MEXICAN IMMIGRANT WOMEN’S VIEWS ON WESTERN
MENTAL HEALTH SERVICES AND FACTORS
THAT INFLUENCE THEIR DECISION
TO SEEK SERVICES
A Thesis Presented to the Faculty
of
California State University, Stanislaus
In Partial Fulfillment
of the Requirements for the Degree
of Master of Social Work
By
Nancy Murillo
May 2015
CERTIFICATION OF APPROVAL
MEXICAN IMMIGRANT WOMEN’S VIEWS ON WESTERN
MENTAL HEALTH SERVICES AND FACTORS
THAT INFLUENCE THEIR DECISION
TO SEEK SERVICES
by
Nancy Murillo
Signed Certification of Approval Page is
on file with the University Library
Dr. Robin Ringstad
Professor of Social Work
Date
Dr. John Garcia
Professor of Social Work
Date
© 2015
Nancy Murillo
ALL RIGHTS RESERVED
DEDICATION
Quiero dedicar mi tesis a las personas mas importantes en mi vida, mi padres,
que siempre me han apoyado durante toda mi educación. También, le dedico mi tesis
a mis hermanos, Bobo, Chipi, y Tavio por siempre creer en mi. Los quiero mucho.
iv
ACKNOWLEDGEMENTS
Primeramente, quiero agradecerle a Dios por la oportunidad que me regaló al
lograr este sueño y por bendecirme con una familia que me ayudó a alcanzar mi
sueño. Durante este proceso, Dios me ha enseñado a vivir un día a la vez y siempre
buscar el lado positivo en las situaciones mas difíciles.
Le agradezco profundamente a mi mamá, Zita Murillo, por su fe incondicional
de que lograría este sueño. Uste es la mujer más importante en mi vida y me ha
enseñado a ser fuerte y a creer en mi misma y nunca darme por vencida. Usted es mi
mejor amiga y sin usted no se que haría. La amo desde lo másprofundo de mi corazón
y le agradezco por ser la mamá mas linda del mundo.
También le doy las gracias a mi papi, Armando Murillo, por su apoyo y por
enseñarme a trabajo duro y luchar por lo que quiero. Papi, lo amo con todo mi alma y
le doy gracias a Dios por ser su hija. Gracias por todo el sacrificio que ha hecho por
asegurarse que su familia esté bien.
Le quiero agradecer a mis hermanos, Luis, Bladimir, y Octavio Murillo por
todo el apoyo que me han dado y les quiero recordar que los amo con todo mi
corazón. En los mementos duros se que puedo contar con ustedes para hacerme reír y
protegerme. También le doy las gracias a Mónicay Javier Huerta por siempre creer en
mi y por todo su apoyo, los quiero mucho. No puedo olvidar a Xavier y Diego
Huerta. Los quiero mucho y recuerden que pueden alcanzer sus sueños.
v
I want to acknowledge Dr. Robin Ringstad and Dr. John Garcia for all their
support throughout this process. I want to thank my cohort, friends, and colleagues
for all their support and words on encouragement.
Finalmente, le doy gracias a toda mi famila aquí y en México por todo el
apoyo y amor que me han dado. Mi familia me ha enseñado que en la vida todo se
logra si luchas por lo que quieres y la importancia de la unión familiar. Todo lo que
he logrado en la vida es por ustedes. Los quiero mucho.
vi
TABLE OF CONTENTS
PAGE
Dedication ...............................................................................................................
iv
Acknowledgements .................................................................................................
v
Abstract ...................................................................................................................
ix
CHAPTER
I.
Introduction ...........................................................................................
1
Statement of the Problem ..........................................................
Statement of Purpose ................................................................
Significance of the Study ..........................................................
1
5
5
Review of Literature .............................................................................
7
Definition of Mental Health ......................................................
The Influence of Cultural Benefits on Mental Health Services
Barriers When Seeking Mental Health Services .......................
Research Related to Service Utilization ...................................
Conclusion ................................................................................
7
8
10
12
15
Methodology .........................................................................................
17
Design .......................................................................................
Sampling ...................................................................................
Data Collection and Instrumentation ........................................
Plan for Data Analysis ..............................................................
Protection of Human Subjects ..................................................
17
18
18
19
20
Results ...................................................................................................
21
The Sample ...............................................................................
Mexican Women’s Views on Mental Health Services .............
Utilization of Mental Health Services by Mexican Women .....
Factors Impacting Utilization of Mental Health Services.........
Summary ...................................................................................
21
22
26
29
34
Discussion and Recommendations .......................................................
35
Major Findings ..........................................................................
36
II.
III.
IV.
V.
vii
Cultural Beliefs about Mental Health Services ....................
Shame, Machismo, and Labels ............................................
Barriers Based on Cultural and Social Beliefs .....................
Strengths and Limitations .........................................................
Implications for Practice and Policy .........................................
Implications for Research .........................................................
36
36
38
38
40
41
References ...............................................................................................................
44
Appendices
A.
B.
C.
D.
Informed Consent (English) ........................................................................
Informed Consent (Spanish) .......................................................................
Guiding Questions for Interviews (English) ...............................................
Guiding Questions for Interviews (Spanish)...............................................
viii
48
49
50
51
ABSTRACT
The purpose of this exploratory study is to develop a cultural understanding of
Mexican immigrant women’s beliefs on western mental health services and what
factors influence their decision as to whether they seek services. This cultural
understanding comes from obtaining information from Mexican immigrant women
living in the United States. Interviews take place in Merced, California and 10 women
are interviewed utilizing open-ended questions. The key findings are that participants
believe that cultural beliefs impact Mexican women’s decision to seek services due to
the stigma associated with mental health services. In addition, the majority of
participants believe that one of the biggest factors that influence Mexican women’s
decision to seek services is the fear of being judged and labeled “crazy” by their
culture which often includes their family. Participants state that although they are in a
country that promotes mental health services, Mexican immigrant women still
experience barriers to seeking mental health services. Implications for policy and
practice should focus on social work education and teaching students the importance
of cultural competence in order to promote best service for this population. Future
research studies should involve Mexican women in general and not be limited to only
immigrant women in order to obtain a better understanding of cultural beliefs and
possibly identify additional barriers to seeking services and deficits in service
delivery by professionals.
ix
CHAPTER I
INTRODUCTION
Statement of Problem
Gaps in service utilization by people of Mexican origin with mental health
problems have been an issue of great attention. Utilization of mental health services is
becoming more important to health planners today due to Mexican Americans being
the most rapidly increasing and largest Hispanic ethnic group in the United States
(U.S.) (Vega, Bohdan, Aguilar-Gaxiola, & Catalano, 2009). Research supports that
there is a wide variety of factors that have contributed to the underutilization of
mental health services by Hispanics living in the U.S. Culture has a great impact on
people of Mexican origin and their decisions to seek mental health services.
According to Vega et al. (2009) the use of natural healers, especially curanderos and
curanderas, was described by researchers as an indigenous treatment system that
replaced the need for formal psychiatric care within the Mexican culture. Also, the
natural support system of Mexican Americans was described by researchers “as
dense, nurturing, and encompassing, thereby lowering the vulnerability of Mexican
Americans to dependence on formal health and mental health care providers” (Vega
et al.,2009, pg. 928). Another explanation for the underutilization of mental health
services by Hispanics is that because the formal mental health system has not
responded to the needs of Hispanics, particularly the monolingual Spanish speaking
and the less acculturated, they turn to family physicians for treatment of their
1
2
emotional distress. In addition, Ramos-Sanchez and Atkinson (2009) concluded that
cultural values, such as family, machismo, folk illness, and religiosity may preclude
Latinos from using counseling services. These studies indicate that people of Mexican
origin ultimately underutilize services for a variety of reasons.
Mexican immigrant women living in the United States, in particular, may
have additional factors that impact their decisions about whether they will consider
seeking help from mental health professionals. The female Mexican population is said
to account for 46% of the nearly 12 million Mexican immigrants living in the United
States (University of California Berkeley, 2010). Collectively, these Mexican women
are characterized by low educational attainment, limited English proficiency, low
naturalization rates, low participation in the formal work force, and the majority live
in low-income households (UC Berkeley, 2010). These characteristics of Mexican
immigrants may negatively impact their emotional well-being as well as their helpseeking behavior.
Several factors would appear to indicate the need for additional services
among this population. Mexican immigrant women face numerous challenges that put
them at increased risk of poor mental health, including low socioeconomic status and
stressors associated with migration and acculturation to the United States. Prevalence
estimates of depressive symptoms among Mexican immigrant women range from
12% to 59% (Ornelas, Perreira, Beeber, & Maxwell, 2009). Research has
demonstrated that this group is significantly more likely to live in poverty and have
lower levels of education than are women of other ethnic groups. Furthermore, they
3
face social isolation and limited access to community resources. Spanish-speaking
immigrant women tend to be more isolated or alienated than the U.S. born, Englishspeaking majority and, therefore, have more limited social networks (Ornelas et al.,
2009).
A study conducted by Ornelas et al. (2009) explored the challenges that
Mexican immigrant women face in order to maintain emotional health. According to
