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Lynette Carrillo felt alone. Looking around her junior psychology doctoral course at Texas Woman’s University in 2021, she realized she was the only Spanish speaker.
Carrillo was almost used to him at this point. After nearly a decade pursuing degrees at Angelo State University in San Angelo and TWU in Denton, she could count on one hand how many professors and classmates came from diverse backgrounds. Such is the field of mental health, she thought.
“For a long time, I didn’t know there were clinicians who spoke Spanish or came from a different background like me,” she said. “In the Latin American culture, community is important, so I had to make an extra effort to find a common language with my classmates. I had to have that mindset so I wouldn’t feel so alone.
As the daughter of Mexican immigrants, Carrillo knew it would be a challenge to become one of the few Spanish-speaking psychologists in Texas. Her parents didn’t go to college, and she never had mentors telling her which scholarships to pursue or which conferences to attend.
Even the mental health curriculum was a challenge for Carrillo, as medical terms are designed for English speakers and most have no direct translation into other languages. For example, she said that explaining anxiety symptoms can be difficult because the best translation in Spanish is “butterflies in your stomach,” but she doesn’t exactly describe the diagnosis.
This leaves many Spanish-speaking psychologists feeling unprepared to serve clients in their native language.
“Many of us have to make this journey alone,” Carrillo said.
Despite the nation’s growing diversity, the mental health workforce is still predominantly white and English-speaking.
As of 2021, the American Psychological Association reported that approximately 80% of the psychology workforce in the United States was white, up from 85% in 2011. At the same time, the U.S. Census Bureau reported that the white population nationally has declined from approximately 64% in 2010 to just under 58% in 2020.
In Texas, more than 40% of the state’s more than 30 million residents are Hispanic, but the population of mental health providers is more than 80% white, according to data from 2023. Also, less than 20% of the 10,440 providers of mental health providers in the state who responded to the 2023 workforce survey said they offer mental health services in a language other than English.
People of color and white people have similar rates of mental disorders; however, people of color are less likely to receive treatment for their mental health problems. According to the National Institute of Mental Health, in 2020, 52% of white people with mental illness received treatment, but only 37.1% of blacks, 35% of Hispanics, and 25.4% of Asians received treatment.
Carrillo said the concept of mental health among diverse populations has become a topic of conversation since the COVID-19 pandemic, but addressing these issues requires more than simply acknowledging their existence. She said it requires culturally competent mental health providers who can relate to the needs of their patients.
“There are different needs within that mental health umbrella, and that also lends itself to different cultural and language issues,” she said. “We all experience the world differently. We all see it differently. And so, in the same regard, we need people who can understand these differences.
Today, 251 of Texas’ 254 counties have been designated in whole or in part by the federal government as “mental health professional shortage areas” in a state where about 5 million people lack health insurance. This means that finding a mental health provider whose client list isn’t long can be a challenge, much less one who speaks a language other than English.
As a result, more Texans are choosing to bypass waiting lists and go straight to emergency rooms with loved ones who need mental health treatment.
As the need for more mental health workers grows, Texas lawmakers and regulatory agencies are taking a closer look at job requirements and ways to get more people licensed quickly to help strengthen the mental health workforce.
The Texas Behavioral Health Executive Board, which oversees mental health licensure for marriage and family therapists, professional counselors, psychologists and social workers, has seen a slight increase in the total number of licensed professionals over the years. But the industry has failed to keep up with the growing demand for mental health providers.
Darrell Spinks, the council’s executive director, said that has forced the state to review its rules to determine the best way to maximize the use of existing providers to meet demand. He said the board recently expanded the types of degrees that can be used to apply for psychology licenses to work in K-12 schools in an effort to expand the state’s numbers.
“We know we can’t get enough providers through in-state training programs or import enough out-of-state providers,” Spinks said.
However, the high cost of obtaining a degree and license as a psychologist has become one of the main obstacles to diversifying the field. Years of study can quickly put a student in debt.
Currently, licensed psychologists in Texas must have a doctoral degree and pass three exams: an $800 knowledge exam from the national testing board, a $210 jurisprudence exam, and a $320 oral exam. This is in addition to the $340 the prospective psychologist must pay to complete the required 3,500 hours of supervised work.
“During my studies, I also worked three different jobs to maintain some financial stability while maintaining the number of hours and training required for my program,” said Carrillo, who is now a postdoctoral fellow in psychology at the Momentus Institute in Dallas.
The National Testing Agency now plans to add a $450 skills test to the other tests. Last week, the Texas State Board of Psychological Examiners began exploring the possibility of taking a lower-cost state exam instead of requiring applicants to take the national test. It would allow the state agency to approve psychologists to work in Texas, but they would not be able to work in other states without passing the national skills test.
“This additional exam will undoubtedly impact the future of the psychology workforce and, to a lesser extent, the diversity of that workforce,” Spinks said.
Jessica Gomez, executive director of the Momentus Institute and a bilingual licensed psychologist, has made it her mission to hire more Hispanics in the field. However, she said reform is needed to make that happen in Texas.
“We have to deal with the high costs of education, licensing and training. Providing more funding, scholarships, loan forgiveness or wage subsidies can help open those doors,” she said.
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