Promoting equity, precision and integration in mental health and neuropsychiatric care.

New Yorkers to Find ‘No Wrong Door’ to Public-Health Facilities

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

In April 2003 the Alberta government integrated specialized mental health services, formerly organized independently, with the health regions, which are responsible for general health services. The objective of this article is to determine whether the transfer was associated with an increase or decrease in the share of resources in the region allocated to mental health care relative to total spending for health care. The measure of the share for mental health care is the total costs for mental health care resources as a percentage of total health care spending. Resources and spending examined were those that were actually or potentially under the regions' control. Annual costs for mental health services in the province were obtained for a seven-year period (fiscal year [FY] 2000 through FY 2006) from provincial utilization records for all residents in the province. Unit costs were assigned to each visit. The trend in the share measure was plotted for each year. The share for mental health care increased overall from FY 2000 (7.6%) to FY 2003 (8.2%), but returned to pre-FY 2003 levels in the three years after the transfer (7.6%). Despite concerns expressed before the transfer by federal and provincial reports over the level of expenditures devoted to mental health care, the integration of mental health services with other health services did not result in an increase of the share for mental health care.

Persistent inequities in HIV health are due, in part, to barriers to successful HIV-related mental health intervention implementation with marginalized groups. Implementation Science (IS) has begun to examine how the field can promote health equity. Lacking is a clear method to analyze how power is generated and distributed through practical implementation processes and how this power can dismantle and/or reproduce health inequity through intervention implementation. The aims of this paper are to (1) propose a typology of power generated through implementation processes, (2) apply this power typology to expand on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to advance HIV and mental health equity and (3) articulate questions to guide the explicit examination and distribution of power throughout implementation. This paper draws on the work of an Intermediary Purveyor organization implementing trauma-informed care and harm reduction organizational change with HIV service organizations. The expanded framework was developed through analyzing implementation coaching field notes, grant reporting, and evaluation documents, training feedback, partner evaluation interviews, and existing implementation literature. The authors identify three types of power working through implementation; (1) discursive power is enacted through defining health-related problems to be targeted by intervention implementation, as well as through health narratives that emerge through implementation; (2) epistemic power influences whose knowledge is valued in decision-making and is recreated through knowledge generation; and (3) material power is created through resource distribution and patterns of access to health resources and acquisition of health benefits provided by the intervention. Decisions across all phases and related to all factors of EPIS influence how these forms of power striate through intervention implementation and ultimately affect health equity outcomes. The authors conclude with a set of concrete questions for researchers and practitioners to interrogate power throughout the implementation process. Over the past few years, Implementation Science researchers have committed increased attention to the ways in which the field can more effectively address health inequity. Lacking is a clear method to analyze how implementation processes themselves generate power that has the potential to contribute to health inequity. In this paper, the authors describe and define three types of power that are created and distributed through intervention implementation; discursive power, epistemic power, and material power. The authors then explain how these forms of power shape factors and phases of implementation, using the well-known EPIS (exploration, preparation, implementation, sustainment) framework. The authors draw from their experience working with and Intermediary Purveyor supporting HIV service organizations implementing trauma-informed care and harm reduction organizational change projects. This paper concludes with a set of critical questions that can be used by researchers and practitioners as a concrete tool to analyze the role of power in intervention implementation processes.

The Future of Nursing 2020–2030: Charting a path to achieve health equity

Back to table of contents Previous article Next article APA & MeetingsFull AccessAPA Celebrates Bebe Moore Campbell National Minority Mental Health Awareness MonthSearch for more papers by this authorPublished Online:24 Aug 2022https://doi.org/10.1176/appi.pn.2022.09.9.30AbstractIn July, APA’s Division of Diversity and Health Equity (DDHE) hosted its second annual APA MOORE Equity in Mental Health 5K. The run, walk, and roll brought together communities from across the country and globally to raise awareness and combat mental health inequities facing young people of color. In addition, over $100,000 was raised to support the DDHE and the APA Foundation’s MOORE Equity in Mental Health Community Grants Program. Five grant recipients received $10,000 to support mental health equity for young people of color, including the Drake University Counseling Center in Iowa, the University of Florida Health Community Clinic, Project Nia in North Carolina, Crear Con Salud in Puerto Rico, and the University of Colorado.In the photo below right (click here to see photos) are APA Deputy Medical Director and DDHE Chief Regina James, M.D., and APA President Rebecca Brendel, M.D., J.D. Pictured below left are runners participating in the APA MOORE Equity in Mental Health 5K at Anacostia Park in Washington, D.C.This year, DDHE expanded the activities under the APA MOORE Equity in Mental Health Initiative, hosting three roundtable conversations that gave attendees the opportunity to gain a deeper understanding of mental health issues, as well as the APA MOORE Equity in Mental Health Community Fair in partnership with Howard University Hospital. The event provided community members with an abundance of general mental health information, resources, and connected individuals with local mental health services and organizations dedicated to improving mental health equity.In the bottom photo (click here to see photos), Cynthia Rodwell (left) and Cynthia Wheeler, M.A. (right), with Howard’s Office of the Dean of the Andrew Rankin Memorial Chapel are leading the mindfulness meditation session during the community fair. ■ ISSUES NewArchived

Equity in health and health care is an important issue. It has been proposed that the pursuit of equity in health care is being hampered by the dominance of individualism in health care practices. This paper explores the way in which communitarian ideals and practices might lend themselves to the pursuit of equity. Communitarians acknowledge, respect and foster the bonds that unite and identify communities. The paper argues that, to achieve equity in health care, these bonds need to be recognised and harnessed rather than ignored. The notion of individual autonomy in the context of the community is examined. Alternative concepts of autonomy--social autonomy and community autonomy--are seen to be more respectful and nurturing of both the individual and the community. Moreover, these concepts appear desirable for the pursuit of health care equity goals. The paper concludes with some thoughts about how equity in Australia's health care system can reasonably progress within a communitarian vision. Disadvantaged communities are discussed throughout, in particular, Australian Aboriginal communities.

Patients With Serious Mental Illness Need Better Primary Care Integration, Health Advocacy

Trends in Behavioral Health Care Service Provision by Community Health Centers, 1998–2007

First Thoughts on a New Era for JACM.

Operationalizing antiracism in health systems: Strategies state government administrative organizations use towards racial and ethnic mental health equity

This new column provides an overview of mental health reforms in Latin America and the Caribbean. Progress has been particularly visible in countries that have implemented policies with strong political support (Brazil, Chile, and Belize, among others). However, lessons may be learned from the collective experience of a region that has faced multiple obstacles to reform. Available resources are still insufficient and inequitably distributed, reform implementation is not complete in most countries, and high levels of unmet need exist. Countries face new challenges related to growing psychosocial problems affecting children and adolescents and increasing violence, which require new responses from mental health services.

Individuals with serious mental illness often are unable to access consumer- and family-oriented community care, resulting in repeated hospitalizations, incarceration, and homelessness. The "medical home" concept was developed in primary care to provide accessible and accountable services for individuals with chronic medical conditions. Building on the work done in primary care, the authors propose a "mental health home." The model of care incorporates medical home characteristics, such as access to and coordination of services, integration of primary and preventive care, adoption of recovery orientation and evidence-based practices, and family and community outreach. Barriers to and strategies for implementation of mental health homes are discussed.

A New Kind of Homelessness for Individuals With Serious Mental Illness? The Need for a "Mental Health Home"

Building on 2022’s Successes in the Year Ahead