Ornelas et al. (2009), despite their expectations of economic opportunity, many
Mexican women experience economic pressures after arriving in the United States.
Many women arrive with a financial obligation to their families back home, such as
repaying loans they used to finance the trip. Most of these women expressed concerns
about their economic status. These concerns serve as a daily stressor and source of
anxiety.
Ornelas et al. (2009) also found that Mexican women faced social stressors
which included family separation, social isolation, and discrimination. According to
Ornelas et al. (2009), many women were separated from their extended families and
felt socially isolated. Like many Mexican women living in the United States today,
participants in the study faced marginalization and discrimination in their new
communities. It was shared that many women had never lived away from their
parents. They had either lived with their parents or lived geographically close to them
in Mexico. The women’s isolation in the United States presented a stark contrast to
their socially embedded lives in Mexico. This isolation resulted in stress, anxiety, and
loneliness among women (Ornelas et al., 2009).
4
According to Ornelas et al. (2009), another stressful aspect of the immigrant
experience is not knowing English and experiencing discrimination. Mexican
immigrant women who had been discriminated against said it made them feel
ashamed and embarrassed, especially when it occurred in front of their children or
was related to their inability to speak English.
Many of these same factors which contribute to stress and anxiety may also
contribute to hesitation in seeking services. Social isolation and lack of Englishlanguage proficiency likely serve as barriers to seeking services. Another factor
contributing to the underutilization of services by immigrant Mexican women may be
financial constraints. As noted, the majority live in low-income households (UC
Berkeley, 2010), and over half (52.3%) of all adult Mexican women in the U.S. are
not covered by a health insurance system. Mexican immigrant women with less than
10 years’ residency in the U.S. have a noninsurance rate of 64%, which falls to 48%
among those who have been living in the US for over 10 years (UC Berkeley, 2010).
This lack of health insurance coverage may play an important role in decisions about
seeking services.
Many Mexican immigrant women are faced with numerous stressors on a dayto-day basis, but the number of women who seek services is very low. It is important
to explore the factors which impact their decisions about whether to seek services.
While prior literature provides some ideas about potential barriers, which factors
actually contribute to these women’s decisions remains unclear. Directly asking
immigrant Mexican women about their views of western mental health services and
5
about why they would or would not utilize such services could contribute greatly to
finding ways to better meet the needs of these women by reducing the barriers that
they face.
Statement of Purpose
Recent research suggests that Mexican immigrant women living in the United
States face many challenges in maintaining emotional health (Ornelas et al. 2009).
Yet, their utilization of mental health services is very low. The purpose of this study
was to gain knowledge about Mexican immigrant women’s views of western mental
health services and to explore why they would or would not utilize these services.
The three questions that guide this study were 1) What are Mexican immigrant
women’s views and beliefs about existing western mental health services?; 2) What
are the reasons immigrant Mexican women would utilize or would not utilize mental
health services?; and 3) What factors do immigrant Mexican women report impact
their decisions about whether or not to utilize mental health services?
Significance of the Study
The findings of this study not only provide social work practice with more
understanding about the views and beliefs of Mexican immigrant women living in the
United States regarding mental health services, but also offer ways to better meet
their needs. This study is relevant to the profession of Social Work because it will
help social workers obtain more knowledge and understanding of this population.
Social workers seek to assist these women in overcoming their struggles, but in order
to assist, one must be aware of culture and beliefs. Understanding the reasons behind
6
these women’s decisions to seek or not seek mental health services can definitely help
social workers become more effective when working with this population. Therefore,
social workers need to understand Mexican immigrant women’s views on mental
health services and the determining factors that influence their decisions as to whether
they will utilize such services. The findings of this study contribute to the cultural
competency of mental health professionals; therefore, these service providers will be
able to more adequately serve this population. There is a large amount of research
that indicates that Latinos face many barriers when seeking mental services. This
study explored these barriers, and explored Mexican immigrant women’s views about
western mental health as well as their decision making about whether to use such
services by asking Mexican immigrant women directly.
CHAPTER II
REVIEW OF LITERATURE
The purpose of this chapter is to review literature related to utilization of
mental health services by Mexican immigrant women living in the United States. It is
organized around four areas: (a) definition of mental health; (b) the influence of
cultural beliefs on mental health; (c) barriers immigrant women experience in seeking
mental health services; and (d) research related to the topic of utilization of mental
health services by immigrant women living in the United States.
Definition of Mental Health
The World Health Organization (WHO) (2014) defines mental health as “a
state of well-being in which the individual realizes his or her own abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and is able to
make a contribution to his or her community.” According to the World Health
Organization (2014) mental health is an integral and essential component of health.
Mental health and well-being are said to be fundamental to our collective and
individual ability as humans to think, emote, interact with each other, earn a living,
and enjoy life. Promotion, protection, and restoration of mental health can be
regarded as a vital concern of individuals, communities and societies throughout the
world (WHO, 2014).
Determinants of mental health include social, psychological, and biological
factors which determine the level of mental health of any person at any point in time
7
8
(WHO, 2014). The World Health Organization associates poor mental health with
rapid social change, stressful work conditions, gender discrimination, social
exclusion, unhealthy lifestyles, risk of violence, physical ill-health, and human rights
violations. It is also said that specific psychological and personality factors can make
individuals vulnerable to mental disorders. There are also biological causes of mental
disorders, including genetic factors, which contribute to chemical imbalance in the
brain (WHO, 2014).
The Influence of Cultural Beliefs on Mental Health Services
Culture is said to be broadly defined as a common heritage or set of beliefs,
norms, and values, and anthropologists often describe culture as a system of shared
meaning (U.S. Department of Health and Human Services, 2001). The U.S.
Department of Health and Human Services states that culture and society play pivotal
roles in mental health, mental illness, and mental health services (2001). In regard to
mental health,
Some aspects of culture may also underline culture-bound symptoms much
more common in some societies than in others. More often, culture bears upon
whether people even seek help in the first place, what types of help they seek,
what coping styles and social supports they have, and how much stigma they
attach to mental illness. All cultures also feature strengths, such as resilience
and adaptive ways to coping, which may buffer some people from developing
certain disorders. (U.S. Department of Health and Human Services, 2001, p.
133)
9
Cultural and religious teachings often influence beliefs about the origins and
nature of mental illness, and shape attitudes toward the mentally ill. In addition to
influencing whether mentally ill individuals experience social stigma, beliefs about
mental illness can affect patients’ readiness and willingness to seek and adhere to
treatment (Unite for Sight, 2015).
The way mental health is perceived is based on cultural beliefs, and ultimately
plays a big part in utilization of mental health services. The U.S. Department of
Health and Human Services (2001) reports that African-American adults are
overrepresented in vulnerable, high-need populations because of homelessness and
incarceration; yet they are less likely than Whites to receive mental health treatment.
African-American adults frequently receive mental health care in emergency rooms
and psychiatric hospitals, partly because they delay seeking treatment until their
symptoms are severe (U.S. Department of Health and Human Services, 2001). Asian
Americans, Pacific Islanders, and refugees from Southeast Asian countries are at risk
for posttraumatic stress disorder as a result of the trauma and terror preceding their
immigration despite the popular stereotype that, as a group, they are mentally
healthier than other groups. Asian Americans and Pacific Islanders also delay using
services until problems become very serious; both stigma and shame are major
deterrents to their utilization of mental health services (U.S. Department of Health
and Human Services, 2001)
According to the American Psychiatric Association (APA), attitudes about
mental illness and mental health services among the Hispanic and Latino community
10
affect the use of services. Among Latinos, depression may be mistaken for
nervousness, tiredness, or a physical ailment, and is viewed as something temporary
(APA, 2014). Due to the negative stigma associated with mental illness in the
Hispanic community, individuals often rely on their natural supports which include
extended families, community, traditional healers, and churches for help during a
mental health crisis. Having these natural supports allows them address their issues in
a way that is supported by their culture. “In 2001, the World Health Organization
identified stigma and discrimination toward mentally ill individuals as the single most
important barrier to overcome in the community” (United for Sight, 2015, 1).
Barriers When Seeking Mental Health Services
One of the most critical barriers that immigrant Mexican women experience in
regard to seeking mental health services is the lack of knowledge or understanding by
professionals about the risk of trauma Mexican immigrants experience when
immigrating to the United States. According to Moya-Salas, Ayon, and Gurrola
(2013), Mexican immigrants experience trauma in stages. The first stage is the
“premigration” stage, which includes the events prior to migrating that were chief
determinants for migration to the United States. The second stage includes the
traumatic experiences while in transit to the new country. The last two stages include
trauma experienced in the process of seeking asylum and resettlement and trauma
