By Luca Boccalato-Rodriguez
Across the United States, mental health needs are widespread, but access to care remains deeply uneven. In 2024, more than one in five U.S. adults, about 61.5 million people, experienced a mental health condition. Yet only about half of adults with any mental illness received treatment in the past year. Even for those who do eventually get care, the path is often long: delays between the onset of symptoms and first treatment can stretch for years, with some anxiety-related disorders showing average delays for treatment of 20 years or more.
These gaps are not simply about individual choice. Many people face barriers such as cost, insurance limitations, transportation, stigma, and language access. These challenges are intensified by a larger workforce crisis. Across the United States and globally, there are not enough mental health providers to meet the need for care.
For marginalized communities, including Spanish-speaking communities, this gap is especially stark. Between 2014 and 2019, the proportion of U.S. mental health treatment facilities offering services in Spanish declined by nearly 18%, even as the Hispanic population grew by 4.5%. In a national American Psychological Association survey, only 5.5% of psychologists reported being able to provide services in Spanish. In other words, the communities that already face the highest barriers to care are often the same communities least likely to find services that are linguistically accessible.
This is where digital mental health tools enter the conversation. Digital tools include online programs, mobile apps, teletherapy, and AI based supports, among other tools. The ability to provide therapeutic services online has reshaped the mental health landscape, and demand for digital options has continued to grow. In one national survey, 55% of patients prefer to use digital tools instead of traditional in-person therapy, and among users of digital tools, 24% prefer completely self-guided options.
At first glance, then, digital mental health tools seem like an obvious part of the solution to the treatment gap. If there are not enough providers, and especially not enough language-concordant providers, then online programs and self-guided interventions can help expand access to care.
But there is an important caution here: access is not the same as equity, and translation is not the same as meeting needs.
Digital tools can help reduce mental health disparities, but they can also sometimes reproduce them. Technology is not bias-free. It reflects the values, data, and blind spots of the people that create it. In health care, biased technologies have already contributed to unequal outcomes, from scheduling algorithms that led Black patients to wait longer for appointments, to health-monitoring tools that performed less accurately for people with darker skin. Mental health technologies are not immune from these same problems.
This is especially important when digital mental health tools are translated for communities they were not originally designed for. A mental health app created in the United States and translated into Mandarin, for example, is not automatically culturally adapted. The words may be in the right language, but the tool can still miss the meaning and embedded assumptions behind it. For example, an app developed in English may focus on stress related to work, school, or personal goals. Those are real stressors, but they may not fully reflect concerns that can be especially important in Chinese American communities, such as family obligation, stigma, and maintaining harmony. When a tool does not account for those differences, it may be technically accessible but still feel disconnected from the people it is meant to support.
This is where cultural humility becomes essential.
Cultural humility is an approach first proposed by Melanie Tervalon and Jann Murray-García in 1998 as an alternative to the idea that providers can become fully “competent” in another person’s culture. Rather than treating culture as something to master, cultural humility emphasizes lifelong learning.
Research shows that cultural humility matters in mental health care. When clients perceive their therapists as more culturally humble, they tend to report stronger therapeutic relationships and better outcomes. The same principle should guide digital mental health. Tools are more likely to feel useful and trustworthy when they reflect the lives, values, and contexts of the people using them.
With this in mind, there are several strategies for finding culturally responsive digital mental health tools:
Look for examples that feel like real life.
One important question is whether the content in the program feels real to you. Do they reflect the kinds of stressors you actually face? Does the language sound natural? Does the tool seem to understand the complex environment around you? A tool does not need to capture every person’s experience perfectly, but it should not feel like it was made for or by someone else. Related, look at whether members of the community that the program is designed for are part of the program team. Look for privacy information you can understand.
Mental health tools often ask users to share personal information. You should be able to know what information is collected, how it will be used, who can see it, and whether it may be shared for other purposes. This is not a small detail. For communities that have experienced discrimination and understandably feel mistrust of health care systems, transparency is part of whether a tool is safe, respectful, and worthy of trust.
MindTrails Español as a case study.
When our team first launched MindTrails Español, we operated on the assumption that we didn’t know exactly what the community needed. So from the earliest stage of developing the program, we ensured we had a diverse team and we repeatedly invite feedback from community members, providers, and partner organizations to understand what feels relevant, useful, and what needs to change.
We also know this work is ongoing. Spanish-speaking communities are not a single, uniform group, and it can be difficult to create one version of a program that feels relevant to everyone. For that reason, we are working to learn from a diverse range of perspectives, including first- and second-generation immigrants, refugees, and people living in rural and urban communities. Our goal is to continue refining MindTrails Español so that it feels as effective and relevant as possible to the communities it is meant to support.
Above all, cultural humility allows us to approach mental health work with greater care, as we learn in collaboration with our community partners how to best reduce health disparities and increase access to quality care.
