Leading Social Change | adler.edu Mental Health Impact Assessment: A tool for mental health prevention and advancing mental health equity Prepared for

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


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])



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



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



Steps Screen Scope Assess Recommendations Reporting/Communications Monitor and Evaluation



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?


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


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


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


Assessment Methodology

Community Survey (N=250)Focus GroupsLiterature reviewInterviews Participant Observation


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...


People with a lifetime arrest records arrest records have … Higher rates of substance abuse Higher rates of psychological distress Lower rates of life satisfaction



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



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



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…


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.



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



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…


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…


Findings: Revised Pathways

History of Arrests

Income Instability (+)

Social Exclusion• Racism-Related Stress (+)• Perceived Discrimination (+)

Psychopathology – Individual Processes

• Psychological Distress (+)• Depression Symptoms (+)


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 (-)


Where we are today...

April 25th - EEOC Ruling


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.

Documents

Leading Social Change | adler.edu Mental Health Impact Assessment: A tool for mental health prevention and advancing mental health equity Prepared for