related to the substandard living conditions in the host country due to unemployment,
inadequate supports, and minority persecution (Moya-Salas et al., 2013).
11
Mexican immigrant women face many challenges that put them at increased
risk for poor mental health, including low socioeconomic status and stressors
associated with migration and acculturation to the United States (Ornelas et al.,
2009). Mexican women then face many different barriers when seeking mental health
services. One barrier is the concept of Familism, which is defined as a cultural
construct encompassing responsibility and a sense of duty toward family members
(Ornelas et al., 2009). Ornelas et al. said that women with high levels of familism
sought out informal help and that when discussing issues such a domestic violence
they felt embarrassed, afraid, and ashamed to do so, therefore, not disclosing the issue
and not obtaining help. According to Leong and Kalibatseva (2011), in collectivistic
cultures, bringing attention to individual needs is often construed as being selfish.
Disclosure of personal problems or family dysfunctions to strangers is highly
discouraged, especially in cultures that place a strong emphasis on maintaining group
harmony and firm in-group versus out-group boundaries (Leong & Kalibatseva,
2011).
According to the National Alliance on Mental Illness (2009), Latinas (which
include women of Mexican origin) tend to underutilize mental health clinics for their
emotional problems because of few accessible, culturally appropriate, and affordable
services. In a study by Bauer, Rodriguez, Quiroga, and Flores-Ortiz (2000) it was
stated that immigrant women face significant barriers to mental health and lacked
access to services simply because they were unaware of the available resources.
12
Another barrier that Mexican women experience when seeking services is
impaired communication due to language differences. Bauer et al. (2000) pointed out
that inadequate translation services compromise patient care, interfere with the
diagnostic power of the interview, impair patient education, decrease compliance and
follow-up, and often result in patient dissatisfaction. According to the American
Psychiatric Association, among Spanish-speaking people in the United States, more
than 13 million speak English “not well” or “not at all” (APA, 2014).
Financial barriers also play a significant role in Mexican women not seeking
mental health services, as Latinos have the lowest rate of health insurance coverage
among all other ethnic groups. According to the American Psychiatric Association
(2014), nationally, 33% of Hispanics are uninsured, compared to 16% of all
Americans. Also, individuals of lower socioeconomic status may not be able to spend
time seeking or receiving services because of their need to work one or more jobs or
take care of family members (Leong & Kalibatserve, 2011).
Research Related to Service Utilization
According to the American Immigration Council (AIC) (2014), Mexico was
the single largest country of origin for female immigrants in the United States.
Mexico accounted for more than one quarter (26%) of all foreign-born females in
2012 (AIC, 2014). Also, women from Mexico earned the least amount of income of
all female immigrant groups in 2012, with an annual median income of $21,489
(AIC, 2014). According to the National Alliance on Mental Illness (2009), Latinos
(which includes Mexican immigrants) are identified as a high-risk group for
13
depression, anxiety, and substance abuse. Hispanic women are more likely than
Caucasian or African-American women to experience a major depressive episode.
One study in Provo, Utah was conducted in order to describe immigrant
Hispanic women’s perceptions of having symptoms of postpartum depression and to
identify barriers to accessing mental health services (Callister, Beckstrand, & Corbett,
2011). The sample consisted of 20 immigrant women who scored positive for
symptoms of postpartum depression and who were receiving health care at a
community health clinic but who declined mental health services (Callister et al.,
2011). The women participated in audiotaped interviews of approximately 60
minutes. The interviews consisted of nine open-ended questions; interviews were
conducted at the homes of the study participants.
The results showed that the women in the study identified personal, social, and
health care delivery barriers to accessing treatment for symptoms of postpartum
depression (Callister et al., 2011). In regard to personal barriers the women stated that
they should be able to handle everything, and when they couldn’t they were
embarrassed and felt guilty about their feelings. They reported being hesitant to share
their feelings with family members or professionals and being reluctant to seek
mental health services (Callister et al., 2011). Social barriers, including lack of
support, were a significant barrier for participants. Participants sought help from their
families rather than health care providers, but many reported feeling isolated and
lacking social support. They described a sense of social isolation and reported feeling
very much alone. It was also stated that traditional social networks are often
14
compromised for immigrant women because of family separations. The researchers
also pointed out that the health care delivery system was a barrier for immigrant
women. Participants identified financial and time constraints as well a lack of child
care and transportation as barriers to seeking services.
Another study, conducted in northwest Arkansas, focused on assessing the
mental health needs, service utilization rates, satisfaction with services, and perceived
barriers to help-seeking among immigrant Hispanic adults (Bridges, Andrews, &
Deen, 2012). Eighty-one participants participated in a multimethod (self-report,
semistructured interview, open-ended questions) assessment. A total of 54 women
and 27 men were interviewed; 84% of the participants had emigrated from Mexico
(Bridges et al., 2012).
The results in regard to prevalence of mental illness showed that one third
(33%) of the participants met current criteria for a psychiatric disorder (Bridges et al.,
2012). More specifically, 18.5% of participants met the criteria for Major Depressive
Disorder, 9.9% met the criteria for Posttraumatic Stress Disorder, and 23.5% met the
criteria for Generalized Anxiety Disorder. Furthermore, 40.7% of the female
participants met the criteria for a current mental illness, compared with 18.5% of
male participants (Bridges et al., 2012). For service utilization, 42% of the
participants reported consulting with a physician for a chronic illness such as
diabetes, allergies, migraines, or pain; 12.3% of participants reported utilizing
alternative healers for health-related concerns such a gastrointestinal and body aches
and pains (Bridges et al.). Mental health care provided by counselors and therapists
15
were used by 23.5% of the sample, and the most frequent reasons for utilizing
services were for depression, family problems, and domestic violence (Bridges et al.).
Bridges et al. (2012) also assessed satisfaction with services by the
participants. For participants who sought specific services, satisfaction rates were
highest for services provided by counselors and therapists. Participants were similarly
satisfied with help they received from religious healers. Lastly, barriers to utilization
of services also played a role in participants’ help seeking behaviors (Bridges et al.).
Economic barriers were commonly identified by the sample: 58% of participants
reported that services were too costly and 35% were impeded from seeking services
because of the lack of health insurance. Participants also identified additional barriers
to utilization of services by Hispanic immigrants. These included the lack of Spanishspeaking providers (31.3%), a belief that services would not be helpful (6.3%), lack
of knowledge about helping services (3.8%), fear of being deported (6.2%), and lack
of transportation (6.2%) (Bridges et al., 2012).
Conclusion
Mexican immigrant women’s hesitation to seek mental health services
continues to be a problem in this country. Although mental health awareness is
growing in the United States, there is still much more that needs to be done.
Exploring Mexican immigrant women’s views on western mental health services may
bring more awareness of the need to educate the Mexican community as a whole
about mental health and to provide services as Mexican immigrant women are at
higher risk of developing mental health disorders. Mexican immigrant women living
16
in the United States may have important information as to what their cultural beliefs
are in regards to mental health and how their beliefs may influence the decision to
seek help when Mexican women immigrate to the United States.
CHAPTER III
METHODOLOGY
Mexican immigrant women face many challenges that put them at increased
risk of poor mental health, including low socioeconomic status and stressors
associated with migration and acculturation to the United States (Ornelas et al., 2009)
The purpose of this study was to gain knowledge about Mexican immigrant women’s
views of western mental health services and to explore why they would or would not
utilize these services. The study also examined what factors influenced Mexican
immigrant women’s decisions to use these services or not. The three questions that
guided this study were 1) What are Mexican immigrant women’s views and beliefs
about existing western mental health services?; 2) What are the reasons immigrant
Mexican women would utilize or would not utilize mental health services?; and 3)
What factors do immigrant Mexican women report impact their decisions about
whether or not to utilize mental health services?
Design
An exploratory design was used in this study because it allowed for discussion
of the attitudes and beliefs about mental health services among Mexican immigrant
women living in the United States. Standardized open-ended interviews were
conducted to explore participants’ perceptions on western mental health services and
on factors that influenced their decisions about whether they would use such services
or not. According to Rubin and Babbie (2008) an advantage to conducting
17
18
standardized open-ended interviews is that interviews are conducted in a consistent,
thorough manner with a minimum of interviewer effects and biases.
Sampling
The sampling plan consisted of a nonprobability sampling technique. This
study obtained participants by using snowball sampling. Snowball sampling is a
technique that begins with a sample with a few relevant participants one has
identified and then expands through referrals (Rubin & Babbie, 2008). It was
intended that the study would consist of 10 to 12 Mexican immigrant women ages 20
to 60, residing in Merced County. The first few participants would be recruited by the
author identifying specific individuals who were relevant to the study; then, others
would be recruited through referrals from initial recruits. Potential participants were
provided with the researcher’s name, phone number, the time frame of the study, and
purpose of study. They were asked to contact the researcher if they were willing to
participate.
Participants resided in Merced, California. Participants had to be Mexican
immigrant women. The interviews were facilitated in either Spanish or English,
whichever the participant preferred. Participants needed to provide information and
communicate their views or beliefs regarding the questions that were asked.
