Is it the right time to make a paradigm shift in mental health care?

NEW ORLEANS – A paradigm shift in mental health care is needed, according to a review published in the journal. American Journal of Psychiatry and presented at the annual meeting of the American Psychiatric Association (APA).

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

Alegría and the group said there is a serious need to address mental health care inequalities in minority communities, with more severe and enduring mental health conditions and less access to the necessary resources due to lack of funding for services, as well as insurance coverage. .

Mental health care has not “significantly improved” for minorities “in the last 20 years,” they noted.

“It’s a timely opportunity because we can disrupt the main patterns of individual pharmacological treatment … and really start thinking about how to bring services to communities,” Alegria said. MedPage Today. “It’s an opportunity to re-imagine how we can put these dollars into practice and open the door to more community-based intervention.”

The idea is to address the “structural factors that affect wealth, education and neighborhood conditions” that are linked to care inequalities, he added.

Alegria and colleagues reviewed a variety of research and programs to reduce these differences in the use of evidence-based approaches by mental health professionals. One of the first initiatives mentioned was the CDC Health Impact in 5 Years (HI-5) framework, a nutrition pyramid-like scheme that demonstrates interventions from counseling and education (top level) to social determinants of health (lower level). mental health care.

“Based on the HI-5 model, we highlight specific community-level or community-based approaches that can significantly change the mental health landscape of people of color,” wrote Alegria and the group. “By investing in social decision-makers and prevention interventions as discussed in this vision – and better coordination between these programs and primary care screening and referral systems – fewer people will need to go to a clinic with staff who may be overwhelmed. addressing structural and social problems “.

As noted, previous reviews have shown that paraprofessional interventions have led to better outcomes in community-based environments. In a systematic review, for example, 69% of 27 randomized controlled trials significantly improved mental health outcomes with programs that included community health workers.

Alegría and colleagues also highlighted programs that increase green spaces (gardens and parks) and blue spaces (access to rivers, lakes, and oceans) in communities, and have been shown to reduce the chances of depression among the elderly, reducing the chances of depression among the elderly. income districts.

There are barriers to implementing these changes in mental health care, said Ned Kalin, director of the University of Medicine and Public Health at the University of Wisconsin in Madison. American Journal of PsychiatryAt the APA meeting at the presentation of the review.

“One of the challenges is for academic institutions to work with their leadership to ensure that they prioritize additional resources and focus on additional community efforts for the population who currently do not have the resources to access this type of care,” he said.

“One of the things they can do is collaborate with academic communities … bring their expertise to the communities and share with them what may be important ways to facilitate evidence-based care in the communities,” Alegria said, adding that resources are available. The National Institute of Mental Health and the National Institute for Minority Health and Health Inequality to help develop these partnerships.

  • Michael DePeau-Wilson MedPage is a current business and research team journalist. Includes psychiatry and other clinical news related to the U.S. health care system. Continue

Disclosures

This review was supported by the National Institute for Minority Health and Inequality, the National Institute on Drug Abuse, the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Child Health and Human Development.

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