APA Fall Conference to Focus on Determinants of Mental Health

Systemic trauma in communities will be the focus of several sessions. Trauma can consist of neighborhood violence, gun violence, mass shootings, police violence, and incarceration. These sessions will explore the policies that have been developed to address trauma as a social determinant of mental health, the level of success of those policies, and their practical application to improve resiliency within diverse populations.

Structural racism in the mental health care community will be another focus. In response to a reinvigorated national dialogue on structural racism, the American Association for Community Psychiatry has created a roadmap for community behavioral health providers that would (1) provide metrics specific to disparity and inequity issues in community behavioral health, (2) extend beyond cultural competency and linguistic appropriateness to incorporate structural inequity, and (3) promote a stepwise, concrete quality improvement process that can be adapted for self-directed use in community behavioral health settings. The Self-assessment for Modification of Anti-Racism Tool (SMART) will be introduced—this is a quality improvement tool that aims to facilitate organizational change in community behavioral health care.

Discriminatory practices will be addressed in a session that examines disparities at several levels and their effects within APA, in hospital system training programs, and in the community (see infographic). Within APA, the voices of marginalized people need to be heard and recognized. Presenters will discuss the work that has been done so far, where we have fallen short, and where we need to go from here. In our hospital training programs, it is important to carefully evaluate and revise expectations and competencies for trainees to incorporate sociopolitical issues. Attention to these critical determinants of mental health early in training will help to improve the level of care that future clinicians can provide to the diverse patient populations under their care. Finally, in the community, we need to promote good behavioral health practice. We will introduce the key components of the SMART, describing our process in developing this organizational tool based on key inequity issues that are most relevant to community mental health practice. Lastly, we will use a case example to illustrate the process for using the SMART and describe future directions for piloting this framework.

Integrated care of those with SMI has an important role in reducing health disparities and achieving mental health equity for all patients. In integrated care practices, addressing the social determinants of mental health that impact our patients is critical to improving outcomes. With regard to social determinants related to race and ethnicity, peer supports and people with diverse backgrounds with lived experience with SMI have unique insights that we need to acknowledge and understand.

Climate change disproportionately impacts minority communities and is a driver of migration across the globe, undeniably a sociopolitical determinant. Addressing climate change and its impact on patients is an important aspect of ensuring quality patient care.

Criminal justice issues will be presented and will showcase how to work with police, patients, and detainees to avoid stigma, facilitate an optimal reentry into society, and prevent the injury or death of people with mental illness in crisis. Presenters will also explore the utilization of current systems and the systemic reforms that are needed to effectively treat patients within the criminal justice system.

Rural and indigenous populations are often overlooked and require unique and careful considerations to ensure quality care. Promoting mental health that emphasizes interdependence and holistic healing is critical for a culturally competent approach to caring for these populations.

COVID-19 has revealed a syndemic—biological and social interactions that increase a person’s susceptibility to harm or experience worse health outcomes. The September 2020 Lancet reported that infectious diseases such as COVID-19 were clustering within certain minoritized groups according to well-established patterns of inequality, especially in Black and Latinx communities. Presentations will discuss policy changes that should be considered to address and eliminate these kinds of systemic issues.