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MENTAL HEALTH AND DISORDERS

Mental Health and Disorders: A Trending Epidemic on the Chicago Southside

Kehinde Adeyemi

College of Nursing and Health Sciences, Lewis University

NURS 53400-005: Population Health

Dr. Kathy Dunn

January 30, 2021

Abstract

Aims: Notable awareness is growing on the rising trend of mental health disorders in individuals on the Chicago south side areas. While giant strides have been made towards a population-based approach to mental health, research has shown ineffectiveness in the areas of policy interventions by government officials, policy makers and healthcare system administrators.

African-Americans of all ages are more likely to be victims of serious violent crime than non-hispanic white individuals, making them more likely to meet the diagnostic criteria for post-traumatic stress disorder. African-Americans are also twice as likely as non-hispanic white individuals to be diagnosed with schizophrenia. Methodology: Project IMPACT research study is based on a tool previously used to identify students at risk for vulnerable mental health status created from a 12-item general health questionnaire and Antonovsky’s abbreviated sense of coherence scale. Data of the target population will be taken from a mental health survey of the adult African-Americans living on the south side of Chicago, from multiple credible sources for correlation of facts and figures following a multistage stratified cluster sampling.

Each participant will fill a paper-based, self-administered, anonymous questionnaire. The distribution and recollection of questionnaires will be carried out by health care volunteers who understand the importance of objectivity and transparency of the study. Results: The expected result will be an increased risk for mental health disorders among African-Americans. Conclusion: Decreasing the risk for mental health disorders among African-Americans is essential for improving the overall health of the African-American population.

Keywords: mental health, policy interventions, questionnaire, posttraumatic stress disorder

Mental Health and Disorders

Definition and Significance of Mental Health

Mental health is an important part of overall health and well-being. Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make healthy choices. Mental health is important at every stage of life, from childhood and adolescence through adulthood (Centers for Disease Control and Prevention [CDC], 2020.

African American individuals today are over-represented in our prisons. People of color account for 60% of the prison population. African-Americans also account for 37% of drug arrests. Illicit drug use is frequently associated with self-medication among individuals with mental illnesses (Kerby, 2018).

CDPH’s 2018 Healthy Chicago survey found that about 178,000 Chicago adults needed

mental health treatment at some point in the previous year but did not receive services. This

lack of access can be devastating for vulnerable residents—including our young people and communities of color.

There is a rising trend of mental disorders in individuals on the Chicago south side areas Research shows ineffectiveness in the areas of policy interventions through public health policies and healthcare system interventions.

A complete need for in-depth and complete overhaul of the mental health crisis in underserved areas needs to be undertaken.

CDPH’s 2018 Healthy Chicago survey found that about 178,000 Chicago adults needed

mental health treatment at some point in the previous year but did not receive services. This
lack of access can be devastating for vulnerable residents—including our young people and communities of color.

Stakeholders

The burden of mental health disorders is not an individual affliction. The devastating effects have health and financial implications for all including the medical centers and community. Stakeholders in this program includes families, health care practitioners, advocacy groups, hospitals, churches and organizations across the length and breadth of Chicago.

Notable stakeholders are the Englewood Mental Heal Clinic, Thresholds, Trilogy Behavioral Health, Access Community Health Network, Chicago Board of Health, Ann and Robert H. Lurie Children’s hospital of Chicago as well as the University of Chicago among many others.

Morbidity

In 2019, there was an estimated 51.5 million adults aged 18 or older in the United States with any mental illness (AMI). This number represented 20.6% of all U.S. adults. Young adults aged 18-25 years had the highest prevalence of AMI (29.4%) compared to adults aged 26-49 years (25.0%) and aged 50 and older (14.1%). More females with AMI (49.7%) received mental health services than males with AMI (36.8%)

https://www.nimh.nih.gov/health/publications/my-mental-health-do-i-need-

)

Hospitalizations for behavioral health conditions (mental health and alcohol/substance use) have seen marked increases in the past decade and now represent over one in six hospitalizations. Overall rates of mood dis- order hospitalizations in Chicago eclipse the national rate by more than four times. Non-Hispanic black Chicagoans are hospitalized for mental health-related conditions at two to ten times the rate of non-Hispanic white and Hispanic Chicagoans. Residents of East and West Garfield Park, Uptown, Englewood, Washington Park and Woodlawn have the highest rates of hospitalizations due to mental health conditions (Healthy Chicago,

2016

). An estimated 526,000 adults in Illinois (5.4% of the adult population) had a serious mental illness (SMI) in 2012, which is higher than the national rate of 4%. For people with SMI, it carries significant rates of morbidity and mortality.

