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'This Would Take A Toll On Anybody.' St. Louis Clinic Addresses Need For Immigrants' Mental Health

Casa De Salud

Several parts of the country have only a quarter or less than the mental health professionals they need, according to the federal Health Resources and Services Administration. That means it can take months to receive treatment.

A need for bilingual services means the wait can be even longer, and for uninsured people, much longer still.

For example, in St. Louis, the wait for an appointment with a Spanish-language therapist for someone without insurance can be a year or longer, according to providers.

Jorge Riopedre, president of St. Louis-based Casa de Salud, which serves uninsured immigrants and refugees at a clinic inside an old auto parts store, hopes to change that.

"[Immigrants] have high rates of trauma, things that happened to them on their journey to the United States … this would take a toll on anybody,” Riopedre said. “If mental health services are not available, it affects the physical health as well.”

To make room for appointments, the organization is renovating the building next door, which once housed a truck parts manufacturer. Uninsured patients will pay a flat fee or a sliding scale, based on their income.

Riopedre estimates the project will cost $1 million. Casa de Salud has raised more than half of the funding from foundations and an anonymous donor. The rest will be loaned to Casa de Salud by Saint Louis University, which owns both buildings.

Counselors will be provided by Bilingual International Assistant Services, St. Francis Community Services, the Saint Louis University Medical Family Therapy Program, and the St. Louis Psychoanalytic Institute. Casa de Salud already refers patients to the organizations for mental health services.

Alina Hille, a therapist who sees patients at St. Francis Community Services, estimates that three quarters of her clients have experienced traumatic events. Spanish-language services are important, because even if a patient speaks English well, therapy in English might not cut it.

“Emotion is really tied to language. Some of the experiences, if they take place in Spanish, it’s going to be really difficult if you’re speaking in English,” Hille said. “When you talk about that intense emotional processing, it’s really effective in the same language.”

Therapists in private practice will be able to use offices within the space for free, in exchange for devoting a portion of their caseload to Casa’s patients. Casa de Salud’s leaders expect construction to be complete in January.

Although the need for bilingual mental health services encompasses the entire country, only California is looking to address the need at the state level. A state-run iniative works to recruit candidates from high-need communities and help them pay for student loans if they return home to work in the mental health realm, according to the Pew Charitable Trusts.

Otherwise, advocacy organizations—such as Casa de Salud—are left to fill the gap.

Counselors said the Trump administration’s tough stance on immigration makes the need for bilingual services more acute.

Katrina Orlit, a clinical social worker who works for Bilingual International Assistant Services and plans to provide sessions at Casa de Salud, said many patients may fear the deportation of a family member. Others may worry what will happen to their U.S.-born children if they are deported themselves, she said.

At the same time, many of those who do not have a legal immigration status likely have been separated from family in their home countries for many years.

“I have a client right now who hasn’t been home the entire time he’s been in the United States, for 14 years,” Orlit said. “I am talking with families who have been separated for over 10 years, and they don’t have the confidence that they would be able to go home, visit and come back to the United States.”

Follow Durrie on Twitter: @durrieB

Durrie Bouscaren covers healthcare and medical research throughout the St. Louis metro area. She comes most recently from Iowa Public Radio’s newsroom in Des Moines, where she reported on floods, a propane shortage, and small-town defense contractors. Since catching the radio bug in college, Bouscaren has freelanced and interned at NPR member stations WRVO, WAER and KQED. Her work has aired on All Things Considered, KQED’s The California Report, and Harvest Public Media, a regional reporting collaborative.