Sergio Aguilar-Gaxiola, M.D., Ph.D., 59, is a professor of clinical internal medicine and the founding director of the University of California Davis Center for Reducing Health Disparities. He's also the director of the UC Davis Community Engagement Program at the Clinical Translational Science Center, co-director of the National Institute of Aging-funded Latino Aging Research and Resource Center, sits on a dozen university advisory and state government committees – including a consulting position for the World Health Organization – and, according to the Sacramento Bee, has a curriculum vitae that's 51 pages long.
But Aguilar-Gaxiola might just have easily been a writer, philosopher, poet or entered another profession that delved deeply into what it means to be a human. He was a young reader of Sigmund Freud, grew up in a house filled with rich characters from around his hometown and is fascinated by people, he told the Sacramento Bee. Instead, he became what the news source called a "pioneering mental health professional."
Now, however, Aguilar-Gaxiola and his mental healthcare contemporaries face a growing challenge with the immigrant paradox. And it's one that coordinated care models may be able to help solve.
An advocate for the underserved
Aguilar-Gaxiola is specifically renowned for his work within mental healthcare for the Latino population in California, where needs are rarely met. As an example, Aguilar-Gaxiola was the principal investigator of the largest mental health study conducted on Mexican Americans in the U.S. As a result of the study, he was able to develop a model of care delivery that increased access to mental health services for low-income populations in the California Central Valley area.
As the Sacramento Bee explained, Latino culture is filled with taboos relating to mental health. Seeking care can create a massive stigma, and there's a pervasive masculine view that denies the existence of problems such as depression entirely. It doesn't help that Latinos make up the largest immigrant population in California, or that, according to the California Reducing Disparities Project of 2012, the lack of mental healthcare for this population is "severe."
The immigrant paradox
There is a sociological term called "the immigrant paradox," a view supported by research indicating that newly arrived immigrants to the U.S. have better mental health than citizens of the same age who were born within the country. Furthermore, the Sacramento Bee noted that studies show that the longer immigrants live in the U.S., the more at risk they are for mental disorders and the more rates climb.
In a 2008 paper, titled "Prevalence of mental illness in immigrant and non-immigrant U.S. Latino groups," a group of researchers from the Center for Multicultural Mental Health Research in Somerville, Mass., examined data from two of the largest nationally representative samples of psychiatric information in the U.S. and found that, in the aggregate, U.S.-born Latino subjects consistently reported higher rates for most psychiatric disorders than Latino immigrants. In fact, the immigrant paradox remained consistent for Mexican subjects with relation to mood, anxiety and substance abuse.
According to Aguilar-Gaxiola's work, depression is the most common mental health condition among Latinos, both of Mexican origin and born in the U.S. And in three out of four cases, it goes untreated.
As a result, not only is there a treatment gap, but according to the immigrant paradox and the rising Latino population, that treatment gap can only widen unless there is a bridge to cover it.
Creating a continuum of care
Two things can help. The first is the emotional intelligence and technical knowledge that professors and mental health professionals like Aguilar-Gaxiola have. He is renowned in his community for his demeanor and kindness as well as his accomplishments. Second, with the help of better systems of coordinated care, mental health workers such as Aguilar-Gaxiola can reach a wider underserved demographic.
Part of this is transferring community health workers, typically volunteers known as "promotores" who go door-to-door to talk about health with local Spanish speakers, into licensed and salaried jobs. The next step is creating a system of coordinated care not only between doctors and academicians like Aguilar-Gaxiola, but those health workers who sit down with members of the underserved population each day.
With the help of behavioral health software and accountable care systems, the hard and dedicated workers serving the Latino community can take on challenges like the widening disparities gap and immigrant paradox. Success stories already exist.
In an October 2011 edition of the American Journal of Orthopsychiatry, a study indicated that mental health treatment for the low-income immigrant population was extremely important. But creating a low-cost and effective treatment model would have been more difficult, if not for the use of a coordinated care platform.
"Without such programs," the authors wrote, "the needs of these multiply burdened patients will go unmet."