Incorporating mental health into health impact assessment in the United States: a systematic review
| Date | 19 September 2016 |
| Published date | 19 September 2016 |
| DOI | https://doi.org/10.1108/JPMH-01-2016-0003 |
| Pages | 150-176 |
| Author | Kelsey Lucyk,Kim Gilhuly,Ame-Lia Tamburrini,Bethany Rogerson |
| Subject Matter | Health & social care,Mental health,Public mental health |
Incorporating mental health into health
impact assessment in the United States:
a systematic review
Kelsey Lucyk, Kim Gilhuly, Ame-Lia Tamburrini and Bethany Rogerson
Kelsey Lucyk is a PhD
Candidate at the Department of
Community Health Sciences,
Cumming School of Medicine,
University of Calgary,
Calgary, Canada.
Kim Gilhuly is a Program Director
at Human Impact Partners,
Oakland, California, USA.
Ame-Lia Tamburrini is based at
Habitat Health Impact
Consulting, Calgary, Canada.
Bethany Rogerson is a
Manager at Health Impact
Project, a collaboration of the
Robert Wood Johnson
Foundation and The Pew
Charitable Trusts, Washington,
District of Columbia, USA.
Abstract
Purpose –Health impact assessment (HIA) is a systematic research and public engagement tool used to
elevate health and equity in public policies. However, HIA practitioners often overlook potential mental health
impacts. The purpose of this paper is to review the degree to which mental health is included in HIAs in
the USA.
Design/methodology/approach –The authors conducted a systematic review of 156 HIAs that were
completed between 1993 and 2013 for their inclusion of mental health. HIAs were subdivided to assess if
mental health conditions or their determinants were measured,and if predictions or mitigation strategies were
made in the scoping, assessment, or recommendations phases.
Findings –Overall, 73.1 percent of HIAs included mental health. Of the HIAs that included mental health
(n ¼114), 85.1 percent also included the determinants of mental health and 67.6 percent included mental
health outcomes. 37.7 percent of HIAs measured baseline mental health conditions and 64.0 percent
predicted changes in mental health as the result of implementing the proposed policy, plan, or program.
Among the HIAs that made predictions about mental health, 79.5 percent included recommendations for
potential changes in mental health, while only 46.6 percent had measured mental health at baseline.
Research limitations/implications –Although many HIAs included mental health in some capacity, this
paper quantifies that mental health is not included in a robust way in HIAs in the USA. This presents a difficulty
for efforts to address the growing issues of mental health and mental health inequities in the populations.
Originality/value –This paper represents the first academic endeavor to systematically assess the state of
the field of HIA for its inclusion of mental health.
Keywords USA, Policy analysis, Health impact assessment, Mental health/wellbeing, Social determinants
Paper type Literature review
Background
Health Impact Assessment (HIA) refers to the rigorous and systematic “combination of
procedures, methods and tools by which a policy, a program or project may be judged as to its
potential effects on the health of a population […It] aims to mitigate negative health impacts and
enhance beneficial effects on health”(WHO European Centre for Health Policy, 1999). The HIA
approach seeks to examine how public decisions might influence health and equity using the
broad social determinants framework; looking at the political, social, and economic conditions
that shape the way we grow, live, work, and age (World Health Organization, 2008). HIAs draw
on multiple methods (e.g. epidemiology, risk analysis, systematic review, qualitative data
analysis) to present evidence-based recommendations for modifying a policy, program, or
project to maximize health benefits and minimize adverse health outcomes for populations and
population subgroups that may be affected (Ross et al., 2014). While the process of HIA is
Received 11 January 2016
Revised 1 June 2016
Accepted 5 July 2016
Kelsey Lucyk was supported by
a Population Health Intervention
Research Network Research
Policy Internship, funded by CIHR,
to complete this work and is
currently supported by an Alberta
Innovates-Health Solutions
Graduate Studentship.
