Help needed

The lack of Latino psychologists in this country is affecting Hortensia Amaro.

In addition to being a distinguished professor of health sciences at Northeastern's Bouve College of Health Sciences, Amaro founded the Mom's Project , an outpatient drug addiction program for pregnant women in Mattapan, about 16 years ago. Then 11 years ago she created Entre Familia , a residential drug treatment program in Mattapan for Latinas and their children.

But every time Amaro tried to fill positions in her organizations, she found it difficult to locate Latino workers with the master's or doctorate level of mental health education needed to do the jobs. She had to track down qualified employees in Puerto Rico. Amaro even hired local Latinas who worked in human services but didn't meet her educational requirements, then trained them in-house as they studied for their master's degrees.

The reasons for Amaro's difficulties come down to two statistics. In 2003, only 2.5 percent of psychologists in this country were Latino, according to the American Psychological Association . Those psychologists care for a community of Hispanics that now makes up about 14 percent of the US population.

``There's an incredible unmet need for . . . Latino psychologists, especially in the Northeast," Amaro says.

To change the situation, Amaro was among a small group of about 15 advisers who over the last two years helped the Massachusetts School of Professional Psychology in West Roxbury create a Latino Mental Health certificate for students in its four-year doctorate in psychology program. The certificate program will welcome its first group of students next month.

In a country where 1 in 10 household residents speaks Spanish, the program will help students become fluent in the language. It will also acknowledge the cultural differences among Latinos from different countries by educating students about the diversity of the community.

MSPP is one of a handful of psychology schools in the country offering students an opportunity to become both culturally and linguistically fluent in this world. The specialty is so new, no one in the psychology community really knows how many programs exist. But Our Lady of the Lake University in Texas, the California School of Professional Psychology at Alliant International University in California, and the University of Miami are among the growing number of schools offering an opportunity to focus on this area.

Nicholas Covino , the president of MSPP, credits the small size of the school for allowing it to develop a program that caters to the needs of the growing Latino community.

``The literature suggests that when Hispanic patients go to mental health providers who are Anglo, they don't come back most of the time," Covino says. ``As you would think, it's because they don't feel understood and because they're not understood. Sometimes it's really not understood because of the language, but a lot of times it's because people don't understand the culture."

Of the 56 entering students who will be doctoral candidates at MSPP this fall, 12 expressed an interest in participating in the Latino Mental Health program. Half of those dozen students described themselves as Latino, says Mario Murga , MSPP's director of admissions. The program is open to Latino and non-Latino students.

``Even though we want to attract more Latinos," says Amaro Laria, director of MSPP's Latino Mental Health program and a native of Cuba , ``it's going to take a while until we have more Latinos in the field. So at the same time, we want to have non-Latinos who have already some fluency in Spanish. . . . It's taking those students and really trying to push them to the level of fluency."

What the program can't combat are the elements that keep Latinos from exploring this profession. One problem, Laria notes, is that according to the 2002 census , only 11 percent of Latinos have a college degree; a doctorate is needed to practice psychology. Often, Laria explains, when Latinos make career choices, they don't have the luxury of devising educational plans that will be several years in the making.

``We have a short-term orientation, not a future orientation," he says of the Latino population. ``When you're living in poverty or stressed financially, you're not thinking about, `Seven years from now, when I get my PhD, I'll start making some money.' You're thinking about, `Let me [get] practical training, and in six months I'll do something practical.' "

Others simply can't fit into their lives the four years of training required to get a doctorate in psychology. That wasn't a problem for George Soto , a 42-year-old Puerto Rican from the Bronx who's among the incoming students signed up for the Latino Mental Health certificate.

``I'm not married," says Soto, who also won a $15,000-a-year scholarship that will make the $25,000-a-year tuition more affordable. ``I'm single. I think that for people who have families and children, it might be harder for them to commit to the time frame."

Nevertheless, Soto took a scenic journey before arriving at the decision to get an advanced psychology degree. He had dropped out of college in 1986. But in 1998, while working at an outpatient clinic on the Lower East Side in New York City, he fell in love with social work. Soto went on to get his bachelor's and master's degrees in this area at Fordham University in New York, completing his education two years ago. But his experiences in the field quickly convinced him that he needed additional training to learn how to treat the psychological trauma his clients were going through.

Soto was dealing with Latinas who had survived incest or physical violence at the hands of parents or spouses. He says he realized, ``All the relationships they were getting into were the same. . . . [But] for these women, it was difficult for them to understand this could have started from the trauma they experienced when [they] were younger."

The fact that MSPP offered the Latino Mental Health certificate made the school that much more desirable to him. From his experiences in social work, Soto knows that ``more and more we're getting people from Central America, South America, bringing in concerns [that are] different than the Caribbean and European [Latin] population."

Being Puerto Rican doesn't give him the tools he needs to attend to this population. Mari Carmen Bennasar , an associate director of Boston University School of Medicine's Center for Multicultural Training in Psychology, emphasized this point as part of the core group of eight that met monthly to help design MSPP's certificate program.

``People can assume, `OK, I'm Dominican. I can work with any Latino I want,' and that is just not true," says Bennasar, a Dominican native. ``Someone from Nicaragua, for example, comes from such different backgrounds with the civil war, with the trauma they have suffered. I have no idea what that's about; I don't come from that history."

The students in the MSPP certificate program will begin exploring these differences after spending their first academic year taking an uncredited weekly course to fine-tune their language skills. For two summers Laria will lead a course called ``Latino Mental Health in the US Context" about Latino mental health work. After taking Laria's course, students will spend the rest of the summer in a language-immersion class in South or Central America; they'll visit a different country each year. There, they'll not only discover new cultures but also have an opportunity to provide psychological counseling to the locals.

Among the other requirements for the certificate is a course called ``Advanced Topics in Latino Mental Health , " led by local Latino psychology professionals , that students will take in their third and fourth years. Their required clinical training will be at sites with a large number of Latinos, such as the Joseph M. Smith Community Health Center, where Laria leads a class of student psychologists. Their doctoral theses will focus on Latino mental health issues.

The training will help counteract the stereotypes and misunderstandings that occur when a Latino encounters a mental health professional who doesn't understand his language or culture. There's a tendency, says Laria, for mental health professionals to translate a Latina's desire to defer to her husband as the warning sign of an `` imbalanced relationship," he says. Since Latinas tend to be emotionally expressive, says Laria, they also tend to be overdiagnosed with borderline personality disorder and histrionic personality disorder. Because of their emotional remove, Latin men tend to be overdiagnosed with antisocial personality disorder, says Laria.

Psychologists also fail to calculate the impact a patient's surroundings may have.

``If someone is having panic attacks," says Laria, ``we follow a very medical model of meditation and breathing and medication. We forget that this person may be living in a neighborhood where there is violence and shooting. Panic may be a normal reaction to living in that setting."

The certificate program will be MSPP's first step in getting a handle on a problem that affects all people of color. The percentage s of African-American and Asian psychologists in this country are even less than the percentage of Hispanic ones.

``Our hope," says Laria, ``would be, for the future, to create [programs] for other groups as well."

Plans for expansion include offering a version of the Latino Mental Health certificate to students in the school's master ' s program, which also launches this fall. Laria is in the process of creating a program that will help Latinos with psychology degrees from foreign countries get the credits they need to practice in the United States.

``It's another way," says Laria, ``of getting to the same outcome of having more professionals to serve the population."