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Why School Based Mental Health providers can no longer ignore the role faith, religion, and spirituality have in the Latinx student community and their mental health treatment.”
Martha Rodriguez, Licensed Clinical Social Worker
University of South Florida
Ohio - Jaime Torres a bright, timid, high school senior has been seeing his School Social Worker, Theresa Jones for individual and family therapy for some time now. Jaime struggled for several years with feelings of hopelessness, and panic attacks. It started with palpitations, night sweats, and a feeling like the room was spinning out of control. Jaime also began to experience a sense of desperation, sadness, and hopelessness. He could not take control of his thoughts and started to struggle with suicide ideation. Jaime knew something was wrong and needed help.
Yet Mr. Torres was concerned with his parent’s reactions and responses concerning therapy, therefore he chose to not share his decision to engage in psychotherapy at school with anyone at first. Jaime’s parents did not agree with him engaging in therapy, especially his father David Torres. Mr. Torres would often say to Jaime, “tu no eres loco”, “you need to be strong”, “los hombres no lloran”, and “don’t you have faith?” David argued with Jaime that; his faith and religion should be enough to help him get through his struggles with mental illness.
Unfortunately for Jaime these attitudes regarding men and mental health are common in the Latinx community. Jaime also received negative feedback from some of his uncles and family members about seeking help for mental illness which validated his concerns about sharing his decision to engage in treatment with his family.
Mr. Torres friends at church also agreed that maybe he needed to work on strengthening his faith and should hold off from seeking any treatment, perpetuating the idea that lack of faith is what leads to mental disorders. But Jaime disagreed and sought out treatment. He found the help he needed in Theresa his School Social Worker, who was able to integrate Jaime’s faith into his treatment.
Jaime never imagined being able to share the struggles confusion, and guilt, associated with his illness, faith, & religion. Guided by Mr. Torres, Theresa had conversations about how these extremely important determinants affected all aspects of Mr. Torres health including his mental health and mental illness. Mrs. Jones treatment plan included an assessment of Jaime’s faith, spirituality & religion. Theresa was aware of the beliefs shared by the Latinx community regarding cultural and religious values. The Research demonstrating the “Latinx community utilize mental health care at a rate that is about half that of non-Hispanic Whites.”
Mrs. Jones was sensitive to the Latinx community beliefs and attitudes surrounding mental health which are complex and often misunderstood. She educated herself on religion, faith, and spirituality serving as strong protective factors for the Latinx community, as well the possibility that men share negative perceptions about discussing mental health conditions and seeking treatment. As a result, the Latinx community and Latinx students are struggling with mental illness at alarming rates; many failing to receive treatment because of their religious and cultural values.
Mr. Torres is one of the lucky ones, who received treatment because of Mrs. Jones competency in the perception and values of this community in relation to their religion and faith. Unfortunately, many school based mental health professionals fail to address these values and their contribution to the stigma against mental disorders that contribute to mental health care utilization disparities that currently exist.
Jaime hopes school based mental health providers will increase efforts aimed at raising awareness, on the need for competency in integrating faith, religion, and spirituality in treatment in an ethical manner. Mrs. Jones believes this is one of the many ways to make strides in combining faith and psychotherapy.
Mr. Torres questioned; If his faith is such a significant part of his life, why would it not be addressed in his mental health treatment? Why are people so afraid to talk about faith, religion, or spirituality? For us “Latinos our faith can define how we see the world, for many of us it is everything.” Everyone is talking about mental health, everywhere he goes Jaime reads, sees, or listens to someone at school talking about the importance of seeking help. He feels however schools need to do a better job at understanding the whole student. School Mental Health staff should be able to apply every aspect of our lives to our illness. According to Jaime, “all they do is talk about it, but can they try to figure out why we are not engaging in treatment?”
While Jaime makes an excellent point, school mental health staff often struggle with the dilemma of how to incorporate faith and therapy. Why should schools even consider this, when everyone is so scared of being sued or facing legal action?
To consider Jaime’s needs school based mental health professionals will have to figure out how to address the ethical and legal requirements involved in this work. Hence this sensitive and perhaps complex effort school based mental health professionals may choose to not address spirituality, faith, or religion. It makes perfect sense why we lack research and actions towards school-based curriculums to support school based mental health professionals.
In New York City, Teachers like Leidy Garay explained that educators and school based mental health staff, as well as administrators are aware religions cannot be forcibly practiced in any public school. Mrs. Garay however believes all students should still have the right to practice their personal beliefs. She has worked alongside school Social Workers, and school Counselors, to become sensitive to her students and families spiritual and religious beliefs. Leidy a Special Education Teacher with over 15years of experience recognizes how faith, spirituality, and religion can provide protective factors for mental health.
