As a "white boy from Arkansas" who attended high school in the late '80s and early '90s, Luke Smith heard some then-unconventional wisdom from his father: "You're going to learn that, boy, because everybody's going to be speaking it one day."
Smith's father was referring to Spanish, the language—and accompanying culture—his son would later embrace as executive director of El Futuro, a nonprofit mental health center dedicated to treating the state's underserved, and largely uninsured, Latino population. In 2004, Smith founded the center, based in Carrboro, to pool the efforts of therapists and psychiatrists who were versed in the language and culture of area Latinos, many of whom had never sought treatment for serious addictions and psychiatric illnesses.
In the past three months alone, El Futuro has served 123 new patients and logged more than 750 visits to their Siler City and Carrboro offices, where staff members treat everything from immigration-related trauma and depression to sexual addiction and alcoholism. Smith credits the spike in treatment to his staff's ability to build confianza among Latinos.
"It's more than just trust; it's a relationship," Smith says of the word, one of many Spanish phrases that have stuck with him. "By building that, we [were] able to get into the community and access them better. But it was based upon relationships they already had with their doctor, teacher, translator or friend. That's been a big thing that's driven a lot of our work."
Maria Pavón, an outreach worker for the Coalition for Peace in the Family, a nonprofit organization that raises awareness about domestic violence among Latinos, refers victims to El Futuro for psychiatric care and therapy. She uses the same word as Smith—confianza—to describe the center's effectiveness.
"I believe El Futuro is an effective organization for our community, and I believe that it's an opportunity for people who are both providing [mental health] services and receiving them. I hope El Futuro receives more opportunities, more time, a larger clinic," she says in Spanish. "The community is growing, and so are the number of clients."
Before Smith became a psychiatrist fluent in the nuances of region-specific Spanish, he was a University of Arkansas medical school graduate who "made the mistake" of mentioning during his psychiatry residency at UNC that he spoke un poco de español.
"As a resident, I'm down in the E.R. seeing psychiatric patients, and all of a sudden a trauma patient comes in. They're looking for translators, but they don't have time, so they grab me and put me in there," he says.
Smith, who grew up wanting to be a medical missionary, refers endearingly to his sink-or-swim Spanish training as his "immersion experience." But he knew other people in the community could provide equally effective Spanish-language services—it was just a matter of finding and connecting them.
"Someone may be doing counseling over there and they spoke Spanish, or social work over there and they spoke Spanish, but they didn't have anyone at their agency who was doing similar stuff," he says. "So it was just lucky if a Hispanic person actually got to see them. If a primary care doctor found depression in his clinic, it was lucky if he would know if someone down the street was doing family therapy or substance-abuse counseling or psychiatry [in Spanish]."
In 2002, Smith began volunteering at Piedmont Health Services, a federally funded network of community health centers dedicated to serving minorities. The centers, which traditionally offered services to African Americans, had suddenly experienced an influx of Spanish-speaking immigrants.
"They called [El Futuro founding member] Leslie Montana, because they heard she spoke Spanish and was a psychiatrist, and said, 'We don't have anywhere to refer these people, because nobody speaks Spanish, and these are psychiatry cases,'" he says.
Smith says Montana brought him along, and he in turn brought other friends. After work, the volunteers met in coffee shops to discuss ideas about managing the caseload.
"I sent out an e-mail one time and got 80 responses saying, 'Let's do it.' It felt very exciting—people were thinking along the same lines; they were experiencing the same kind of barriers to providing good care," he says.
In 2004, El Futuro opened shop in Siler City, providing a "one-stop shop" for Latino mental health care and substance abuse treatment. The following year, they opened their Carrboro office. They built partnerships with nonprofits such as Durham's El Centro Hispano and Siler City's El Vinculo Latino; private companies including Weaver Street Market and Value Options; and Chatham County schools.
Sally Scholle, a clinical social worker in the Siler City school system, says El Futuro has fulfilled a much-needed niche for Chatham County's growing Latino population. The center is often able to identify larger clinical problems, she says, many of which only rear their heads as language or behavioral problems in the classroom.
"We see [Latino] kids with post-traumatic stress disorder from things they underwent trying to get here," she says. "Some kids were left in their home country while their parents earned money to bring them here. Some of them were abused and neglected in the meantime."
Scholle says many Latino families have returned for follow-up care at the center, a rarity in the mental-health field, and more so for Latinos who have never sought mental health treatment.
"Even at the local mental-health center, most people don't come back after their intake," she says. "[El Futuro] seems to serve a population that's welcoming, and they make people feel welcome."
Alejandra Martinez-Lacabe, an El Futuro therapist who refers Siler City middle and high-school students to the center, says the staff's attention to cultural detail makes first-generation parents feel welcome.
"The parents have a lot to say, and they can talk to the therapists themselves," she says. "It's not the same as going through an interpreter; it's talking to someone from your culture who understands immigration and acculturation."
Ximena Martinez, business manager for El Futuro, began volunteering there in 2005. A Colombian immigrant who has struggled with many of the pressures El Futuro's clients face, she taught Smith the meaning of another Spanish phrase: la lucha, or "the struggle."
"It's a marvelous organization that helps my community," she says in Spanish. "Every day at El Futuro is spectacular. The thing I like most is the mission we have, to help the Latino community in the villages, where they have less access [to care] in this country."
Karla Siu, a childhood and adolescent therapist at El Futuro, split her childhood between Honduras, Japan and the United States. Previously, she specialized in treating Latino male domestic-violence offenders at the CHANGE program in Durham. She also uses the word "mission" to describe El Futuro, where staff members specialize in treatment but all share common cultural knowledge.
"At El Futuro, there's this sense that we'll work and do this and do that because we know we're small, and we know it's a one-stop shop [for Latino mental health]. I think we're just motivated, and we love the people we serve," she says.
Meanwhile, Smith says he has been moved by the graciousness of his clients, some of whom have brought him tamales to therapy sessions. He now trains interns to develop similar cultural rapport. The effect of a finely tuned ear has been enormous.
Smith says of some of his most common clients: "[They're] young men who work here in dishwashing jobs or lawn care or construction who are coming to us with big, heavy problems—falling apart, not sleeping, not able to go to work. We're able to offer them a little bit of treatment, and they're back in society again. Which is what they want—they came here to work and support their families."
El Futuro will host an open house Tuesday, Nov. 27 from 5:30-7:30 p.m. at 110 W. Main St., Suite 2H, in Carrboro. For more information, visit www.elfuturo-nc.org or call 338-1939.