6 Decreasing mental health expenditures will require smarter health promotion strategies that focus “upstream” on the root causes of health inequalities.
3 Mental health is highly correlated with adverse health behaviors that lead to physical illnesses. For instance, depression is associated with higher levels of physical inactivity, smoking, drinking and other substance abuse and linked to a wide range of chronic illnesses such as heart disease, diabetes, and infectious diseases (Centers for Disease Control and Prevention, 2011). 4 Social conditions have documented impacts on mental health. For instance, living in poverty is a predisposing factor for stress, anxiety, and depression (Orpana, H.M, Lemyre, L., & Gravel, R., 2009). Chronic exposure to neighborhood and interpersonal violence is associated with depression, suicidal ideation, and post-traumatic stress disorder (Mazza & Reynolds, 1999; Pico-Alfonso et al., 2006). Nutritional deficits—due, for instance, to living in a food desert—predisposes children to aggression and other behavioral and mood disorders (Golomb, Evans, White, & Dimsdale, 2012). Thus HIA, which helps to ensure that social conditions promote population health and narrow health disparities and inequalities, is as critical for mental health as it is for physical health. 5 When mental health is left out of the HIA equation, we fail to fully understand the mechanisms by which the social environment impacts physical health (Matthews, Gallo, & Taylor, 2010). For instance, Collins and colleagues (2004) found that experiencing discrimination and segregation contributed to heightened emotional distress and stress hormone production. This in turn contributed to cardiovascular disease and preterm and low birth weight babies. Thus, emerging research findings suggest that mental health is an important link between social conditions and physical health.
In 2012, Illinois Governor Pat Quinn made drastic cuts to the state budget reducing state payments for mental health services. Subsequently, Chicago Mayor Rahm Emanuel closed six of the city’s 12 clinics due to lack of funding. As cities and states continue to face hard economic realities that lead to the shuttering of mental health facilities and services, it will become increasingly important to take preventative efforts, such as MHIA, that help to ensure that social conditions promote mental health and well-being, especially that of vulnerable populations. In assessing mental health impacts, the MHIA described in this report followed standard sources of authority for HIA practice, notably Minimum Elements and Practice Standards for Health Impact Assessment (North American HIA Practice Standards Working Group, 2010). The Practice Standards are not rigid criteria, but offer guidance for effective HIA practice. The MHIA also drew on standards articulated in sources such as A Health Impact Assessment Toolkit: A Handbook to Conducting HIA (Human Impact Partners, 2011), Health Impact Assessment: A Guide for Practice (Bhatia, 2011), and Improving Health in the United States: The Role of Health Impact Assessment (National Research Council of the National Academies, 2011). According to the Minimum Elements and Practice Standards, the MHIA includes the following steps: Screening, Scoping, Assessment, Recommendations, and Reporting. The MHIA process also included a process, impact, and outcome Evaluation and Monitoring to track the outcomes of the decision and its implementation. These latter two steps are necessary for HIA field development and practice improvement. Each of these steps is described in the succeeding sections of this report.
Adler School Institute on Social Exclusion: Mental Health Impact Assessment
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