番茄社区

NEW ORLEANS -- Mental health care delivery needs a paradigm shift, according to a review that was published in the and presented at the American Psychiatric Association (APA) annual meeting.

Mental health professionals should move from an individual therapy and pharmacological treatment-focused approach to a community-level, public mental health-focused approach to achieve a more equitable model of mental health care, said Margarita Alegría, PhD, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues.

There is a pressing need to address mental health care disparities in minority communities, who experience more severe and persistent mental health conditions and less access to necessary resources, Alegría and team said, due to a lack of funding for services, as well as insurance coverage.

Mental health care has "not meaningfully improved" for minority individuals in "the past 20 years," they noted.

"This is a timely opportunity because we can disrupt dominant models of individualized pharmacological treatment ... and really start thinking about how to move services out to communities," Alegría told 番茄社区. "This is an opportunity to reimagine how we put these dollars in practice and open the door to more community-based interventions."

The idea is to address "structural factors that have an impact in terms of wealth, education, and neighborhood conditions" that are tied to disparities in care, she added.

Alegría and colleagues looked at a variety of studies and programs that demonstrated ways that mental health professionals can apply evidence-based approaches to reduce these disparities. One of the primary initiatives they cited was the CDC's framework, a food pyramid-like outline that shows interventions from counseling and education (top level), to social determinants of health (bottom level), for mental health care.

"Building on the HI-5 model, we highlight specific community-level or community-based approaches that could significantly shift the mental health landscape for people of color," Alegría and team wrote. "Through investing in social determinants and preventive interventions like those discussed in this review -- and better coordination between these programs and primary care screening and referral systems -- fewer people will need to make their way to a clinic with staff that may be overwhelmed in dealing with the structural and social issues contributing to clients' mental health needs."

They noted that prior reviews have shown that interventions from paraprofessionals in community-based settings have led to improved outcomes. In one for example, 69% of 27 randomized controlled trials showed significantly improved mental health outcomes with programs that included community health workers.

Alegría and colleagues also highlighted programs that increase the amount of green space (gardens and parks) and blue space (access to rivers, lakes, and oceans) in communities, which has been shown to reduce the among older adults in low-income neighborhoods.

Implementing these changes to mental health care delivery does come with obstacles, noted Ned Kalin, MD, of the University of Wisconsin School of Medicine and Public Health in Madison and the editor-in-chief of the American Journal of Psychiatry, during the presentation of the review at the APA meeting.

"One of the challenges is having the academic institutions work with their leadership to make sure that their additional resources are prioritized and devoted to additional community efforts for populations that currently do not have the resources to access that kind of care," he said.

"One of the things they could do is academic-community partnerships ... bring their expertise to communities and share with them what could be important ways of facilitating evidence-based care in communities," Alegría said, adding that resources are available from the National Institute of Mental Health and the National Institute on Minority Health and Health Disparities to assist in developing these partnerships.

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