Effects of various policy actions on a community’s mental health usually are not given the same consideration as physical health effects during the policy debate.

(First published in the February 21 2011 issue of Mental Health Weekly, available to subscribers electronically on February 18.)

The director of an institute at the Adler School of Professional Psychology has launched an 18-month research project that will explore an often ignored driver of mental health-related costs. The question being informed through this initiative: Could communities become healthier and need fewer mental health services if public policy-makers had a better way of evaluating in advance the mental health impacts of their decisions?

“If we can make better decisions up front, we’ll need fewer resources for cleaning up the messes we make,” Lynn C. Todman, Ph.D., executive director of the Institute on Social Exclusion at the Chicago-based Adler School, told MHW.

What Todman will be working toward in the Robert Wood Johnson Foundation-supported project involves an effort to ensure that mental health factors are considered alongside the physical health effects that have become routinely assessed in the vetting of public policy proposals covering areas such as land use decisions.

Discussions of how a proposed housing development near high-traffic areas or removed from recreation sites will affect residents’ physical health have become common in public policy debates. But what of the question of how the policy decisions that state and local leaders make affect a community’s level of stress and anxiety, or even perhaps the prevalence of some of the most serious mental health diagnoses in the population?

Todman said this project, which goes well beyond basic research in seeking to develop a widely usable Mental Health Impact Assessment (MHIA) tool, intends to build on the case for integrating the consideration of mental health implications into policy decisions of many types.

“We are advancing [health impact assessment] practice by more purposely incorporating mental health considerations,” Todman said.

Project details

In seeking to develop an MHIA, the research project will look specifically at either one government policy or a suite of policies in a related area, and the potential impacts of these policies on residents of the low-income Englewood community of Chicago.

Todman cited several possible examples of policies that the project will examine. Among the possibilities are a current state legislative proposal to create school safety zones, with possible misdemeanor charges against those who enter these areas without a reasonable purpose; a current proposal that would allow 18-year-olds to obtain a gun license; a proposal that would allow power companies to impose automatic rate increases on consumers upon initiating improvements to infrastructure; and a proposal to increase the minimum wage over the next three years.

In seeking to establish an assessment instrument, the research will involve a combination of reviewing existing literature about mental health impacts of policy decisions and then engaging in fact-finding through community discussions and focus groups.

Todman said that if an assessment tool were widely available to communities across the country, policy-making boards would be able to engage in a similar process of evaluation, based of course on having sufficient resources for that purpose. Her project is being financed with a $250,000 Robert Wood Johnson Foundation grant; it is the largest private foundation grant to a project in the Adler School’s 50-year history.

The assessment tool that this project will develop would be a public-domain resource and not an item that government authorities would have to purchase from a consultant or vendor.

Besides expanding the health impact assessment process to incorporate mental health effects, the project also intends to make a case for broadening the range of public policy decisions that would be subject to a community health assessment. Todman said that a vast number of areas besides land use are suited to undergoing this type of analysis, including education, labor and social welfare policies.

More attention to mental health impacts in communities’ past histories likely could have averted some disastrous public policy decisions, Todman said. She cited as an example Chicago’s historically troubled large-scale public housing developments such as the much-chronicled Robert Taylor Homes.

“Had we put a health lens on those decisions, particularly a mental health lens, we would have realized it was not a good idea to house people in tall concrete silos,” Todman said.

Todman’s project kicked off at the beginning of January. It will involve professionals from mental health, public health and urban planning, along with representatives from the Englewood community.

Current research

Todman said the idea for the project was conceived nearly two years ago in a review of research literature on the social determinants of health. The literature was replete with details about how social factors affect high blood pressure, obesity and other chronic health issues, but mental health would receive no more than an “oh, by the way” mention in these reports, she said.

The communities with which Todman works closely are characterized by high unemployment and poverty rates, and experience heightened stress and anxiety. It is clear that certain policy decisions affecting these communities can play out in increased levels of depression, anxiety and other mental health problems, she said.

Todman added that research literature even has pointed out links between certain policy directions and other mental health diagnoses. She cited as an example existing research that suggests a link between access to green space and the prevalence of attention-deficit/hyperactivity disorder (ADHD) diagnoses.

A statement from the Adler School about the new research project states in part, “Although the precise role of social conditions in causing mental illness are not fully known, it is generally understood that conditions such as social inequality, physical isolation, and economic recessions play important roles.”