National Mental Health Equity Framework
FOREWARD
Mental health is a fundamental aspect to our overall well-being, affecting every dimension of human life. Unfortunately, equitable access to high-quality mental health care and services remains inaccessible for many due to racial and political bias, including inadequate resources, workforce support, and untapped family, peer, and provider networks. This National Mental Health Equity Framework is a decisive step towards addressing these disparities and ensuring that everyone, regardless of their background or circumstances, can achieve their full potential of health and well-being by ensuring they have optimal mental health.
The following narrative outlines a comprehensive strategy to dismantle systemic barriers, promote inclusive practices, and foster environments where mental health can flourish. It emphasizes the importance of cultural competence and the need for community engagement and advocates for policies supporting equitable access to mental health services.
The development of this framework is rooted in a commitment to health justice and the recognition that mental health equity is not merely a goal but a necessity. The recommendations are crafted by members of the Equity Braintrust, which is a group of industry experts, mental health advocates, and champions that collaborated over the last four years with a shared mission of operationalizing mental health equity into a series of strategic actions that can catalyze sustained community and policy impact. The authors have undertaken rigorous research, extensive consultation, and the invaluable input of diverse stakeholders, including mental health professionals, community leaders, policymakers, and those with lived experience.
The framework is not an end but a beginning—a call to action for all of us to join forces and work towards a future where mental health equity is a reality for everyone.
On a personal note, I extend my deepest gratitude to all who have contributed to this pivotal work. I am honored to work with a committed team of thought leaders, advocates, and community change agents who continue to offer meaningful solutions to improve mental health equity and make it a reality. Together, let us champion the cause of mental health equity and build a world where every individual can thrive.
Courtney Billington Chair, The Equity Braintrust Veteran and Mental Advocate
Executive Summary
The National Mental Health Equity Framework serves as a transformative blueprint designed to dismantle systemic inequities in mental health care and promote equitable access for all individuals. Developed by The Equity Braintrust—a collaborative of advocates, policymakers, and mental health experts—the framework identifies critical barriers to care. The narrative offers actionable solutions to address disparities rooted in the political and social determinants of health.
Mental health is foundational to overall well-being, yet equitable access to care remains elusive for many, particularly marginalized communities. The authors acknowledge the importance of racial bias, fragmented systems, and inadequate resources that have perpetuated disparities in mental health outcomes, with a direct impact on Black/African Ancestry communities. The framework is built on the fundamental understanding that achieving mental health equity is essential for fostering resilience and improving quality of life and healthcare.
Key priorities in the text include access to quality care, workforce development, decriminalization of mental health, and improving care navigation and transitions in care settings. We acknowledge the impact of the political determinants of health as grounds for advocacy of policy reforms to ensure equitable resource distribution and dismantling of systemic and structural barriers.
Workforce expansion, particularly in underserved areas, is prioritized through diversification, debtfree education initiatives, and the integration of community health workers and peers. Youth and peer support programs are also critical components of equitable care that are referenced and outlined as a priority for the future of mental health care delivery in the U.S.
Cultural humility underpins the framework, fostering trust and engagement through culturally responsive, patient-centered approaches. Recognizing the interconnectedness of physical and mental health and expanding inclusive practices within care teams highlights the important role of patient education.
The authors call for strategies to support workforce wellness, address burnout, and ensure fair compensation and supportive workplace policies. Decriminalizing mental health care by eliminating punitive practices and investing in community-based crisis response systems is another critical focus.
Addressing these multifaceted challenges, The National Mental Health Equity Framework lays the groundwork for a future where equitable mental health care is not just a goal but a reality and underscores the importance of policy, advocacy, community-based interventions, and culturally responsive care.
Introduction
The Equity Braintrust is a convening of thought leaders committed to advancing recommendations for a national policy on mental health equity. The focus of the writing is grounded in four pillars: access to quality mental healthcare, developing a more robust workforce, decriminalizing mental health, and advocating for strategies that support navigation and transitions in care delivery settings. The goal is to promote solutions transforming mental health equity, informing clinical practice, and providing responsive approaches to equitable treatment, diagnosis, and systems of care.
The framework for mental health equity creates opportunities for engagement with diverse multidisciplinary stakeholders to improve overall health outcomes for marginalized populations. The collaboration on the narrative emphasizes the importance of race, ethnicity, and linguistic considerations and recognizes intentionally addressing the experience of communities of color.
The information presented is designed to inform audiences as an advocacy tool, increase awareness of the current barriers in mental health care, explore some of the workforce constraints, and the decriminalization of carceral systems. Ultimately, the policy recommendations are designed to address the challenges of overcoming systemic inequities, the importance of honoring patients, and upholding personal dignity and autonomy within the health care system. Central to this work is addressing how communities experience care transformation and navigation when accessing and advancing mental health.
Thus, there is an inherent understanding that undergirds the narrative, namely that we do not live, diagnose, or treat in isolation. Still, we are a microcosm and a part of a complex and racially polarized system of care. Arguably, this is most prevalent when addressing the advocacy needs for mental health care across gender lines.
Political Determinants of Health
The political determinants of health—including poor environmental conditions, inadequate transportation, unsafe neighborhoods, insufficient healthy food options, and the lack of a professional workforce—create barriers to accessing proper mental health care for marginalized communities. These determinants affect all other dynamics of health. By understanding these health inequities, their origins, and their impact on the equitable distribution of opportunities and resources, we, as individuals and community stakeholders, are better equipped to develop and implement actionable solutions to close the health gap.1
The structural and institutional barriers to health equity elevate the need and the opportunity to introduce a framework that
POLITICAL DETERMINANTS OF HEALTH MODEL
provides recommended action steps that disrupt that status quo and expose the true drivers of disparities in care and outcomes.2 These disparities are part of the political determinants of health. Thus, the systematic process of structuring relationships, distributing resources, and administering power provides operational insights and simultaneously and mutually reinforces or influences outcomes that either advance health equity or exacerbate health inequities. There is perhaps no greater case example than witnessed in the convoluted and fragmented system of mental health care. The current mental health system seeks to treat without addressing the comprehensive needs of the care paradigm, preventing solutions to achieve resilience, restoration, and long-term successful outcomes.
Source: John Hopkins University Press
1 Dawes, D. (2024). Political Determinants of Health. Meharry Medical College School of Global Health. Retrieved from https://meharryglobal.org/research-scholarship/political-determinants-of-health/ #:~:text=The%20Political%20determinants%20of%20 health%20involve%20the%20systematic%20process%20of,equity%20or%20exacerbate%20health%20inequities. 2 Ibid.
Historical Background
In Roosevelt’s 1944 State of the Union Address, FDR defined freedoms the government had a duty to recognize and protect, including “the right to adequate medical care and the opportunity to achieve and enjoy good health.”3 FDR directly contradicted the rise of the eugenics movement and the denial of a right to health care, which defined disease as a consequence of bad genes and implemented policies to euthanize “life not worthy of living.”4 Eugene Bleuler promoted sterilization,5 while Emil Kraeplin, “grandfather” of the Diagnostic Statistical Manual of Mental Health Disorders (DSM), recommended euthanizing schizophrenia.6 Sterilization practices of those diagnosed with mental illness plagued communities along racial lines, denying a preexisting right to life and choosing who should live or procreate. There was a confluence of ideas and a clear separation and delineation of physical and mental health care and diagnosis. The emergence of policies that promoted stigma continued to evolve, and recent rhetoric in the current election cycle and fractured political system has reiterated and reinforced an unjust separation between individuals living with diagnosis, resulting in attacks targeting those with mental health disabilities and threats against humanity that individuals living with mental health disorders should “just die.”7
After World War II, the Allies transformed public health from a fee-for-service privilege to the government’s responsibility to protect citizens’ health, creating national health services. In the United States, a right to health care dangles precariously between changing Administrations and politicized judiciaries recognizing and denying the fundamental and inherent right to healthcare.
