When Luke Smith, a psychiatrist from Arkansas, became a doctor more than 20 years ago, he noticed that a lot of Hispanic and Latino patients were having trouble accessing the mental health care they needed.
“I saw a lot of people coming into the health system, and they were struggling to navigate the system,” he told Healthcare Brew. “They were struggling to have trust—or confianza—with the system, with their providers, providers who may speak Spanish but may not culturally relate to that person.”
That’s why he founded El Futuro, a mental health services provider in North Carolina that has specialized in treating Hispanic and Latino patients for two decades. Hispanic communities can face barriers to quality healthcare: Pew Research Center reported in 2022 that 44% of Latinos said problems with communication due to language or cultural differences lead to worse health outcomes.
Services include therapy, substance use treatment, and support groups for both children and adults—all designed to be culturally competent, meaning the care meets the social, cultural, and linguistic needs of the patients.
Smith, who is the executive director of the nonprofit, is not Latino, though he speaks Spanish. He wanted to help reach new populations with staff that could make cultural connections and address stigma in mental health treatment.
“How do you bridge those trust avenues? And how do you meet people where they are and bring them along, instead of making them wander through a complicated system?” he said. “It really becomes a [cultural] engagement.”
Holistic care. El Futuro’s 70-person staff, which includes providers, hail from all but two Latin American countries (the center is currently recruiting in Panama and Paraguay) and meet patients where they are: at churches, schools, workplaces, doctor’s offices, community centers. They provide initial counseling in Spanish to help patients understand what they may need and go over additional treatment options if necessary.
This work is done by community health workers as well as “peer support specialists” who have struggled with their own mental health and now support others as an initial point of contact for care.
Dennis Duke, a therapist at El Futuro who’s originally from El Salvador, said in an emailed statement that culturally informed care helps “build rapport with clients,” “understand where they come from in order to provide appropriate care,” and makes it easier to “conceptualize the clients’ goals.”
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At its brick-and-mortar facilities in Silver City and Durham, North Carolina, El Futuro connects members to nature through a community garden, offers health classes about food and nutrition, provides resources about technology management, and hosts cultural events including a Día de los Muertos celebration in November and a Posada (a nativity celebration) in December.
“We believe that treatment oftentimes happens behind the doors of a clinic, but that mental wellness and mental wholeness happens not just in the clinic, but in the community,” Smith said. “We’re very interested in community engagement and celebrating culture, reconnecting people to rich identities of culture to help that healing process.”
Corporate collabs. El Futuro’s nonprofit status is meant to help patients who cannot afford access to care, don’t have health insurance, or may not qualify for government assistance programs, Smith said. A June study from the US Department of Health and Human Services found that about 18% of Latinos under the age of 65 are uninsured and are twice as likely as non-Latino whites to be uninsured.
As a nonprofit, the organization can accept donations and other contributions from local companies that want to support its work. For instance, employees from tech company Lenovo have volunteered at the center and offer technical support for patients, Smith said. And El Futuro members have gone into the Lenovo office to talk about wellness initiatives.
Employees from skincare company Burt’s Bees have also helped El Futuro curate its outdoor green space and provide the brand’s products to patients. And research firm RTI International has sponsored events and helped the nonprofit study and publish research about its care model.
On September 29, El Futuro will hold its annual Kermes festival to celebrate Latino culture with dancing, crafts, and games during Hispanic Heritage Month. Smith said events like these help patients connect with the community.
“We found that, when people feel isolated, that if we can connect them back to home cultures and back to identities that they feel proud of…levels of anxiety, levels of depression go down,” Smith said. “Fiesta becomes a treatment intervention.”