Closing the Treatment Gap: Individualized Care for Hispanic Patients

For Hispanic Heritage Month, Roger Rivera, PMHNP, highlighted that symptom minimization among Hispanic patients should not automatically be interpreted as dishonesty or resistance to treatment. The pattern appeared across the board but was especially evident in Hispanic communities. Stigma, including fear of judgment and concern about how a diagnosis might affect family or employment, was a real-world barrier, he said. The neuropsychiatric features of conditions like bipolar disorder, including mania and impaired insight and judgment, compounded it.¹

The treatment gap was substantial. In 2024, fewer than half of Hispanic adults with a mental illness received treatment, compared with nearly 60% of non-Hispanic white adults.² Rivera said untreated illness could lead to worsening symptoms, debilitation, hospitalization, or suicidality.

Cultural competency required more than translation, Rivera said. Patients could describe anxiety, agitation, or feeling overwhelmed in expressions that did not map directly onto psychiatric assessment terminology, and symptoms left unexplored could be missed. Rivera advised keeping language as simple as possible and aligned with each patient's needs. Where a language barrier existed, institutional language services and cultural understanding were important resources. Nonverbal cues also carried weight, and when communication stalled, Rivera sometimes asked family members how best to communicate with the patient.

Family involvement could cut both ways. Relatives sometimes questioned recommended medications, which required Rivera to address the family directly while preserving the patient's autonomy. Rather than making assumptions based on ethnicity, Rivera asked patients what mattered to them.

Cultural humility was part of diagnostic accuracy rather than an accessory to psychiatric care, according to Rivera. Clinicians had to look beyond controlling episodes of mania or depression: "We have to understand the whole individual. Their longitudinal illness course, their biology, their cultural identity, their family systems," as well as what meaningful recovery looked like to the patient. Individualized care, not a presumption that every Hispanic patient needed a different approach, was the key. "Culturally responsive, evidence-based psychiatry gives us a better opportunity to build trust, sustain treatment, and improve long-term outcomes," Rivera said. Clinicians, he concluded, were not simply treating bipolar disorder but a person who happened to be living with it.

Dr Rivera is a dual board-certified mental health and family nurse practitioner, and the medical director of Mente Suave psychiatry and medicine in Central Florida.

References

1. Salcedo S, McMaster KJ, Johnson SL. Disparities in treatment and service utilization among Hispanics and non-Hispanic whites with bipolar disorder. J Racial Ethn Health Disparities. 2017;4(3):354-363.

2. Substance Abuse and Mental Health Services Administration. Mental health treatment among people who had a mental health condition in the past year. NSDUH Population Statistics Reports. September 2025. Accessed October 19, 2026. https://www.samhsa.gov/data/sites/default/files/reports/rpt56771/2024-nsduh-psr7-mhtx-adult-adol.pdf