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Melissa Harris-Perry: The deadly shooting at Robb Elementary School in Uvalde, Texas left a close-knit, predominantly Latino community in mourning, and in Buffalo, where less than two weeks ago a white supremacist took 10 Black lives in a racist shooting at a top supermarket that was predominantly Black community.

Mental health support can be crucial in times of grief and loss, but African Americans and Latinos are less likely than their white counterparts to seek mental health care. In 2019, the Bureau of Labor Statistics found that nearly 88% of mental health counselors are white. Joining me now is Luis Zayas who is dean of the School of Social Work and a Professor of Psychiatry at The University of Texas at Austin. Dean Zayas, I appreciate you joining us.

Dean Zayas: Thanks for inviting me, Melissa.

Melissa Harris-Perry: In Buffalo, there was a racial motivation to the crime, does not seem to be the case in Uvalde, but this is a predominantly Latino community. Does that identity matter? Do Latino identities matter when it comes to the question of grief and loss in this moment?

Dean Zayas: Melissa, it matters to the families and the community that's been deeply affected, primarily because how we grieve, how we mourn is influenced by our culture and our background. In Uvalde, unfortunately, we had this awful tragedy. It wasn't seemingly a question of race, but rather just a troubled young man, and so the community will have its own way of mourning and grieving the loss of these children. Regardless of our race, ethnicity, religion, this is, as president Biden said, ripping a part of our soul out of us, so the parents and the community are really suffering.

Each and every one of those families will be mourning in their own way informed by their culture, because we cannot think of Latinos as monolithic in the community of Uvalde which involves primarily Mexican and Mexican Americans, we would expect to see other folks from Central America, for example, who might have integrated into the community whose children were perhaps in that school. Oftentimes, those folks may be undocumented, so it's going to be hard for them to grieve the way the other families grieve.

Melissa Harris-Perry: Why would undocumented status be associated with the capacity for public grieving of your child?

Dean Zayas: Undocumented people have to live in the shadows constantly even with US-born children or children who are also undocumented, they send their kids to school, but they do not have access to the benefits of much of our society. Things like insurance and the protection of the law. To go to a federally qualified health center, for example, or another clinic or hospital to get mental health services means that it exposes them.

Consequently, their grieving will be different than the families who have been in Uvalde state for generations, who work for the town, for the local merchants, have their own businesses, who are insured or perhaps receive Medicaid and other benefits, the undocumented won't, and their grieving may be done much more privately.

In Uvalde, we will probably see families who can come together and mourn in a public space with the television cameras and reporters all around them, where many of the undocumented will have to grieve quietly at home, perhaps without grief counselors and other services. That's not to say that there won't be local social service agencies, nonprofit organizations that will step up and offer services, but it still means that the fear remains and to some families, it may not matter. They've lost a child, so to lose their chance of pursuing the American dream here may all have gone down with that child and are willing to take the risk of deportation, but it is going to be very difficult for those families.

Melissa Harris-Perry: I so appreciate the way you walked us through some of the reasons that an individual or a family might be reluctant to seek mental health care grief counseling at this time. What constitutes culturally competent grief counseling or mental health services at a time like this?

Dean Zayas: What we mean by that, Melissa, is that the individuals, the grief counselors, must have some working knowledge at the very least of how a particular community mourns and grief mourning loss is very imbued with culture all around it. How one culture mourns and grieves the loss of a loved one may differ from others.

In a community such as Uvalde, we may have the different forms and it may be different, for example, for an undocumented family of indigenous background from, say, the Highlands of Guatemala who may grief differently based on their religion or their beliefs than we might do in a Western world.

For a grief counselor, that individual needs to at least have a working knowledge of that culture even if it means learning it at the moment from the very family that they're working with. The approach of culturally competent mental health care really begins with a certain level of humility that I don't know your culture, I'm learning your culture, but I'm here to help you, and that's vital so that the trust can be earned by that family, knowing that someone deeply cares, may not really understand us, but is here with full empathy for us.

At the beginning of the show, you mentioned the workforce is largely a non-Hispanic, non-minority workforce in the mental health workforce and, indeed, that is the case, but I'm also of the mind that it doesn't require someone of the same culture to serve us. Yes, it's important to be knowledgeable, sensitive to the culture, and work very hard at it, and we face what we face, which is a largely non-Hispanic, non-minority mental health workforce, but it's incumbent on them to learn how to work with these families. That's where this culturally competent service comes in.

We do trainings and it's part of every licensing exam, but when it comes down to the day-to-day practice, we don't know who we're going to face on any given day. That is culturally, just like the grief counselors in Atlanta may not have known exactly what the Asian community would need, but they had to learn it, so too do we have to think about that. It doesn't stop counselors from providing good services. They must understand and enter it with cultural humility with a certain naivety and a respectfulness for the different ways that people mourn.

Melissa Harris-Perry: This is perhaps less about culture, but it certainly ends up having racial and ethnic effects. Can you talk to me about the cost of mental health care? We talk about a reluctance to reach out and seek services, but even really high-quality physical health care plans often have somewhat abysmal mental health care plans. I'm wondering what we know about the costs and whether or not it's prohibitive for many working-class communities.

Dean Zayas: Mental health care in the United States is so desperately needed across all groups and it is very expensive, and of course, the higher the quality, the more expensive it becomes. That's a tragedy in and of itself that we cannot provide everyone with a certain level of care. Oftentimes, insurance companies or employers may not include mental health benefits in their packages, or if they do, they may be limited to about eight sessions or fewer. That means that after that the individual now has to go out and either continue with that therapist at the therapist's running rate or stop the care.

It's a tragedy in our country that we cannot continue to provide care for people who will need it long term. It is prohibitive. We do know that the rates are very high for such services, and there are very few places that will pay. Even the state and federal programs pay under-market rates for the therapists who will be available to serve and, of course, that doesn't incentivize them to necessarily care for those.

I want to say that there are many, many therapists who will do pro bono work and provide services beyond what is needed, that is, what is permitted by an insurance company so that they may help their communities but it's not all the time. I do believe that many of the families will be left without services, again, depending on their employment and the insurance that they have, whether it's public or private and how generous it is with mental health services.

Melissa Harris-Perry: Luis Zayas is dean of the School of Social Work at The University of Texas at Austin. Dean Zayas, thank you so much for joining us.

Dean Zayas: You're very welcome, Melissa. Thank you very much.

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