Disparities Research Unit, Massachusetts General Hospital, Boston (Alegría, Zhen-Duan, O'Malley); Department of Medicine (Alegría, Zhen-Duan) and Department of Psychiatry (Alegría), Harvard Medical School, Boston; Department of Psychology, Florida International University, Miami (DiMarzio).
Am J Psychiatry. 2022 Jun;179(6):402-416. doi: 10.1176/appi.ajp.21100970.
The Biden-Harris Administration's FY22 budget includes $1.6 billion for the Community Mental Health Services Block Grant program, more than double the FY21 allocation, given the rising mental health crises observed across the nation. This is timely since there have been two interrelated paradigm shifts: one giving attention to the role of the environmental context as central in mental health outcomes, the other moving upstream to earlier mental health interventions at the community level rather than only at the individual level. An opportunity to reimagine and redesign the agenda of mental health research and service delivery with marginalized communities opens the door to more community-based care interventions. This involves establishing multisector partnerships to address the social and psychological needs that can be addressed at the community level rather than the clinical level. This will require a shift in training, delivery systems, and reimbursement models. The authors describe the scientific evidence justifying these programs and elaborate on opportunities to target investments in community mental health that can reduce disparities and improve well-being for all. They select levers where there is some evidence that such approaches matter substantially, are modifiable, and advance the science and public policy practice. They conclude with specific recommendations and the logistical steps needed to support this transformational shift.
拜登-哈里斯政府在其 2022 财年预算中为社区心理健康服务拨款项目（Community Mental Health Services Block Grant program）拨款 16 亿美元，是 2021 财年拨款的两倍多，鉴于全美各地不断出现的心理健康危机。这是及时的，因为有两个相互关联的范式转变：一个关注环境背景在心理健康结果中的核心作用，另一个则将重点转移到社区层面的早期心理健康干预上，而不仅仅是在个体层面。重新构想和重新设计边缘化社区的精神卫生研究和服务提供议程的机会，为更多的基于社区的护理干预措施打开了大门。这涉及到建立多部门伙伴关系，以解决可以在社区层面而不是临床层面解决的社会和心理需求。这将需要改变培训、提供系统和报销模式。作者描述了支持这些项目的科学证据，并详细说明了有机会针对社区心理健康进行投资，以减少差异，提高所有人的幸福感。他们选择了一些有证据表明这些方法非常重要、可改变的，并推进科学和公共政策实践的杠杆。最后，他们提出了具体的建议和支持这一变革性转变所需的后勤步骤。
