Santa Ana Clinic Spans Cultural Chasm to Reach Mentally Ill Latinos : Health: County-funded Clinica Nueva Esperanza reaches out to a group long isolated by their language and background.

When Josefina first came to the Clinica Nueva Esperanza, she was hooked on antidepressant drugs that she had bought over the counter in Mexico.

Rosina McKay, her counselor at the only county-funded mental health clinic catering specifically to Spanish speakers, said she has seen the problem many times.

“A lot of times people don’t know where to turn, so they go to Tijuana and get this medication that is way too strong for them,” said McKay, who is from Mexico. “By the time they come to us, they have developed an addiction to the drug and their symptoms for depression are so severe. That’s why Josefina came to us. We had to take her off that medicine before we could work with her.

“We see that a lot among Latinos here.”

McKay and other clinic officials say the case of Josefina--she requested that her last name not be used--is just one example of why there is a need for a center that understands the unique concerns of low-income Spanish speakers suffering from severe mental problems.

Not only is most private psychiatric help too expensive for most low-income Spanish speakers who suffer from severe mental problems, but health professionals versed in the Latino culture and the Spanish language are rare.

Two months ago, convinced by the testimony of dozens of people that mental health care for low-income Latinos in the county was inadequate, the Board of Supervisors approved a 13% budget increase for the Clinica, an outpatient treatment center that provides bilingual counseling and medical care for sufferers of schizophrenia, depression and other advanced mental illness.

Clinica officials say the new attention to the problem is long overdue.

“The access to health care for Latinos in this county is minimal to none,” said David Burciaga, executive director of the nonprofit center, which is under contract to the county. “And mental health care is even farther out of reach.”

The clinic, at 431 Bristol St., treats many people who are on medication to control their problems, and some have recently been released from mental hospitals. The need for more such services in the county is so great, says Clinica board member Maria Moreno, who is also a councilwoman in the city of Placentia, that she spearheaded an effort to open a satellite office to the Clinica in her city. Officials are still searching for a site, but they expect to open the small center in March with one part-time therapist.

While serving 290 patients, the Santa Ana facility employs six therapists and seven part-time psychiatric residents from UC Irvine’s psychiatric medicine department, in addition to a number of volunteer professionals. The clinic charges its patients on a sliding scale.

Clinic officials say their bilingual staff members understand how culture and language contribute to the ability of someone to adjust to their jobs, marriage and schooling here. Central American refugees, for example, are more likely to suffer from depression, anxiety and feelings of hopelessness than the population in general, said Ana Deutch, supervisor of the therapists and other social workers at the Clinica.

“They have gone through this traumatic experience,” Deutch said. “They have been exposed to violence, they have been witnesses to the war. Their homes have been bombed, they have seen friends and family members massacred, husbands or wives or children.

“People trying to deal with the problems of war--that is a very new phenomenon in Orange County,” said Deutch, a noted researcher on Latinos and mental health. “In Los Angeles County, mental health care agencies are more prepared to deal with that issue, but here in Orange County, we are just starting to see this problem in groups of certain Latinos moving here.”

The budget increase for the Clinica--which also receives some funds from United Way--comes at a time when mental health care throughout the county, and indeed, the state, is suffering from severe budget cuts.

Doug Barton, Orange County deputy mental health director, said the additional funds will be used mostly to try to improve salaries for the bilingual social workers who are difficult to find, and good ones difficult to keep.

“If someone is a licensed clinical social worker and is both bilingual and bicultural, that individual is somewhat of a premium in this state,” Barton said. “There are a lot of counties and other public and private agencies looking for individuals like that. We need to be able compete if we’re going to serve Orange County communities.”

The clinic was founded when a group of Latino health care professionals in the early 1970s noticed a glaring need for specialists who understood the cultural differences of this growing population. Board member Rolando Castillo, an assistant clinical professor with UCI’s department of medicine, and a native of El Salvador who was among the clinic’s founders, said misdiagnoses of Latino patients were very common.

“We noticed in our work that cultural differences were being viewed as pathological behavior by many professionals,” he said. “Everyone became concerned. At that time, it was not OK to speak a different language, not OK to exhibit cultural differences.”

The new advocacy led to the creation of more community-based programs to make mental health care more accessible to people, such as Clinica Nueva Esperanza--which means the clinic of new hope in Spanish.

“I think one of (Clinica’s) main features is that it is not just another mental health program in the community, but it recognizes language and culture,” Castillo said. “It uses language and culture as therapeutic aspects. It’s what we call the transcultural approach, which is taking the individuality of a patient’s problems as they relate to their sociocultural background.”

About seven years ago, the county contracted with the Clinica to provide mental health care services for Latinos, something that the county had been trying to do with its own staff, but without much success.

“Some of the individuals are undocumented, and they were very apprehensive about going to any government agency for assistance,” said Barton, the deputy mental health director. “We were just not as accessible and acceptable as we like to be. The Clinica, on the other hand, is really not seen by the community as tied to the government. So their staff is able to deal with individuals that otherwise would not come to us. It’s got a real value that way.”

Under Burciaga, who was hired less than a year ago, the clinic has made several changes. Two months ago, it finalized an agreement with UC Irvine’s psychiatric medicine department in which residents-in-training will provide part-time service to the center, which once relied mostly on peer counseling.

Burciaga said that before the new arrangement, the clinic had the services of a psychiatrist about five to 11 hours a week, and a waiting list of about 200. With such little time to see so many people, he said, the doctor could do little but monitor clients’ medication.

The new arrangement will help the UCI residents as much as the clinic, he said, because they are being exposed to problems in a cultural setting they might not otherwise see, Burciaga said.

“It’s not only important to know how to medicate a person, but also for the doctors to understand these different cultural values,” he said. “Now we’re looked at as a potential research center.”

Besides providing much-needed mental health counseling and supervision of medication, Burciaga said he also wants to provide educational programs that will familiarize more Latinos, and especially low-income Latinos, with the role of mental health care.

McKay, the therapist, leads group therapy sessions in Spanish for women suffering from a number of problems, ranging from severe depression to addiction to marital difficulties. During one of the sessions, an older woman who did not want her name used and who suffers from depression, said she was grateful that the Clinica is there to serve her.

“If you go to another hospital, they don’t speak Spanish and they make you wait five hours for a translator, and they leave us until the end,” she said. “Here, you feel so comfortable talking with Rosina because she understands us. She is like us.”