The spirit of and the significant tenets of the Affordable Care Act, Medicare, and Medicaid offer the opportunity to advance access as a right to health care; however, the interpretation of federal law often embeds an inherent set of vulnerabilities, leading to an eventual outcome that limits access to care among historically marginalized racial and ethnic groups, the poor, disabled, underserved, and disenfranchised – the very “beneficiaries” policies were designed to protect.
The unmeasured impact is unnecessary relapse, extended morbidity, and increased risk of death. Patients, particularly from racial and ethnic groups, are frequently denied care for being “too sick.” Patients are akin to captives within a consolidated and often volatile healthcare system. Clinical management is frequently compromised by systemic barriers of care, at the whim and mercy of what payers approve or disapprove of.
3 Roosevelt, F. (1944). 1944 State of the Union Address. National Archives. https://www.fdrlibrary.org/sotu
4 Binding, & K., Hoche, A. (2012). Allowing the Destruction of Life Unworthy of Living: Its Measure and Form. Suzeteo Enterprises.
5 Moskowitz, A. & Heim, G. (2011). Eugen Bleuler’s Dementia Praecox of The Group of Schizophrenias (1911): A Centenary Appreciation and Reconsideration, 37(3), 471-479. Retrieved from https://doi.org/10.1093/schbul/sbr016
6 Kraeplin, E. (2018). Psychiatrie: Ein Lehrbuch für Studierende und Aertzte: Vol. 1, Allgemeine Psychiatrie, (Classic Reprint)(German Edition). Forgotten Books.
7 Trump III, F.C. (2024). All in the Family: The Trumps and How We Got this Way. Simon and Schuster.
The impact of market consolidation creates corporations that employ mental health providers, primary care providers and mental health clinics, home health companies, and urgent care that can discriminate while dictating diagnosis and treatment. The potential to define disease through privatized entities is concerning because it can compromise appropriate diagnosis and address the social and political influencers that impact individual mental health care. Cost-saving and risk-reduction strategies deny a right to health care when embedded inside policies; all the while, the burden remains on patients to navigate the health care system with a level of discernment and responsibility that even the most sophisticated and health literate struggle to master adequately.
Mental Health Workforce
There is a well-documented consensus that the U.S. mental health system is experiencing a workforce shortage, with many people unable to access care, particularly in mental health deserts (MHD). MHDs are geographic areas with limited or no access to mental health services like psychologists, psychiatrists, social workers, peer support specialists, and counselors. These areas are more prevalent in rural regions than in urban settings.
According to Mental Health America, approximately 65% of rural counties lack a practicing psychiatrist, whereas urban areas have
Our United States of America faces the specter of Project 2025 projections to gut Medicare, Medicaid, the Centers for Disease Control, and the Food and Drug Administration.8 In response, there is a state and moral imperative to amend state constitutions to establish healthcare as a guaranteed right, as seen in many countries throughout the modern world. With well-defined principles and rigorous rules to restrain diagnosis, treatment, and disease definition, empowering patient autonomy to secure equitable mental health must be prioritized as a necessity to advance and achieve the right to health for all.
a higher concentration of these professionals.9 However, many urban regions, especially those with high poverty rates or underserved populations, also face significant shortages of mental health professionals. In 2024, the Health Resources and Services Administration (HRSA) reported that 32% of urban areas are designated as mental health Health Professional Shortage Areas (HPSA).10 These figures highlight the widespread need for healthcare professionals in diversified geographies, implicating the need for proactive solutions in urban and rural settings.
8 Dans, P., Groves, S. (2023). Mandate for Leadership. The Conservative Promise. Project 2025 Presidential Transition Project. The Heritage Foundation. Retrieved from https://static.project2025.org/2025_MandateForLeadership_FULL.pdf
9 Mental Health America (MHA). (2024). Rural Mental Health Crisis. MHA. Retrieved from https://www.mhanational.org/rural-mental-health-crisis
10 Health Resource & Service Administration. (2024). Designated Health Professional Shortage Areas Statistics: Fourth Quarter of Fiscal Year 2024, Designated HPSA Quarterly Summary. U.S. Department of Health & Human Services. Retrieved from https://data.hrsa.gov/Default/ GenerateHPSAQuarterlyReport
In 2023, over half of adults with a diagnosable mental health condition did not receive treatment, totaling more than 20 million people. That percentage increases to 60% for youth.11 There is a greater need and demand for racially focused solutions to address the current mental health crises noted in Black adolescent youth. The suicide rate among Black adolescents is increasing faster12 than other racial and ethnic groups. From 2007 to 2020, the suicide rate rose 144% among 10- to 17-year-olds who are Black.13
Meeting a communities’ mental and behavioral health needs necessitates an enhanced workforce that includes more providers across different areas of expertise from a range of racial, ethnic, linguistic, and geographic backgrounds. Policymakers are poised to create a pipeline of allies that can work in the community and foster intentional opportunities to bring more providers
of color into the workforce who represent and understand the communities they are supporting and those who can offer culturally responsive and patient-centered care.
Achieving the goal of building a mental health workforce that meets the needs of the community, the connection between peers and community health workers (CHWs) must be realized to bridge the gap between the lack of mental health professionals in geographically disparate areas. Peers and CHWs have a shared focus on improving health outcomes by leveraging trust, lived experience, and cultural competence to engage with individuals and communities. Both roles complement traditional healthcare systems by addressing social determinants of health, enhancing access to care, and providing personalized support.
11 Mental Health America (MHA). (2023). Access to Care Data, 2023. MHA. Retrieved from https://mhanational.org/issues/2023/mental-healthamerica-access-care-data
12 Emergency Taskforce on Black Youth Suicide & Mental Health. (2019). Ring The Alarm: The Crisis of Black Youth Suicide in America. Congressional Black Caucus. Retrieved from https://watsoncoleman.house.gov/imo/media/doc/full_taskforce_report.pdf.
13 Akkas, F., Corr, A. (2024). Black Adolescent Suicide Rate Reveals Urgent Need to Address Mental Health Care Barriers: Cultural competency in health care, expanded use of screening tools, and more research on risk factors could help address increase among this demographic group. The Pew Charitable Trusts. Retrieved from https://www.pewtrusts.org/en/research-and-analysis/articles/2024/04/22/blackadolescent-suicide-rate-reveals-urgent-need-to-address-mental-health-care-barriers.
Similarities
PEERS
Typically, individuals who have personal experience with a specific condition (e.g., mental health, substance use recovery) and use their lived experience to support others facing similar challenges.
COMMUNITY HEALTH WORKERS
Often members of the communities they serve, which helps them build trust and establish rapport based on shared cultural, social, or linguistic backgrounds.
Both roles focus on advocacy and support and emphasize patient empowerment. They help individuals navigate healthcare systems and advocate for their needs.
