Mental Health Care in the US: Social Justice and Epidemiology

This report provides a comprehensive overview of mental health care practices in the United States. It begins by defining mental illness and highlighting its prevalence, emphasizing the role of primary health care. The report then delves into the social determinants of mental health, including demographic, economic, and environmental factors, as well as equity and social justice considerations. It explores key epidemiological studies, such as the Epidemiologic Catchment Area and the National Comorbidity Survey, to understand the prevalence and risk factors of mental disorders. The role of mental health care nurses is examined, including their cultural competence in providing care. The report concludes by emphasizing the growing issue of mental illness in the US and the importance of integrated systems to deliver quality services and assistance to those in need. The report highlights that mental health services in the United States are an important driving force in economy and social determinants act as a framework which focuses on circumstances in which an individual lives, born, learn, age and work. Understanding these determinants will reflect a country’s key issue in education, economic stability, neighbourhood and in health and health care.

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Contents
Introduction..............................................................................................................................2
Social Determinants of Mental Health...................................................................................2
Demographic.........................................................................................................................3
Economic...............................................................................................................................3
Environmental......................................................................................................................3
Equity.....................................................................................................................................4
Social Justice.........................................................................................................................4
Epidemiological Studies relevant to mental health...............................................................5
Epidemiologic Catchment Area..........................................................................................5
National Comorbidity Survey.............................................................................................5
Medical Outcomes Study (MOS)........................................................................................5
Composite International Diagnostic Interview (CIDI).....................................................6
Role of Mental Health Care Nurse.........................................................................................6
Cultural Competence in Mental health..................................................................................7
Conclusion.................................................................................................................................8
References...............................................................................................................................10

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Introduction
Mental Illness can be described as a condition of emotional, mental and behavioural disorder.
In United States, mental health is a growing issue which involves people from all ages.
According to recent statistics, 26% of population over 18 years and 1 in every 4 adults in
America, suffers from mental disorder (NAMI, 2020). This includes, clinical depression,
bipolar depression, obsessive-compulsive disorder and schizophrenia. Furthermore,
depressive illness leads to anxiety disorder and substance abuse disorder.
Primary Heath Care is an approach which act as an essential service to prevent disease,
manage illness and promote health. This involves all the major aspects of health and well-
being. It incorporates community development and encompasses a relevant understanding of
the determinants of health, which includes, personal care, prevention of illness and
management of illness. The significant role of mental health services is to promote positive
mental health practices by addressing on mental illness.
In the following segment, there will be an analysis of mental health care and their practices in
US. There is a demonstration of social justice, equity and the epidemiology studies of mental
health and disease across different population groups in global context. Also, there will be an
evaluation of the nursing practices which promotes the mental health among individuals,
communities and population. This will reflect the cultural competence in mental health care
and the significant role of psychiatric nurses in improving the mental illness.
Social Determinants
Mental health services in United States, is considered as an important driving force in
economy. Social determinants act as a framework which focuses on circumstances in which
an individual live, born, learn, age and work. Understanding these determinants will reflect a
country’s key issue in education, economic stability, neighbourhood and in health and health

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care. Country’s physical and social environment promotes good health. Even in United
States, people deserve equal opportunities to make choices which will lead to good mental
health (NIMH, 2019).
There are five major social determinants which contributes in causing and solving the mental
health issues in United States.
Demographic
The determinant includes the age, gender, life expectancy and ethnicity. According to the
recent statistics, 19.1% of the American adults, experiences mental illness and 4.6% of these
adults, experiences very serious mental issues (EBPH, 2016). The annual treatment rates for
the adults are Male (34.9%) and Females (48.6%) (EBPH, 2016). Almost 43.3% of the adults
with mental issues get treatment in 2018 (Lancet Psychiatry, 2018).
Economic
Mental health issues are prominent among the marginalised groups which experiences social
exclusion, trauma, discrimination. According to the report by World Economic Forum,
mental issues can create a greater impact to the economic output than heart disease, cancer
and diabetes (NCBI, 2016). This report signifies that the cost of mental disorder is $16
trillion, worldwide. Low-income countries have lesser percentage in health budgets
(MFMER, 2019). Whereas, country like US, the total expenditure on mental health is given a
significant importance. Also, it has been found that the untreated depression and anxiety costs
$1.15 trillion in society annually (Phillips & Bazemore, 2010).
Environmental
Environmental determinant are the external stressors which have a significant influence on
mental illness. These external stressors act as a strain which develops into a diagnosable
mental illness. Toxicant exposure and air pollution linked to develop certain psychiatric