Mortality

It is estimated that people with serious mental illness (SMI) die about 25 years earlier than the general population and that 60% of this excess mortality is due to chronic conditions. Individuals with SMI experience significantly higher prevalence rates for chronic conditions including metabolic disorders, cardiovascular disease, chronic pulmonary disease, gastrointestinal disorders, chronic viral infections, and obesity. (ECHO-Chicago: Serious Mental Illness-Winter 2020).

The overall numbers of 

suicides in Illinois and nationwide have been rising

 over the past two decades, according to the federal Centers for Disease Control and Prevention. The national suicide rate has increased nearly 35 percent between 1999 and 2018. The rate among African American youth, who make up a smaller percentage of suicides overall, has increased. (

https://www.injusticewatch.org/author/lakeidra-chavis/

) Among Black populations, suicide rates peak during adolescence and young adulthood, then decline. This is a different pattern than is seen in the overall U.S. population, where suicide rates peak in midlife.​

Healthy People 2020 Topic & Objective

The objective of this proposed population based program is MHMD-5 “Increase the proportion of primary care facilities that provide mental health treatment onsite or by paid referral

Level of Prevention, Genetic and Environmental Risk Factors

Level of Prevention

There are three categories of prevention: primary prevention focuses on various determinants in the whole population or in the high risk group. Early identification of triggers and at risk behaviors in addition to promoting good mental help can help stop mental health issues before they occur. Secondary prevention comprises of early detection and intervention. This aims to give continuous education and provide support and intervention for those at high risk. Tertiary prevention targets for advanced recovery and reduction of relapse risk. This is done by supporting mental health patients and providing adequate mental health treatment(NHS Digital. (2018). Mental health of children and young people in England,

2017

)

Genetic Impact

Mental disorders are not uniformly dispersed across the globe. The magnitude of people diagnosed with mental disorders varies across geographical spaces, cross culturally, and throughout generations. There is evident variation in the genetic identification of mental disorders across geographical spaces, cross culturally, and through time. Studies have shown that an abnormal production of certain genes are recognized as a possibly cause of increasing a person’s susceptibility to some mental disorders. Additionally, studies have presented variation in the racial/ethnic groups affected by a mental illness. Specifically, multiple studies have recognized African Americans as a primary victims of schizophrenia. Moreover, the exposed environment of individuals have been linked to their predisposition to mental illness. Hopefully, future studies can further target the mechanisms causing mental disorders and acquire prevention techniques.( Sedera Moore, Department Of Biology, Howard University ’16)

Health Determinants/Disparities/Risk Factors

Growing evidence connects economic inequality and poor mental health ( Platt et al., 2017). Experience of socioeconomic disadvantage, including unemployment, low income, poverty, debt and poor housing, is consistently associated with poorer mental health (Silva et al., 2016; Elliott, 2016; Platt et al., 2017;).

Mental health problems are particularly prominent amongst marginalised groups experiencing social exclusion, discrimination and trauma, leading to compound vulnerability (Rafferty et al., 

2015

). Greater inequality within societies is associated with greater prevalence of mental illness ( Pickett and Wilkinson, 

2010

), and economic recessions have had devastating impacts on population mental health (Platt et al., 2017)

Smart Goals

Smart goals are specific, measurable, attainable, relevant, and time bound. It’s a tried and true formula for creating successful goals. The goals align with personal values and the end result of them should bring us a feeling of accomplishment or a reward. Setting SMART mental

health goals will bring motivation and fulfillment and improve wellbeing. To practice on self-love and self-compassion.

The goals include taking care of and be kind to your body .and making time for mindfulness. Others are finding new ways to manage stress, anxiety or depression as well as seeking support (from friends and family or by starting therapy).

Evidenced-based support Practice Support

Several studies have indicated that social skills training has helped in reducing negative symptoms and improve social skills and functioning. Family psychoeducation has primarily helped in decreasing illness recurrence, length and rates of hospitalization and increase illness knowledge while increasing treatment adherence and caregiver burden.

A dialectical behavior therapy approach has also helped in reducing anger, suicide and self injurious behavior.