Both bring a holistic approach to care, addressing medical issues and social, emotional, and environmental factors impacting health.
Both peers and CHWs work to bridge gaps by acting as intermediaries between individuals and healthcare systems by reducing barriers like stigma and mistrust.
Differences
PEERS
Specialize in a specific lived experience, such as recovery from addiction, mental illness, or chronic disease.
Training often emphasizes peer support principles and recovery models.
Frequently work in mental health or substance use contexts.
COMMUNITY
HEALTH WORKERS
Focus on broader community health, addressing diverse health issues and social determinants.
Training is broader, covering public health, disease prevention, and resource navigation.
Engage in preventive care, chronic disease management, and general health education.
Policymakers must improve the quality of care and access barriers by increasing and diversifying the range of current and future mental health providers. Expanding or diversifying the workforce is a realistic and tangible opportunity to shift care outcomes, not only by race or ethnicity but also by broadening the definition of individuals “qualified” to match community needs.14
14 Weerasinghe, I. & Tawa, K. (2021). Core principals to reframe mental and behavioral health policy. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/publications/report/brief/core-principles-reframe-mental-and-behavioral-health-policy/.
TO ACHIEVE THESE GOALS, POLICY CHANGES MUST HAPPEN:
Advance affordable education for future mental health professionals. Diversify the mental and behavioral health workforce by working towards debt-free college and strengthening and expanding loan repayment strategies. Ensure education and training programs for mental health professionals are accessible and affordable.
Support lived experience as equivalent to educational experience by expanding state scopeof-practice laws and increasing reimbursements for peer support specialists and providers and, similarly, standing in the community with and augmenting the role of community health workers who have lived experience or remain trained to support the psycho-social dynamic of the mental health continuum of care. The role supports individuals with various perspectives on treatment, supporting those with lived experience on their individualized care journey with support services and shared experiences as adjunctive to medication management and talk therapy.
Integrate providers with credentials/professional expertise in mental and behavioral health systems to ensure a diverse workforce. Providers should come from multiple backgrounds/ identities; this includes augmentation of linguistic competencies and connected care with communities as community or lay health worker supportive personnel while ensuring adequate racial and ethnic representation at the medical professional level.
Promote fair pay and sufficient training for all mental health providers. High job quality must be assured for everyone in the mental healthcare workforce, including a living wage, fair scheduling, paid sick time, and paid family and medical leave.15
Develop strategies to connect appropriate providers to communities in need. Recognize the problematic and often laborious process for patients and facilities to find providers, particularly for those in rural and frontier designated communities, whose geography serves as an access barrier for health services, and even more so for mental health services.16,17 Providers must serve as community allies to understand the diversity of patient needs and work to build trust. People of color are not monoliths.18
15 Ibid.
16 McAndrew, C. & Henandez-Cancio, S. (2014). Network Adequacy and Health Equity: Improving Private Health Insurance Provider Networks for People of Color. Families USA. Retrieved from https://familiesusa.org/wp-content/uploads/2019/09/ACT_NetworkAdequacy-Brief_final_082214_web.pdf
17 Lipson, D., Libersky, J., Bradley, K., Lewis, C., Wishon Siegwarth, A., & Lester, R. (2017). Promoting Access in Medicaid and CHIP Managed Care: A Toolkit for Ensuring Provider Network Adequacy and Service Availability. Division of Managed Care Plans, Center for Medicaid and CHIP Services, CMS, U.S. Department of Health and Human Services. Retrieved from https://www.medicaid.gov/ medicaid/downloads/adequacy-and-access-toolkit.pdf
18 Weerasinghe, I. & Tawa, K. (2021). Core principals to reframe mental and behavioral health policy. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/publications/report/brief/core-principles-reframe-mental-and-behavioralhealth-policy/.
Importance of Youth Peer Support
Youth peer support is a non-clinical practice rooted outside Western medicine that taps into a new provider workforce: peers. Research shows peer support is an effective and equitable practice.19 Despite its promise, youth peer support remains unavailable to most young people and is generally concentrated in grant-funded programs. In an ideal scenario, young people could easily access peer support services in various locations, including schools and community centers.20
A question must be raised: what would a workforce that centers on equity look like, and what can be put in place now to create it? There will likely be insufficient clinicians to meet the increasing demand for mental health needs in this country. For many communities of color, clinicians are also not preferred care providers, nor do they offer the full range of the types of care that community members want and need. To achieve mental health equity, policymakers must expand who can provide mental health care, how these individuals are credentialed, and what services they can provide, and invest in strategies that follow the lead of people most impacted by mental health challenges. Shifting our understanding and investments can move the country to a future of accessible, community-based care commensurate with the level of need in our communities, a system that honors the work of community health workers, recognizes the importance of geographic-specific solutions (rural and urban), and
honors community partnerships as a tangible lowcost intervention to ensure immediate wrap-around services are accessible and easy to mobilize.
The existing mental health system is failing to meet the needs of young people, particularly Black, brown, and Indigenous young people, 2SLGBTQIA+ young people, and young people with disabilities.21 Within the current mental health system, they often experience the effects of institutionalized racism, such as harsher treatment, stigmatization, and professionals minimizing their mental health symptoms.22 And while the COVID-19 pandemic brought unprecedented attention to the harmful mental health challenges experienced, notably isolation, there was a disproportionate impact on young people.
In line with the Center for Law and Social Policy (CLASP’s) 2023 policy framework for youth peer support, the following methods should be implemented to expand access to youth peer support services among federal, state, and other stakeholders.23
19 C4Innovations (C4I). (2023). Peers supporting youth and young adult recovery. C4I. Retrieved from https://c4innovates.com/brsstacs/Value-of-Peers_ YYAPeerSupports.pdf
20 Davis, K., Chilla, S., & Do, N. (2021). Youth and young adult peer support: Expanding community driven mental health resources. Mental Health America. Retrieved from https://mhanational.org/sites/default/files/reports/Youth-and-Young-Adult-Peer-Support.pdf
21 Davis, K., Chilla, S., & Do, N. (2021). Youth and young adult peer support: Expanding community driven mental health resources. Mental Health America. Retrieved from https://mhanational.org/sites/default/files/reports/Youth-and-Young-Adult-Peer-Support.pdf
22 Cohut, M. (2020). Racism in mental healthcare: An invisible barrier. Medical News Today. Retrieved from https://www.medicalnewstoday.com/articles/ racism-in-mental-healthcare-an-invisible-barrier
23 Tawa, K, Kim, E, & Howdershelt, M. (2023). Giving the [young] people what they want: A policy framework for youth peer support. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/publications/report/brief/giving-the-young-people-what-they-want-a-policy-framework-foryouth-peer-support/
REQUESTED ACTIONS FOR CENTERS FOR MEDICARE AND MEDICAID SERVICES (CMS)24
• Create guidance specific to youth peer supporters that:
• Explore ways to minimize documentation requirements for non-clinical providers, increase access to preventative services for young people, and remove medical necessity criteria as a barrier to preventative services.
• Encourage states to create separate billing codes for youth peer support and family peer support and encourage states to create TAY(Transition Age Youth) specific codes that can be used in child—and adult-serving systems.
• Recommend peers to be supervised by fellow peers and recommend youth-specific supervision for youth peer workers.
• Clarify that youth aged 16-26 can be certified as peer support providers.
• Removes guidance around coordinated care and recognizes peer support as a preventative service, a supplement to clinical care, and a service in and of itself.
