Better Access to Mental Health Help
Dr. Susan Beane, Executive Medical Director, Healthfirst
Deborah A. Levine, Director, Harlem Health Initiative, City University of New York School of Public Health & Health Policy
Andrea Isabel López, Project Manager, Center for Innovation in Mental Health, CUNY School of Public Health & Health Policy
Last fall, a national mental health poll revealed that 90% of Americans believe the country is in a mental health crisis, with half of adults saying they’ve had a severe mental health crisis in their family. Unfortunately, far too many are going without help: In the same poll, only one in five adults used mental health services within the past year.
Meanwhile, data from the Kaiser Family Foundation indicates 47% of the country lives in an area with a shortage of mental health professionals. This problem is often associated with rural areas. However, underserved individuals in urban areas, especially members of racial and ethnic minorities and sexual orientation and gender identity minorities, face a one-two punch of limited access to mental health services and poorer quality of services — the latter driven by unconscious bias, stereotyping, and a lack of cultural competence among practitioners.
COVID-19, of course, further widened these disparities. Rates of depression and anxiety and rates of suicidal ideation were higher at the height of the pandemic among Black and Latino individuals than among white individuals, driven in part by a death rate two to three times higher in Black and Latino communities.
When mental health conditions go unaddressed, clinical outcomes and quality of life suffer. Research from Tufts Medical Center shows financial outcomes are worse as well — individuals with a diagnosis of major depression can spend nearly $11,000 per year on healthcare costs, compared to about $4,600 for individuals without such a diagnosis.
It’s against this backdrop that the Harlem Health Initiative at the City University of New York (CUNY) Graduate School of Public Health & Health Policy decided to do two things: Determine what the neighborhood needed and see how members of the community could respond. Below, frequent Healthfirst collaborators, Harlem Health Initiative Director Deborah A. Levine and Andrea Isabel López, project manager for CUNY’s Center for Innovation in Mental Health, discuss their efforts.
Addressing many needs at the community level
The Harlem Health Initiative launched in 2020 just as the pandemic started. Our leadership anticipated that our community would need tremendous support as everyone dealt with death in their own families and among the leaders they looked up to in the communities. We were seeing increased requests among community members to talk about depression and anxiety, and we were seeing front-line staff who were so burned out that they struggled to provide the support our community needed.
Working with Healthfirst and other partners, we started by surveying Harlem residents. The data was sobering:
- More than 40% of residents were at risk of depression, and nearly half were at risk of anxiety.
- Close to 75% were experiencing loneliness, and roughly half were experiencing housing, food, or employment insecurity.
- Half of respondents were misusing alcohol and about 20% were using other substances as unhealthy coping mechanisms, as often happens in stressful situations.
- Seven in eight respondents – nearly 90% — reported a barrier to accessing mental health services.
Given the historic lack of resources in low-income, ethnic-minority communities, we knew it would take a significant effort from multiple culturally responsible and social justice-oriented stakeholders to address this wide range of needs. We set out to create a community-wide model, with mental health services available from primary care physicians but also in housing developments, community-based organizations, and houses of worship as a way to build trust with those seeking help.
We set out to implement this program in three ways. One group of participating sites will receive a range of educational resources, mental health screening and stress management tools, and resource directories. A second group of sites will get those tools as well as collaborative care services such as care navigators, an online community forum, and additional implementation support. A third group of sites will receive the same things as the first and second groups, along with a technology component we’re developing alongside other community partners.
Recruitment and enrollment is happening now. Over the next three years, it’s our goal for all sites to reach that third group, where residents have access to educational resources, community navigation support, and technology tools that make it easier to get help.
Along the way, we’re going to be measuring the impact of our work and using those findings to retool the program as needed. As an example, we quickly learned that our program would benefit from being more inclusive of older adults and providing resources to help reduce the stigma of seeking mental health services. The more that we can share information like this with our partners in the community, the better they can service the residents who come to them for help.
This is the fourth in a series of posts highlighting partners of Healthfirst who are working to address various forms of health inequity for the New Yorkers we serve together. Read our other posts: