The US is currently experiencing a Mental and Behavioral Health (MBH) crises with projections suggesting increasing prevalence rates. Access to MBH care is lower than for other types of care but especially so compared with other chronic conditions. MBH problems result in a unique situation in which the disorder itself impairs one’s ability to seek out and successfully manage treatment yet it has the fewest number of patients receiving care coordination or navigation, the longest delays between diagnosis and treatment, and the most limited follow-up. Like many other medical conditions, screening, early detection, and effective and ongoing treatment, often through care coordination, can have a profound impact on one’s quality and quantity of life—all while reducing overall health care cost; however, this is not occurring with MBH.
Wicked Problem Description:
Our hospital’s catchment area in Southeast Washington, DC represents one of the most under-resourced in the nation, yet just a few miles away there are some of the nation’s wealthiest communities. This area is also designated as a medical underserved area and a mental health professional shortage area. This is especially unfortunate because there is evidence that common mental disorders such as depression and anxiety are distributed according to a gradient of economic disadvantage across society and the poor and disadvantaged, like the individuals living in this community, suffer disproportionately from common mental disorders and their adverse consequences. Furthermore, under- resourced communities are less likely to receive the effective treatments that are available for MBH problems and if they do, their efficacy is often reduced due to a lack of attention to the social determinants of mental health.
Our MHI-STREET program is designed to focus on improving mental health wellness in the Ward 8 community and has four components:
- Data gathering: We will survey Ward 8 residents and primary care providers on their knowledge, attitudes and behaviors around MBH and the MBH resources in their area. We will host focus groups of community residents, faith leaders and barbershops to better understand and mobilize resources to meet the MBH needs of the community.
- Community Engagement: We will work through the Ward 8 Health Council’s MBH Subcommittee with over 30 multi-discipline community partners. We will analyze the data collected from the surveys and focus groups and use this information to adapt and implement existing MBH education tools. We will utilize an innovation in governance method called Embedded Education in faith based organizations and barber shops. We will create a Ward 8 Smartphone Application to map out and provide information on MBH sites and wellness resources specific to Ward 8.
- Social determinants of mental health: We will aim to influence food insecurity as a social determinant of mental health in Ward 8. We will establish a food pharmacy/pantry at the only safety net hospital in Washington, DC United Medical Center through a collaborative effort with DC Capital Food Bank, DC Hunger Solutions and DC Greens.
- Social marketing campaign: We will create a social marketing campaign that will be specifically targeted to the Ward 8 community. Positive messaging around mental health and mental health resources will be conveyed to mitigate stigma around MBH and provide useful information about community resources.
To reduce stigma around MBH, increase knowledge related to MBH disorders in the community and to increase the opportunities for MBH wellness in the community.
YEAR ONE: Create the MBH Subcommittee on the Ward 8 Health Council; Begin to collect Ward 8 resource information for the Smartphone application; Conduct surveys and focus groups of residents and faith leaders.
YEAR TWO: Conduct surveys and/or focus groups of residents, barbers and faith leaders; Conduct surveys of primary care providers; Establish the embedded education program (faith leaders and barber shops); Establish a food pantry; and Develop the Ward 8 Health App.
YEAR THREE: Implement a social marketing campaign to focus on destigmatizing mental illness in Southeast DC; Continue engagement and education of community and primary care providers; and Evaluate program effectiveness.
Community (Ward 8 Health Committee composed of over 30 community partners; barbershops), Local government (Department of Behavioral Health), Academia (George Washington University) and Faith-based partners.
We plan to collect the following process indicators (not a comprehensive list) and will develop outcome indicators in collaboration with our partners
- Number of downloads of the Ward 8 App
- Number community members trained on MH First Aid
- Number of MH trainings in faith based settings
- Number of barbers/beauty shop staff trained and
- Number of customers referred to MBH
- Number of food pantry customers screened and referred for MBH