mhc prelim 2

Policy environments shape distress

State economic and social policies influence mental health by shaping economic security, stress exposure, and access to care; mental health varies geographically because policies cluster within states

Policy bundling

States tend to adopt clusters of policies (e.g., high minimum wage + Medicaid expansion), creating distinct policy environments that shape mental health outcomes

Frequent mental distress (FMD)

≥14 days of poor mental health in past 30 days; used to measure population mental health

Three mechanisms linking policy to mental health

(1) Improve wages/reduce poverty (2) Reduce economic hardship (3) Buffer stress effects of hardship

Economic hardship

Inability to meet basic needs like housing, food, or healthcare; strongly linked to poor mental health

Loneliness definition

Subjective distress from lack of meaningful relationships

Social isolation definition

Objective lack of social interaction or relationships

Loneliness vs isolation

Distinct but related; weak correlation; someone can be isolated but not lonely and vice versa

Loneliness as social pain

A distressing internal state caused by mismatch between desired and actual connections

Loneliness and social contacts

Negative monotonic relationship; fewer contacts → higher loneliness

Loneliness network effect

Spreads up to 3 degrees of separation in social networks

Loneliness clustering

Lonely individuals tend to be located at the periphery of social networks

Health effects of loneliness

Increased risk of heart disease, stroke, depression, suicide, cognitive decline, mortality

Economic effects of loneliness

Billions in healthcare costs and lost productivity

Social connection as SDOH

Key determinant of health affecting resilience, safety, and wellbeing

Access vs quality

Access to care does not ensure high-quality or appropriate care

Workforce shortage

Too few providers to meet demand

Workforce maldistribution

Providers unevenly distributed geographically (e.g., rural shortages)

Fragmentation

Lack of integration across healthcare, education, and social services systems

Default to crisis care

System prioritizes acute services due to payment incentives

Crisis system role

Entry point to mental health system; must be available anytime/anywhere

Crisis system goals

Prevent suicide, ED visits, hospitalization, incarceration

Crisis continuum

Talk (988), Respond (mobile teams), Recover (stabilization)

988 hotline

National 3-digit crisis line connecting to ~180 centers

Mobile crisis teams

On-site response to mental health crises in community settings

Crisis stabilization

Short-term treatment to avoid hospitalization

Overreliance on ED/jails

Due to lack of community-based services

Deinstitutionalization problem

Closure of institutions without sufficient community care capacity

Criminalization of mental illness

People in crisis interact with criminal justice system

Peer workforce

People with lived experience providing care/support

Community health workers

Non-clinical workers connecting patients to care and resources

Nontraditional care sites

Barbershops, community spaces used for outreach and care

Fee-for-service (FFS)

Payment per service; incentivizes volume

FFS limitations

Does not support prevention, coordination, or outreach

Capitation (PMPM)

Fixed payment per patient per month; incentivizes prevention and coordination

Episode-based payment

Single payment per episode of care

Population-based payment

Total cost of care model for population

Risk adjustment

Adjusts payment based on patient complexity to avoid selection bias

Quality metrics

Measure outcomes like follow-up care, medication adherence

Primary prevention

Prevent disease before it occurs

Secondary prevention

Detect disease early and intervene

Tertiary prevention

Treat and manage disease to reduce complications

Upstream interventions

Policy-level interventions addressing root causes

Midstream interventions

Behavioral and early disease interventions

Downstream interventions

Treatment-focused interventions

Screening level

Midstream prevention

Mental health parity

Insurance must treat MH and medical benefits equally

NQTLs (nonquantitative treatment limits)

Barriers like prior authorization or step therapy

Same-day billing restriction

Limits reimbursement for mental + physical care same day

Parity enforcement problem

Weak enforcement allows disparities to persist

IMD exclusion

Medicaid cannot fund institutions >16 beds

IMD purpose

Encourage community-based care

School-based mental health (SBMH)

Mental health services delivered in schools

SBMH advantage

Near-universal access and reduced barriers

MTSS framework

Universal, selective, indicated tiers of support

SBMH delivery models

School-employed, community-partnered, school-based health centers

SBHCs

On-site clinics providing integrated care

SBMH workforce

Includes counselors, psychologists, psychiatrists

Youth MH treatment gap

Many youth receive no or delayed care

Social media harms

Exposure to harmful content, addiction, sleep disruption

Social media benefits

Community, identity formation, social support

Haidt thesis

Social media is major causal factor in youth MH crisis

Odgers thesis

Evidence is correlational; structural factors matter more

Causation vs correlation

Association does not prove causation

Policy debate framing

Responsibility: individual/family vs corporations vs government

Top-left quadrant

Strong regulation of tech companies (class consensus)

Algorithm bans

Restrict algorithmic recommendations for minors

Age verification

Require proof of age for social media access

Perinatal mental health

Mental health during pregnancy and postpartum

Maternal mortality

Deaths during pregnancy or shortly after

Postpartum risk period

Up to 1 year after birth

Mental health as leading cause

Includes suicide and substance use

Parental stress

Parents have higher stress than non-parents

Policy tension (parenthood)

High expectations for parenting but low structural support

Biopsychosocial model

Health shaped by biological, psychological, social factors

Mental health definition

Emotional, psychological, social wellbeing

Care continuum

Self-help → outpatient → intensive → inpatient

Guardrails

Preventive supports maintaining stability

Liferafts

Crisis interventions for acute needs

Therapy modalities

CBT, DBT, ACT, exposure therapy

Psychiatry role

Medication management and diagnosis

Interventional psychiatry

TMS, ECT, esketamine

Collaborative care model

Integrates mental health into primary care

Population-level metrics

System-wide measures like prevalence, access

Individual-level metrics

Patient outcomes like PHQ-9 scores