Engaging the Mexican American farmworker community in improving the delivery of mental health services

Mexican American farmworkers experience high rates of mental health conditions; however it is difficult for them to access care.  Patient-centered care is a systems-wide approach to improving healthcare delivery for diverse populations in the primary care setting.  We describe the application of community-based participatory research methods to assess and address gaps in mental health care as perceived by both providers and migrant worker patients living in a US-Mexico Border community. Academic partners worked with a federally qualified migrant/health center which serves the approximately 60,000 agricultural workers. Community Health Workers (CHWs) facilitated the engagement of patients in the study.  Focus groups with patients (n=64) and FQHC staff interviews (n=16) explored attributes and dimensions of patient-centered mental health care.  Patients and staff both prioritized increased access to mental health care and patient-centered care.  Patients were more concerned with interpersonal care and providers with coordination of care.  All participants stressed the relationship between life events and mental health and the centrality of family in care. Patients also emphasized the importance of a good attitude, the ability to solve problems, positive family relationships and reliance on faith. Patients suggested that the clinic inform patients on mental health resources, provide community informational talks to address stigma and offer support groups.  Results will allow the FQHC to tailor patient-centered mental health care through the use of specific protocols and targeted staff training. The process of using CHWs to engage patients could be utilized by other FQHCs to improve the delivery of health care services.