Data Collection and Instrumentation
It was important to choose an accessible setting for the interviews and a place
where participants felt safe and comfortable to talk about their views and beliefs. The
participants were given the opportunity to be interviewed in their homes or at the
19
Merced County Library. When the author identified potential participants, they were
contacted in order to set up a time and place where the interviews would take place.
Participants were informed that the interviews would last approximately 1 hour.
The first step in conducting the interview was discussing confidentiality and
participant rights. Participants were given a consent form printed in either English or
Spanish (see Appendices A and B) to read and any questions that arose were
answered. The participants had the choice to have the interview conducted in Spanish
or English. Participants were also informed that the interview would be audio-taped if
allowed by them. After explaining the study and obtaining informed consent, the
interviewer proceeded to ask the participants a series of questions (see Appendix C
and D for English and Spanish versions) that were aimed at exploring the research
questions.
Plan for Data Analysis
Neuman’s (2003) five-part approach for data analysis was used to create
themes during qualitative data analysis. These steps included a) Sorting and
Classifying, b) Open Coding, c) Axial Coding, d) Selective Coding, and e)
Interpreting and Elaborating. The first step involved gathering all the data and
organizing it around the research questions. The second step was going over the data
in order to identify themes and assign initial codes or labels. The third step was again
going through the data and focusing on the initial codes in an attempt to develop
additional codes or new themes in order to begin organizing themes and identifying
key concepts. The fourth step was scanning through data and previous codes in order
20
to identify direct quotes to support the themes. The final step consisted of examining
the major themes and categories in the context of the existing literature in order to
draw comparisons and contrasts. Findings were presented in narrative form and used
direct quotes were used to highlight findings.
Protection of Human Subjects
When the interviews were conducted the interviewer first gave the participants
information regarding the purpose of the study and their rights. Participants were
given a consent form in either Spanish or English depending on their preference.
Participants were made aware that their participation was entirely voluntary and that
they could refuse to participate in the interview or withdraw from the interview at any
time without any penalty. Participants were given information about the duration of
the interview and were informed that the interview would be audio-taped if they
consented. Potential harm that might arise from participating in the interview was
discussed. Participants were informed that if any stress arose from the interview,
information would be provided that would link them to services if needed. Most
importantly, participants were informed that all data collected would be protected
from any inappropriate disclosure and that their names would not be linked to the
answers they provided. Participants were informed about confidentiality and made
aware that their names or any other identifying information would not be use in the
reporting of the results. At the end of the study, the data were only viewed by the
researcher and the thesis advisors. All notes and audio-tapes were destroyed at the
end of the study after the thesis was completed.
CHAPTER IV
RESULTS
This chapter presents data obtained from standardized open-ended interviews
with Mexican immigrant women living in Merced, California. This study was guided
by the following major questions: 1) What are Mexican immigrant women’s views or
beliefs about existing western mental health services?; 2) What are the reasons why
Mexican women would utilize or not utilize mental health services?; and 3) What
factors impact Mexican women’s decisions about whether or not to utilize mental
health services? Specific interview questions were designed to address each of the
major research questions of this study. Findings are organized around the research
questions.
The Sample
The sample for this study included Mexican immigrant women residing in
Merced, California. The first few participants were recruited by this author
identifying specific individuals who were relevant to the study, and then more
referrals came from those initially recruited. When participants were initially
recruited they were given the researcher’s name, phone number, the time frame of the
study, and the purpose of the study. The participants who were referred contacted the
author by phone, and the interviews were scheduled either in their homes or at the
Merced County Library. Ten Mexican immigrant women participated in the
21
22
interviews. The following analysis includes excerpts of the responses given by the
participants to the research questions addressed in the interviews.
Mexican Women’s Views on Mental Health Services
The first major question was, What are Mexican immigrant women’s views or
beliefs about western mental health services? The first major theme in the response to
this question was that participants felt that seeking services was beneficial for issues
that were too difficult to resolve within their family circle. Participants agreed that
when the problems were too difficult for them to solve on their own, it was best to
seek help from counselors and psychologists. A participant stated, “not a friend, not a
neighbor, can give you the advice that a counselor or psychologist gives us.” Another
participant stated, “You recognize you have a problem that you can’t treat yourself,
so then you look for help from someone, someone that specialized in that.” Another
participant also shared, “there comes the time when we become an adult and
sometimes you say, I can do it, but sadly enough, you can’t without the help of a
counselor.” Participants believed that some problems were so difficult that even with
the help of family they were very difficult to overcome, and that individuals had no
choice but to seek help. A participant shared,
They have problems that are very hard that they can’t resolve themselves.
They need help to move forward. I imagine that if they want to move forward
and seek help it’s because they feel they definitely can’t do it on their own.
The second major theme was that many immigrant women believed the most
common reasons why people, in general, sought mental health services were due to
23
depression, suicide, and domestic violence. Participants believed that depression,
suicide, and domestic violence were issues that needed professional help. One
participant shared,
Sometimes being a kid means carrying a lot of trauma from physical,
emotional, and sexual abuse and it’s really hard for one to overcome that
because some people then experience blackouts, aggressive behavior, thoughts
of suicide, and depression as a result of all the trauma.
Another participant stated, “when I first told my sister I was seeing a psychologist
and that I was depressed, she said, if you want to take your life away, cut your veins,
here is the knife, just kill yourself now.” Participants believed that any issues aside
from depression, suicide, and physical abuse were problems that they could resolve
on their own and did not need professional help. If services were sought it was
because of symptoms of depression, suicide, and physical abuse, but nothing else.
Another participant shared, “you seek help when you suddenly realize you’re having
thoughts of suicide, thinking of hurting yourself, and of hurting others.” Participants
also believed that seeking help due to depression was very common. One participant
stated, “stress is one reason for seeking services, but depression, too. Depression,
depression due to postpartum, depression because of your child, depression because
of your husband, or even because of violence.”
The third major theme was that although participants believed that mental
health services were beneficial, their culture as a whole continued to perceive it as
negative and unnecessary. A participant stated, “they always would say, a good
24
spanking, some good belt whipping, and a hard hand, so that they can succeed and
that’s not true.” Participants agreed that their culture believed they could handle their
problems on their own if they really wanted to. One participant shared,
I was going through a very difficult depression, and a lot of Mexicans would
ask me why I would go to counseling. [They would say] that counseling
doesn’t work, and that I could mentally overcome it on my own. But
sometimes you do need that counselor, that psychologist, and sometimes even
medication.
Participants believed that because mental health services were so negatively
perceived by their culture, even when people recognized obvious signs, they often did
not address the issue. One participant shared, “If someone needs help, we can’t act
like we don’t see it and, instead, we need to seek help. They need the help; we need
help so that we don’t close our eyes to when we see a problem.” Participants agreed
that even when people were open to the idea of mental health, they could not ignore
all the negative things their culture has taught them about mental health. A participant
stated,
In my culture you’ve never heard anything good about this. In my culture, like
I’ve told you throughout this interview, it’s the worse. My culture counts for
90% of the reason why I would not do it, because I would be afraid. Afraid of
what? I don’t know, but that’s something that I’ve never thought about or even
considered.
25
The fourth major theme in relation to mental health services was the belief
that people who sought mental health services were “crazy.” Nine out of the ten
participants agreed that their culture continued to have the belief that if you sought
help from a counselor or psychologist it was because you were truly “crazy.” A
participant shared,
Look, a lot of people think it’s bad. And right away, the first thing they say is
‘no I’m not crazy’. But that’s not the point or reason. It’s not because one is
crazy. It’s because one really needs the help.
Participants believed that if a person was labeled “crazy” for seeking out services, he
or she would be alienated by their own culture. One participant shared,
Well, in my culture they always hid them. They wouldn’t take them out of
their homes. They would be locked in their homes. If they went out, the whole
world would be scared, and say ‘oh, he’s crazy,’ and the whole world would
be scared of them. Instead of helping them, we are probably making them
worse.
One participant believed that seeking help really helped her through her depression
despite being labeled as “crazy,” and she reported she struggled with trying to get her
partner to seek services for himself. She stated,
The man that I’m with, I tell him to go see a psychologist because he’s been
traumatized really bad since he was a kid. He’s had a lot of trauma but he
doesn’t want to go see a psychologist. Because he’s Mexican, from Oaxaca,
and more closed minded.
26
Participants believed being labeled as crazy was one of the main reasons why people
of the Mexican culture did not seek mental health services.
Utilization of Mental Health Services by Mexican Women
