Front Matter

“The authors of Struggle and Solidarity narrate stories that mark some of the most important milestones in the history of American mental health, and the prowess of the editorial team—Dr. Michael T. Compton and Dr. Marc W. Manseau—shines through in comprehensive yet succinct chronological chapters that make for an easy read. It is hard to set down the book once you start reading it—it is logical and flows easily, and you find yourself coming away from each chapter, unique in its own content, having learned a lot by putting pieces of history together. A remarkable amount of work has gone into decoding and studying the various laws and eloquently elucidating the events and circumstances that led to their enactment. The book shows how history, advocacy, and politics collectively wove the tapestry of the societal structures in which Americans lived, learned, and worked, and created and then sought to address racial and ethnic divides.

After setting the stage in the first chapter by informing readers how federal laws affect basic social determinants and thus directly mental health, the authors take us chapter by chapter through the stories behind seven major federal laws. Interspersed are pictures of the tireless advocates who dedicated a significant chunk of their lives to enacting these laws, and illustrations that depict change spanning decades. The book beautifully wraps up with a concluding chapter summarizing the lessons one can learn from history, with an unmissable commentary on systemic racism.

The concept is brilliant, the organization immaculate, the presentation uniform, and the execution seamless. Let us use the knowledge contained in this book to inform policies and drive the change that the American public is in desperate need of today. The book is a must-have for just about any bookshelf in any American household.”

“The stories in this volume are presented in fascinating and engaging vignettes about ordinary people and their struggle for dignity and a better life. Social needs such as freedom from poverty, food insecurity, climate change, racism, and exploitation are elaborated to draw the reader to an inevitable conclusion. Mental health suffers because of these preventable social determinants. Policy-level change is imperative for impacts on large populations. This is a must-read historical review for anyone interested in advocating for the rights of populations and improving mental health.”

“This volume provides a fascinating historical journey into federal legislation of the United States and the impact these legal decisions have had on social determinants of mental health. The authors help us to step out of the medical model of treating illness and into a better understanding of how social factors must be addressed to gain and maintain mental health.

The authors begin by introducing the reader to Jack Geiger, M.D., and his lifelong dedication to treating the whole person, in their community, rather than just focusing on illness. This first chapter sets the stage for the remaining ones, which eloquently retell the history of significant legislation that had impacts on each of several identified social determinants of mental health. The chapters cover farming and access to food, labor and employment, income security, clean air, civil rights, education, and housing. The authors of each chapter describe the impacts of the legislation on these social and environmental systems and the resulting effect the laws had on public and individual mental health.

In each chapter, the balance between fiscal, political, and social needs is played out through the advocacy of great leaders and affected communities. This book tells the story of social rights, or lack thereof, and it is a mustread for mental health providers, policy makers, and advocates.”

“Drs. Compton and Manseau and the many chapter authors have done the field of psychiatry and the world of mental health an extraordinary favor by removing our blinders and locating us in the world we inherited and can help to recreate. They take the concept of health in all policies, no doubt obscure to many, if not most, psychiatrists, and firmly locate it in the historic actions of passionate advocates for change. Beginning with a eulogy for Dr. Jack Geiger, a leading activist physician of the past 60 years, they then lead us through the dramatic stories of seven legislative victories outside of health care, from the Agricultural Adjustment Act of 1933 to the creation of the Department of Housing and Urban Development in 1965, that changed American lives, including their mental health, for the better. Their argument is simple: When faced with societal challenges to their health, mental health, and well-being, regular Americans have found ways, through legislation and policy, although not always perfect, to move forward. It is tempting to ask if there is a need for psychiatry and psychiatrists to join these efforts. Compton and Manseau make a convincing argument that our profession’s voice matters. They point to the emerging concept of mental health impact assessments and the need for psychiatric input in policy development. In the challenging world we live in, we have a choice to be silent or to follow the example of those before us who struggled to make it better. The stories in Struggle and Solidarity represent an excellent launching point for psychiatry’s renewed engagement with our society and its future.”

Contributors vii

Foreword ix

1 Fixing the “Endlessly Revolving Door”: How Laws Impact Social Determinants and Thus Mental Health

Marc W. Manseau, M.D., M.P.H.

Michael T. Compton, M.D., M.P.H.

2 Saving Farmers and Striving for Food Security: The Agricultural Adjustment Act of 1933

Michael T. Compton, M.D., M.P.H.

Julie C. Suarez, M.A.

3 From Worker Exploitation to Union Solidarity: The National Labor Relations Act of 1935

Flávio Casoy, M.D.

Marc W. Manseau, M.D., M.P.H.

4 A Stay Against Financial Catastrophe: The Social Security Act of 1935

Caroline L. Bersak, Esq.

Matthew Wolfe, B.A., M.A., M.Phil.

5 Clearing the Air for Mental Health: The Clean Air Act of 1963

Benson S. Ku, M.D.

Elizabeth Haase, M.D.