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symptoms which are negative. These symptoms can lead to depression, anxiety, cognition
and mood changes. Physical health area is also associated with mental health. Good physical
health will develop positive emotions and elevates the mood states of depression and anxiety.
Efforts are required to elevate the consciousness about mental health, in workplace, health
care centres, educational setups (Schultz, 2010).
Equity
Equity determinant of mental health care is related to medical care in general. According to
recent statistics, 56% of an American adult does not receive any treatment for their mental
illness (Phillips & Bazemore, 2010). To promote mental health by equity, American
Psychological Association suggests to foster positive relationships and initiatives within
ethnic and racial minority communities to enhance awareness. In 2008, the Addition equity
act plans to cover mental and substance use disorders, which includes around $5 million for
treatment and screening of maternal; depression (NAMI, 2020). Also, $10 million has been
given for accessing mental health care in United States (Robert Graham Center, 2018).
Social Justice
Mental health is considered to be an issue of social justice as much it is for a healthcare issue.
Approach of social justice in mental health focuses on having equitable access of all
psychiatric services. For about, 25% African-American requires the psychiatric and
counselling services as compared to 40% of white (NCBI, 2016). These statistics
demonstrates that the need for mental health services is for all the communities around the
nation. Racial discrimination, for a person’s colour can sometimes lead to post-traumatic
stress disorder (PTSD). Also, people living with thoughts and feelings that are related to
Suicide. This issue acts as a public health and social justice issue (Todman, 2011).

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Epidemiological Studies relevant to mental health
Epidemiology comprises of controlling and understanding of a certain disease by examining
the external environmental conditions. Psychiatric epidemiology is an area which studies all
the relevant causes of mental illness and disorders in the society (Susser & Patel, 2014).
Epidemiologic Catchment Area
This was the largest and the most comprehensive survey in the area of mental disorders,
which was conducted in United States. The purpose of this survey, was to give the prevalence
rates and estimates the mental disorders in current population. This would be useful for
private and public health planning purposes. Also, to highlight the given findings from the
data and analyse the common requests related to the epidemiology of mental illness in United
States (Sparks, 2019).
National Comorbidity Survey
It is considered as the first survey that is conducted on psychiatric epidemiology. This survey
was designed to evaluate the risk factors and the consequences of psychiatric comorbidity
and morbidity. It estimates that on average 26.2% of American population above 18 years
have mental health issues (Safaei, 2012). This survey was representing the US population and
administering a structured interview by using DSM-III-R (Safaei, 2012).
Medical Outcomes Study (MOS)
The Medical Outcome Study (MOS) is an evaluative study of chronic diseases, which
includes depression and hypertension. It is designed to determine the variations in patients.
This can be related to differences in the system of primary health care, interpersonal styles
and practitioner specialty. This study also enhances the practical tolls which are required for
the monitoring and determining the outcome of patient in medical practice. The application of

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Medical Outcomes study is or measuring the quality of health-related in life. This includes
clinical practices and health interventions evaluations (Silva, 2016).
Composite International Diagnostic Interview (CIDI)
This is a structured and comprehensive kind of interview which is designed for interviewers
for assessing the mental disorders. This allows the practitioner to measure the severity,
prevalence and determine the significant burdens of mental disorders. This also, asses the
usage of medications and service use in mental illness. Mental disorder is considered among
the prevalent class of chronic diseases (Shim & Crompton, 2018).
Role of Mental Health Care Nurse
In United States, primary medical care is delivered on the basis of general paediatrics, family
medicines and general internal medicine. In order to elevate the mental health practices,
specialists such as psychologists, psychiatrists and psychiatric nurses provides the managed
services. The combine workforce of doctors which are about 222,000, have the primary
function to serve their patients and work towards primary care (Safaei, 2012). In 2017, the
number of nurse practitioners that held National Provider Identifier were 129,000 (Robert
Graham Center, 2018).
Nurses ensures to recognize the differentiated symptoms and psychiatric signs of different
cultures. They acknowledge the influence and role of ethnic, cultural and spiritual aspect in
developing the treatment for their patients with mental disorders. Nurses also, evaluates the
interventions of the patients during the therapy. The interventions, communication, and
therapeutic practices are created with the consideration of patient’s spiritual and cultural
identity. The aim of psychiatric nursing is to promote well-being and mental health (PATH,
2019).