The second guiding question in the current study was, What are the reasons
why Mexican women would utilize or not utilize mental health services? The first
reason identified regarding why Mexican women were not utilizing services was that
whatever problem they were going through was normal and nothing they could not
have handled on their own. For example, a participant stated, “Because they think that
everything that is happening to them is normal. If they get pushed, if they get yelled
at, it’s normal to them.” Participants believed that Mexican women normalized any
negative physical changes in their body or drastic change in mood. A participant
explained this well when she reported,
I think they think that any change is normal, that any hormonal change is
normal, and that’s the reason the changes are happening. They don’t treat
themselves on time, and then time goes by, and they think that little by little
it’s going to go away or that it’s going to pass.
Participants believed that Mexican women see their problems to be normal until
something very serious happens. A participant shared, “there is a moment, when
unfortunately one ends up in the hospital or the police intervene because the abuse is
much stronger and then that’s when one begins to recognize that it’s out of your
hands.” Another participant reported, “Maybe by going to get help they are actually
agreeing there is a problem.”
27
The second reason participants gave for Mexican women not utilizing services
was shame. Participants believed that women were affected by what others might say
about them seeking services and did not want to feel embarrassed. One participant
stated,
Well, the culture affects you. You’re embarrassed, embarrassment of what
other people are going to say. What is the neighbor going to say? What are my
friends going to say? That I have a problem or that my kids have a mental
disorder. Most of all, embarrassment.
Another participant shared, “Fear that, for example, that people will find out, your
friends, that you are seeking services.”
The third reason participants gave for Mexican women not utilizing services
was the fear of being judged. Participants believed that women were judged even by
their own families if they sought mental health services. A participant shared,
We are judged, I go back to the same thing. They judge us because they say
we need attention, that we are overdoing it, that whatever we are going
through is not that painful, that we have to get other people’s attention.
Another participant reported,
I think we are judged. People would think that maybe we are acting dumb, that
we are exaggerating, that we do not need to be doing that. That’s what people
would think. For me, what I think they would say is, ‘that little problem or
symptoms, she can fix that on her own.’
28
The fourth reason for not utilizing services was due to the concept of
machismo. Participants believe that a woman had to first take care of the needs of her
husband and children before she took care of herself. One participant reported,
It’s part of the culture to say that you are not sick, that you have to care for
your kids, that you have to cater to your husband, that you have to be at home,
and then you don’t even realize that you have a problem or that you need
mental health services.
Another participant shared,
A mother always has to be thinking, what I am going to do tomorrow, what I
am going to cook, I have to wash, I have to iron, I have to attend to my
children, I have to attend to my husband, I have to go pay the bills, I have to
go shop, that I have to do a lot of things and that’s when you don’t realize you
have stress.
Participants also believed that by their husbands having the sense of power and
control it was even more difficult to seek services, especially if their partner was not
open to it. A participant shared,
Us Mexican women are used to or are raised with the idea that we are only
housewives; that the man can boss us around. And since we are kids, us the
women, we are the most traumatized. It’s because the man has to always be on
top and us women have to be below listening to them.
Another participant shared, “Like in the Oaxaca culture, because of the partner I have
right now, I have to ask him for permission if I want to go anywhere. I don’t think
29
that’s right.” Participants believed that if their partners were not being open to
services, they would not seek services because that would bring about marital
problems.
The fifth reason for Mexican women not utilizing services was the fear of
being labeled “crazy.” The participants believed that no matter how small or big the
problem was, if they sought any type of mental health services, whether it be a
counselor, psychologist, or psychiatrist, they would be labeled “crazy.” Participants
believed that due to the lack of discussion around mental health in their culture people
just have been programmed to call people crazy. A participant shared, “Since we
don’t have words for people who seek them, we just refer to them as the crazy
people.”
The first and only reason participants identified as a reason why Mexican
women would utilize mental health services was because it gave them a sense of
worth and helped boost their self-esteem. A participant shared, “Ever since we were
little, we were always humiliated. They treated us wrong, and when you get help from
psychologist, one starts to value yourself, and you start loving yourself.” Another
participant stated, “they [counselors or psychologists] teach you that we both have the
same value, both the man and the woman, that we both work, that we both are worth
the same, and that we both talk about the same issues.”
Factors Impacting Utilization of Mental Health Services
The third major question was, What factors impact Mexican women’s
decision to utilize mental health services? The first major factor in Mexican women’s
30
decision to utilize services or not was their immediate family members’ thoughts on
services. The participants whose husbands or mothers were open to mental health
services stated that they would not hesitate to seek services if they felt they needed
them. A participant shared, “she [her mother] would be okay with it, because it’s
going to benefit me and help me.” Another participant stated, “I think my family
would support me, especially how I am now with my husband. It would help my
family and improve our interactions.”
Participants also believed that if they had a good relationship with their
husbands they would be more in agreement about utilizing services. For example, one
participant shared that when she decided to seek mental health services it had been
discussed with her husband. She stated, “My husband and I, we decided it together.
He was super in agreement. Sometimes it is good to seek for a third opinion, so that
someone can listen to you.” Participants whose immediate families were not open to
mental health services would more likely not have utilized services or would have
kept that information from them. One participant shared, “I don’t think I would tell
my family if I did go in, or if I needed counseling.” Another participant shared how
her husband’s thoughts about services impacted her decision to not utilize services as
she stated,
Honestly, I would think that he would say that I was crazy, that I’m
exaggerating, that I don’t need to be telling other people, or looking for help
where I’m not supposed to, because I’m always seeing things for more than
what they are.
31
Overall, participants believed that their immediate families impacted their decision to
utilize services or not to utilize mental health services.
The second factor that impacted Mexican women’s decision to utilize services
was whether the women recognized they or a child had experienced some sort of
trauma. Two of the participants who shared that they had sought services for
themselves also were able to recognize they had experienced trauma and that they
needed to process it in order to move on with their lives. A participant shared,
When I was 6 years old an uncle abused me by touching my body. I did not
understand this until I got married. That’s when I realized I had been abused.
Thank God for the psychological help that I received that I was able to move
on. I was able to understand that it was not my fault, that I was only 6 years
old, and that I had to move on.
Another participant shared, “when I began talking to my psychiatrist, my psychiatrist
began opening doors that I had closed from my childhood years.” A third participant
shared that she had sought services for her son due to his drastic change in mood and
behavior. The participant shared,
I noticed that he would suddenly feel a little depressed and he felt that I did
not want him. Suddenly he was also a little rebellious so he went to a
counselor. Then they told me that it was normal because he was entering
adolescence; I then felt calm.
32
The other seven participants shared that they had not sought out services because they
believed they did not need them. A participant stated, “No, I have never thought
about it.” Another participant shared, “I don’t feel I need it.”
The third factor that impacted women’s decision in relation to utilizing
services was the fact that they felt they were in a country that was open to mental
health services and that encouraged people to seek out services. A participant shared,
“In this country, they open our eyes and we know that there is help for everyone and
that one does not have to worry about any type of consequences.” Another
participant also stated, “we are in a country where things are a lot different. There are
more workshops, discussions, or people who motivate you to seek services.”
Participants also believed that if they were back in their country (Mexico) they would
be less likely to utilize services due to the negative stigma. One participant shared,
My mom says it’s okay to get services because if it helps you to move forward
then good, because sadly enough, the place she currently lives it’s impossible
to seek services. So that’s why it’s better to keep quiet and let life go on.
The fourth factor that had an impact in utilization of services was language.
Participants believed that their inability to speak English negatively impacted their
decision to seek services because they would not have been able to communicate their
needs to professionals and they believed they would not have been understood. A
participant shared,
Mexican women that come from Mexico don’t speak English. We don’t speak
English; then we are going to be embarrassed when someone has to interpret
33
for us. You would think that because interpreters are so common now, we
would not be embarrassed to let them know our mental problems.
Participants also believed that the language barrier impacted one’s decision to utilize
services because not only were there few professionals that spoke their language, but
that if they did, they didn’t understand the context of the information they received. A
participant explained it very well by sharing, “we need to be trained, somebody has to
tell us, somebody that speaks our language, not just Spanish, and it’s talking the
Spanish that our culture understands.”
The fifth major factor that impacted women’s decision to utilize services was
their financial situation. Participants believed that if services were more affordable or
free of cost, they would be utilized a lot more frequently by their culture. A
participant shared,
There are no funds, as Hispanic or Mexican we think, with what I’m going to
