Men of Color and Mental Health: Spotlight on Haitian and Cuban Communities

Spotlight: Coles Voyard RN, MSN & Fernando Rodriguez-Villa, MD - McLean Hospital

Coles Voyard and Fernando Rodriguez-Villa share their insights about mental health care for men in the Haitian and Cuban communities.

• Coles – Nurse Director, Clinical Evaluation Center,  grew up in Haiti and came to the US to pursue a career in psychiatric nursing, to bring awareness and relief to those suffering with mental illness.
•  Fernando – Medical Director, Short-term Unit, was born in Cuba and has worked in several healthcare settings. He has gained relevant perspective from his clinical experience, being embedded in the Spanish clinic at BWH, through teaching medical students and participation in the Patient/Family Advisory Committee at McLean.

Barriers to Seeking Treatment

Haitian community

• Concerns about not being welcomed or treated well
•  Assuming they or their culture will not be understood
•  Community beliefs that mental health is a myth or the result of Voodoo
•  Viewing mental illness as a sign of weakness, rather than a medical condition, which involves a chemical imbalance
•  Not understanding how to navigate the medical system
  -Even in an emergency, there is a tendency to call a family member or person from the community rather than 911

Statistics show a high suicide risk for young Black males. What are the causes for this in the Haitian community?

• Getting help is “not cool” with Haitian teens and young adults
•  There is added stress due to violence in communities
•  Taboos around sexuality preferences result in untreated anxiety and depression
•  Alcohol use is common and accepted at a young age. Many young men may self-medicate when they are under stress. This is compounded by a lack of understanding about the impact of alcohol on depression.

Cuban Community

• Mental Health is generally not discussed
•  Talking about feelings does not come easily for Latino men
•  It’s a weakness to have any problem, but especially an emotional problem
•  Psychiatric issues are not a real or are “loco” (crazy)
•  There is not a strong understanding of how mental health professionals can help
•  Some Cubans prefer to seek help via prayer or through Santeria Traditions and Orisha Gods
•  Dr. Rodriguez-Villa emphasized that the COVID virtual care model presented additional treatment barriers for Latino men
  -Typically, access is increased when primary care can introduce patients to mental health providers informally while on site.
  – This option was largely paused during COVID

Suggestions for Improving Mental Health Access and Usage for both Populations

Community outreach and education

• Both Fernando and Coles stressed the importance of having liaisons in the community to de-stigmatize the concept of mental health
  -This might be via doctors/primary care, religious leaders, schools, and those who have benefitted from mental health assistance
  -It’s preferable to start education with children at a young age
• Fernando suggests not making assumptions that patients are knowledgeable about depression and anxiety, or the connection between alcohol, depression, and suicide
•  Normalize mental health as a medical condition (with biological causation), just like diabetes
•  Provide formal and informal navigators for accessing mental health assistance

Partnering with other medical professionals such as primary care

• Fernando discussed the importance of informal “warm” hand-offs in introducing and building a relationship with the mental health provider
• Providers can collaborate to read between the lines” diagnostically, with issues such as unexplained medical symptoms (headaches, gastro)

Meet the patient where they are

• Provide culturally competent care
  -Offer interpreters as needed
• Coles explained that McLean includes cultural background and needs as part of every assessment
  -This translates to treating everyone as an individual
• Start with what matters to the patient and build a relationship from there
  -A Latino male may be more open to discuss an issue about his child than one about himself
• Both Fernando and Coles recommend being inclusive of family and/or important community members in during treatment
• Utilize strengths to increase access and achieve better outcomes
  -For example, being strong and having a thriving family is important, then stress that a healthy father, brother, etc. is best for a family