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"I want to use my education to help make things better for people who are in situations similar to what I experienced growing up."
WHEN IMELDA PADILLA-FRAUSTO (MPH ’07) WAS STILL IN MIDDLE SCHOOL, her older brother became ill and, after several challenging years, was diagnosed with schizophrenia. “Living in a small rural town in Texas, my family had trouble finding services or even information to help us understand what was going on with him,” Padilla-Frausto recalls. “I took it upon myself to learn more so I could help him, and eventually decided that I wanted to dedicate my career to improving mental health awareness and services, particularly in Latino communities."
Since earning her MPH at the Fielding School, Padilla-Frausto has worked at the FSPH-based UCLA Center for Health Policy Research where, as a graduate student researcher, she plays a key role in the center’s mental health research and policy work. Padilla-Frausto now divides her time between the center and her studies as a doctoral student in the Fielding School’s Department of Community Health Sciences. Her dissertation will examine the inequities in mental health service use among Latinos.
Through her work at the center, Padilla-Frausto has helped to put a spotlight on the extent to which adults and children in California need mental health services, and in many cases are not receiving them. In 2012 she was the lead author on a study that found, based on results from the center’s 2009 California Health Interview Survey (CHIS), that an estimated 1.6 million adults ages 18-64 reported they had symptoms consistent with severe psychological distress, and that their mental health status interfered with their day-to-day functioning. Approximately one-third of those adults were uninsured for all or part of the year.
Implementation of the Affordable Care Act may improve access to mental health services for some communities, but not all, Padilla- Frausto notes. In particular, she says, the exclusion of the state’s 2.2 million undocumented immigrants from purchasing coverage through the state-run health insurance exchange or obtaining coverage under state Medicaid expansion is “extremely shortsighted in ensuring the overall health and wellbeing of our society."
Barriers to Latinos accessing mental health services go beyond insurance-related issues, Padilla-Frausto notes, which is why she is focusing in her doctoral studies on additional factors. “There are important structural issues,” she says. “We find a shortage of mental health professionals overall, but particularly in Latino communities, as well as a shortage of mental health professionals who are bilingual and/or able to provide culturally sensitive services. In the Latino community, as in all of U.S. society, there are additional issues contributing to the stigma associated with mental illness that keeps many people from seeking the care they need.”
Padilla-Frausto’s work at the center has led to an ongoing relationship with the office of California state Sen. Jim Beall, who chairs both the Select Committee on Mental Health and the Mental Health Caucus. Padilla-Frausto is frequently called upon to provide Beall and his staff with mental health and service-use data and has been invited to speak at the Mental Health Caucus, as well as to provide specific data on Latinos for members of the senate’s Latino Caucus.
In early 2015, Padilla-Frausto responded to a request from Beall’s office to provide CHIS data on the mental health needs and service use of California schoolchildren. Padilla-Frausto had been the lead author on a 2014 UCLA Center for Health Policy Research policy brief reporting that in 2011-12, only one-fourth of the more than 300,000 California children ages 4-11 with mental health needs were receiving any type of counseling. Beall used the data to request a state audit of mental health services provided to students in California schools. Under Assembly Bill 114, signed into law in 2011, school districts rather than county mental health agencies are responsible for providing mental health services to students who need them.
The audit, designed to examine whether school districts are appropriately using state mental health funds to meet the needs of their students, was approved. “Imelda’s help in identifying the necessary data to demonstrate the problem in our schools was invaluable, and I know contributed to the passage of the audit request,” Sen. Beall says.
Padilla-Frausto knew little about the potential for public health to address the problems her family had experienced following her brother’s diagnosis until, as a college undergraduate, she volunteered for a community-based research project that involved training Latino lay health workers to be mental health practitioners. After seeing how enthusiastic Padilla-Frausto was about the work, the principal investigator suggested that public health would be an ideal field for her and introduced her to the late Dr. E. Richard Brown, founding director of the UCLA Center for Health Policy Research, who ultimately served as one of Padilla-Frausto’s mentors when she went to work at the center following completion of her MPH at the Fielding School. A few years later, Brown and Dr. Steven P. Wallace, the center’s associate director, encouraged Padilla-Frausto to pursue her interest in returning to FSPH for her PhD.
“I want to use my education to help make things better for people who are in situations similar to what I experienced growing up,” Padilla-Frausto says. “I will never forget what it was like, in the beginning, to be part of my family’s struggle – not understanding mental illness or what mental health services were, and not having any place to speak about it. I also know that with the appropriate mental health services and other supportive services, recovering from a mental illness is possible. My brother courageously continued his educational pursuits and received his BA in 2013, 25 years after being diagnosed. I want to help others, especially in the Latino community, to realize that they don’t have to go through this alone, and I hope to inform policies that will provide them with better services.”