pay for a psychologist I’d rather buy a pound of tortillas or a gallon of milk.
And that’s why a lot of times we Hispanics don’t go see counselors or doctors,
because there are no funds.
Participants believed that even if they sought services, financially they would not be
able afford them. Another participant stated,
I hope to God that there are programs that help people. Because there are
people like me that are low income and we don’t have the resources to pay for
a counselor. There isn’t. There are hardly any programs like that, and if there
is, maybe we don’t know about them.
34
The final major factor that impacted women’s decision to utilize services was
the lack of knowledge and understanding of mental health services. Participants
believed that if they were educated and informed about mental health services, people
would be more receptive to utilizing services offered in their community. A
participant stated, “First, we are not informed. We were not informed because
commonly one that is from Mexico, we come without knowing about a lot of things.”
Another participant also shared, “A lot of times a lot of people take too long to go get
help because they are not familiarized with counseling or anything like that, with
psychologists or anything else. They don’t believe in that.”
Lastly, participants believed that the reason for the lack of knowledge about
mental health services was due primarily to their culture’s belief that it was
something to be ashamed of; therefore, it was never discussed in their families. A
participant shared, “in my family there is a person that I think needs help, but my aunt
says, ‘my son is okay.’ And so you really can’t go forward and talk about it because
it’s something that you just don’t talk about.”
Summary
Data obtained through the interviews allowed participants to share their
beliefs and experiences regarding underutilization of mental health services.
Participants believed that underutilization of services was due to cultural beliefs,
family roles, language barriers, lack of knowledge regarding mental health services,
and a lack of culturally sensitive service providers.
CHAPTER V
DISCUSSION AND RECOMMENDATIONS
The primary purpose of this study was to explore Mexican immigrant
women’s views on western mental health services and factors that influenced their
decisions to seek services. During the study, participants were asked 16 questions in
order to address the three major research questions. Participants described mental
health as a topic that was almost not allowed to be talked about in their culture.
Participants believed that mental health services were beneficial and that bringing
more awareness about mental health would assist in shifting cultural beliefs about
mental health services. Participants also described how individuals were shamed and
judged if they sought out services, and often were labeled as crazy. Participants
believed that women who sought out services would develop greater self-esteem and
self-worth as they would be able to process and overcome adversity. Although
participants reported being open to mental health services due to living in a country
which promoted mental health, they agreed that there are still barriers that Mexican
immigrant women face when seeking services. In the following section three major
findings are discussed, along with the strengths and limitations of the study. The
section concludes with the implications for social work practice and policy and for
future research.
35
36
Major Findings
Cultural Beliefs about Mental Health Services
The first major finding of this study was that cultural beliefs about mental
health services played a major role in participants’ views about mental health
services. The participants spoke about the beliefs they were taught when they were
growing up and how their culture perceived mental health services in a negative light
and as unnecessary. For example, a participant expressed that in the Mexican culture
mental health services would only be beneficial for serious issues that could not be
resolved within the family circle. Participants also shared that the only issues needing
additional support would be issues around depression, suicide, and domestic violence.
In regard to the participants, nine of the ten agreed that being labeled “crazy” for
seeking mental health services was one of the major reasons for women’s hesitation
to seek out services.
All participants agreed that the Mexican community as a whole continues to
struggle with the idea of seeking mental health services. According to the American
Psychiatric Association (2014), Mexican women deal with the stigma associated with
mental illnesses, and many rely on extended family, traditional healers, and churches
instead of seeking professional help. Having these natural support systems available
to them is beneficial as is allows for some sort of intervention.
Shame, Machismo, and Labels
The second major finding of this study was that participants believed Mexican
immigrant women did not utilize services due to shame, machismo, and being labeled
37
as “crazy.” Participants believed that admitting or sharing that they received some
type of mental health services brought shame and embarrassment. According to Bauer
et al.,(2000), traditional gender roles in Mexican families influenced Mexican
women’s willingness to seek out mental health services because they believed that
they would be bringing shame upon themselves, their families, and their community
by disclosing their situations. The findings in this study support prior research that
has found Mexican women’s fear of being shamed and labeled by their culture as a
major factor in their decision to seek mental health services. Participants believed that
seeking professional help was admitting that one was not strong enough to resolve the
issue within their family circle. Participants also believed that if services were
actually utilized by an individual, they would automatically be judged and labeled
“crazy” no matter what the reason for seeking services was. Participants shared that a
lot of judgement would come from their own families and partners.
One of the biggest reasons for Mexican immigrant women not utilizing
services was due to the concept of machismo. Participants believed their culture
continued to have the expectation that women should be able to take care of their
families, to be the problem solvers for their families, and most importantly to not give
others reasons to judge them or their families. Callister et al. (2011) found that in the
Mexican culture, motherhood was viewed as a valued and respected role and were
said to be “essential to the integrity of the family unit”, therefore, seeking services
was difficult.
38
Barriers Based on Cultural and Social Beliefs
The third major finding of this study was that the majority of the participants
indicated their cultural beliefs were a barrier to seeking mental health services. They
also identified language, finances, and education as barriers. According to Bridges et
al. (2012), Mexican women’s barriers to service utilization included services being to
costly, lack of insurance, lack of Spanish speaking providers, belief that services
would be unhelpful, lack of knowledge about helping services, and fear of being
deported. Participants also shared that their immediate family’s thoughts about
services impacted their decision about whether to seek services or not. Participants
believed that women’s lack of acceptance and recognition of trauma served as
barriers to seeking services. All participants shared that a major factor that impacted
Mexican immigrant women’s decision to utilize services was a lack of knowledge
around mental health and mental illness. Participants believed that if members of their
culture were more educated about mental health they would be more receptive to
services.
Strengths and Limitations
There were three main strengths to this study. The first strength involved the
expansion of the knowledge base about mental health services in relation to Mexican
immigrant women. This study was unique in that it examined the cultural beliefs of
Mexican immigrant women residing in Merced, California. The second strength of
this study was that within a safe environment participants were able to vocalize their
beliefs and perspectives on mental health services and articulate their responses in
39
their own words. Participants were also able to reflect on their own personal
experiences or what they had learned through their culture. An additional strength of
this study was that it provided an international perspective on mental health services
and will add to the literature and research that focuses on Mexican immigrant women
and their beliefs about western mental health services.
There were two primary limitations of this study. The first limitation was that
it was based on the beliefs of only 10 Mexican immigrant women residing in Merced,
California. Unfortunately additional immigrant women could not participate in this
study due to the limited time frame. Since the time frame of the study was limited,
only those who were initially recruited and those that were then referred were able to
be part of the study. There is a possibility that more Mexican women may have
participated if more participants were initially recruited as there is a large population
of immigrant women in Merced, California. The second limitation to the study was
that only immigrants were allowed to participate in the study. Opening the study to
women with any Mexican origin and not limiting it to immigrant women would
provide a broader understating of cultural beliefs impacting the utilization of mental
health services. These Mexican women’s cultural beliefs about mental health services
may not portray the majority of the beliefs of Mexican immigrant women in regard to
mental health services and cannot be generalized to all immigrant women residing in
Merced, California.
40
Implications for Practice and Policy
There are implications for social work practice and policy that can be taken
from this study. First, information about the cultural beliefs of Mexican women who
immigrate to the United States will assist social workers who serve Mexican
immigrant women and their families. Service providers must advocate for policies
that allow families to work legally in this country, secure health care and education,
and support the development of healthy individuals. The findings of this study are
meaningful and important to direct social work practitioners because immigration and
acculturation affect families as a whole. For the social work profession, these findings
suggest that the profession should prepare individuals for social work practice that are
culturally competent as there is a large population of Mexican immigrant women in
California. Social work education should focus on teaching students how to assess
cultural beliefs with people from different countries, but most importantly to be
culturally sensitive in order to provide the best services possible. This study can assist
practitioners to develop and implement culturally relevant programs to promote the
positive mental health of Mexican immigrant families and assist these women in
building natural supports within their communities.
Findings of this study support the idea that community organizations need to
focus on promoting more outreach to the Mexican community in order to provide
