Many, if not most, of our current approaches to mental health focus on providing clinical services to individuals, not necessarily on improving the conditions that promote good mental health or prevent mental disorders. Difficult as this would be, the latter is also a responsibility of public mental health. The papers in this issue call for innovations that will infuse a public mental health agenda more thoroughly into community/societal-level interventions, basic research, and targeting of legislative and social policies, a necessity to reduce the sequalae of the current mental health crises.
While it is widely recognized that COVID-19 has affected youths, Perry et al. (P. S258) show the need for balance in public health policy advisories so that the focus is not just on infection control, but also on policies’ mental health consequences, particularly for emerging young adults. Importantly, their findings show how the social networks these young adults have built through technology applications may not nurture and sustain some aspects of their development, including mastering emotional tasks common to their age group. We are reminded about similar social vulnerability of youths in the Pearson and Borba editorial (p. S246), which cites the increased rates of suicide among Black youths, some as young as 5 years of age. While the National Institute of Mental Health (NIMH) works to reach zero suicides, the papers in this special issue leave a haunting sense of the need for addressing how and why rates of anxiety, depression and suicide are increasing among youths. Pearson and Borba offer insights into the priorities of NIMH as a scientific pathway for gaining that understanding.
Alegría et al. (p. S278) highlight the importance of improving overall quality of care in primary care referrals so as to mitigate harmful social determinants of mental health effects. Critical attention to remedying how particular determinants (e.g., utility insecurities, unemployment) affect well-being, along with referrals for mental health services are essential. Arseniev-Koehler et al. (p. S268) use text narratives about suicides to detect differences in gendered aspects of how behavior is perceived in the social environment; these perceptions may result in under-recognition of men’s distress, and suicide prevention may require greater attention to such gender biases. Cochran and Mays (p. S239) call for social policies that address the need for workplace bereavement and grief policies, which are currently deficient in the United States.
Two articles in this issue push for understanding how historical legacies complicate resolving mental health burdens, grief, and bereavement. Interwoven colonial and racist history undergird many current social practices and legal policies. The Riley et al. editorial (p. S242) illuminates the need for community-level psychological interventions to interrupt what we anticipate will be prolonged, complicated grief from the devastating fire in Lahaina, Maui. Psychological recovery here will be challenged by long standing legal and social polices related to water rights, protection of indigenous cultures, and property ownership. Providing individuals with psychological services for their individual recovery while failing to address community level needs will not be enough to heal the collective trauma. Similarly, Edwards-Grossi and Willoughby (p. S250) argue that success in addressing the mental health needs of the Black/African American population can only come by understanding the historical legacy and impact of racist psychiatric concepts. Using Jordan Neely’s killing as an example, they draw connections between the legacies of 19th century racial science and biological racial realism with current day mental health and the carceral practices in the United States.
The US population has experienced its share of trauma and grief in the past several years, including mass shootings, unjustified killings of marginalized persons and the preventable COVID-19 deaths of parents and loved ones. Demanding interventions for the social context of psychological distress, mental health disorders, bereavement and complicated grief may be mental health’s best contribution to a healthier society. This AJPH supplement is both a first step in this direction and a call for action.
68. Years Ago
Mental Illness, a Public Health Concern Then and Now
It has been thoughtfully predicted that one of each dozen children born this year will spend some part of its life in a mental hospital. One half of all hospital patients in the country - some 750,000 - are in hospital because of mental illness. Almost every individual needs, at least on occasion, specialized professional counsel concerning self-understanding, relations to other people, and adjustment to his life environment. The magnitude of the problem of mental illness and deficiency defies statistics. . . . Though not presently susceptible to precise definition and measurement, the mental illnesses demand aggressive concentration of epidemiologic study and development of methods for mental health maintenance and illness prevention. . . . The solutions will not easily be formulated, but neither were they for yellow fever, pellagra, or septicemia. Here, for one place, we must be going in public health!
From AJPH, May 1956, p. 623
92. Years Ago
The Impact of Stress on Mental Health
In times like the present there is much talk about widespread mental and nervous disturbances, due to the stresses and strains induced by economic distress. It is natural to assume that conditions such as those created by the current depression, which is so severely taxing the adaptive capacities of a large section of the population, would tend to unbalance many of the more poorly adjusted and result in a higher frequency of mental and nervous disorders. It is true that the depression is adversely affecting the mental and emotional lives of a great many of us and is causing all sorts of maladjustments in individual, family, and social life, especially among those whom the depression has hit the hardest—the unemployed . . . . There is no evidence that it is greatly increasing admissions to mental hospitals, and there is little ground for alarming statements, such as have recently appeared in the press, that point to a tremendous rise in insanity, crime and suicide.
From AJPH, June 1932, pp. 634–635.
108. Years Ago
The Role of Psychiatric Care in the Schools
[P]sychiatric clinics in the schools may offer reasonable hope of reducing insanity in the later life of the pupils . . . . [s]ince school life is generally the first great adaptation which the child meets on leaving the nursery, it may easily hinder his development if he be incapable of meeting its demands. His careful observation at this point may lead to a discovery of his latent inelasticity of character at the time when such defect may be remedied. The function of the psychiatrist in the school would therefore be twofold: to guide the education of the normal child, with the view, to maintaining his normality, and to detect and remedy abnormal tendencies.
From AJPH December 1916, pp. 1266–1267
Biography