Mrs. Garay believes Latinx students like Jaime exist all over the world. Leidy is correct, as Latinx students struggle with thoughts of suicide up to 8 times higher than their peers. The numbers just keep rising for mental health issues as well as serious mental illness, suicidal thoughts, plans, and attempts. Not to mention that Latinx students are more inclined to mental anguish associated with trauma due to immigration and acculturation.
Mrs. Garay has witnessed how often schools fail to assess’ students and families’ various determinants. These students are wonderful, full of light, dreams, and deep-rooted family systems. Latinx students enter into our school system with a multitude of traumas, loss, violence, and extreme poverty. Leidy believes we are missing the opportunity to end the stigmas associated with mental illness within this community. Instead of looking at all aspects of the family’s life and how they will inform their understanding of mental illness and stigmas associated with these conditions the educational system often confuses this communities’ perceptions and beliefs with lack of parent engagement in their child’s treatment, or a complete denial that their child/adolescent has a mental health condition.
According to Leidy “it is not that parents do not want to engage with school based mental health professionals it is more like we are not properly engaging them. If our engagement does not include an assessment of all their determinants, cultural identify, values, and their beliefs as well as family stressors, our assessments are invalid.”
Mrs. Jones explained it took time for Jaime’s parents to understand and accept his mental health condition and treatment needs. It involved a genuine desire on both ends to go on a journey that at times was uncomfortable, unknown, and challenging. Constantly requiring Theresa to develop her skills, assess her competency, build her knowledge, examine her own biases, and keep her personal beliefs in check. Mrs. Jones learned from Elena Torres (Jaimes mom) that faith for many Latinx parents is an incredibly strong protective factor and some believe it is they’re faith that “saves” them when struggling with depression and/or mental illness. Holding on to their faith in God, using prayer and meditating on the biblical word are their coping mechanisms. It is their faith and/or religion which gives them strength to get through the bad days and increases their resiliency. Mrs. Jones had to learn about these beliefs, coping mechanisms, and make a decision to respect these as well as how these affected their understanding and treatment of Jaime’s condition.
In working with the Latinx community Theresa has found often some students will have gaps in service as it pertains to mental health treatment, or no treatment history at all. This is because the students and families she has served searched for some time before they found a mental health professional who was competent and knowledgeable in their faith and religious beliefs. A mental health provider who understood and integrated the value and significance of these systems in their life and supported them without judgement or fear.
Schools can work towards providing education and increasing professional development on competencies in clinical practices surrounding the integration of faith and the challenges associated with utilizing spirituality in psychotherapy. This will allow for school based mental health providers within their field of discipline to practice this integration in a matter that is ethical, reducing fear, and avoiding legal dilemmas.
We will still have schools concerned with not upholding a particular religion. Mrs. Jones understands this as a school Social Worker and Licensed Clinical Social Worker, and she makes clear the ask here is; not for schools to practice religion rather provide students with the opportunity to observe their personal faith and be able to integrate this in combination with their mental health treatment if the student and family desires to do so.
Mr. Torres argued that school mental health providers are not practicing with full ethics when they leave out religion and spirituality. According to Jaime, “if you ignore how these inform, influence, and affect my environment and life, ultimately mental health professionals are not fully addressing and breaking down barriers which could lead to me or my family accepting, and understanding treatment of mental disorders.”
School Social Workers often use the Biopsychosocial Model, which declares “interactions between people’s genetic makeup (biology), mental health and personality (psychology), and sociocultural environment (social world) contribute to their experience of health or illness.” School Social Worker Theresa Jones used this model to gain awareness, and competency on how faith, religion, and spirituality often have correlations with the student’s mental health. The Biopsychosocial model used in her assessment of Jaime, allowed her to develop, and expand her abilities on the spiritual, religious, and faithful facets of her student in a holistic and ethical manner.
In combination with the Biopsychosocial Model Mental Health Providers share integrating faith into treatment can begin with: Proper communication and assessment- asking questions about their beliefs and values, the role faith, religion, and spirituality have in the student’s life in the past and at present, how these may affect or influence their values and beliefs and If they desire to discuss these issues with the school based mental health professional.
Mr. Torres shared a turning point for his parents occurred when; Theresa allowed them to share their beliefs regarding their faith, talking about the feelings of guilt in the context of their religious background. For example, David and Elena Torres shared they felt as if they were doing something wrong by seeking therapy, that they were putting God second, or that professional help was against Gods will. Mr. David Torres explained they felt validated, understood, and accepted by Mrs. Jones. The Torres family found Theresa allowed their faith, and religion to have the role Jaime choose and the value he desired in treatment.
Jaime’s mom: Elena Torres went back to church and told their pastor about their experience. Elena felt it was necessary for her to communicate this journey in an effort to help other mothers who struggled with the decision to integrate faith and therapy. For Jaime, this whole process allowed him to help other students who are suffering. Jaime shared he was able to tell them they do not have to give up on their faith and their belief that God is first and, it is through him only as the agent we achieve success. He also explained that he believed God wanted those suffering to get help if they need it, there is no shame, guilt, or judgement in that.
