Marblehead Cares: Why public mental health matters

If asked to make a list of the positive outcomes from the COVID pandemic, many of us would probably scratch our heads and would have to think a bit. Our lists would tend to be quite small. Perhaps, however, one item would be on a few of those lists: The pandemic has brought increased and more thoughtful attention to the task of improving the collective mental health of our community. The sense of isolation and separation generated by the pandemic has been widespread and profound enough to encourage a broader discussion of this issue, which, historically, has been either ignored or awkwardly addressed. The Marblehead Mental Health Task Force (MMHTF) which develops these columns for the Marblehead Current has been established to add value and bolster mental health in our community. 

The traditional approaches to mental health care have focused on providing services to individuals with serious mental illness or those demonstrating significant distress. Unfortunately, even with this relatively narrow focus many who need services do not get them due to workforce shortages and the costs of individual clinical care. And this narrow focus neglects the large populations who live with the mental health challenges caused by the daily stresses of contemporary society. The pandemic obviously added significantly to this community-level distress and anxiety. As a result, there is considerable attention now being given to alternative models of improving mental health in our society. 

Expanding the mental health capacities of our existing public health systems is one of those models. Major public health schools are expanding their activities in this area and are developing programs to support local departments of public health. Because the MMHTF is a subcommittee of the Board of Health which oversees the public health efforts of our town, this seems like a reasonable place to consider that approach. At the minimum, a review of this alternative should encourage meaningful conversations at the MMHTF and throughout the community.  

Before addressing the public mental health concept per se, it is probably helpful to clarify what the term “public health” means in this context. The CDC Foundation defines public health as “the science of protecting and improving the health of people and their communities. This work is achieved by promoting healthy lifestyles, researching disease and injury prevention … Overall, public health is concerned with protecting the health of entire populations.” In the mental health setting, public health approaches describe (generally non-clinical) interventions and activities intended to improve mental health outcomes and the determinants of those outcomes in communities or populations. 

The idea of Marblehead developing its own approach to improving mental health is consistent with the proposition that local communities should have more input into public health policy development. Even before the pandemic, it was clear that broad federal guidelines were sometimes not flexible enough to provide everything that local public health departments needed. The response to that awareness was to advocate for more strategic authority at the local level. This concept, known as Public Health 3.0, was gaining momentum prior to the pandemic. The basic tenet of Public Health 3.0. approach is that the local public health departments should be the strategic planners for their own communities. The central and the local are complementary. Knowledge should flow from the bottom up as well as from the top down.  

The MMHTF with its designated membership slots is well designed to reflect the community perspective and requirements. As a subcommittee of the Marblehead Board of Health and working through the regional hierarchy and relevant agencies, it can propose ideas to the state public health officers and ultimately to the federal level. And it can provide useful services to the community that might not rise to the level of a CDC focus. In such a setting, the MMHTF would concentrate on identifying specific public health services and responses that would respond to the unique needs of our community. These services would be complementary to current programs and not be substitutes for them.  

The article by Mark Libon and Melissa Kaplowitch on strengthening positive and hopeful attitudes in undirected adolescents which was published in the Current in July is a good example of adding complementary public health methods to existing programs. Suicide rates are increasing among adolescents. The suicide prevention hotline is an existing, important and necessary service. The Libon/Kaplowitch article attempts to deal with the situation before it reaches the crisis stage necessitating the hotline. Introducing prevention-oriented changes early in the process are characteristic of public health interventions.   

This short document is not an attempt to endorse, to examine or even to list all the issues involved in public or population-based mental health approaches. Its primary purpose is to expand on the introduction to the MMHTF and endorse the activities of that group. The existence of the MMHTF speaks to the uniqueness of the Marblehead community and the entrepreneurial ethos that exists. It deserves the attention and engagement of the community it cares about and it seeks to serve. 

Dr. Thomas Massaro is a member of Marblehead Cares. Learn more HERE.

Thomas A. Massaro, MD PhD
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