STATE PEER SUPPORT OFFICES
• Create a separate training curriculum designed for young people by young people and invest in multiple youth training programs so young people can be credentialed in a program that works for them, and certify youth peers to work in child- and adult-serving systems.
• Establish a separate office/team that oversees youth peer support and builds trust and relationships with peer-run organizations in the state, particularly culturally specific peer-run organizations.
• Ensure clinicians and clinical organizations understand the value and ethos of peer support.
OTHER STAKEHOLDERS
• State departments of health and accrediting and licensing bodies should allow young people ages 16 – 26 to be certified youth peer support specialists.
• Managed Care Organizations (MCO) should contract a youth-led peer-run organization to provide peer support to transition-age youth.
• The U.S. Department of Labor should create a standard occupational code for peer support professionals (including youth peer professionals), so peer support professionals are no longer included under community health workers.
• States should diversify funding sources to fund a full continuum of peer support services. This includes advocating for percent setasides in general operating funds, using funds from the Substance Abuse and Mental Health Services Administration (SAMSHA) block grants for youth peer support, braiding funding from across agencies, and maximizing prevention funding sources.
• The U.S. Preventive Services Taskforce should evaluate the effectiveness of peer support as a preventative service.
• Medicaid reimbursement can increase billing capacity by developing relationships with training programs, outsourcing medical billing via contract, or hiring peer billing specialists. Peer-run organizations could also partner with clinicians who understand the value of peer support.
24 Centers for Medicare & Medicaid Services (CMS). (2022). CMS Framework for Health Equity 2022-2032. U.S. Department of Health & Human Services. Retrieved from https://www.cms.gov/files/document/cms-framework-health-equity.pdf.
Elevating Workforce Wellness
There must be a solid strategy to address disparities in mental health equity, in order to build, maintain, and support wellness in the workforce. Even before the devastating impact of the pandemic, there was a lack of health equity in workplaces across the United States. This was especially true for people representing Black Indigenous People of Color (BIPOC), women, and members of the LGBTQ+ community. For example, women who became pregnant during their employment realized an inconsistency among employers about healthcare benefits that included sufficient birth-related leave. Some companies require employees to use the Family and Medical Leave Act (FMLA). This federal law provides eligible employees up to 12 weeks of unpaid, job-protected leave per year for certain family and medical reasons instead of having a standard parental leave policy.25
Gaps in healthcare benefits are well known among the LGBTQ+ community, and similar disparities exist in healthcare support available to employees working in industries that provide little to no healthcare benefits. The disparity in healthcare benefits became more visible during the onset of the COVID-19 pandemic when employees labeled as “essential” workers were not allowed to “work from home” as they represented industries considered essential to support the infrastructure of the economy (i.e., healthcare professionals,
truck drivers, warehouse workers, delivery, keeping stores stocked with supplies, etc.). Not surprisingly, workers deemed “essential” were representative of the BIPOC community.
Employee “burnout” is also challenging across all industries due to various risk factors, such as an imbalance in “return-to-work” policies postpandemic. Interestingly, disparities in healthcare access and support for working remotely or a hybrid work schedule necessitated a change in language from “workplace” to a more accurate term of “workforce.” Not everyone returned to the workplace after the pandemic, yet there is still the need for mental health equity in the workforce.
In the EY Center for Health Equity’s 2024 Health Equity Outlook Report, there is highlighted data related to racial and ethnic health disparities:
• The estimated total annual cost of racial and ethnic health disparities in the U.S. is $93 billion in excess medical care costs.26
• The estimated total annual cost of racial and ethnic health disparities in the U.S. is $42 billion in untapped productivity.27
Hence, wellness in the workforce was buoyed by the national attention and support from Surgeon General Vivek Murthy, MD, when he issued his Current Priorities Report that included “Workplace Mental Health and Well-Being.”
25 Wage & Hour Division. (2024). Family and Medical Leave Act. U.S. Department of Labor. Retrieved from https://www.dol.gov/agencies/whd/fmla
26 Ernst & Young (EY). (2024). 2024 Health Equity Outlook Report. EY. Retrieved from https://www.ey.com/en_us/industries/health/healthequity-services?WT.mc_id=10820886&AA.tsrc=paidsearch&gad_source=1&gclid=CjwKCAjw8rW2BhAgEiwAoRO5rAUJrR4idemsv5nxwt101 ZOxVSJSdtO-GOPeNNXxDzgzQvqYGwub3xoCCcUQAvD_BwE
27 Ibid.
The report highlighted outcomes related to mental health and well-being in the workplace:
• Our workplaces play a significant role in our lives.28
• Work affects both our physical and mental well-being—in good ways and bad.29
• The COVID-19 pandemic clarified the relationship between work and well-being.30
The 2021 Mental Health at Work Report by Mind Share Partners highlights the following:
• 76% of U.S. workers reported at least one symptom of a mental health condition.31
• 84% of respondents said their workplace conditions contributed to at least one mental health challenge.32
The American Psychological Association’s (APA) 2022 Work and Well-being Survey results indicate that 81% of workers reported that they will be looking for workplaces that support mental health in the future.33
Healthcare professionals in service across the U.S., including advocates, must serve as ambassadors for mental health equity. In the wake of DEI backlash, corporate layoffs, and geopolitics, we see that “stress about mental health is the top obstacle to productivity at work.”34
• 89% said better work-life balance would improve their work experience.
• 84% said ensuring fairness and equity would improve their work experience.
• 80% want their employer to remain politically neutral.
It is essential to understand how the holistic approach to good mental health and positive well-being can be implemented, whether there is a “workplace” or a hybrid work environment; the following priorities position the need for equity in mental health care:
• Protection from harm (i.e., safety and security)
• Opportunity for growth (i.e., learning and accomplishment)
• Mattering at work (i.e., dignity and meaning)
• Work-Life harmony (i.e., autonomy and flexibility)
• Connection and community (i.e., social support and belonging)
Advocates must raise awareness of disparities in access to healthcare, call attention to inequalities in culturally appropriate responsive mental healthcare, and support well-being in the workforce. Healthcare professionals should advocate for mental health equity for all, regardless of racial and ethnic backgrounds, gender, sexuality, and age. Whether healthcare professionals or employees across the broad spectrum of industries in the U.S., everyone can be intentional about learning ways to prevent burn-out and maintain healthy mental, emotional, psychological, behavioral, and spiritual well-being.
28 U.S. Department of Health & Human Services (HHS). (2022). The U.S. Surgeon General’s Framework for Workplace Mental Health & Well-Being. HHS. Retrieved from https://www.hhs.gov/sites/default/files/workplace-mental-health-well-being.pdf
29 Ibid.
30 Ibid.
31 Mind Share Partners (MSP). (2021). 2021 Mental Health at Work. MSP. Retrieved from https://www.mindsharepartners.org/ mentalhealthatworkreport-2021
32 Ibid.
33 American Psychology Association (APA). (2022). 2022 Work and Well-Being Survey. APA. Retrieved from https://www.apa.org/pubs/reports/work-wellbeing/2022-mental-health-support
34 Mind Share Partners. (2024). Mind Share Partners/Harris Poll Survey Helps Guide Company Efforts During Mental Health Awareness Month 2024 and Beyond. MSP. Retrieved from https://www.mindsharepartners.org/_files/ugd/94aa4e_f08c1ca416884a56b77db999e63e9f17.pdf
Workforce Visibility: The Role of Pharmacists
Workforce expansion in mental health largely depends on the elevation of care providers. Disease management for equitable mental health care continues to evolve into considerations requiring a healthcare team approach, including medication management with pharmacist inclusion and oversight. The role of the pharmacist is finally emerging with increased visibility, necessitating support and resources for individuals diagnosed with mental health disorders. The emergence of pharmacy and psychiatric pharmacists as integral to care teams in acute and sub-acute care settings evolves mental health provider advocacy. This is particularly true for minoritized pharmacists and patients within clinical settings and pre/ post-discharge. There is a long history of trust, a symbiotic relationship rooted and grounded in respect, and a co-dependence for ensuring equitable and properly managed care.
