Doubling Down on Access to Mental Health Care

Why lifelong advocate Cynthia Telles is more dedicated than ever to her goal of achieving greater equality in access to mental health care

Cynthia Telles. Photo by Sheila Barabad.

Doctor Cynthia Telles comes from what can only be described as a legendary El Paso family, full of men and women who made history by rocking the boat. It was because of her upbringing in this particular family that Telles would eventually become one of the most recognized mental health advocates  in the country and one of only a handful of Latina corporate board directors. Telles chairs the community benefit committee on the board of Kaiser Permanente, the largest integrated health care system in the United States.

The psychology professor and director of UCLA’s Neuropsychiatric Institute Spanish-speaking Psychosocial Clinic is proud to have followed in the footsteps of family members like her maternal great-grandmother, who opened an orphanage for sick and disabled children in Juarez, Mexico. Her grandmother was also a nurse who cared for wounded soldiers from both sides during the Mexican Revolution.

Telles also cites her father, Raymond Telles, as a major source of inspiration. Upon returning from World War II, he wanted to advocate on behalf of Latinos, so he entered politics. In 1957, he became the first Mexican-American to be elected mayor of a major US city, El Paso, Texas, and later served as the ambassador to Costa Rica. He was appointed by President John F. Kennedy, making Telles’ father the first Hispanic-appointed US ambassador. Her father became a close friend and adviser to President Kennedy and also served under three other presidents.

“When my father announced he was running for mayor, he was told by a bank president, ‘As long as I draw breath, no Mexican will ever be mayor of El Paso’,” Telles recounts. “He didn’t let that deter him. He saw public service as a noble career, and it instilled a sense of duty.”

That duty is something Telles has taken very seriously. She was raised to believe in public service and to respond to the needs of the community. Her career thus far reflects exactly that. The El Paso native has served on countless nonprofit boards over the years, including nine years on the board of directors of the California Endowment, the largest health foundation in California. For 16 years, Telles served as commissioner for the City of Los Angeles.

Currently, she is chair of the California Community Foundation, where she has served since 2004. And on the corporate level, for over a decade, she has been a board director for Kaiser Foundation Health Plan and Hospitals, the country’s largest integrated health-care system. Add to that the fact that she serves on the White House Commission on Presidential Scholars, and a clear illustration of her commitment to service emerges.

Telles spent the bulk of her childhood in Costa Rica. She was in elementary school when her father became an ambassador. At 10, a mosquito bite gave her a deadly viral infection, putting her in a coma. Her parents were told she’d likely die in three days, and if she didn’t, she’d suffer permanent, irreversible brain damage and paralysis. Neither prediction came true, but it was a long road to wellness. Telles had to relearn how to walk, write, and speak. It was the amazing care she received during this time that convinced her she wanted to enter a field where she could help others get well.

The real catalyst for her career, however, came in college.

During an internship with the National Institute of Mental Health (NIMH), she was responsible for reviewing Hispanic mental health literature. She found so little literature geared toward Latinos and found that what existed wasn’t culturally relevant. Telles says the framing around mental health within the Latino community was also problematic. It was widely assumed by the medical community that Latinos would not utilize services pertaining to mental health because they were taboo. Telles quickly realized that it was because bilingual and bicultural services were non-existent.

Her experience at NIMH catalyzed a lifetime commitment to increasing access to linguistically and culturally competent mental health services. She eventually developed a UCLA psychiatric training clinic whose mission is to expand the cadre of socio-culturally proficient mental health professionals.  To date, the clinic has taught and trained hundreds of clinicians that work in all sectors, including community clinics, public hospitals, and academia.

“When I was in grad school, there were only three licensed Mexican American clinical psychologists in the entire country. There is a stigma surrounding mental health no matter your ethnic background or culture; our barriers have really been structural. Historically, mental health services have been inaccessible both geographically and financially. To this day, there aren’t enough Spanish-speaking mental health professionals. So, it’s not a matter of not wanting services; it’s a matter of not being able to access them,” Telles says.

According to the American Psychological Association, less than 25 percent of mental health professionals are minorities, and of those minorities, most are not bilingual. The National Association for Mental Illness (NAMI) reports that only one percent of licensed psychologists identify themselves as Latino.  It’s also reported that management of facilities haven’t enforced culturally relevant strategies.

When the right people and the proper practices are put into place, efforts have been incredibly successful. In fact, a Los Angeles clinic that opened in an underserved community offered bicultural and bilingual mental health services and subsequently became over-utilized. Education is also key; sometimes people don’t recognize that the symptoms they are experiencing, such as depression and anxiety—two disorders that hit the Latino community especially hard—are, in fact, mental health issues.

“We have to debunk the myth that cultural prohibitions are the principal cause of underutilization of mental health services.”

The importance of culturally competent care can’t be overstated, especially when we consider the specific needs of different communities. Often, all Latinos are lumped together, despite drastically different cultures, levels of acculturation, national origin, and immigrant status. This can be especially problematic when you consider how differently mental health issues play out in different Latino communities.

According to a new report from Albert Einstein College of Medicine of Yeshiva University and the Hispanic Community Health Study/Study of Latinos, rates of depression and anxiety vary widely among different segments of the US Hispanic and Latino population, with the highest prevalence of depressive symptoms in Puerto Ricans, as an example. That being said, research has provided broad insight into the mental health challenges of the wider Latino community.