psycho-education around this topic and to inform the community of the different
services and resources that are available to them within their communities. Lastly,
these findings continue to support efforts to increase the number of bilingual
41
professionals who understand the culture and who can incorporate some traditional
interventions into their practice, as that continues to be one of the biggest barriers
within the Mexican community.
Implications for Research
Implications for future research in this area are extensive and very important
since more information regarding mental health services will benefit Mexican women
who have immigrated and will continue to immigrate to the United States. Social
work practitioners will also have more information that will assist them in better
serving this community; as well being able to make appropriate referrals to different
services. According to the American Psychiatric Association (2014), Latinos, which
include Mexican immigrant women, make up 15% of the U.S. population and are the
fastest growing minority in the nation. It is important that social work practitioners
are culturally sensitive when working with this population. It is extremely important
to understand the cultural beliefs that people bring with them from their motherland
in relation to immigration to the United States, and the daily barriers they experience
in their new country.
Specific research could be focused on Mexican immigrant women who have
resided in the United States for many years, immigrants who have recently migrated
to the United States, and immigrant women of different socioeconomic status.
Information from a more diverse sample could assist in gathering additional
information that may or may not be similar to the cultural beliefs obtained from the
participants in the current study. Women who have been in the United States for a
42
longer period of time might have different cultural beliefs than women who have
been in the United States for a shorter time. Future research related to the topic of
mental health services has significant potential to build on current knowledge to be
able to apply the findings to agencies where Mexican immigrant women might seek
services to ensure that they receive the professional help that they need.
REFERENCES
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REFERENCES
American Immigration Council. (2014). Immigrant women in the United States: A
portrait of demographic diversity, 1-9.
American Psychiatric Association (2014).Mental Health Disparities:
Hispanics/Latinos.
Bridges, A., Andrews, A., & Deen, T. (2012). Mental health needs and service
utilization by Hispanic immigrants residing in mid-southern United States.
Journal of Transcultural Nursing, 23(4), 359-368.
Bauer, H. M., Rodriguez, M. A., Quiroga, S. S., & Flores-Ortiz, Y. G. (2000).
Barriers to health care for abused Latina and Asian immigrant women.
Journal of Health Care for the Poor and Underserved, 11(1), 33-44.
Callister, L. C., Beckstrand, R. L., & Corbett, C. (2011). Postpartum depression and
help-seeking behaviors in immigrant Hispanic women. Journal of Obstetric,
Gynecologic, and Neonatal Nursing, 40(4), 440-449.
Leong, F. T. L., & Kalibatseva, Z. (2011). Cross-cultural barriers to mental health
services in the United States. Cerebrum: The Dana Forum on Brain Science,
2011, 1-13.
Moya-Salas, L., Ayon, C., & Gurrola, M. (2013). Estamos traumados: The effects of
anti-immigrant sentiment and policies on the mental health of Mexican
immigrant families. Journal of Community Psychology, 41(8), 1005-1020.
National Alliance on Mental Illness. Women & Depression. (2009). Retrieved from
45
http://www2.nami.org/Template.cfm?Section=Women_and_Depression&Tem
plate=%2F ContentManagement%2FContentDisplay.cfm&ContentID=88285
Neuman, W.L. (2003).Social Work Research Methods: Qualitative and Quantitative
Approaches, Boston: Pearson Education.
Ornelas, I. J., Perreira, K. M., Beeber, L., & Maxwell, L. (2009). Challenges and
strategies to maintain emotional health: Qualitative perspective of Mexican
immigrant mothers. Journal of Family Issues, 30, 1556-1575.
Ramos-Sanchez, L., & Atkinson, D. R. (2009). The relationship between Mexican
American acculturation, cultural values, gender, and help seeking intentions.
Journal of Counseling and Development, 87, 62-71.
Rubin, A. & Babbie, E.(2008). Research Method for Social Work (6th ed.). Belmont,
CA: Brooks/Cole Cengage Learning.
Unite For Sight.(2015). Cultural perspective on mental health. Retrieved from
http://www.uniteforsight.org/mental-health/module7
University of California, Berkeley, School of Public Health. Fact sheet migration and
health: Mexican immigrant women in the U.S. Retrieved October 3, 2010,
from the Web site: http://hia.berkeley.edu/
U.S. Department of Health and Human Services. (2001).Mental health: Culture, race,
and ethnicity: A supplement to mental health: A report of the Surgeon
General.
46
Vega, W. A., Bohdan, K., Aguilar-Gaxiola, S., & Catalano, R. (1999). Gaps in
service utilization by Mexican Americans with mental health problems.
American Journal of Psychiatry, 156, 928-934.
World Health Organization.(2014). Mental health: Strengthening our response.
Retrieved April 22, 2015, from http://www.who.int/
mediacentre/factsheets/fs220/en/
APPENDICES
48
APPENDIX A
INFORMED CONSENT
Nancy Murillo
801 W. Monte Vista Avenue
Turlock, CA 95382
02-09-2015
Dear Participant:
You are being asked to participate in a research project that is being done to fulfill requirements for a
Master’s degree in Social Work at CSU Stanislaus. We hope to learn how to better understand
views/beliefs of Mexican immigrant women about western mental health services. If you decide to
volunteer, you will be asked to participate in a one-time interview related to the study to provide your
perspective. The results of this study will be used to develop recommendations for social workers who
provide services to Mexican women who immigrate to the United States. The interview will take
approximately one hour during which you will be asked to answer a list of questions related to your
beliefs/views about western mental health services.
There are no anticipated risks to you for your participation in this study. However, if any questions
make you feel uncomfortable you may decline to answer it. You may also withdraw at any time with
no penalty or loss of benefits of any kind. If you have any uncomfortable feelings after the completion
of the interviews you may contact Golden Valley Health Center, 847 W. Childs Avenue, Merced, CA,
(209)383-7441for services.
It is possible that you will not benefit directly by participating in this study. The information collected
will be protected from all inappropriate disclosure under the law. All data will be kept in a secure
location. Your identity will not be linked to the answers you provide. If you agree to participate you
will be audio-taped if you consent to it. The information gathered with the audio-tape will be
transcribed and discussed in major themes and categories and the findings will be presented in
narrative form and direct quotes. During the completion of the study the collected data will be kept in a
locked file cabinet and will only be reviewed for research purposes. All data will be maintained until
the completion of the study when the thesis is filed with the Graduate School. After that time all notes
and audio-recording will be destroyed.
There is no cost to you beyond the time and effort required to complete the procedure(s) described
above. Your participation is voluntary. Refusal to participate in this study will involve no penalty or
loss of benefits. You may withdraw at any time without penalty or loss of benefits.
If you agree to participate, please indicate this decision by signing below. If you have any questions
about this research project please contact me, Nancy Murillo, at (209)628-9594 or my faculty Sponsor,
Dr. Robin Ringstad, at (209)667-3355. If you have any questions regarding your rights and
participation as a research subject, please contact the Campus Compliance Officer by phone (209)6673747 or email [email protected].
Sincerely,
Nancy Murillo
Master of Social Work Student
Participant Signature: ___________________________ Date: _________________
49
APPENDIX B
INFORMACION DE CONSENTIMIENTO
Nancy Murillo
801 W. Monte Vista Avenue
Turlock, CA 95382
02-09-2015
Estimado participante:
A usted se le a pedido participar en este projecto de investigación que es parte de mi requisito para mi
tesis de Maestría en Trabajadora Social en la Universidad Estatal de California, Stanislaus. Esperamos
aprender como entender las creencias culturales que las mujeres inmigrantes Mexicanas tienen sobre
los servicios de salud mental occidental. Si usted desea ser voluntaria, al participar, se le pedirá que
participe en un entrevista en relación a este estudio para ayudarnos a desarrollar recomendaciones for
trabajadores sociales que proveen servicios a mujeres Mexicanas que emigran a los Estados Unidos.
La entrevista durara aproximadamente 1 hora y en ese tiempo se le pedirá que conteste un lista de
preguntas escritas relacionadas a sus creencias sobre los servicios de salud mental.
No hay ningún riesgo anticipado para usted si participa en el estudio. Sin embargo, si hay cualquier
pregunta que la haga sentir incomoda puede declinar su respuesta. Usted podrá retirarse a cualquier
tiempo sin ninguna penalidad. Si tiene alguna sensación incomoda después de completar la entrevista
usted puede contactar a Golden Valley Health Center, 847 W. Childs Avenue, Merced, CA, (209)3837441 para servicios.
Es posible que usted no se beneficie directamente con su participación en este estudio. La información
que se obtenga de usted será protegida de divulgarse inapropiadamente de acuerdo a la ley. Su nomber
( e identidad) no será conectado con las respuestas que usted provea. A usted se le informara que si
usted desea participar en la entrevista será grabada. La información grabada será escuchada y
compuesta en temas principales y categorías y los resultados serán presentados en forma narrativa y
comentarios directos. Durante el proceso del estudio la información obtenida se mantendrá en un
archivo cerrado y solo se escuchara con propósitos del estudio. Todo material se mantendrá hasta que
el estudio se termine y cuando la tesis sea archivada en la escuela de Graduación. Cuando el estudio
termine, el material será desecho/destruido.
No hay ningún pago pare usted mas allá del tiempo y esfuerzo requerido de usted para completar el
procedimiento que se le explico arriba. Su participación es completamente voluntaria. Si rehúsa
participar no habrá penalidad o perdida de beneficios. Usted puede retirarse en cualquier momento sin
penalidad o perdida de beneficios.
Si usted esta de acuerdo en participar, por favor indique esa decisión al firmar abajo. Si usted tiene
preguntas sobre este estudio, por favor no dude en llamarme a mi, Nancy Murillo al (209)628-9594 o a
mi asesor de facultad, Dra. Robin Ringstad, al (209)667-3355. Si usted tiene preguntas sobre sus
derechos y su participación en este estudio, por favor contacte al Oficial de Conformidad de la escuela,
por teléfono al (209)667-3747 or mande correo electrónico a [email protected].
Sinceramente,
Nancy Murillo
Estudiante de Maestría en Trabajador Social
Firma:_________________________________ Fecha: ________________________
50
APPENDIX C
GUIDING QUESTIONS FOR INTERVIEWS
1) What are Mexican immigrant women’s views/beliefs about existing western
mental health services?