Pharmacists are well-trained, readily accessible members of healthcare teams who practice in various inpatient and outpatient mental health settings.35 Black pharmacists and ethnically diverse pharmacy specialists bear a more significant burden of clinical oversight as providers who can serve as trusted agents of recovery and resilience. Responsibilities extend beyond dispensing medications to include a variety of clinical and supportive functions.
36
The clinical role of the pharmacist in addressing mental health equity involves a comprehensive program of several distinct service areas:
• Access to Medications: Accessing and streamlining pharmacy visits and the prescription drug refill process and connecting patients with costcontainment resources to obtain medication through special care programs.
• Medication Therapy Management: The profession works to improve and sustain acceptable patient adherence to the prescribed drug regimen. This includes mitigating refill lapses, patient education, symptomatology, and reinforcing prescriber orders for taking medications as prescribed. Side effect management and reporting are critical aspects for patient continuity and addressing barriers to adherence, such as misapplication and misunderstanding of the medical treatment plan.
37 The stabilization of mental health conditions is primarily attributed to pharmacy services. Pharmacists prevent duplication of drug therapy and the avoidance of drug interactions. The regular review of medications ensures appropriate use and advocates for necessary adjustments in collaboration with other healthcare providers if required. They recommend preventive measures to patients
35 Moore, C.H., Powell, B.D., Kyle, J.A. (2018). The Role of the Community Pharmacist in Mental Health. U.S. Pharmacist, 43(11): 13-20. Retrieved from https://www.uspharmacist.com/article/the-role-of-the-community-pharmacist-in-mental-health#:~:text=Face%2Dto%2Dface%20 interactions%20with,patient%20to%20ensure%20their%20understanding
36 Ibid.
37 Eaves, S., Gonzalvo, J., Hamm, J. A., Williams, G., & Ott, C. (2020). The evolving role of the pharmacist for individuals with serious mental illness. Journal of the American Pharmacists Association: JAPhA, 60(5S), S11–S14. Retrieved from https://doi.org/10.1016/j.japh.2020.04.017
and primary health care providers when necessary, such as immunizations and routine laboratory tests established by evidence-based medical guidelines.
• Monitoring and Managing Side Effects: Pharmacists help manage and mitigate the side effects of psychiatric medications, which can improve patient comfort and adherence. Pharmacy services identify, monitor for, and prevent or minimize adverse drug events or medicationrelated complications. Pharmacy personnel evaluate the appropriateness of medications and may monitor patients for side effects, therapeutic outcomes, and signs of drug interactions, adjusting treatment plans as needed.38
• Collaborative Care: The workforce is often a part of a multidisciplinary team, collaborating with doctors, nurses, social workers, and mental health specialists to provide comprehensive care and care navigation support. The importance of pharmacy as a profession is the validation of healthcare utilization and minimizing of individual healthcare costs. Pharmacy contributes to developing and adjusting treatment plans, bringing their expertise in pharmacology to care management.39
• Patient and Family Education: Pharmacists educate patients and their families about mental health conditions, treatment options, and the importance of adherence to therapy. A vital aspect of the pharmacist’s role is empowering patients by providing comprehensive information about their medications.
By showing empathy and compassion toward patients dealing with mental health challenges, pharmacists can help alleviate feelings of loneliness, isolation, and stigma, fostering a sense of validation and acceptance.
• Screening and Referral: The profession of pharmacy is uniquely positioned to recognize signs of mental health issues during interactions with patients. By listening, observing, and questioning patients, pharmacists can discern changes in mood, behavior, or physical movements that may indicate issues with the medication and the underlying expected outcomes. When necessary, pharmacists can refer patients to mental health specialists for more comprehensive care.40
• Advocacy and Support: As a vital aspect of the healthcare workforce, pharmacy provides or coordinates access to additional support services, such as counseling, support groups, and educational programs.
• Public Health Role: Pharmacists participate in public health initiatives to increase awareness and understanding of mental health and can be involved in preventive care efforts, such as educating the public about lifestyle factors that impact mental health.41
38 Leenhardt, F., Perier, D., Pinzani, V., Giraud, I., Villiet, M., Castet-Nicolas, A., Gourhant, V., & Breuker, C. (2017). Pharmacist intervention to detect drug adverse events on admission to the emergency department: Two case reports of neuroleptic malignant syndrome. Journal of clinical pharmacy and therapeutics, 42(4), 502–505. Retrieved from https://doi.org/10.1111/jcpt.12531
39 Romney, M., Robinson, R. F., & Boyle, J. (2022). Mental Health Pharmacists: Increasing Necessary Mental Health Service Delivery. Federal practitioner: for the health care professionals of the VA, DoD, and PHS, 39(3), 106–108. Retrieved from https://doi.org/10.12788/fp.0237
40 Ou, K., Gide, D. N., El-Den, S., Kouladjian O’Donnell, L., Malone, D. T., & O’Reilly, C. L. (2024). Pharmacist-led screening for mental illness: A systematic review. Research in social & administrative pharmacy: RSAP, 20(9), 828–845. Retrieved from https://doi.org/10.1016/j. sapharm.2024.06.001.
41 Cameron, G., Chandra, R. N., Ivey, M. F., Khatri, C. S., Nemire, R. E., Quinn, C. J., & Subramaniam, V. (2022). ASHP Statement on the Pharmacist’s Role in Public Health. American Journal of health-system Pharmacy: AJHP: official journal of the American Society of Health-System Pharmacists, 79(5), 388–399. Retrieved from https://doi.org/10.1093/ajhp/zxab338
The versatility of healthcare providers, demonstrated through pharmacy services, expands professional roles and yields a broader acceptance of patient support within psychiatric and behavioral health practice settings. Strong and active patient advocates, and Black and racially diverse pharmacists demonstrate a long-term and historical commitment to equitable patient care.
Evolving clinical care teams should consider the mandatory inclusion of pharmacy as
integral to the holistic management of patient care, the appropriateness of adherence strategies, and therapeutic concordance with disease diagnosis. Pharmacists who reflect the communities served increase the likelihood of adherence and trust by fostering empathy, resourcefulness, and support for comprehensive management.
Decriminal izati on of Mental Health
THE FOUNDATION OF THE EARLY CARCERAL SYSTEM
The American mental health system has deep and longstanding ties to the carceral system. From the earliest days of this nation, there has also been a racial overlay on our understanding of mental health. Before the Civil War, Samuel Cartwright pathologized enslaved people who ran away, labeling their desire for freedom as a psychological disorder called “drapetomania.”42 The recommended treatment for this “psychological disorder” was state-sanctioned violence in the form of whipping.43 Although now recognized as scientific racism and pseudoscience, criminalizing people of African descent for their expectable reactions to their circumstances and engaging in carceral control strategies are longstanding American practices.
