Maria, Bipolar and Schizophrenia; Language barrier to treatment

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(En español) Maria has faced language barriers and issues paying for medication since arriving in the US from Puerto Rico (Massachusetts).
Maria doesn't remember much about her adolescence—the period right before she was diagnosed with bipolar disorder and schizophrenia. Some of her relatives have told her that during her teen years, her paranoia made her aggressive. They even tell a story about a day when she poured gasoline all around the house intending to set it on fire. She grew up in Puerto Rico and had anything but an idyllic upbringing. Maria's mother was an alcoholic whom she had to take care of from an early age. Maria suffered both physical and sexual abuse at the hands of family members and then endured more trauma after marrying an abusive man at 17. 

Her bipolar and schizophrenia diagnosis came when she was 19 and, though the mental health care system in Puerto Rico has flaws, she began to get basic treatment. Maria found solace working with fellow victims of domestic violence in her community. She would aid them in finding employment and starting a new life—something she was hoping to do herself. The first step came when she divorced her husband.

Then, in 2000, Maria moved to the United States to join her two younger children, both of whom had immigrated with her ex-husband. Her bipolar disorder and increasingly paranoid schizophrenia have limited her ability to work, so she receives subsidized medical care through a state-run program. The program gives her access to community health care clinics and some prescription coverage.

A significant obstacle that non-English speakers encounter when dealing with the mental health care system in the United States, however, is access to timely care. "6 or 7 years ago, I was hospitalized about 9 times in the span of about a year," Maria explains. Because Maria doesn't understand English well, she required assistance in communicating with medical personnel. In 2009, Maria was so deep into a depression that she was considering suicide. She was brought to the hospital where she began a long waiting game. "I waited for 4 hours while they tried to find an interpreter," she remembers. During that time, she says that nobody attempted to talk to or console her. "I was sitting there, crying, until finally somebody came and got me," Maria says. The initial assessment of her mental condition was completed with the help of the interpreter, and the attending physician determined that she needed to go to the psychiatric wing of the hospital. There, she had to wait another hour for a second interpreter to help her talk to the psychiatrist on call. By the end of this process, Maria says she "felt ignored and discriminated against."

In addition to problems accessing timely mental health care, Maria has encountered obstacles in paying for medication. "All of my money goes to rent and food; I never have extra," she says when explaining why even the small co-pay is too much for her. For the time being, her local clinic has allowed her to fulfill prescriptions on credit. She now owes over $1000 in co-pays, and she has no idea when the clinic is going to cut her off or how she will pay her bill if they do. On top of that, she believes she needs to change medications. "I'm still hallucinating a lot and it makes me paranoid. I can feel people touching me in the back; I can hear them calling me," Maria says.

Despite these hardships, Maria tries to stay positive. She thrives in her position as a peer-to-peer facilitator for the Central Massachusetts Recovery Learning Center (RLC). Through the RLC, she runs a support group in Worcester and helps others discuss their mental health. "It feels so good to talk to my peers," she says. She even credits them with helping her when she has slipped into a depression. Therapy is covered by her state-run health care plan, and she finds it essential to maintaining wellness. "I believe in recuperation," Maria affirms. "Medications do help, but you need to go to therapy and talk openly about what is going on. If you don't, you can get a lot worse."

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