Leading Social Change | adler.edu Mental Health Impact Assessment Prepared for Innovation in Public...

Leading Social Change | adler.edu

Mental Health Impact AssessmentPrepared for

Innovation in Public Service in Public Service Psychiatry: How recovery, integration and

population health will transform our work

American Association of Community Psychiatrists Winter Meeting - Phoenix AZ

March 2, 2012

Lynn C. Todman, Ph.D.Executive Director Institute on Social Exclusion


Social Determinants of Health (SDOH) …. the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources…which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status (among groups of people). (World Health Organization)

The Building Blocks


Health Impact Assessment (HIA) is “a combination of procedures, methods and tools that systematically (and prospectively) judges the potential, and sometimes unintended, effects of a policy, plan, program or project on the health of a population and the distribution of those effects within the population. HIA identifies appropriate actions to manage those effects.” (International Association of Impact Assessment)

The Building Blocks


Committee on Health Impact Assessment. National Research Council. 2011. Improving Health in the United States: The Role of Health Impact Assessment. National Academy of Sciences, Washington, D.C.

The State-of-the-Art


Obesity – 40 Diabetes – 13Cardiovascular – 13Asthma – 14Cancer – 12 Infectious – 4

Mental Health – 1Anxiety – 1Depression - 1 Behavioral Health – 0Stress – 0 PTSD – 0ADHD – 0 Suicide – 0

Where’s Mental Health?


Mental Health Impact Assessment – prospective assessment of the impact of public proposals – plans, projects, policies – on the collective mental health and well-being of a population of people.

What’s MHIA?


What do we mean by “community” mental health?

Is it …standard mental healthcare – medication, counseling, etc. – …delivered not in hospitals but

rather in clinics, care homes, or domiciliary visits to the patient’s own home? Is it …..the post-war model

of de-institutionalization and ‘‘care in the community’’ ….?

Major Premise


What do we mean by community mental health?

…. is it more a matter of working with other community agencies to maintain vulnerable

individuals in an ordinary life, a home and a job? Is it about the encouragement to inter-agency partnership

work with housing, leisure services and faith communities, and a wide variety of institutions and

agencies that make up ‘‘the community’’?

Major Premise


What do we mean by community mental health?

Or, is it more radical still, and concerned with the mental health of the community as a whole, an aspect of public health, intended to encourage a more enlightened, less

stressed and self-destructive society?

Johnson, R. and Haigh, R. 2011. “Social psychiatry and social policy for thetwenty-first century – new concepts for new needs: relational health,” Mental Health and Social Inclusion. Vol. 15, No. 2, pp. 57-65,

Major Premise


The Community: Englewood

The Proposal: Equal Employment Opportunity Commission Guidance on the Use of Arrest Records in Employment Decisions. Between January 2006 and March 2010, District 7 of the Chicago Police Department, wherein Englewood is located, recorded more than 65,000 arrests.

The Question: What is the impact on the mental health and well-being of the community when employers use arrest records in making their employment decisions?

MHIA in Chicago demonstration project


more rigorously integrating mental health considerations; considering a wider range of public decisions and actions; more rigorously evaluating and monitoring the HIA

processes; advancing the “radical” idea of community mental health

as collective well-being; shifting the point of intervention from the “individual” to

the “contextual”; and shifting the paradigm from a focus on” risk and illness” to a

greater focus on “protection and wellness”.

Project Goal: To advance HIA practice by …


1.Screening2.Scoping3.Assessment4.Recommendations 5.Communications and Reporting of Findings6.Evaluation & Monitoring

MHIA Steps


Surveys Focus groups Interviews Participant observation Systematic literature review Meta-analysis of existing studies Observational Tool (in development)

Assessment Methods


M age = 39 years old 59% (135) are female 71% are single Predominantly African American (96.5%) Most reports lower level of education, <6% have a

college degree or higher Some high school, high school diploma, and some

college as education level are evenly distributed (25 – 30% each)

Assessment Methods: Community Survey


Predominantly low income: 77% report < $15,000 as total household income

72% unemployed Voting: 92% registered ; 80% voted in last

presidential election; 71% voted in last local election

42.4% (97) reported lifetime history of arrest M # of arrests = 4.97

Assessment Methods: Community Survey


Individuals who have a history of arrest have…

Greater financial burden/ economic instability Lower perceived collective efficacy Greater substance abuse Greater participation in informal economy Lower life satisfaction Greater psychological distress Greater race-related stress, higher perceived

discrimination, greater distress from discrimination

Findings: preliminary correlations of survey data


Greater financial burden/economic instability is significantly related toLower general functioning and well-beingLower psychological sense of communityLower collective efficacyGreater substance abuseLower life satisfactionGreater psychological distressGreater depressionGreater race-related stress Greater perceived discrimination



Preliminary correlations - Greater number of arrests is significantly related toLower psychological sense of communityLower life satisfactionGreater psychological distressGreater depressionGreater perceived discrimination



Unemployment due to inability to get hired as a result of criminal records creates an environment of hopelessness, depression, and loneliness in the community

Since some men with arrest records cannot provide a steady source of support for their families, they tend to disengage …. “If I don’t care about me, I’m not gonna care about you, the community, nothing.”

Preliminary findings from focus groups


Residents report that the political/social structures in Englewood don’t support positive family processes….

police don’t allow parents to be involved when youth are arrested schools don’t engage parents effectively social services only available to women who do not have

husbands/males in the home supporting the family

Young men and women spoke more about individual responsibility for outcomes, while older men and women highlighted social factors for negative community outcomes such as crime, violence, un/underemployment.

Preliminary findings from focus groups


Conceptual disconnect – Units of analysis (individual vs. community)

Frameworks, methods, tools, language

Definitional issues – What is mental health? What is community mental health?

Indicators?

Disciplinary disconnect – What does ….have to do with mental health?

MHIA – Lessons Learned

MHIA – Lessons Learned


Data availability Conceptual (limited “population level” data)Stigma

Fragmentation of vulnerable communitiesMultiple issues (screening)

Proposal Moving target (especially legislation and policy)


Drawing attention to the concept of population (or public) mental health

Exploring new literatures – The Psychological Sense of Community (SOC), Social Capital

Developing an observational tool – visual, auditory and olfactory indicators of safety and security (resident developed and employed)

Help others understand how their decisions and actions impact mental health

MHIA - Value Added


Thank [email protected]

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