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Leading Social Change | adler.edu HIA … Is a preventative tool (prospective assessment) Addresses the social determinants of health Puts a “health lens” on public decision-making Facilitates understanding about how decisions outside the health sector impact health outcomes Distributes responsibility for health outcomes to other sectors Narrows health disparities and advance health equity Health Impact Assessment
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Leading Social Change | adler.edu
Mental Health Impact Assessment: A tool for mental health prevention and
advancing mental health equityPrepared for the
Department of Preventive MedicineRush University Medical Center
May 15, 2012
Lynn C. Todman, Ph.D.Adler School of Professional Psychology
Health Impact Assessment
Leading Social Change | adler.edu
DefinitionHIA is a systematic process that uses an array of data sources and analytic methods and considers input from stakeholders to determine the potential effects of a proposed policy, plan, program, or project on the health of a population and the distribution of the effects within the population. HIA provides recommendations on monitoring and managing those effects.
(Adaptation of the current working definition of the International Association of Impact Assessment [Quigley et al. 2006])
Health Impact Assessment
Leading Social Change | adler.edu
HIA … Is a preventative tool (prospective assessment)Addresses the social determinants of healthPuts a “health lens” on public decision-makingFacilitates understanding about how decisions outside the
health sector impact health outcomesDistributes responsibility for health outcomes to other sectorsNarrows health disparities and advance health equity
Health Impact Assessment
Leading Social Change | adler.edu
HIA addresses the facts that …As physicians, you do what you, but if the environment in which
people live, work , etc. is toxic, your work you do is undone…Prevention starts well before people get to the doctors office …We have a growing knowledge about how a wide range of
health has health effects that are not factored into the decision making process and then you – as health care providers – have to figure out how best to undo the damage.
We need tools like HIA to undo silos that undermine effective prevention efforts
Health Impact Assessment
Leading Social Change | adler.edu
Steps Screen Scope Assess Recommendations Reporting/Communications Monitor and Evaluation
Health Impact Assessment
Leading Social Change | adler.edu
National Research Council. Improving Health in the United States: The Role of Health Impact Assessment. Washington, DC: The National Academies Press, 2011.
Obesity – 40 Diabetes – 13Cardiovascular – 13Asthma – 14Cancer – 12 Infectious – 4
Mental Health – 1Anxiety – 1Depression - 1 Behavioral Health – 0Stress – 0 PTSD – 0ADHD – 0 Suicide – 0
HIA and Mental Health?
Leading Social Change | adler.edu
Objective: To integrate mental health considerations into HIA practice in a more
comprehensive and rigorous manner
Rationale: 1. Mental health is projected to be the leading causes of mortality and
morbidity (WHO, SAMHSA)2. Mental health is a key mechanism by which the social environment
impacts physical health, e.g., … Neighborhood violence, stress hormones, early menarche, teen pregnancies, low birth
weight babies…. Chronic/concentrated poverty, depression/anxiety/stress, allostatic load,
cardiovascular/infectious disease
Mental Health Impact Assessment
Leading Social Change | adler.edu
Expansion of the definition of property ‘owner’ to include banks and other entities that initiate foreclosure proceedings on vacant properties
The imposition of higher fees and fines on owners of five or more properties that maintain vacant properties
The requirement that owners of five or more properties post a $10,000 bond for each vacant property; and
the requirements that owners of five or more properties pay a 5% finder’s fees to city residents who report building code violations.
MHIA Pilot: Chicago Vacant Buildings Ordinance
Source: Todman et al. 2012
MHIA Pilot: A Pathway
Leading Social Change | adler.edu
The Proposal: To clarify the use of arrest records in employment decisions, the Equal Employment Opportunity Commission (EEOC) is revising its Policy Guidance on this issue.
Research Question: What is the impact on the mental health and well-being of a community when employers use arrest records in making their employment decisions?
MHIA: Equal Employment Opportunity Commission
MHIA: Our Hypothesis
Leading Social Change | adler.edu
Assessment Methodology
Community Survey (N=250)Focus GroupsLiterature reviewInterviews Participant Observation
Leading Social Change | adler.edu
60% of the survey sample (n = 149) had never been arrested
Average number of arrests reported was approximately 5 The majority (65.4%) had been arrested between 1 and 3 times 10% reported they had been arrested 10 or more times
Average number of convictions reported was 2
40% reported that their arrest had not lead to a conviction
What We Learned from the Community Surveys...
Leading Social Change | adler.edu
People with a lifetime arrest records arrest records have … Higher rates of substance abuse Higher rates of psychological distress Lower rates of life satisfaction
What We Learned from the Community Surveys...
Leading Social Change | adler.edu
People with a lifetime arrest records arrest records have Lower levels of collective efficacy Increased likelihood to participate in the informal
economy More racism related stress Higher frequency of perceived discrimination
What We Learned from the Community Surveys...
Leading Social Change | adler.edu
Participation in the informal economy is associated with economic instability which is associated with… Lower levels of life satisfaction Lower levels of general health and functioning Lower levels of collective efficacy Lower psychological sense of community Higher levels of racism-related stress Higher levels of perceived discrimination
What We Learned from the Community Surveys...
Leading Social Change | adler.edu
Experiences of looking for work with an arrest record:“When you like, constantly try to do the right thing and the more you try but you get shut down in the process of doing it so it like, it breaks you down mentally.” -Young man
“They make you wanna go back to jail. They’re making me feel like if the job isn’t gonna happen why not just go ahead rob everybody, sell drugs.”-Young woman
What We Learned from the Focus Groups…
Leading Social Change | adler.edu
People with arrest records talked about feeling “depressed,” “hopeless,” and “discouraged” when looking for employment.
Most of the groups talked about discrimination because of race, gender, and zip code.
What We Learned from the Focus Groups…
Leading Social Change | adler.edu
Strategies for finding employment:
“…if you don’t retreat then you can kind of see a little clearer, you can kind of make relationships, you can kind of build relationships, that people will trust you, and then give you an opportunity”-Older woman
What We Learned from the Focus Groups…
Leading Social Change | adler.edu
Impact of unemployment on overall community well-being:“It affects the whole community because now there’s more negativity in the community because you gotta worry about somebody breaking into your house, stealing your car, busting you in the head when you come home from work.”-Older woman
“You know what it’s like to not have control? You know when fear, when you, when you get into that zone of fear, that’s like you in an area where they got control and you don’t.”-Older woman
What We Learned…
Leading Social Change | adler.edu
Community Effects - Economic instability affects those with and without arrest records
Social Capital - People feel as though the support networks are not as strong as they once were in Englewood
Social Marginalization - There are some programs and resources available, but many residents are not aware or think they aren’t eligible
What We Learned…
Leading Social Change | adler.edu
Findings: Revised Pathways
History of Arrests
Income Instability (+)
Social Exclusion• Racism-Related Stress (+)• Perceived Discrimination (+)
Psychopathology – Individual Processes
• Psychological Distress (+)• Depression Symptoms (+)
Leading Social Change | adler.edu
Findings: Revised Pathways
History of Arrests
Income Instability (+)Income Instability (+)
Social Exclusion• Racism-Related Stress (+)• Perceived Discrimination
(+)(+)
Community Mental Community Mental Health ProcessesHealth Processes
• Psychological Sense of Psychological Sense of Community (-)Community (-)
• Collective Efficacy (-)Collective Efficacy (-)
Leading Social Change | adler.edu
Where we are today...
April 25th - EEOC Ruling
Leading Social Change | adler.edu
Implications for your work...
Many public decisions – that seem to have nothing to do with health – in fact, have very important health impacts.
Real prevention must start outside of the health sector – before the doctor’s office.
Other sectors must recognize and play active roles in health prevention and achieving health equity.
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