What is your opinion about people who seek mental health services?

Why do you think people seek services?

What are your cultural beliefs on mental health services?

Do you think mental health services are helpful to a person?

How are mental health services viewed in your culture?
2) What are the reasons why Mexican women would utilize or not utilized metal
health services?

What are some reasons why Mexican women might seek mental health
services?

What are some reasons why Mexican women might be hesitant when
considering mental health services?

Do you think women are judged if they seek services? If yes, how do you
think people may view them?

Do you believe mental health services are beneficial to a woman and why?
3) What factors impact Mexican women’s decision to utilize mental health services or
not?

Have you ever sought mental health services?

What would your family say if you were to seek mental health services?

How do you think your husband would react if you were to seek services?

Do you think your culture plays a big part on your decision about whether to
seek services? If so, why?

Where would you go first to seek mental health services?

Do you think your culture is open to mental health services? If no, why not?
51
APPENDIX D
GUIA DE PREGUNTAS PAR LAS ENTREVISTAS
1) Que creencias culturales tienen las mujeres inmigrantes sobre los servicios de salud
mental?

Que es su opinión sobre las gente que busca servicios de salud mental?

Que cree que son las razones que gente busca servicios de salud mental?

Que son tu creencias culturales sobre los servicios de salud mental?

Tu crees que los servicios mentales ayudan a la gente?

Como son los servicios mentales visto en tu cultura?
2) Que son las razones que las mujeres Mexicanas deciden si o no utilizar los
servicios de salud mental?

Que son unas de las razones porque mujeres Mexicanas duran tiempo en
considerar si buscar servicios de salud mental?

Que barreras piensas tu que las mujeres Mexicanas enfrentan cuando deciden
buscar servicios de salud mentales?

Tú crees que las mujeres son juzgadas si buscan servicios? Y si, como crees tú
que la gente las juzgue?

Tú crees que servicios mentales benefician a las mujeres y porque?
3) Que factores impactan las decisiones de las mujeres Mexicanas en su decisión a
buscar servicios o no?

Has tu buscado servicios de salud mental?

Que tú crees que tu familia diría si tu buscaras servicios mentales?

Como crees que tu esposo reaccionaria si tu buscaras servicios?

Tú crees que tu cultura juego una parte grande en tu decisión a buscar
servicios? Y porque?

Donde irías a buscar servicios primero?

Tú crees que tu cultura está abierta a servicios de salud mental?