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VOL. 15 NO. 3 2016, pp. 150-176, © Emerald Group Publishing Limited, ISSN 1746-5729 DOI 10.1108/JPMH-01-2016-0003
flexible in its application, there are six steps involved: first, screening, to determine whether and
how the HIA will add value to the decision-making process; second, scoping, to create objectives
and outline steps for the HIA; third, assessment, to describe baseline health conditions in a
population and predict potential health effects; fourth, recommendations, to identify strategies to
mitigate potential negative consequences and maximize potential benefits of the predicted
changes; fifth, reporting, to disseminate findings to decision-makers and other stakeholders; and
sixth, monitoring and evaluation, to consider the quality, impact, and outcome of an HIA (Ross
et al., 2014; National Academies for the Sciences, 2013).
HIA can be incorporated into decisions in many sectors –such as education, transportation, land
use planning, criminal justice, and others –that have the potential to affect mental health, which is
significant considering the increasing attention being paid to the mental health status of
populations internationally and in the USA. Due to high prevalence rates, public health
researchers and practitioners are calling for action to promote mental wellbeing, prevent mental
disorders, and treat those affected by them (Garland et al., 2010, 2013; Krieger and Higgins,
2002; Schmutte et al., 2009; Sue et al., 2012; Gary et al., 2003). Nationally, nearly 25 percent of
Americans live with a diagnosable mental, behavioral, or emotional disorder (Centers for Disease
Control and Prevention, 2013). Globally, it has been estimated that 29.2 percent of the population
will experience a common mental disorder (i.e. mood, anxiety, substance use), which includes
over 350 million people currently affected by depression (Steel et al., 2014; World Health
Organization, 2016). Substance use disorders (i.e. abuse of or dependence on alcohol or illicit
drugs) often co-occur in the presence of other psychiatric disorders and represent a growing
problem that affects approximately 8.2 percent of the US population (Schulden et al., 2009;
Substance Abuse and Mental Health Services Administration, 2014). Because HIA connects
different sectors and explores multiple ways that policy changes can affect health, it is a tool that
can be used to address complex and inter-sectoral problems. Using HIA as a tool to improve
mental health across populations is therefore timely.
Health equity is a core value of HIA that is also relevant for population mental health. Health
equity encompasses the disparate health experiences across a population and the notion of
creating equal opportunities for health and reducing health disparities, especially those which
are unfair and unjust (Whitehead and Dahlgren, 1991). HIA can be used as a tool to identify and
address health inequities and support the improvement of mental health and other health
outcomes across population groups. Many researchers, practitioners, and policy makers
attempt to address h ealth equity from a social determi nants of health perspective. S ome social
determinants of co mmon mental disord ers include househ old income, materi al disadvantage ,
unemployment, job security, socioeconomic status, poverty, and early childhood adversity
(Allen et al., 2014). HIA addresses these social determinants by examining how changes in
policies or projects will affect an entire population, with a specific focus on how subgroups may
experience impacts differently.
A recent recommendation for increasing mental health equity proposed by Dean et al. (2013) is
the implementation of policies that eradicate the social and economic structures that perpetuate
mental health inequities. HIA has been effectively applied to projects and policies in a variety of
sectors (e.g. transportation, natural resources and energy, housing, agriculture, education, and
labor) to address potential and unintended health consequences on affected populations
(National Research Council, 2011). Decisions that are made regarding projects and policies from
these sectors often have implications for mental health. For example, the decision to close a local
industry may create community conflict related to the reduced employment rates and property
values for residents and former workers. As such, this decision may also increase stress among
residents regarding their immediate circumstances (e.g. mortgage payments) or anxieties about
the future (e.g. potential unemployment), which may potentially worsen mental health in the long
term (e.g. depression, anxiety disorder). HIA seeks to identify and make explicit such linkages and
recommend ways to reduce negative impacts and enhance positive health outcomes.
The field of population mental health is also concerned with the inequitable distribution of mental
illness across different social and economic population groups. Literature reveals that the
distribution of mental illness as well as the accessibility to and quality of health care differs across
these groups. For example, episodes of major depression in the USA are experienced
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