As psychiatry and psychology grew as fields in the late 19th and early 20th century, institutionalization of people experiencing mental health challenges was the norm. The deinstitutionalization movement in the 60s and a series of lawsuits in the 1970s sought to end inhumane practices in mental health facilities and codify the civil rights of people experiencing mental health challenges.44 Then, as now, people of color were disproportionately subject to the most inhumane practices. The culturally based healing practices of many indigenous communities have also long been criminalized and
undermined.45 Understanding this history is critical to understanding the deep, well-deserved mistrust of the mental health system experienced by many communities of color.
Today, a dearth of culturally responsive communitybased services means that the criminal legal system is the primary entry point to mental health care for Black and brown communities. Prisons and jails have become de facto mental health facilities; the American Psychological Association reports that 64 percent of jail inmates, 54 percent of state prisoners, and 45 percent of federal prisoners” have reported mental health concerns.46 Youth-serving providers in the criminal legal system note that where a white young person might be diagnosed with a mental health condition, young people of color are often arrested.47
Carceral practices have no place in mental health care. If a person is handcuffed, restrained, secluded, or otherwise harmed while receiving “treatment,” they are not receiving mental health care. These tactics retraumatize people and can increase mental health challenges. Mental health advocates and providers should resist the co-opting of mental health services by the criminal legal system and ensure that receiving mental health care is never traumatizing and that all mental health services are rooted in choice.48
42 Willoughby, C. (2018). Running Away from Drapetomania: Samuel A. Cartwright, Medicine, and Race in the Antebellum South. The Journal of Southern History 84, No. 3: 579–614. Retrieved from https://www.jstor.org/stable/26536293
43 Ibid.
44 Yohanna, D. (2013). Deinstitutionalization of People with Mental Illness: Causes and Consequences. American Medical Association Journal of Ethics. Retrieved from https://journalofethics.ama-assn.org/article/deinstitutionalization-people-mental-illness-causes-and-consequences/2013-10
45 Page, C. and Woodland, E. (2023). Healing Justice: Dreaming at the Crossroads. Retrieved from https://books.google.com/ books?hl=en&lr=&id=aJVuEAAAQBAJ&oi=fnd&pg=PR11&dq=criminalization+of+indigenous+healing+practices+US&ots=w2hmd9Ru To&sig=wn1kzYeYs7YkLTo8vb6olIX0uKU#v=onepage&q=criminalization%20of%20indigenous%20healing%20practices%20US&f=false
46 American Psychological Association (APA). (2014). Incarceration nation: The United States leads the world in incarceration. A new report explores why — and offers recommendations for fixing the system. APA. Retrieved from https://www.apa.org/monitor/2014/10/incarceration
47 West-Bey, N., Sethi, S, Shorsleeves, P. (2019). Policy for Transformed Lives: Barriers to Meeting the Mental Health Needs of Young Adults. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/wp-content/uploads/2022/01/YA-MH-Scan_Policy-for-Transformed-Lives_ Barriers.pdf
48 Tawa, K. (2024). Forced ≠ treatment: Carceral strategies in mental health. The Center for Law and Social Policy: CLASP. Retrieved from https://www. clasp.org/publications/report/brief/forced-treatment-carceral-strategies-mental-health/
According to the Center for Law and Social Policy (CLASP) , to reduce the harm and traumatization of individuals caused by forced treatment and carceral approaches to care, it is recommended the following policy changes be made:49
• Limit the use of restraints, seclusion, and other carceral techniques in mental health facilities.
• Issue guidance around removing law enforcement from mobile response teams and ensuring mobile response teams don’t force treatment or hospitalization.
• Improve oversight and reporting on forced treatment:
• Require in-patient facilities to report how many individuals are being treated involuntarily and how long each involuntary stay lasts.
• Require clinicians performing involuntary evaluations to report each evaluation, including whether the criteria for an involuntary evaluation were met, what care was recommended, whether the criteria for forced treatment were met, the time between entering the facility and when the evaluation occurred, whether law enforcement initiated the evaluation, and whether the individual was handcuffed while en route to the evaluation.
• Require schools to report all forced mental health evaluations initiated in schools, including if law enforcement responded, if the child was removed from campus, if handcuffs or restraints were used, if the child has a disability, what steps were
49 Ibid.
taken to deescalate the situation, and if the child was forced into treatment.
• Require localities to improve oversight of their conservatorship systems, tracking the number of people with disabilities under public conservatorship and the medical care they’re receiving involuntarily.
• Establish legislative boundaries to ensure that the clinician performing a mental health evaluation cannot work for the facility an individual is committed to or otherwise financially benefits from the individual’s commitment.
• Support minor consent legislation that states that minors cannot receive inpatient mental health treatment unless both the minor and their parents consent to it and that either party can withdraw their consent at any time.
• Ensure that informed consent to mental health care is always sought and that the right to refuse admission and treatment is also respected.
• Adopt updated standards of care for individuals with lived Serious Mental Illness (SMI) experience and include consultation with peer specialists and families for training.
• Support psychiatric advanced directives and uphold privacy protections that protect health data.
Decriminalizing mental health requires significant investments in community-based, mobile crisis outreach teams (MCOT) and police-free alternatives. In line with CLASP, the following recommendations reflect the need for more external stakeholders to be involved in policymaking.50 In support of improving the continuum of care in carceral situations, advocacy efforts should:
Actively involve people with disabilities in decision-making processes about policies and programs, especially those directly impacting them, which includes practical and full participation in public affairs.
Develop community-based services and support for people with mental and behavioral health conditions or disabilities.
Address mental health among unhoused populations through permanent supportive housing solutions that engage a housing-first approach.
MOBILE RESPONSE OUTREACH STRATEGIES
Embed mental health support services into communities to ensure that people can access mental health care where they live.
If a mental health facility evaluates an individual who has been handcuffed or restrained, they should refer that individual to community-based services, including peer support services, that could support them in healing from the evaluation.51
The utilization of mobile response services has unrealized potential. These services can play a significant role in decriminalizing mental health. Mobile response is one service in a continuum of crisis services for individuals who are experiencing a traumatic event, mental health symptoms, or crisis in their communities. Mobile response as a first responder model is only as good for safety and healing as its implementation.52
• Create a point of entry. Mobile response systems should use a different phone number than emergency lines, such as 988. Creating points of entry will make the services more inclusive to minoritized communities, particularly Black and brown communities.
• Train all staff involved in the mobile response. Everyone from the dispatch team to the emergency medical technician (EMT) should be trained to acknowledge and engage someone experiencing a crisis. This will alleviate the issue of police presence from the onset.
• For mobile response to be effective and equitable, services must be free for clients and reimbursable for all providers. Medicaid provides sustainability to many services, including mobile response in some states.
• Invest in a continuum of services to address the whole person. Mobile response is only one way to ensure Black and brown people are safe and policymakers are financially supporting their communities.
50 Tawa, K. (2024). Forced ≠ treatment: Carceral strategies in mental health. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/publications/report/brief/forced-treatment-carceral-strategies-mental-health/ 51 Ibid.
