A Canary in the Mine Shaft: Bringing Mental Health Awareness Beyond the Month of May

Image of a canary in a cage

by Erin Hagan, PhD, MBA, E4A Deputy Director. Originally posted on Thrive Global, May 28, 2019.

More than 300 million people worldwide suffer from depression, yet the first time I heard someone talk openly about mental well-being was when I moved to the North East for grad school in the early 2000s. I was having a hard time making the transition from the rural mid-west to metro-New York City, and someone offered to recommend a good therapist. I remember being both surprised and a bit indignant at the idea. No one went to see a therapist where I grew up (if they did, they certainly didn’t talk about it).

Living outside of New York – where it seemed everyone had a therapist on speed-dial –  I gradually became more receptive to that initial offer and the concept of therapy itself. By the time I left for California, I was comfortable enough to seek out a mental health professional myself. 

Access to mental well-being services isn’t just about acceptability and availability though; it’s also about affordability. Despite mental health being less taboo in coastal metropolitan cities, services were still relatively expensive and mostly not covered by health insurance plans. Attending to mental wellbeing seemed to be a luxury afforded only to those who could afford to pay out of pocket.

Even as insurance coverage has started to include prevention and treatment for mental health and well-being, conversations about mental health haven’t become a routine part of every primary care visit and services are often not integrated into traditional health care. The onus usually falls to the patient to navigate the nuances of receiving care – finding a provider, ensuring coverage applies, seeking out a referral, etc.

With increasing normalization through references in popular culture, the rise of meditation apps, and public health education campaigns bringing attention and accessibility to the masses, people are becoming more attuned to mental health awareness – at least on an individual level. At the population scale, the lack of better integration and tracking of mental health and well-being is a missed opportunity. For researchers, integrating mental outcome measures in their theories of change. For practitioners, it’s about better integrating mental and physical health into the health system. For the general public, it’s about reducing the stigma and being more open about seeking care. 

In her 2017 book, “Happiness for All? Unequal Lives and Hopes in Pursuit of the American Dream”, Dr. Carol Graham likens well-being indicators to the canary in the mine shaft for population health. Mental health measures change more rapidly than longer-term biometric outcomes, but there is well-established evidence supporting the relationships between the two – links between stress, anxiety and cardiovascular disease, for example.

In our work at Evidence for Action, we fund research evaluating the health and well-being impacts of interventions – programs, policies, practices – with a particular focus on research that will help advance health equity and target the social and economic conditions believed to influence health outcomes.

Often, the most immediate health impacts of changing social or economic circumstances are effects on mental health.  Many of our grantees consider mental health measures the primary outcomes of interest in their evaluations of interventions ranging from housing assistance, and economic opportunity, to employment practices, and food security, among others

In a recent post on the Foundation’s Culture of Health Blog, Dr. Dwayne Proctor delves more deeply into the role of mental health in achieving this vision. The blog recounts an interview with Mr. Yolo Akili Robinson, the executive director of the Black Emotional and Mental Health Collective (BEAM), in which he concludes by stating that mental health and well-being is “not something extra that you do after work; this is the work”. As we move past mental health awareness month in May, let’s apply that sentiment to how we approach mental health year-round.


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