Healing the nation requires cross-cutting reforms that help health systems, judicial systems, the education system and the workplace be greater than the sum of their parts. Mental health and recovery are impacted by all aspects of community life and engaging whole communities to improve mental health will be more powerful than any single program or intervention.
Decades of local leadership have offered lessons in how cross-sector initiatives can be effective, and increasingly organized networks across the country are trying to build on these efforts.
Set Common Goals
Federal funding streams each come with their own goals and metrics, which can make it hard for different stakeholders to collaborate on common objectives. For example, if housing providers are evaluated on how many people they find housing for, mental health providers are evaluated on how many people they serve, and community development is evaluated on the number of units available to low-income individuals, diverse metrics will make it hard for stakeholders to work together and ensure people get access to housing that meets their specific needs. Federal policy can allow communities to align goals and metrics across programs to facilitate collective impact.
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- The federal government should initiate a review of current measures used across programming and the extent to which grantees in communities across the programs are likely to collaborate, and implement a streamlined measure set – which should recognize the centrality of mental health (and the role of families in the case of children’s mental health).
- The federal government should allow for waivers of certain federal program requirements when grantees are engaged in collective impact around common goals that advance the purpose of the program, allowing grantees to focus on metrics and activities relevant to the common goals, and which may be implemented in tandem with Medicaid innovations.
Share Infrastructure for Continuous Improvement
To make progress toward common goals, stakeholders need to be able to share data and develop some capacity to learn about how to most effectively serve their population. For example, some communities have used data to “hot spot” areas that are experiencing especially poor outcomes and deploy additional health care and social services accordingly, but few are able to rapidly evaluate the impact of the intervention and share learnings to improve for next time.
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- The federal government should ensure that all federal funding streams to communities specify privacy and data sharing requirements in the context of collective impact that effectively advances the program’s goals.
- The federal government should increase the Medicaid matching funds for IT investments that support collective impact for population health, and systematically specify the extent to which other federal funding streams may be used to contribute toward a shared data infrastructure.
- The federal government should fund a network of quality improvement organizations that support collective impact in communities for population health, with a focus on mental health (and the role of families in the case of children’s mental health).
Ensure Financial Sustainability
Many collective impact arrangements are sustained by grants that may provide enough resources for stakeholders to come together and identify common problems, but not enough to implement a shared solution. Often, they don’t even survive after the grant expires. Federal policy can ensure that investments in communities are better leveraged by supporting the sustainability and effectiveness of collective impact.
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- The federal government should fund a learning collaborative and technical assistance for states in implementing Medicaid waivers or state plan amendments that allow some amount of Medicaid funds to support collective impact to advance population health.
- The federal government should systematically specify the extent to which federal funds across various programs can be used to sustain collective impact activities that advance the goals of the program – although does not need to be (and should not be) a separate collective impact initiative specific to that program’s goals.
- The federal government should fund technical assistance and learning collaboratives for implementing community-level financing approaches that can make available the necessary resources for meeting common goals and include the participation of various federal agencies to ensure that their program requirements align with the financing approaches.
Tackle Stigma and Discrimination
Community attitudes toward mental health impact how likely individuals are to discuss their needs and seek help, and can create or limit social and economic opportunities. In fact, communities that prioritize emotional wellbeing, mutual support, and optimism toward the future experience lower rates of mental health problems.1Donnelly L, McLanahan S, Brooks-Gunn J, Garfinkel I, Wagner BG, Jacobsen WC, Gold S, Gaydosh L. Cohesive neighborhoods where social expectations are shared may have positive impact on adolescent mental health. Health Affairs. 2016 Nov 1;35(11):2083-91. While community norms and attitudes are shaped indirectly through a range of social and economic policies, federal policy can also target norms and attitudes directly.
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- The federal government should incorporate funding to support prominently displays of messaging around mental health screening across a variety of federal funding programs that are likely to reach underserved populations.
- The Department of Justice should issue guidance on requirements under the Americans with Disabilities Act to initiate certain universal accommodations (modifications that are available without having request individualized accommodations, such as wheelchair ramps on buildings) for mental health. Although individuals currently have a right to individualized accommodations for mental health, no guidance has been issued on the need for universal accommodations despite the high prevalence of mental health as a disability.
- The federal government should place a requirement in federal funding of mental health programs to include screenings for potential legal needs around discrimination and indicate that such screenings may be covered under state Medicaid plans, and increase federal funding for the Protection and Advocacy of Individuals with Mental Illness program to accommodate the additional need.
Promoting Positive and Supportive Norms
When communities work together to overcome challenges and attain a bright future, everyone experiences better mental health outcomes. Federal policy can help generate and disseminate the best available evidence for how to improve mental health across communities and invest in norm change interventions to make it second nature for communities across the country.
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- The federal government should fund a learning network of community social norm and attitudinal change interventions that test different approaches and evaluate impacts on population mental health outcomes.
- The federal government should fund projects to test methods of social norm and attitudinal changes through national or regional media, potentially including television, movies, and books, and evaluating impacts on population mental health outcomes.
- The federal government should create incentives for the development of new consumer technologies that advance social norm, and attitudinal change, and evaluate impacts on population mental health outcomes.
Leverage Community Development
Congress currently supports billions of dollars of investment in the economic development of underserved communities, but despite growing evidence on how different approaches to economic development can improve or hurt the mental health of a community, mental health impacts are rarely considered in the way these funds are used.2Jutte DP, Miller JL, Erickson DJ. Neighborhood adversity, child health, and the role for community development. Pediatrics. 2015 Mar 1;135(Supplement 2):S48-57. 3Joyce Buckner-Brown et al., Using the Community Readiness Model to Examine the Built and Social Environment: A Case Study of the High Point Neighborhood, Seattle, Washington, 2000–2010, 11 Preventing Chronic Disease E194 (2014).
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- The federal government should fund a research consortium to advance the evidence for community development and mental health and create recommended approaches and evaluation tools for community development projects that seek to improve mental health.
- The federal government should pilot altering some of the existing community development funds so that they must both increase investment in underserved areas and improve the mental health of the current community members, including support for evaluation.
- The federal government should put requirements for meaningful engagement with community members (and especially those with mental health conditions or other disabilities) in community, economic, and workforce development federal funding programs.
Prioritize Social Inclusion
Although more and more research connects social isolation with mental health problems and a range of other chronic conditions, relatively few resources have been invested in creating social opportunities at the community level.4Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on psychological science. 2015 Mar;10(2):227-37. Without dedicated resources and tools for evaluation and improvement, communities will not be able to meaningfully advance inclusive social opportunities for their members.
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- The federal government should fund the development of a common set of evaluation tools and methods for community social outcomes, including the extent to which each individual’s experience needed forms of social support and community and whether individuals have access to diverse social opportunities.
- The federal government should review federal funding in communities and systematically include, as appropriate, measures of community social outcomes to help various programs add to the vibrancy of the community – including a particular focus on community development funding.
Tailored Policies for Unique Needs
To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.Explore our recommended policies for focus populations