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Mental Health Nursing are the experts for mental health assessment, patient assistance, crises
intervention meditation and therapy. When working with a patient with mental illness, nurses
work closely with doctors to develop an individualized plan for patient. Their aim is to help
their patient to have a productive live. They provide individual counselling for the patient and
their families. They are experts in diagnosing treating and assessing psychiatric problems
(NIMH, 2019).
In United States, the registered nurse can only do the diagnoses of a mentally ill patient.
Mental health includes the overall normality of emotional, social and behavioural aspects in
an individual. Nurses in the psychiatric areas receives specific training for conducting
therapies, dealing with extreme behaviour, therapeutic alliance and administering a
psychiatric medication (WHO, 2019). Nursing process, includes the health mental health care
practices which promotes safety and health of the patient. Also, this acknowledges the
interpersonal relationship such as empathy, moral integrity and self-awareness.
Cultural Competence in Mental health
Cultural competence is considered as an ability to relate an individual from a different group
effectively. It represents an individual’s approach to improve the healthcare quality. Nurses
are considered as the largest group of health care professionals. In US, the psychiatric nurses
provide a culturally competent care. This is done by delivering the care for patient with
respect to spiritual and cultural beliefs. Cultural aspect of an individual is a brad concept
which encompasses areas of age, religion, political viewpoints, spirituality and physical status
(WHO, 2014).
Culture is considered as a multi layered concept that can be influenced by any issues
regarding, gender, religion, language, class and nationality. Mental health practitioners are
now fully aware about the challenges they face in providing their heath care services. Despite

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these concerns, it is well established that culturally competent care requires knowledge of
cultural values, beliefs and practices. These are necessary in process of diagnosis of mental
disorder. Cultural competency occurs when there is emergence of racial and ethnic mix of
workforce that represents the local population.
In United States, the nursing practice is based on western scientific and philosophical
framework. In Western Framework, one’s individuality is component to find their identity.
Body and Mind are considered as separate entities, so they believe that the disease will also
have an observable and measurable cause and treatment (NIMH, 2019). Understanding the
cultural competency during the services of psychiatry, is important as it helps to develop an
effective and respectful mental health care practices. This will enable doctors and patients to
have a better understanding and come together for an effective communication. In psychiatric
nursing care, cultural competence provides nurses to apply their skills and knowledge in
some cross-cultural situations. Communication and language barrier during the psychiatric
process can lead to low quality of care, patient dissatisfaction and poor comprehension. Also,
lower amount of cultural competency in health care services, creates a dissatisfaction among
patients.
In order to elevate the cultural competency in mental health care system, policies are required
which can address the literacy and language barriers. Efforts are required to improve this
among the mental health care professionals and organizations which will help the quality of
psychiatric and mental health care system in US.
Conclusion
In recent years, mental illness is starting to grow in United States. This consists of diverse
mental states that differs in the frequency of severity, ranges from normal to severe. Mental
health care can be delivered by evaluating an integrated system which provides different

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quality services. This also provides a wide range of quality services and assistance to their
patients. The health care professionals ensure that they provide the overall guidance and
diagnosis to their patient.
The report evaluates, the social determinants of mental health in United States. These
determinants consist of demographic, economic, environmental, equity and social justice. By
analysing the epidemiological studies in United States, we came across Epidemiologic
Catchment Area, National Comorbidity Survey, Medical Outcome Study and Composite
International Diagnostic Interview. These are the relevant studies in US, which were designed
to understand and analyse the mental disorders. Furthermore, we critically examined the
cultural competence of mental health of United States and the role of primary nurses, which
signifies the all over working and diagnosing methods that primary health care nurses and
psychiatric nurses apply in order to assess their patient.

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