52 Bunts, W. (2021). Youth mobile response services: An investment to decriminalize mental health. The Center for Law and Social Policy: CLASP. Retrieved from https://www.clasp.org/publications/report/brief/youth-mobile-response-services-investment-decriminalize-mental-health/
Without decriminalization, there will never be mental health equity. The time is now to permanently and unequivocally disentangle mental health from criminalization and carceral
strategies. Engagement in a community-based manner and imagining new systems, care strategies, and pathways centered around humanity is the real mark for systemic change.
Advancing Transitions in Care and Patient Navigation
The role of culture in shaping our understanding of ourselves, the world around us, and, by extension, our overall well-being cannot be overstated. This reality has historically been underappreciated in health, public health, and mental health, to the detriment of many, particularly populations that have long been medically underserved. To achieve any meaningful impact in promoting mental health and addressing associated health disparities, culture must be thoroughly examined and must inform mental health interventions for diverse communities.53
Culture may be described as an integrated pattern of learned core values, beliefs, norms, behaviors, and customs shared and transmitted by a specific group. It may be communicated from one generation to the next via language or other communication. 54 Moreover, Erez and Gati propose a multi-level model of culture consisting of structural and dynamic characteristics that explain the interplay between various levels of culture. 55 Kagawa-Singer et al. posit that
cultural functions (values, cultural values, beliefs, practices, and signifiers) are vital to the survival and well-being of its members. 56 Every culture defines health for its members, determines the etiology of diseases and disorders, establishes the parameters within which distress is defined and signaled, and prescribes appropriate and acceptable means to address the disorder medically and socially. 57 Culture is considered a dynamic entity, and research that focuses more on the interplay between different cultural levels is needed to understand the intricate phenomena fully.
Concerning mental healthcare, intersectional cultural identity aspects are significant for diverse communities.58 This is particularly meaningful in a healthcare setting, where building trust and comfortability is necessary to improve the likelihood of patient adherence to a proposed treatment plan(s).59,60 Both verbal and nonverbal communication styles are objective aspects of a culture.
53 Holden, K., McGregor, B., Belton, A., Hopkins, J., Blanks, S., and Wrenn, G. (2016). Community Engaged Leadership to Advance Health Equity and Build Healthier Communities, Social Sciences, 5, 2; doi:10.3390/socsci5010002.
54 Assoratgoon, W., & Kantabutra, S. (2023). Toward a sustainability organizational culture model. Journal of Cleaner Production, 136666.
55 Erez, M., & Gati, E. (2004). A dynamic, multi-level model of culture: from the micro level of the individual to the macro level of a global culture. Applied Psychology, 53(4), 583-598.
56 Kagawa-Singer, M., & Kassim-Lakha, S. (2003). A strategy to reduce cross-cultural miscommunication and increase the likelihood of improving health outcomes. Academic medicine, 78(6), 577-587.
57 Ibid.
58 Schouten, B.C., Cox, A., Duran, G., Kerremans, K., Banning, L.K., Lahdidioui, A., & Krystallidou, D. (2020). Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. Patient Education and Counseling, 103(12), 2604-2608.
59 Stubbe, D. E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49-51.
60 McGregor, B., Belton, A., Henry, T. L., Wrenn, G., & Holden, K. B. (2019). Improving behavioral health equity through cultural competence training of health care providers. Ethnicity & disease, 29(Suppl 2), 359.
Still, subjective elements can only be adequately understood with an appreciation of the meaning of the communication within the culture. Effective intercultural communication between patients and clinicians is essential for delivering high-quality, equitable health care.61
Community-engaged leadership that overtly demonstrates respect for ethnically, culturally, and linguistically diverse populations and encourages bidirectional accountability is optimal.62 This orientation can enhance more effective communication, which may yield compliance with trajectories for improved mental health and wellness. According to Schouten et al., one strategy to mitigate a cultural barrier is actively engaging patients’ family members.63 For example, family members may be helpful with communication issues (e.g., language barriers, etc.) and support treatment-related decisions that are tuned to the patient’s culture-based communication and treatment preferences.
Healthy People 2030’s framework includes a vision in which all people can achieve their full potential for health and well-being across the life span and five overarching goals: (1) attain healthy, thriving lives and well-being free of preventable disease, disability, injury, and premature death; (2) eliminate health disparities, achieve health equity, and attain health literacy to improve the health and well-being of all; (3) create social,
physical, and economic environments that promote attaining the full potential for health and well-being for all; (4) promote healthy development, healthy behaviors, and well-being across all life stages; and (5) engage leadership, key constituents, and the public across multiple sectors to take action and design policies that improve the health and well-being of all.64 Given the significance of mental health disparities that plague underserved/at-risk/vulnerable/ underresourced communities, attention must be given to culturally centered communication that offers connection to and ongoing engagement with quality healthcare.65,66 Addressing the mental health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive communication strategies to reduce risk factors and buttress protective factors to promote greater wellness among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities and with significant changes in the constellation of multiple risk factors that can influence health outcomes, strategic efforts must be delineated that encourage better access to primary care, focused community-based programs, clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life.67,68
61 Logan, S., Steel, Z., & Hunt, C. (2014). A systematic review of effective intercultural communication in mental health. Cross-Cultural Communication, 10(5), 1-11.
62 Holden, K., McGregor, B., Belton, A., Hopkins, J., Blanks, S., and Wrenn, G. (2016). Community Engaged Leadership to Advance Health Equity and Build Healthier Communities, Social Sciences, 5, 2; doi: 10.3390/socsci5010002.
63 Schouten, B. C., Cox, A., Duran, G., Kerremans, K., Banning, L. K., Lahdidioui, A., & Krystallidou, D. (2020). Mitigating language and cultural barriers in healthcare communication: Toward a holistic approach. Patient Education and Counseling, 103(12), 2604-2608.
64 Levine, R.L. (2021). Healthy People 2030: a beacon for addressing health disparities and health equity. Journal of Public Health Management and Practice, 27(6), S220.
65 Dawes, D., Holden, K. & Williams, D.R. (2023). Health equity, African Americans, and public health. American Public Health Association Press.
66 Gadomski, A., Wissow, L.S., Slade, E., & Jenkins, P. (2010). Training clinicians in mental health communication skills: impact on primary care utilization. Academic pediatrics, 10(5), 346-352.
67 Lewis, C.L., Yan, A., Williams, M.Y., Apen, L.V., Crawford, C.L., Morse, L. & Beatty, D. (2023). Health equity: A concept analysis. Nursing Outlook, 71(5), 102032.
68 Williams, D.R., Lawrence, J.A., & Davis, B.A. (2019). Racism and health: evidence and needed research. Annual review of public health, 40, 105-125.
Despite the intended objectives promoting cultural competence in health professions education and training, the past decades have seen increasing awareness and attention around limitations in capacity and oppositional efforts to prepare future health professionals to engage culturally diverse populations. One such challenge has to do with a critical premise or assumption of the idea of cultural competence—namely, the idea that mastery is a viable goal in this area. There is a fixed point at which sufficient “competence” is achieved, suggesting no additional work is needed in this area. Another vital challenge to efforts targeting cultural competence has been the incomplete/inadequate nature of the scope. There is a lack of evidence supporting impact on trainee behaviors and outcomes for diverse patient populations. Additionally, discussions of populations often over-emphasize one identity element while neglecting the complexities inherent
RECOMMENDED ACTIONS INCLUDE:
Implementing culturally responsive care navigation strategies as a requirement for discharge so that individuals are clear about where they are going, what they need to do, and who they should call for follow-up, support, and crisis mitigation.
