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Bringing Mental Health Inequities Out of the Shadows

A shadow pandemic is emerging globally–a growing mental health crisis made worse by COVID-19. MITRE is building a path to a more hopeful outcome starting with Black communities, where longstanding inequities exist.

As the United States surpasses 11 million coronavirus cases, public health officials are sounding an alarm about the pandemic’s effects on emotional and mental health. Disruptions to life routines, stress over risks of illness, and profound loss—of loved ones, social connections, income—continue to test our resilience.

At MITRE, we’re tapping our data expertise, tools, and public health resources to help measure the scope of this challenge and recommend solutions.

“We know the way trauma occurs—even through low-grade, long-term stress,” says Cassandra Okechukwu, a social epidemiologist in the MITRE-operated Health FFRDC. “Our bodies internalize it. COVID-19 is making all of the other burdens we already carry even heavier.”

MITRE is developing a framework to address this unfolding challenge in communities where the need is greatest.

“We’re trying to be at the forefront of this instead of waiting for the disparities to occur and reacting,” Okechukwu says. “We’re beginning with the Black American community because we know there is disproportionate impact there. We have history to tell us.”

Confronting a Challenge Acknowledged Decades Ago

As early as 2001, a Surgeon General report, Mental Health: Culture, Race, and Ethnicity documented the challenge. The report contained important lessons, Okechukwu says. “When non-White people suffer from mental illness, the outcomes are worse and more prolonged. This was always the case.”

A 2020 report from the Centers for Disease Control and Prevention described increased rates of mental health conditions, substance use, and suicidal ideation—thoughts about suicide—that are especially worse among Black Americans and other vulnerable groups.

Health agencies were grappling with the doubling of suicides among Black youth, which prompted a study from the Congressional Black Caucus’s Emergency Taskforce on Black Youth Suicide and Mental Health.

Learning from Disparities in Healthcare Access for the Underserved

We operate the Health FFRDC, a federally funded R&D center sponsored by the U.S. Department of Health and Human Services (HHS) and administered by the Centers for Medicare & Medicaid Services (CMS). In 2016, we partnered with the Health Resources and Services Administration (HRSA) to quantify the unmet need for primary healthcare services and the amount of direct federal funding to the geographic areas where basic healthcare needs are greatest.

“MITRE has addressed health disparity in our work program repeatedly,” says Kim Warren, vice president, The Health FFRDC. “Now we are focused as a corporation to bringing our own resources to address this large, persistent, and detrimental problem.”

Where the HRSA solution determined unmet healthcare needs by zip code, MITRE’s proposed mental health framework will provide an “equity lens” that focuses on specific populations, starting with Black Americans.

Confronting the increasing mental health prevalence requires collaboration with multiple federal agencies including the CDC, CMS, HHS, the Veterans Health Administration, and the departments of Education and Housing and Urban Development. The solution may also involve private sector partners, including foundations and health alliances.

Irving Lachow, who leads MITRE’s Social Justice Platform, notes that we’re relying on our expertise across multiple domains to tackle this issue: “Mental health challenges are affecting a broad segment of the U.S. population, but access to mental health services isn’t distributed equitably. We’re building on previous work on primary care, as well as our experience looking at mental health challenges with veterans, to address the issue so that everyone can get the help they need.”

As a not-for-profit organization, MITRE operates without commercial conflicts of interest. That means we can serve as an objective and trusted partner to deliver data-driven solutions to our sponsors’ toughest challenges.

Applying Systems Thinking to a Mental Health Dilemma

“MITRE is combining the multidisciplinary talents and expertise of clinicians to technologists, epidemiologists to systems engineers in taking on this challenge,” says Linda Fischetti, director of MITRE’s Health and Society Innovation Center. “What we discover can address the multifaceted conditions that, along with COVID-19, are creating a mental health crisis for Black individuals, their families, and their communities.”

MITRE teams will define the scope of the problem by gathering input from health equity experts, reviewing existing government, non-government, and academic research. These expert teams will first determine where the unmet needs exist. They may recommend new care delivery methods, or new ways to pay for services where costs are an impediment. The teams will also identify existing local or regional approaches that could be scaled to address a larger population.

The overarching goal is to develop a new equity-focused model for mental healthcare delivery and payment that increases access and improves the quality of mental health services for largely Black communities.

“The Surgeon General’s report, published in 2001, sent a message that ‘We’re going to fix this,’” Okechukwu says. “But we—as a nation—didn’t. Now, with a pandemic adding immense stress, the problem is something that the nation has to be ready to confront.”

—by Molly Manchenton