What do you feel would help destigmatize mental health, and how can local government can support this important work for residents?

As I describe in my book, The Rabbit Effect, ample studies show mental health is critical to physical health. So the first step for local government is to link mental health with general health policy. Too often, mental health takes a backseat to physical health, even though depression is the leading cause of disability worldwide, according to the World Health Organization. In addition, it’s estimated at one out of every five people in the U.S. is affected by some form of mental illness, with kids particularly impacted by increasing rates of depression and suicide. The more we include emotional wellbeing as an essential part of overall health, the more we reduce shame and stigma.

For example, innovative government leaders are running public education campaigns about adverse childhood experiences, which impact both long-term physical and mental health. Beyond billboard service announcements, this work can take the form of offering local parenting groups/training programs with free childcare, home visits for parental support, and community peer health educators.

Rates of mental illness and substance use are higher in the U.S. than in other wealthy nations. There are not enough psychiatrists, psychologists, and mental health services to go around. Developing peer support networks both engages citizens and expands the mental health infrastructure. Local governments can sponsor community, school, and workplace training that help us all respond thoughtfully to people in distress. For example, you can organize mental health first aid training in a variety of community settings. It’s the new CPR. We all can effect positive change in our day-to-day work by simply raising the topic of emotional health. It touches nearly every aspect of our lives.

As a physician, what are the top three local government policies you would like to see prioritized within the next couple of years? And, why?

The Rabbit Effect illuminates the different hidden factors (or social dimensions) that impact our health far more than medical care alone. This includes policies that support positive connection in our homes, relationships, workplaces, schools, neighborhoods, and broader communities.

Support our youngest community members. Research shows that community-based help for new parents has a high-dividend ripple effect for decades down the road, including better health outcomes, less substance use, and reduced violence. Support can include hands-on education (such as prenatal and early childhood home visits), an economic safety net (including paid parental leave, family-friendly work policies, universal preschool, affordable onsite childcare, and healthy food programs), and emotional skill building (such as community parent groups/training). These policies, which begin at the local level, help families thrive. For example, a study in JAMA found that compared to usual care, home visits in a semirural New York community significantly reduced the rate of criminal behavior in the children fifteen years later. Politicians talk about being tough on crime, but it seems the best preventive policies are gentle on new moms and families.

Cultivate shared green spaces, pedestrian routes, and safe bike lanes. Increasing the walkability of our towns and cities encompasses many of the hidden factors of health described in The Rabbit Effect. These policies not only build healthy bodies, but evidence shows also improves community mental health, social interactions, property values, and reduces pollution. Greenery, for example, boosts immune functioning, lowers blood pressure, and cortisol levels. Studies have shown that people living on streets with more trees have lower rates of antidepressant prescriptions even when controlling for income. Trees boost wellbeing even when there is neighborhood poverty and greening vacant lots has shown to reduce gun violence.

In 1969, nearly 50 percent of all children in the United States (and nearly 90 percent of those within a mile of school) walked or bicycled to school. Today, that number has plummeted to fewer than 15 percent. During the morning commute, school drop-offs represents 10–14 percent of traffic on the road. Creating safe routes for kids and bikes is where local government plays a critical role in land use decisions. Developers must be incentivized to create real communities that include affordable homes, community serving retail, open space, etc. And that aren't reliant on the automobile.

And I add this one because it’s the elephant in the room:

Access to quality health care is critical. Medical expenses remain the top cause of bankruptcy in the US. The US is richer than ever yet roughly one in 10 of us still don’t have health insurance. While
the investment in mental health treatment ultimately offsets the high societal cost, in the U.S. in 2018, 32 states still didn’t guarantee equal coverage for mental health care. If national policies are in a gridlock, local leaders can support expansion of state Medicaid programs and reduce barriers to entry. I remember as a high school student the constant worry because my dad lost his health insurance due to a pre-existing condition. The stress of not having coverage—or inadequate coverage—takes an unnecessary emotional and financial toll. It ultimately costs our families, communities, and society far more when we don’t invest in prevention.