Generally speaking, Latinos are affected by mental illness at rates similar to those of the general population, but they become a high-risk group because of the overwhelming disparities in seeking services and in following through with treatment.

Doctor Telles still finds a large degree of victim-blaming that takes place among mental health providers. “Communities are blamed for not seeking help, which is another way of blaming people without resources and access for their own illnesses,” she says. Now that there is more of a profit motive for helping low-income communities of color, health care is slowly making a shift, but the idea that certain communities are resistant to care continues to be perpetuated. And, according to Telles, it’s simply wrong.

“An aversion to treatment isn’t as deeply ingrained in people as we assume,”  Telles says. “I’ve found that people are very amenable to receiving mental health services when the usefulness of treatment is explained. It also helps when these services are provided in a comfortable environment that is linguistically and culturally proficient. This is why having therapists and psychologists who speak the language and represent the community they serve is critical and why having facilities located in underserved communities is so important. We have to debunk the myth that cultural prohibitions are the principal cause of underutilization of mental health services. It’s primarily a lack of access, lack of bilingual/bicultural care, and lack of education.”

For a long time, part of the problem was that a large percentage of the community was uninsured. Historically, Hispanics have been the least insured of all the racial and ethnic groups in the country.

Though the Affordable Care Act (ACA) enabled six million uninsured Latinos to access affordable health care, it did not extend coverage to 11 million undocumented immigrants.

According to the Hastings Center, undocumented immigrants are currently ineligible for the major federally funded public insurance programs, including Medicaid, Medicare, and the Child Health Insurance Program (CHIP) because, as Hastings says, they are not “lawfully present” in the US, which is required by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996. Some states, like New York and California, which have the highest concentration of undocumented immigrants, allow undocumented immigrants to enroll in Medicaid and CHIP. Permanent legal residents have to wait five years to become eligible for Medicaid and the ACA.

Never before has Telles been more driven to achieve greater equality in access to quality health and mental health care. Pure passion is what drives her, and though it could be characterized many different ways according to her many different roles, she says the thread that ties it all is that one goal. The undocumented community is particularly near and dear to her heart. Because immigrants are a vulnerable community rarely granted access to much-needed services, Telles has spent an increasing amount of energy advocating in Los Angeles and has made strides on their behalf.

As a long-time board member of Kaiser Permanente, Telles has done everything in her power to improve mental health services for immigrants and underserved populations. In an unprecedented move, Kaiser Permanente began offering a large-scale child health program for uninsured California children younger than 19 who don’t have access to Medi-Cal or other coverage, regardless of immigration status. Coverage ranges from absolutely free to $20 per child.

It was also through her work with The California Endowment and Kaiser that Telles was able to contribute to the effort that would result in the recent opening of the new Martin Luther King, Jr. Community Hospital in South Los Angeles, something Telles cites as one of her proudest accomplishments.

Interestingly, the creation of the old hospital was a direct result of the Watts Riots. When the dust settled after the riots, the McCone Commission was tasked with both exploring the root cause of the riots and making recommendations to Congress on measures that might be taken to improve the lives of the citizens of South LA. The commission was formed under then-Governor Pat Brown, with then-CIA director John McCone leading the charge. The commission came to the conclusion that upgrading health-care services in South LA would improve health conditions for residents in the area, who had historically been neglected in terms of resources for medical attention. Hopes were high that the hospital would represent the beginning of a turn-around for South LA residents, who had become accustomed to receiving low quality health care.

The original Martin Luther King, Jr./Drew Hospital opened its doors in 1972. Located in the Willowbrook area of South LA, it was one of the largest urgent care centers in the region that also offered inpatient services, primary care, and specialty services that were in high demand and short supply.

Sadly, there were signs of bigger problems after the hospital opened its doors. Things only got worse around 2003, when a series of untimely deaths linked to neglect gave the hospital the grisly nickname “Killer King.” The final nail in the coffin came with a Los Angeles Times exposé revealing countless instances of a “grossly inadequate facility and improper incidents” from 2004 to 2007. The hospital closed its doors for good in 2007.

It has been reported that the hospital’s closure left 1.2 million South LA residents without an urgent care facility for eight years, but that changed in July 2015 when the hospital reopened its doors. No longer run by the county, Martin Luther King, Jr. Community Hospital is now operated as a non-profit by a public/private partnership involving the University of California.

In a speech given to honor of the new hospital, Telles remarked to the crowd that it was hard to imagine a time of greater need for partnership and collaboration among different sectors, including community leaders, philanthropy, labor, government, business, and even the entertainment industry, all of whom were desperately needed to make the new Martin Luther King Jr. Community Hospital a reality.

The usual thanks were given, to community members, board members, even to her family, but Telles knew everyone was there for reasons that went beyond celebration. It took a village to make it possible for the hospital to reopen its doors; it was a community effort in a community desperately in need of care.

Audience members showed their support for “this dream that all people should have the right to good health”: a dream, she says, “that was emblematic of a more just society.” Telles’s years of crucial work, advocacy, calls for compassion, and political action may be her way of carrying on her family’s legendary dedication to community. But thanks to her, the mental health community, the Latino community, at-risk populations, and those who just want to better understand the issues are closer to realizing that dream.