A New Agenda for Optimizing Investments in Community Mental Health and Reducing Disparities

Abstract

The Biden-Harris Administration's FY22 budget includes $1.6 billion for the Community Mental Health Services Block Grant program, more than double the FY21 allocation, given the rising mental health crises observed across the nation. This is timely since there have been two interrelated paradigm shifts: one giving attention to the role of the environmental context as central in mental health outcomes, the other moving upstream to earlier mental health interventions at the community level rather than only at the individual level. An opportunity to reimagine and redesign the agenda of mental health research and service delivery with marginalized communities opens the door to more community-based care interventions. This involves establishing multisector partnerships to address the social and psychological needs that can be addressed at the community level rather than the clinical level. This will require a shift in training, delivery systems, and reimbursement models. The authors describe the scientific evidence justifying these programs and elaborate on opportunities to target investments in community mental health that can reduce disparities and improve well-being for all. They select levers where there is some evidence that such approaches matter substantially, are modifiable, and advance the science and public policy practice. They conclude with specific recommendations and the logistical steps needed to support this transformational shift.

Keywords: Community Integration and Recovery-Oriented Care; Environmental Risk Factors; Mental Health Care/Service Delivery Systems; Minority Issues and Cross-Cultural Psychiatry.

Figure 1:

The CDC’s Health Impact in Five Years Framework Figure re-produced with permission from the Centers for Disease Control and Prevention (CDC). Source: The CDC Health Impact in Five Years [Internet]. Office of the Associate Director for Policy and Strategy; 2018. Available from: www.cdc.gov/hi5