Anna Marceau, PharmD
Inpatient Psychiatric Pharmacy Practitioner
William S Middleton Memorial VA Hospital
Improving mental health equity is a daunting topic to consider. Diversity, Equity, and Inclusion (DEI) work involves acknowledging the current state as being unacceptable. And being such a vast issue, one can feel at a loss as to what can be done to improve it. When seeking concrete, actionable steps for improving equity in your community, the essential word is “community”. Taking care of our neighbors is how we start to change the world; finding systems and solutions that work on a small scale is a path forward to adapting and figuring out how those solutions can be implemented at incrementally larger and more complex levels.
To find out what your community needs, you must find a way to ask them questions and ensure they are willing to entrust you with their answer. We must identify where inequities are present. A disparity is, almost by definition, caused by systemic inequity. It is not a difference in innate qualities of the patient’s health care needs or patient preferences, but the structure of the health care system itself. One contributor to mental health inequity among marginalized populations is lack of access. Some ways to improve access to care include increasing integrated mental health care services, increasing funding and resources to crisis community services, and the formation of community coalitions. One tangible action item is to address language barriers; however, a translation service by itself does not address all aspects of a cultural disparity.
The above strategies are appropriate if patients are already identified. However, often overlooked are the patients too alienated from the medical field to consider seeking care. To earn the trust of these patients there is no option but to spend time within your shared community. Examples of community relationship-building include attending community meetings, bringing food to meetings, volunteering at community events, and making financial investments in the community. From there, conversations can develop about disparities within the community and how to address them. You may have achieved enough trust to be able to ask the question concerning what they need. You will likely find that community members already have ideas about potential solutions.
Good research is the basis of equitable treatment of mental health conditions. Community-building is necessary in the setting of research to ensure that the study populations we are recruiting represent the entire population we aim to treat. Often, when reading literature about marginalized communities, you will see phrases such as “there is a paucity of data” and “there is insufficient data to conclude”. We are in a position of privilege to have the opportunity to change that. A challenge of this community-based approach to research is that you are recruiting people in populations that have historically been mistreated by the medical field. We must remember that study populations’ lack of representation could lead to support for therapies that may not be effective for the entire population, specifically those with marginalized identities. This leads to patients who are already marginalized spending resources on treatments that don’t work for them which results in financial burden and further mistrust of the medical system. Researchers must invest in the community they are trying to study in order to develop and adjust their approach and involve marginalized communities in the assessment of the results. The researcher’s interpretation of the findings may not be borne out of the context of that community’s lived experience – marginalized individuals deserve a say in the story being told about them.
There are plenty of strategies for addressing mental health equity. For those interested in more techniques for research, you may find the Community-based Participatory Research approach and the Human Centered Design models helpful. There are small things that clinics can do, such as reserving appointment slots for people with marginalized identities, like a primary care physician who is not taking new patients, except for transgender patients. That is an objective, concrete example of equity. Never be afraid to challenge systems of power. All laws, rules, policies, procedures, etc. were just made up by someone at some point. It is our right as citizens and our duty as health care providers to fight for equity in our communities. Don’t let the fear of no one listening keep you from speaking up.
References
Alves-Bradford JM, Trinh NH, Bath E, Coombs A, Mangurian C. Mental health equity in the twenty-first century. Psychiatric Clinics of North America. 2020;43(3):415-428.
Mersky JP, Topitzes J, Langlieb J, Dodge KA. Increasing mental health treatment access and equity through trauma-responsive care. American Journal of Orthopsychiatry. 2021;91(6):703-713.
Moore Q, Tennant PS, Fortuna LR. Improving research quality to achieve mental health equity. Psychiatric Clinics of North America. 2020;43(3):569-582.
Sudak DM, DeJong SM, Bailey B, Rohrbaugh RM. Training psychiatrists to achieve mental health equity. Psychiatric Clinics of North America. 2020;43(3):555-568.