6 Still on the Road to Freedom: The Civil Rights Act of 1964

Daniel Neghassi, M.D.

Taiwo P. Alonge, M.D., M.P.H.

7 The Times They Are A-Changin’: The Elementary and Secondary Education Act of 1965

Rebecca A. Powers, M.D., M.P.H.

8 Remodeling and Breaking New Ground: The Housing and Urban Development Act of 1965

Jacob M. Izenberg, M.D.

Brie A. Garner, M.P.H.

Andrew T. Turk, M.D., A.M.

9 Learning From History’s Lessons: How Mental Health Professionals Can Participate in Policy Change

Michael T. Compton, M.D., M.P.H.

Marc W. Manseau, M.D., M.P.H.

Index 229

Adult Psychiatry Resident, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

Director of Legal Services, Legal Wellness Institute, The Family Center, Brooklyn, New York

Private practice, Brooklyn, New York

Professor of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons; Research Psychiatrist, New York State Psychiatric Institute, New York, New York

Senior Project Manager, Housing for Health, NYC Health+Hospitals, New York, New York

Associate Professor of Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Nevada School of Medicine at Reno, Reno, Nevada; Medical Director of Psychiatry, Carson Tahoe Regional Medical Center, Carson City, Nevada

Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California

Assistant Professor, Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia

Clinical Assistant Professor of Psychiatry, Department of Psychiatry, New York University Grossman School of Medicine, New York, New York

Assistant Clinical Professor of Medicine, Center for Family and Community Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Adjunct Clinical Associate Professor, Stanford University School of Medicine, White Oak Medical Office, Campbell, California Email address for complimentary book ordering information:

Associate Dean for Land-Grant Affairs, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York

Associate Professor, Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York

Doctoral candidate, Department of Sociology, New York University, New York, New York

Although steady advances in treatments for mental illnesses and substance use disorders are undoubtedly helping countless Americans, we must strive to promote well-being, mental health, and resilience in addition to offering treatment. To do this, with a goal to reach all Americans, policy must be a key part of the strategy. And policy with the farthest reach is that enacted by the U.S. Congress.

Recent decades have witnessed a recognition in the field of public health of health in all policies, meaning that health is created (or damaged) by many factors beyond the health care system and even beyond the traditional public health infrastructure. Health is shaped largely by the social determinants of health. As such, health-promoting policymaking across sectors—as diverse as education, energy, environment, farming and food, housing, labor, and transportation—in addition to the public health and health care sectors, can improve the health of all Americans. Relatedly, mental health in all policies means that there are hidden mental health impacts, either positive or negative, in all policies because they affect the social determinants of mental health. But how can we collectively influence the social determinants of mental health? One of the most powerful ways to shape these social and environmental factors in order to improve the mental health of millions of Americans is to ensure that policymaking takes such impacts into consideration.

The authors of this book tell the stories of seven major federal laws that had (mostly positive) mental health impacts “hidden” in plain sight, and which have largely gone unconsidered. These case studies make vivid the idea that policies, whether within an institution, an organization, local government, state government, or, in this case, federal legislation, can have far-reaching and long-lasting effects on mental health. Improving mental health and reducing the risk of mental illnesses and substance use disorders require smart, thoughtful, and rigorously analyzed and implemented policies. Furthermore, getting such policies passed legislatively and implemented well requires enormous efforts—often over decades—of everyday Americans, fighting for the conditions in work and life that would allow them, their families, and future generations a better, happier, and healthier future. The authors tell these stories of struggle and solidarity through key pieces of twentieth-century federal legislation.

Throughout my career in psychiatry and public health, I have witnessed the power of policy in promoting health and reducing risk of physical illnesses and behavioral health disorders. When I was a senior policy fellow and lobbyist for the Barton Child Law and Policy Clinic at the Emory University School of Law, we worked hard—in part through legislative advocacy—to improve measures that protect children from abuse and neglect. In my administrative duties as Medical Director of the Fulton County Department of Behavioral Health and Developmental Disabilities and as Director of the Fulton County Department of Health Services, I helped leverage state, local, and agency policy to improve the integration of public health, behavioral health, and primary care services as a means of improving access to care for all, but especially for those who had struggled most with access. In my elected roles—as president of the Georgia Psychiatric Physicians Association, Trustee of the American Psychiatric Association, Trustee of the American Medical Association (AMA), and, eventually, as President of the AMA—legislative advocacy was a necessary and crucial tool for advancing the health of populations. When I was Chair of the AMA Council on Legislation, the health impacts of federal legislation took priority.

We can make America healthier, with improved well-being, fewer psychosocial stressors, reduced structural determinants of health inequities, and longer and more meaningful lives. One key way to accomplish this is to fight for and pass laws and other policies that have beneficial, not detrimental, mental health impacts for all Americans. By demonstrating how Americans have worked together to improve mental health in the past, this book helps show us the way forward to a brighter, more equitable, and healthier tomorrow.