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As a clinical psychologist with 15 years of experience working with a predominantly Latino outpatient population, I believe that in discussing mental health issues among Latinos, it is important to make it clear that the Latino population in the USA is more heterogeneous than might be commonly believed. There are considerable cultural differences among Latino subgroups as well as important cultural similarities that they all share. Culture affects the way people understand and respond to mental illness; socioeconomic status also plays a very important role in such understanding and in the willingness and capacity to access mental health treatment services.

The Latino consumers with whom I usually work are often first- or second-generation immigrants. Socioeconomic problems predominate in such a population and they affect their mental health. Most of them have emigrated from their native lands looking for better economic and educational opportunities for themselves or for their families; therefore, most of them did not have access to a good education in their countries. This lack makes their adjustment to a different language and to a different culture much more difficult than for the relatively few who arrive to the USA with a good educational background. Added to the stress involved in such an adjustment, there is the difficulty that many face in finding work and affordable housing.

The Latino population that many mental health professionals work with in the New York area has to be understood within this context of low educational and socioeconomic status. The most common psychiatric illness among them is depression. Aside from individual and familial predispositions to depressive illnesses, the common factor triggering many such illnesses is a reactive response to poverty, inadequate housing, and a profound sense of powerlessness and disappointment in their lives.

Cultural issues complicate matters further by making some of them reluctant to seek mental health treatment for fear of being considered "crazy" by their families and friends. Others feel shame for what they perceive to be a "weakness" on their part. Many poor Latino women have lived lives defined by emotional and economic deprivation and their only hope have been their children. If problems develop with them, these women often sink into despair.

A great number of Latino men are culturally conditioned to adopt a "macho" attitude and their daily reality of low-wage work and second-class citizenship often results in feelings of humiliation and rage. Unfortunately, those feelings either trigger serious depressions or are expressed in a manner not conducive to having a good relationship with their family members. Furthermore, more often than not, those men accept mental health treatment only when their emotional or mental problems reach a catastrophic level. Otherwise, they suffer in silence, denying themselves the help that might relieve their suffering.

I am convinced that Latino families-and particularly Latino men-need better education about mental health problems, so that they can seek help when needed or offer support to their ill relatives. They also need access to affordable housing. Crowded living conditions, crime-ridden housing projects and other related problems often contribute to familial conflict and trigger mental illness.

I also believe that treatment providers not only need to be well-trained professionals but also the kind of people who truly understand the socio-cultural and economic issues that affect poor Latino consumers. In order to gain their trust, mental health providers have to show sincere understanding and respect for their culture and for the socioeconomic problems that they often face.