Mental Health Awareness Month

Legal & policy solutions to address the structural drivers of mental health inequities

By Liz Olson & Patrick Glass

At a Glance

  • Mental Health Awareness Month is a time to recognize that psychological well-being is an essential component of an individual’s overall health.
  • Mental health challenges are on the rise, and there are inequities in access to mental health services as well as health outcomes.
  • Mental health inequities stem from the fundamental drivers of health inequity.
  • ChangeLab Solutions’ tools and resources can help policymakers and advocates dismantle the root causes of mental health inequities.
  • Equity-promoting mental health resources have been created by our governmental and organizational partners across the country.

Mental Health Is Health

Mental health is an essential component of overall health and well-being, shaping how we cope with stress, build relationships, and operate at work, in school, and in our communities. While mental health and physical health are equally important (and deeply interconnected), mental health services are often less accessible and more highly stigmatized than many other forms of health care. In part, these barriers resulted from law and policy decisions that have criminalized mental illness, fragmented mental health services, and underfunded other vital supports for people facing mental health challenges.

Mental Health Challenges Are on the Rise

While rising rates of mental health challenges predate COVID-19, heightened stress, grief, social isolation, and economic insecurity throughout the pandemic have exacerbated these challenges. For example, the prevalence of mental, emotional, and behavioral health conditions among children increased by nearly 35% between 2012 and 2018 and is likely to have grown even more rapidly during the pandemic. In winter 2021, emergency department visits for suspected suicide attempts among youth ages 1217 increased by nearly 40% in comparison with the same period in 2019. Fewer than half of all children and adults with a treatable mental health disorder receive any mental health care, facing barriers that include severe provider shortages and high costs for services that too often are not covered by insurance.

If you are struggling with thoughts of suicide or are worried about a friend or loved one, help is available. Call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or text HOME to 741-741 (Crisis Text Line) for free, confidential emotional support 24 hours a day, 7 days a week.

Inequities in Mental Health Access & Outcomes

Mental health challenges affect people of every race, ethnicity, income level, gender, and sexual orientation. However, due to structural racism and other forms of structural discrimination, some communities are more likely to experience stress, trauma, and other situations and conditions that can undermine mental health. Children and adults who are Black, Indigenous, or other people of color (BIPOC); who live on low incomes; or who identify as LGBTQ+ are more likely to experience mental health challenges and less likely to have access to therapy and other essential mental health services. Like other health inequities, mental health inequities are deeply rooted in the fundamental drivers of health inequity.

Mental Health Inequities Are Rooted in the Fundamental Drivers of Health Inequity

To improve mental health outcomes, we need to invest in mental health infrastructure. Our communities also need support to implement law and policy interventions that remove barriers to accessing mental health services and that address the fundamental drivers of health inequity. These drivers of inequity — structural discrimination (including structural racism), income inequality and poverty, disparities in opportunity, disparities in political power, and governance that limits meaningful participation — shape the social, economic, and environmental conditions in which we live. Those conditions, in turn, shape our mental health and sense of well-being. Here are some examples:

  • Structural racism exposes BIPOC individuals and communities to chronic stressors — including racial bias in school, workplace, and health care settings — and acute stressors like racial trauma.
  • Poverty and income loss can also cause or exacerbate mental health challenges. People living on very low incomes experience anxiety and uncertainty about how to make ends meet and how to juggle trade-offs between essential expenses. Job loss or periods of unemployment, too, can result in feelings of helplessness about the future. These experiences have been linked to increased anxiety, depression, and deaths by suicide.
  • Families of color and those experiencing poverty are more likely to have housing instability or live in environments with poor physical housing quality, both of which can affect children’s mental health. Families who have experienced an eviction face greater risk of depression, and people with housing instability may experience increased psychological distress. Research suggests that the presence of lead, mold, or pests and the lack of heat, water, or adequate light can also worsen mental health.
  • Laws and policies that drive over-policing and mass incarceration leave Black Americans and some other communities of color vulnerable to harmful, violent, or, too often, fatal encounters with law enforcement. Interactions with police are associated with poorer mental health outcomes among Black Americans, and risks increase significantly among those who are incarcerated as a result of those interactions. Deploying police to respond to mental health crises is especially dangerous for BIPOC individuals already experiencing a mental health condition and can worsen symptoms.
  • Relying on criminal enforcement mechanisms to enforce laws and policies that are intended to safeguard public health can lead to inequitable impacts and cause harm to the populations that the policies are meant to protect. Laws that penalize minors for possession, use, or purchase of tobacco products, for example, can lead to punishment as severe as school suspension or incarceration in some jurisdictions. Such penalties reinforce the harms of over-policing and mass incarceration and can have detrimental impacts on young people’s mental health.

Leveraging Law & Policy to Address Upstream Drivers of Inequity

Just as laws and policies have played a central role in creating mental health inequities, they can also be leveraged to undo the conditions that produce inequitable mental health harms. Policymakers and health advocates can push back against laws and policies that uphold drivers of inequity such as structural racism (including the punitive sentencing laws and policing practices that drive mass incarceration); income inequality and poverty (including low minimum wage, inadequate sick and family leave, and systematic underinvestment in affordable housing and other critical infrastructure in low-income communities); and other factors that drive adverse mental health outcomes. Community officials and advocates can also advance policy solutions that strengthen systems of care and ensure that everyone has the resources they need to thrive.

Many organizations committed to health equity are working to increase access to mental health services and prioritize treatment over punishment for people with mental, emotional, and behavioral health needs, including the Hopeful Futures Campaign, National Alliance on Mental Illness, National Council for Mental Wellbeing, Vera Institute of Justice, and Drug Policy Alliance.

ChangeLab Solutions is also working on a range of legal and policy interventions that can help tackle the upstream drivers of mental health inequity. We invite you to explore the many relevant tools and resources in our library, including these: