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Community Health Workers: A Sustainable Solution Positively Impacting Mental Health

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The COVID-19 pandemic has made mental health a critical focus for all Americans. A World Health Organization study found that the prevalence of mental illness increased by 25% during the first year of the pandemic. [1] And America’s prevalence of mental illness had already been significant prior to the pandemic; in 2020, 21% of adults experienced mental illness (1 in 5 adults) [2]. 

Social isolation, loneliness, fear of the virus, suffering, grief, and financial worries have been common stressors leading to increased anxiety and depression. These stressors have impacted all, but youth, women and vulnerable populations have been hardest hit. [3]

As a result, we are experiencing a wake-up call to address mental health and to do more to bring resources to vulnerable populations and prevent the escalation of community mental illness. Because healthcare and clinical capacity is already overstretched, interventions need to take root outside of clinical walls to create upstream solutions.

Community-based social supports that incorporate community health workers/promotores(as) de salud mental have been proven to decrease social isolation and improve individual and community mental health in fundamental and sustainable ways.

Mental health support provided by community health workers/promotores(as) de salud mental (CHW/PSM) has been proven to be one of the most impactful strategies—one that is embraced by communities across the globe.[4]The free peer support provided by CHWs/PSM breaks barriers because the CHWs/ PSM act as trusted bridges between vulnerable populations, healthcare, and resources. CHWs/PSM are trained to address the stigma and shame that often accompany mental illness, offering warm, informed care in the homes, neighborhoods, faith-based settings, and places where people naturally gather. They educate community members in culturally sensitive ways, conduct outreach to decrease isolation and destigmatize mental illness, and connect isolated people to critical resources.

Let’s explore further why Community Health Workers/ promotores(as) de salud mental provide a timely, cost effective and impactful solution.

Helping People Cope with Financial Stressors

Financial insecurity, unstable employment and unemployment are some of the highest drivers of stress and anxiety, especially when external circumstances make it difficult to predict when employment or entrepreneurial income may return. Financial insecurity hinders the ability to access proper healthcare, jeopardizes stable housing, fresh and nutritious foods, reliable transportation, appropriate childcare, educational attainment and more. During the COVID-19 pandemic, more than four million people lost their form of employment globally, a crisis from which it will take some time to recover.

Those suffering from financial insecurity need immediate connection and coping skills. Community-based mental health support can combat the complicated stressors of financial strain. Communities across the globe have responded effectively by including CHWs/PSM in their COVID-19 rapid response efforts. By doing so, they invest in the training and deployment of these teams who meet people in their neighborhoods. They understand the culture and experience of different segments of the community and respond with care, compassion, and training. First, they listen actively and provide emotional comfort, so community members understand they are not alone. Then they provide free education about coping skills to improve community understanding and knowledge, and to decrease some of the stigma related to financial insecurity, anxiety, and depression. They also share available mental health and financial education/aid referrals to support effective resource utilization.

Fostering Strong Community Bonds

Positive, healthy relationships help to heal loneliness, isolation, anxiety, and depression[6]. Deployment of CHW/PSM interventions has been proven to increase the quality of life in communities, creating trusted communal networks that can identify issues, co-create sustainable solutions, and increase community-level knowledge about available resources. An identified best practice is for CHWs to spend a significant amount of extended face-to-face time with families as this is integral to building a trusting relationship.[7] In some cases, CHWs/PSM may even accompany community members to mental health, health care and financial appointments, providing emotional support. When trust takes root, residents and families grow and learn together, resulting in deeper bonds, improved wellness, and stronger neighborhoods.

More jobs for mental health workers

The demands of 2020 stressed and stretched the healthcare and healthcare workforce to its breaking points. The global pandemic’s overwhelming demand has stretched the capacity of hospitals, clinics and public health departments and created a first responder mental health epidemic of its own. Stretched to their own limits, mental health workers have carried the burden of addressing the trauma of responding to COVID 19’s agony, both for the healthcare workforce and people affected by the virus. The need to provide augmented emotional and psychological triage has created job growth in the mental health workforce and pipeline, opening opportunities for those who have CHW/PSM training in the mental health field. Para-professional and volunteer mental health workers, such as CHWs/PSM, clergy and mental health first aid volunteers can act to fill the gaps in mental health pipelines, providing frontline, community-based response, and treatment outside of clinical walls.

El Sol trains and certifies its CHW/PSM workforce to meet unique core competency standards to ensure successful outcomes and seamless healthcare integration, including community education, case management, disease prevention and evaluation.

Healthcare and Public Health Departments have an opportunity to enlist para-professional workforce, especially CHWs/PSM, compensate them fairly, and train them with additional skills to create a comprehensive and highly impactful response to meet the mental health and wellness needs of a population that has been under siege since the pandemic’s beginning.

Mental Wellness is a Right for All

Responsive mental health services are just as critical as treatment of disease and preventative measures for physical health. However, several of the mental health facilities in the San Bernardino County and Riverside County communities are privatized, which makes them too costly for working class people or those living at or below the national poverty levels. Compounding these factors is a new 2022 County Health Ranking Study that sheds light on America’s cost-of-living crisis and stares that a living wage is out of reach for many.

[8]COVID’s prolonged toll has exposed labor force barriers that place an additional burden on women with low incomes and women of color, who are the least likely to have employer-provided benefits, the study said.

We must invest in low-cost and free community clinics and mental health facilities to care for segments of the population who cannot afford to pay out of pocket for mental health services. Mental wellness is not the sole right of the upper class. Investing in the CHW/PSM workforce creates layered solutions to this crisis: 

1) by bringing free mental health solutions to vulnerable populations; and 2) by creating opportunities for living wages with benefits for CHW/PSM workforces, which are primarily women of color.

Solutions in Action:

El Sol CHWs provided advanced late-life depression care to 150 seniors in the Inland Empire. Ninety-one percent lowered their PHQ-9 depression scores by 50% or more due to the intervention, education and support provided by the CHW’s and 80% improved their social networks, decreasing social isolation.

Conclusion

Given the discomforts we currently face, including recovering from a global pandemic, vulnerable communities need accessible, culturally relevant mental health more than ever before. Innovative approaches to improving health inequalities are increasingly vital. Traditional mental health support programs cannot succeed and meet the needs of their communities alone. CHWs/PSM can play an important and unique role as part of healthcare teams. As members of the community, CHWs/PSM focus on education and health system navigation for their patients, providing a bridge to appropriate healthcare access and usage. Serving at the frontline of healthcare delivery, the skills, and  competencies of CHWs/PSM are essential and have the potential to improve health outcomes for medically complex and vulnerable communities and patients.

Contact Alex Fajardo, Executive Director at alexfajardo@elsolnec.org to learn more about our community health worker trainings, resources, and how we are successfully integrating our model into healthcare delivery systems.

[1]https://www.who.int/news/item/02-03-2022-covid-19-pandemic-triggers-25-increase-in-prevalence-of-anxiety-and-depression-worldwide
[2] https://www.nami.org/mhstats
[3] ttps://www.nami.org/mcstats
[5] Vivek Murthy, the U.S. Surgeon General. “In Pursuit of Happiness.”The Atlantic. Retrieved 5/3/22.
[6] https://nachw.org/wp-conntent/uploads/2020/07/NACDD/Natl41_NewEnglandCECouncil_ActionGuide_2013.pdf
[7] https://abc7ny.com/cost-of-living-2022-what-is-a-wage-gender-pay-gap-inflation/11796627/

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