Podcast: Diego Regalado, MD, on Culturally Responsive Psychiatric Care for Hispanic Patients

In this episode of “Psyched Perspectives,” host Frank Clark, MD, spoke with Diego Regalado, MD, a fourth-year psychiatry resident in Greer, South Carolina, about immigrant mental health, cultural humility, and mental health education in Hispanic communities.

Regalado was born in Mexico, came to the US at about age 6, and was raised mainly in Texas. English is not his first language. He said his family’s struggles with insurance, language barriers, and an unfamiliar health care system led him to become an American Psychiatric Association (APA) Diversity Leadership Fellow. He is now entering the second year of the 2-year fellowship.

His experience reflects documented gaps. Racial and ethnic minority patients with depression are less likely than non-Latino White patients to access mental health treatment, and those who do access it are less likely to receive adequate care.¹

Culture in the Clinical Encounter

Regalado described a case presented during the fellowship. A woman from a small village in Africa was hospitalized in Chicago and became agitated after staff removed her scarf as a safety precaution. Clinicians considered medication. A clinician then communicated with her largely through gestures and learned the scarf held religious importance. Clark called this a reminder of the cultural element in the biopsychosocial-spiritual model.

The DSM-5 Cultural Formulation Interview was developed for the same purpose: to give clinicians a structured way to gather cultural information that bears on diagnosis and treatment planning.²

For trainees, Regalado advised taking a full social history before working through a rapid review of systems. “That way, a patient feels like you’re seeing them like a person,” he said.

With Spanish-speaking patients, he often begins by asking where the patient is from and then shares where he is from. He said this helps reduce a hierarchy in which doctors are traditionally seen as above their patients. Within the first 10 minutes of a visit, he raises stigma directly. In some communities, he noted, mental illness may be seen as weakness or as something to address through prayer alone. He also explains what psychiatrists and psychologists do and what the visit will involve, because many patients are unsure what psychiatric care looks like.

Education on Social Media

Since January, Regalado has posted short videos about psychiatric medications. Each covers common indications and adverse effects and ends with a fun fact. He alternates between English and Spanish. He said many Hispanic patients he saw on consult and addiction services did not know medications exist for alcohol and other substance use disorders.

“If people don’t know what’s happening to them, everything feels scarier,” Regalado said. “You have more control with knowledge.”

Regalado also spoke openly about his own depression and anxiety. He said he shares this so patients understand that a diagnosis does not limit what they can become. Clark has also spoken about his own depression and anxiety. He stressed person-centered language and the point that patients are not defined by their conditions.

Dr Regalado is a fourth-year psychiatry resident at the Greer Center for Psychiatry Residency Program in Greer, South Carolina, and an American Psychiatric Association Diversity Leadership Fellow.

Dr Clark is an outpatient psychiatrist at Prisma Health-Upstate and clinical associate professor at the University of South Carolina School of Medicine, Greenville. He served on the American Psychiatric Association’s Task Force to Address Structural Racism Throughout Psychiatry, and he currently serves as the Diversity and Inclusion section editor and advisory board member for Psychiatric Times.

References

1. Alegría M, Chatterji P, Wells K, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008;59(11):1264-1272.

2. Lewis-Fernández R, Aggarwal NK, Bäärnhielm S, et al. Culture and psychiatric evaluation: operationalizing cultural formulation for DSM-5. Psychiatry. 2014;77(2):130-154.