vibrant, multicultural culinary scene and spending quality time with his family and friends.

Q: What are some of the cultural beliefs or experiences that can make Hispanic and Latino patients less likely to seek behavioral health care?

A: Several factors can play a role, including a strong belief that personal problems should remain within the family to avoid shame or gossip. Traditional gender expectations also influence behavior, for example: some men may feel emotional vulnerability is a sign of weakness, while some women are accustomed to putting the needs of their families before their own emotional exhaustion.

For some patients, emotional suffering is understood primarily in spiritual terms, leading them to turn to prayer rather than considering professional help. There are also practical barriers, such as complicated immigration concerns, financial pressures, work demands, and language barriers, which make people cautious about interacting with large institutions. It is also important to remember that Hispanic and Latino communities are not all the same, and differences in background, language, religion, or education influence how people describe emotional distress and whom they trust.

Q: How does stigma around mental health show up in the patients and families you see at NYC Health + Hospitals/Elmhurst, and are you seeing any signs that attitudes are changing?

A: Stigma often appears indirectly, with patients coming to primary care or the emergency department with headaches, back pain, stomach problems, or fatigue that may actually be related to depression, anxiety, or severe stress. For many people, it feels more acceptable to talk about a physical problem than an emotional one, which leads to families trying to manage issues on their own until a loved one is in a serious psychiatric crisis. At the same time, attitudes are changing. Younger generations, including many born in the United States, are often more comfortable discussing mental health and help their parents or grandparents accept care. The COVID-19 pandemic also led to more open discussions about grief, trauma, depression, and anxiety.

Q: What are some of the ways NYC Health + Hospitals is working to reduce stigma and make behavioral health care feel more accessible and acceptable to Hispanic and Latino patients? 

A: One approach is to integrate behavioral health into primary care, senior care, and pediatric settings, as well as having experts embedded into medical and surgical floors, and the emergency room. When patients can meet with a behavioral health professional in the same clinic where they receive medical care, it feels less intimidating than going to a separate psychiatric facility. We also use warm handoffs, meaning a trusted primary care clinician personally introduces the patient to a behavioral health professional during the same visit. Beyond the hospital, NYC Health + Hospitals works with community organizations and faith leaders in the city to provide mental health education in familiar, comfortable settings.

Q: How do culturally responsive care, language access and a diverse workforce help build trust and encourage people to seek care earlier?

A: The Platinum Rule is especially helpful in health care, which means treating patients the way they want to be treated based on their language, culture, religion, traditions, and preferences.

This is particularly relevant in New York City, where our Hispanic and Latino communities are highly diverse. Trust begins when patients feel understood and respected by a provider who uses their preferred language during the evaluation and recognizes the challenges of migration, family separation, and financial stress.

Language access involves more than interpreting words, it requires understanding the meaning behind them. For example, when a Spanish-speaking patient says “me duele el corazón” (my heart hurts), the phrase often refers to emotional pain or grief rather than a heart problem.

A diverse workforce also helps patients feel that the hospital reflects the community it serves, making it feel less like an unfamiliar institution and more like a trusted source of support. The health system promotes professional diversity with program such as MOSAIC (Medical Opportunities for Students and Aspiring Inclusive Clinicians), or the “Doctors that look like me” mentoring sessions for high school and college students at Elmhurst Hospital.  

Q: What would you want Hispanic and Latino patients and families to know about mental health care, and what should our staff keep in mind when helping connect patients to services?

A: To our patients and families, I would say that seeking mental health care is not a betrayal of your family. It can be a way of caring for yourself and the people who depend on you, and asking for help is not a sign of weakness. Treatment gives you the tools you need to remain healthy and present for your family.

For our staff, building on the Platinum Rule, we should not make assumptions based on a patient’s ethnicity or country of origin. When a patient reports fatigue, body aches, or poor sleep, ask gently about stress, family concerns, and the challenges they may be facing. It also helps to describe behavioral health services as support for coping with stress, grief, or difficult life circumstances rather than presenting them immediately as psychiatric treatment. We should recognize a patient’s strengths and, when the patient agrees, involve family members or faith leaders in the treatment plan.

Q: Can you share a story about a Hispanic patient or family you have helped by helping them overcome stigma and get the behavioral health care they needed?

A: The following is a composite clinical example based on common experiences, and details have been changed to protect confidentiality.  

We treated a man in his late 50s from Ecuador who worked in construction. His daughter brought him to the emergency department because he was having severe chest pain and shortness of breath, which the family feared was a heart attack. After medical evaluation did not show a cardiac cause, the emergency department physician recognized he was experiencing severe panic attacks and brought in our bilingual behavioral health team.

At first, the patient was offended by the suggestion that stress could be contributing to his symptoms, stating he was not “loco” and simply needed to continue working to support his family. Rather than arguing, the clinician acknowledged his strong work ethic and the sacrifices he had made to immigrate to New York. We explained that his body was reacting to years of accumulated stress, much like an engine that had been working too hard for too long. We presented treatment as a way to reduce the physical symptoms, regain his strength, and lessen the worry experienced by his daughter. After several conversations, he agreed to participate in treatment, his chest symptoms improved, and he eventually encouraged his brother to seek help for depression.

The takeaway for all of us is to slow down, ask about their life, and frame care around what they value.