Cultural/Health Issues

The culture of the patient, also known as the consumer of mental health services, influences many aspects of mental health, mental illness, and patterns of health care utilization. One important cautionary note, however, is that general statements about cultural characteristics of a given group may invite stereotyping of individuals based on their appearance or affiliation (Mental Health Culture, Race, and Ethnicity. A Supplement to “Mental Health: A Report of the Surgeon General.”).

African Americans have been found to have positive beliefs and attitudes toward mental health services, but these positive beliefs and attitudes do not translate to seeking treatment. For instance, in one study of racial differences in beliefs about how the natural course of mental

illness relates to perceptions of treatment effectiveness, African Americans were more likely than Caucasians to believe that mental health professionals could help individuals with mental illness. However, the African Americans were also more likely to believe that mental health problems could improve on their own (

Anglin, Alberti, Link, & Phelan, 2008

)

In essence, African Americans are less likely to use services that seek to treat mental illness.

The ecological perspective of using the social media as a means of disseminating information and gaining trust among the African American population of the Chicago South side can not be overemphasized. Social media is about conversations, community, connecting with the target population and building relationships.

Health Literacy

Findings suggest that improving health literacy may be an effective strategy to improve health status and to reduce the use of expensive hospital and emergency room services among elderly patients.

Older adults, adolescents, people with low income and educational levels, and racial and ethnic minorities are disproportionately affected by low health literacy (Prins E. Mooney A. (2019). Literacy and health disparities). African Americans form the bulk of this group .

Culturally tailored and interactive approaches such as storytelling and culturally appropriate graphics have been reported to improve health literacy related to diverse health conditions in African-American samples (

Bertera, 2014

; 

Broussard et al., 2014

; 

Rikard et al., 2012

; 

Ross et al., 2010

)

In addition, interactive and user-friendly digital platforms such as mobile health applications present considerable opportunities for reaching African Americans with LHL more effectively (

Anderson et al, 2015

)

The use of the television, internet and radio communication channels will be very beneficial in dissemination specific health information and interventions in the African American community. In this digital age, there is hardly any person without cellphone or some form of communication channel.

Participatory approaches help capture diverse and shared cultural values, beliefs, and experiences in African-American communities (Rikard et al., 2012). This will trained healthcare workers involve walking the streets, engaging at risk population and offering the much need information.

Agencies for potential Partnership

NAMI, the National Alliance on Mental Illness, is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. With a deep understanding of what how the African American Community on the

Chicago South Side feels about Mental health and associated disorders, partnering with an organization with experience with those living with mental health conditions will help educate

to fight stigma and discrimination, fiercely advocate for our community, and share hope, connection and expertise with people on their mental health journey.

Aims For Quality Improvement

The Chicago Southside African American community suffers disproportionately from the lack of awareness and timely intervention for mental health disorders.

Centering mental health interventions to the specific population it is intended for will go a long way in reducing the rising rate of metal health disorders in the community. Adopting a proactive instead of a reactive approach in treating mental health will also have a positive impact on the mental health situation in the community.

Promoting an equitable strategy in treating mental health disorders without regards to age, gender and race will also benefit the Chicago south side communities at large.

Program Evaluation Method

A similar method used as an assessment tool to identify students at risk for vulnerable mental health status created from a 12-item General Health Questionnaire and Antonovsky’s abbreviated sense of coherence scale and was tested in Hungary to distinguish between those with high or low mental resilience will be used.(Bíró, É., Ádány, R., & Kósa, K. (2019). A Simple Method for Assessing the Mental Health Status of Students in Higher Education)

Data of the general population will taken from a mental health survey representative of the adult Chicago south side population from multiple credible sources for correlation of facts and figures following a multistage stratified cluster sampling.

The timing of data collection on mental health is critical among the target population because stress level fluctuates during the year. A potential source of bias might be excessive stress close to or during the winter months when isolation and loneliness is at the highest. So, data will be collected during the summer in order to reduce this type of bias. Each sampled at individual and at risk families will fill a paper-based, self-administered, anonymous questionnaire. The distribution and recollection of questionnaires will be carried out by health care volunteers who understand the importance of objectivity and transparency of the study.

The questionnaire will include scales on mental health (sense of coherence, psychological distress, perceived stress, depression, social support; the scales for perceived stress and depression, perceived health, health locus of control (how much can do for own health), demographic (age, sex, residence) and socioeconomic data (parents’ educational level, family’s economic status)

The 12-item version of the General Health Questionnaire (GHQ-12) will be used to detect psychological distress. Questions will also be answered on a 4-point Likert scale. Cases will be detected by scoring in the simplest manner which will assign a score of 1 to each symptom, while lack of a particular symptom is scored by 0 so that the total score varies between 0 and 12. Total score above 4 was set as the threshold indicating notable psychological distress.

