Mental health issues still aren’t widely talked about in many Spanish-speaking communities. For generations, mental health experts and advocates have worked to destigmatize therapy and counter shame about “airing one’s dirty laundry” so that people can experience healing.
Stigma isn’t the only issue. There’s another barrier: the dearth of Spanish-language mental health care services and providers in the U.S.
Only 5.5% of psychologists in the U.S. can provide services in Spanish, according to a 2018 survey by the American Psychological Association. These providers often work in big cities like Los Angeles, New York, and Miami. Tens of millions of Spanish speakers who don’t live in or around these areas may not have access to a licensed psychologist who can provide care for them in person in their language.
Is Teletherapy the Answer?
Teletherapy – therapy sessions held online – has the potential to widen access to care. But overall, the needs of people whose first language is Spanish (as well as other languages apart from English) still aren’t being met.
Mental health problems happen in people of all races, ethnicities, languages, and immigration status. But when it comes to treatment, it’s not an even playing field. In addition to stigma and language barriers, the obstacles include legal status, financial income, lack of health insurance, and cultural differences with the provider.
Whether in-person or through teletherapy, many of these barriers still exist.
“Teletherapy is great because it makes receiving mental health care more convenient. You can have a session from wherever you’re at,” says Patricia Alvarado, MA, a Los Angeles-based licensed professional clinical counselor and an advocate for Spanish-language mental health care.
Part of the problem is the underrepresentation of Spanish-speaking clinicians.
“We are a minority within a minority,” says Alvarado, whose entire team at her practice, Alvarado Therapy, is fluent in English and Spanish. Another issue, Alvarado says, is that mental health startups aren’t willing to invest in fulfilling the needs of Spanish-speakers.
“I sometimes wonder why so many corporations are trying to put their hand in the pot when it comes to mental health,” Alvarado says. “There’s a need for this technology, but are they answering these needs? And if they are, which communities are they catering to?”
Since the COVID-19 pandemic began in 2020, teletherapy has been booming. In fact, a Time/Harris poll found that 85% of clinician members conducted most of their sessions virtually that year, up from just 2% before the pandemic. The demand for virtual therapy has continued, and digital health startups are growing to meet this need.
But while teletherapy has improved mental health access for millions of people, it hasn’t exactly democratized care. A Time/Harris poll showed that just 5% of people received mental health care for the first time during the pandemic, meaning that most people who used teletherapy just shifted from in-person to virtual care. This is largely because teletherapy, like in-person therapy, remains more accessible to a certain demographic: insured and/or well-off English-speaking white U.S. citizens.
None of the top three teletherapy apps – Talkspace, BetterHelp, and Cerebral – offer full in-app Spanish-language services and preferences. Across the health tech companies, some provide in-app translations while others work with Spanish-speaking therapists that can be requested, but getting matched with one depends on in-state availability.
However, teletherapy companies are working to close the access gap for Spanish-speakers.
In 2021, Ginger, an on-demand mental health app that offers behavioral health coaching, therapy, psychiatry, and self-care resources, announced that it would add Spanish-language capabilities to its mobile app. Since the start of 2022, the app experience has been fully functional in Spanish. Spanish-speaking users can find original mental health content created for them in their language as well as a team of 45 care providers who offer coaching, clinical, and psychiatric services through in-app messaging or video calls.
“It’s more than just offering in-app translations. We have a team of all Latinos from different countries who are very passionate about making sure we are reaching Spanish-speakers and connecting with Latinos in general,” says Erika Austin, PhD, Ginger’s director of Spanish services. “We want to make these services accessible because we get it. We understand what generational trauma looks like in our communities and we know that stigma runs deep. By making this a fully Spanish experience, and not just an add-on or a translation, we hope this helps to destigmatize mental health.”
Ginger’s innovation and eagerness to serve Spanish-language communities is contagious. Since the company merged with meditation app Headspace (becoming Headspace Health) in 2021, Headspace has added original Spanish-language mindfulness offerings, including meditation courses and singles, sleepcasts (audio content designed to help you wind down before sleep), and video content in Spanish.
“Growing up, I remember my dad saying meditation was for rich people. I was like, ‘What?’ So I started teaching this because I wanted to bring mindfulness and meditation to my people,” says Rosie Acosta, a bilingual mindfulness and meditation teacher with Headspace.
In an effort to reach Spanish-speaking communities, Headspace recently launched a campaign with Los Angeles County offering the mobile app for free to people who reside in the county. “While it’s available to anyone, despite language, in the county, the campaign is targeting Spanish-speakers,” Acosta says. “It’s important to have that connection and to understand culture and identity in your mindfulness practices.”
Like Ginger and Headspace, Equip, a virtual eating disorder treatment company, has made it a priority to serve Spanish-language patients who are often overlooked in eating disorder treatment. Equip provides each client with a dedicated five-person team that gives them and their families tools and resources for recovery. This includes therapists, medical providers, dietitians, family mentors, and peer mentors. There are many Spanish-speaking providers across these areas and interpreters available when they are not.
“Equip believes it is impossible to treat the ‘whole person’ and their eating disorder without accounting for their cultural identity, beliefs, behaviors, and languages,” Equip says in a statement.
Equip also provides interpreters, written materials, and monthly family skills groups offered in Spanish. By offering virtual treatment, the company is also able to overcome physical barriers to care for people who may live in underserved communities not near Spanish-speaking providers who specialize in eating disorders.
Still, It's going to take more than making talk therapy virtual to serve marginalized communities. It’s going to take rebuilding the entire system.
“Truthfully, it’s a complex system,” Austin says. “There's a lot of work on the back end to be able to provide quality care in different languages and for different cultures, to make this work sustainable for the staff and for the patients, and to educate and build trust. But we need to be able to provide Spanish care. We need companies to be invested in this. It's the only way we can destigmatize therapy, normalize the experience, and transform communities."