So why should the Combination Of Faith And Psychotherapy Be Seen As Beneficial?
According to the U.S. Department of Health and Human Services Office of Minority Health, In 2017, suicide was the second leading cause of death for Hispanics, ages 15 to 34. While Suicide attempts for Hispanic girls, grades 9-12, were 40 percent higher than for non-Hispanic white girls in the same age group, in 2017, and Non-Hispanic whites received mental health treatment twice as often as Hispanics, in 2018. These numbers are disturbing and rising yet we can take actions to reduce the lack of competency and feelings of seeing faith and psychotherapy as separate from psychotherapy and rather combine these in treatment.
School Based Mental Health providers can no longer ignore the role faith has in this community. We can no longer decide to not integrate this into treatment because we are fearful or because we lack competency. Some additional strategies school mental health providers can take are to provide education in a manner that is engaging and non-offending. As students and families learn about what therapy really is, and what it is not, they will be able to see how both their faith and therapy could help them heal and cope with their symptoms if they choose to integrate this in their treatment. As the mental health professionals use the Bio-psychosocial perspective to understand how their student’s faith informs their life, decisions and values they will see why it is beneficial to continue to encourage students and families to continue with the emotional support offered by their church for example. In addition to the coping mechanism offered by the church community, and how this can reduce social isolation. School based mental health professionals can also appreciate how faith provides students with hope — a feeling that everything is going to be okay and that they are going to get through this because God is with them. Jaime for example valued being able to use a Bible passage to help with managing his symptoms. In combination with his faith, Theresa also used some cognitive behavioral techniques, to help Jaime understand his negative thinking patterns. These evidence-based practices provided Jaime with validation and specific ways to cope.
How Faith Builds Mental Health Resilience
Research suggests that religion and spirituality may build resilience when facing depressive episodes. This has been the experience shared by Jaime and his parents. His spiritual and religious beliefs that God was in control, God was protecting him and would not leave him decreased his feelings of despair and hopelessness. These positive thoughts and strong social supports offered by his religion and spirituality helped Jaime build resilience against the negative feelings of depression and often stopped them right before they started. School based mental health provider such as Social Workers, School Counselors, and Family Therapist should place emphasis on the positive coping mechanisms that are offered through spiritual practices and the impact of religious and faith-based community supports for people with mental illness. In doing so they can effectively support Latinx families and reduce the stigma associated with mental illness, religion, faith, and treatment.
Mrs. Garay knows first-hand about Latino families who are victimized by various forms of trauma such as violence, and immigration trauma. She has found that in working with her students and their school based mental health providers religious views, beliefs, and experiences, can and almost most certainly influenced their acceptance of approaches to treatment and goals. As a result, we must create opportunities for the Latinx community to combine faith and religion in psychotherapy by promoting mental health literacy to allow for this community to create a healthy balance through which they can continue to use their faith and religion as protective factors against mental illness.
For school based mental health professionals seeking resources and information on how to integrate faith, religion, and spirituality into psychotherapy the following links may be helpful.
Latinx Community Structural Barriers to Mental Health Disparities
A June 13, 2019 Public Hearing on the Public Mental Health Service Expansion Resolution, provided the following results and recommendations to address the changes which need to occur to resolve the pattern of continued "disinvestment in public mental health centers in the City of Chicago."
The barriers that exist in Chicago are common in many cities as a result we must do better to recognize the gaps in those current infrastructures, to be able to expand and strengthen public mental health systems in all communities.
Recommendations included: addressing limited services and cost , increasing culturally responsive and trauma informed services- to include multigenerational trauma, historical trauma ,and identity trauma, invest in safety net to promote long term healing such as psychotherapy as form of mental health service delivery, prioritize investment in public services , and focus on a provision of holistically empowered community based services.
Literature/ Workbooks
Integrating Spirituality and Religion Into Counseling (3rd ed.) A Guide to Competent Practice by Craig S. Cashwell, & J. Scott Young
Handbook of Religion and Spirituality in Social Work Practice and Research1st ed.by Sana Loue
The Therapist's Notebook for Integrating Spirituality in Counseling I: Homework, Handouts, and Activities for Use in Psychotherapy by Karen B. Helmeke, Catherine Ford Sori
The Importance of Faith in Latino Communities
Articles
Support
Webinars
Nami
References
Intersection of Cultural and Religious Beliefs About Mental Health: Latinos in the Faith-Based Setting, March 2019, Hispanic Health Care International 17(1):4-10DOI: 10.1177/1540415319828265 by, Susan Caplan, University of Northern Illinois
Understanding Immigrant Trauma, The Immigrant Learning Center, Posted on March 12, 2020
Against the Stream: religion and mental health – the case for the inclusion of religion and spirituality into psychiatric care, Simon Dein