Instituting low-level literacy, linguistically appropriate, and visually instructive infographic discharge orders, and specific care mapping from emergency departments to in-patient units, acute to subacute, and outpatient care settings for patient and caregiver support.
to multi-sectionality and the interconnections among various identity elements (e.g., ethnicity, gender, sexual orientation, etc.).
While the efforts to promote cultural competence have laid an essential foundation, a shift towards cultural humility is emerging as a more promising course for the current times. Whereas cultural competence work has primarily focused on theoretical mastery of knowledge or a set of skills for engaging representative populations, cultural humility emphasizes an ongoing and everevolving effort to grow in self-awareness through constant self-evaluation and critique toward the aim of becoming more effective in advocating for improved health status and outcomes for diverse populations.69 Culturally centered care must be of paramount importance for reducing mental health stigma, improving mental health disparities, and promoting the advancement of health equity.
Identify culturally responsive community mental health allies who are visible and willing to serve and support an infrastructure of resources that address the social determinants of health, including, but not limited to, housing, employment, education, and transportation.
Crisis mitigation strategies must require a cultural perspective to ensure the safe return of individuals with lived experience from care institutions to communities of support.
69 Stubbe, D.E. (2020). Practicing cultural competence and cultural humility in the care of diverse patients. Focus, 18(1), 49-51.
Conclusion
As the “anti-woke” movement continues to rise, attacks against Diversity, Equity & Inclusion (DEI) proliferate across the nation, and fear, stress, depression, and anxiety remain at an all-time high. The juxtaposition of democratic ideals within a politically divergent nation has birthed a new normal, one that seeks the erasure and invalidation of historical truths as a means to assert privilege, dominance, and control against underrepresented populations. Leaning in and not retracting from commitments to equity in mental health care is essential to advance a healthy citizenry.
Mental health is health and is the heart of achieving a system of health care rather than sick care.
Addressing the needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive policy, systems, and environmental strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. Minoritized populations, from those with lived mental health experience to care providers, must rise as equity ambassadors, unapologetic in their service to transform the care delivery system through a justice lens.
The recommendations are designed with intentional actions to inspire hope and implement change. Our promise is to continue to build out strategies for the community mental health workforce with peers and allies, working in tandem with multidisciplinary care teams, exposing mental health deserts, and providing solutions to care to ease the workforce challenges by mapping individuals to safe and supportive providers.
Achieving mental health equity is about values; it is a political and policy imperative that must serve as a tool to both correct and expose the risk factors that influence mental health outcomes. The mental health advocacy movement requires advocates to encourage salient efforts dedicated to accelerating access to integrated care with a focus on clinical support structures, including community-based mental health interventions, translational research methodologies, and mental health policy initiatives that improve health status, longevity, and quality of life.
The carceral system must not be a system of warehousing those in distress, nor should there be an acceptance that unhoused individuals should relinquish rights and dignity. We exist in a nascent evolutionary stage as we lean into equitable access to mental health care as the foundation for health equity in the United States.
Mental health equity is the root of the health justice movement, and we are marching on until victory is won.
Epilogue
As we navigate a time of profound political and social challenges, The National Mental Health Equity Framework emerges as a pivotal step in dismantling structural barriers and addressing systemic inequities. Our commitment remains to promote accessible, culturally responsive care. The policy recommendations are designed to inform and inspire lawmakers to action, with particular significance for Black and African Ancestry communities, whose resilience in the face of historical and ongoing disparities continues to propel this work forward.
This framework aims to lay the groundwork for transformative change by fostering equitable mental health access, improving care navigation, connecting individuals to trusted and culturally humble providers, supporting linguistic inclusivity, closing mental health care deserts, and optimizing seamless transitions across care settings. The mental health ecosystem must respond with bold action, including workforce transformation that elevates the roles of community health workers, peers, providers, and mental health systems committed to equity and health justice.
Together, by accelerating both individual and collective efforts, we can ensure that mental health care—treatment, services, and support—becomes a fundamental right for all rather than a privilege for some.
Courtney Billington Chair, The Equity Braintrust
Courtney Lang, JD Co-chair, The Equity Braintrust
If you or someone you know is experiencing a mental health crisis, we encourage you to dial or text 988 , the nationwide mental health crisis and suicide prevention lifeline, where support is just a call or text away.
Acknowledgments
The Equity Braintrust is grateful to the following authors who generously volunteered and collaborated in writing to contribute time and expertise to shape The National Mental Health Equity Framework :
Kisha Braithwaite, PhD, MSCR
Poussaint-Satcher Endowed Chair in Mental Health | Director
Satcher Health Leadership Institute
Professor | Director of Research and Scholarship, Department of Psychiatry and Behavioral Sciences
Morehouse School of Medicine
John E. Clark, PharmD, MS, FASHP, FFSHP
Director, Culture and Climate
Associate Professor | Dept. Pharmacotherapeutics & Clinical Research
Taneja College of Pharmacy
University of South Florida
Executive Director—Association of Black Health-System Pharmacists
Daniel Dawes, JD
Founding Dean, School of Global Health
Senior Vice President, Global Health
Meharry School of Global Health Meharry Medical College
Courtney Lang, JD
Founder and Principal Langco + Partners Co-chair, The Equity Briantrust Board of Directors, Mental Health America
Dr. Benjamin Roy III
Past President Black Psychiatrists of America
Nia West-Bey, PhD Executive Director
National Collaborative for Transformative Youth Policy
Formerly Center of Law and Social Policy - Youth Mental Health Division
H. Jean Wright II, PhD
Executive Deputy Commissioner of the Division of Mental Hygiene
Department of Health and Mental Hygiene City of New York
A special thank you to our Editor-in-Chief : Abdul Henderson , former U.S. Marine and Mental Health Advocate
We wish to acknowledge other members of The Equity Braintrust for their leadership:
Jewell Gooding
Executive Director Silence the Shame
Charles Ingoglia, MSW
President and CEO
National Council of Mental Well-Being
Dr. Kristina Peters
Associate Clinical Professor, UCSF Medical Director - Inpatient Forensic Psychiatry
San Francisco General Hospital
Past Chair, Board of Trustees National Medical Association
Will Seto
Chief Diversity Officer
National Council of Mental Well-Being
Special Recognition
This work would not have been possible without the unwavering commitment of Courtney Billington, Chair of The Equity Braintrust; and Board Member of the Congressional Black Caucus Foundation. We are profoundly grateful for your grace and courage in championing mental health equity and your steadfast advocacy for access, treatment, and increased support for individuals living with mental health conditions and their caregivers.
We extend our heartfelt appreciation to the Congressional Black Caucus Foundation for their dedicated research platform, whose visionary leadership and insightful expertise have provided a critical platform for this work, ensuring its accessibility to policymakers, healthcare leaders, grassroots organizations, and communities across the nation.
We also wish to acknowledge the tireless advocacy of Dr. Jonathan Cox, Vice President of the Center for Policy Analysis & Research, Yolanda Raine, Vice President of Marketing and Communications, and Tiffany Browne, Marketing and Communications Consultant. Your efforts have been invaluable in advancing this mission.
A special acknowledgment to those with lived experiences who inspire our work as we continue to push for equitable mental health care. Your resilience remains the heart of this framework.
EQUITY BRAINTRUST
EQUITY BRAINTRUST PUBLICATION THE