MENTAL HEALTH AND DISORDERS

Data will be entered into a Microsoft Excel database. Data entry as well as the full database will be checked and cleaned by removing inconsistent answers. Data from all will be merged into one database and analyzed together. Categorical variables will be analyzed using chi-squared test and Fisher’s exact test. Results will then be compared to that of a representative survey of the Chicago South side adult population using the two-sample test of proportion.

The chi-squared test applies an approximation assuming the sample is large, while the Fisher’s exact test runs an exact procedure especially for small-sized samples.

The basic concept of the assessment tool was that it should assess both the positive and the negative aspects of mental health in a non-stigmatizing manner. GHQ has been widely used as a screening device for identifying minor psychiatric disorders in the general population (Bíró, É., Ádány, R., & Kósa, K. (2019).

The tool has the advantage of having a balanced focus on mental health from an aspect of vulnerability as well as of resilience; it reliably separates those who are psychologically definitely at risk from those who can be considered reasonably resilient. Moreover, it is simple to use and avoids stigmatization. The test could be easily adapted to an online format, and based on its results, respondents could get detailed personalized advice on available supportive services, tailoring the message to their level of risk (Bíró, É., Ádány, R., & Kósa, K. (2019).

Executive Summary

Project IMPACT, a multifaceted mental health and disorders awareness and wellness program with focus on the Chicago Southside African American population will continue to engage community residents and stakeholders on the need to address the rising trend of mental health disorders. The invaluable input from individuals and community partners will help identify and understand the needs of the community for meaningful impact.

Driven by collective effort and a shared mission, Project IMPACT, will collaboratively develop implementation plans and collaborative action targeted to achieving the shared vision of Improved mental health, and wellness in the Chicago South Side Community.

REFERENCES

Shattell, M., & Brown, P. J. (2017, September 1). Black Mental Health Matters: What Nurses Need to Know About Chronic Stressors of Persons of Color. Journal of Psychosocial Nursing and Mental Health Services. https://www.healio.com/psychiatry/journals/jpn/2017-9-55-9/%7B29599a76-181c-429e-8238-a2e6587ffb4e%7D/black-mental-health-matters-what-nurses-need-to-know-about-chronic-stressors-of-persons-of-color. 

U.S. Department of Health and Human Services. (2021, January). NIMH ” Home. National Institute of Mental Health. https://www.nimh.nih.gov/index.shtml. 

Bíró, É., Ádány, R., & Kósa, K. (2019). A Simple Method for Assessing the Mental Health Status of Students in Higher Education. International Journal of Environmental Research and Public Health, 16(23), 4733. https://doi.org/10.3390/ijerph16234733 

Department of Public Health. Department of Public Health | CookCountyIL.gov. (2021, January 25). https://www.cookcountyil.gov/agency/department-public-health. 

Healthy Chicago 2025 – City of Chicago. www.chicago.gov/content/dam/city/depts/cdph/CDPH/Healthy%20Chicago/CHSA .

Kim, H.-Y. (2019). Statistical notes for clinical researchers: the independent samples t-test. Restorative Dentistry & Endodontics, 44(3). https://doi.org/10.5395/rde.2019.44.e26 

Assari, S., Moazen-Zadeh, E., Caldwell, C. H., & Zimmerman, M. A. (2017, May 29). Racial discrimination during adolescence predicts mental health deterioration in adulthood: Gender differences among blacks. https://www.ncbi.nlm.nih.gov/pubmed/28611972. 

National Alliance on Mental Illness(2021)NAMI Chicago.

http://www.namichicago.org/. 

U.S. Department of Health and Human Services. Updated 2021,January. Office of Science Policy, Planning, and Communications (OSPPC). National Institute of Mental Health. https://www.nimh.nih.gov/about/organization/od/office-of-science-policy-planning-and-communications-osppc.shtml. 

Heinz, A. (2017). How a Focus on Learning Mechanisms Can Change Our Understanding of Mental Disorders. A New Understanding of Mental Disorders. https://doi.org/10.7551/mitpress/9780262036894.003.0010 

Public Health. City of Chicago :: Public Health. (2021). https://www.chicago.gov/city/en/depts/cdph.html.