CHAPTER 6

Mental Health Care for Hispanic Americans

Historical Context

To place the growth of the Latino population in context, it is important to review some of the historical events that have brought Latinos to the United States. Although the Spanish language and cultural influence form a bond among most Hispanics, many key differences among the four main Latino groups are related to the circumstances of their migration.

Mexicans have been U.S. residents longer than any other Hispanic subgroup. After the Mexican War (1846–1848), when the United States took over large territories from Texas to California, the country gained many Mexican citizens who chose to remain in their “new” U.S. communities. The considerable economic, social, and political instability during the Mexican Revolution (1910–1917) contributed to the growth of the Mexican population in the United States. Economic pressures and wars have propelled subsequent waves of migration. Both push factors (economic hardships in Mexico) and pull factors (the need for laborers in the United States) have affected the flow. The sheer numbers of people who have come to the United States—well over 7 million—as well as the fact that many arrive “unauthorized” (without documentation) distinguishes Mexican immigration (U.S. Census Bureau, 2000d).

Puerto Ricans began arriving in large numbers on the U.S. mainland after World War II as Puerto Rico’s population increased. High unemployment among displaced agricultural workers on the island also led to large-scale emigration to the mainland United States that continued through the 1950s and 1960s. In the 1980s, the migration pattern became more circular as many Puerto Ricans chose to return to the island. One distinctive characteristic of Puerto Rican migration is that the second Organic Act, or Jones Act, of 1917 granted Puerto Ricans U.S. citizenship.

Although Cubans came to the United States in the second half of the 19th century and in the early part of the 20th century, the greatest influx of Cuban immigrants began after Fidel Castro overthrew the Fulgencio Batista government in 1959. First, an elite group of Cubans came, but emigration continued with balseros, people who make the dangerous crossing to the United States by makeshift watercraft (Bernal & Shapiro, 1996). Some of these immigrants, such as the educated professionals who came to the United States during the early phase of Cuban migration, have become well established, where-as others who arrived with few economic resources are less so. Unlike immigrants from several other countries, many Cubans have gained access to citizenship and Federal support through their status as political refugees (Cattan, 1993).

Central Americans are the newest Latino subgroup in the United States. Many Central Americans fled their countries por la situacion, a phrase that refers to the political terror and atrocities in their homelands (Farias, 1994; Jenkins, 1991; Suarez-Orozco, 1990). Although the specific social, historical, and political contexts differ in El Salvador, Guatemala, and Nicaragua, conflicts in those countries led to a significant emigration of their citizens. About 21 percent of foreign-born Central Americans arrived in the United States between 1970 and 1979, and the bulk (about 70 %) arrived between 1980 and 1990 (Farias, 1994).

The circumstances that caused various Hispanic groups to migrate greatly influence their experience in the United States. Cubans fled a Communist government, and, as a result, the U.S. Government has provided support through refugee or entrant status, work permits (Gil & Vega, 1996), and citizenship. More than half (51 %) of Cuban immigrants have become U.S. citizens, compared to only 15 percent of Mexican immigrants (U.S. Census Bureau, 1998). Puerto Ricans, whether born on the mainland or in Puerto Rico, are by definition U.S. citizens and, as a result, have access to government-sponsored support services.

In contrast, many Central American immigrants are not recognized as political refugees, despite the fact that the war-related trauma and terror that preceded their immigration may place them at high risk for post-traumatic stress disorder (PTSD) and may make adjustment to their new home more difficult. Many Latinos who arrive without proper documentation have difficulty obtaining jobs or advancing in them and live with the chronic fear of deportation. Finally, many Mexicans, Puerto Ricans, Central Americans, and recent Cuban immigrants come as unskilled laborers or displaced agricultural workers who lack the social and economic resources to ease their adjustment.