IPhoto by A. Ricketts for Visit Philadelphia)
In our Generocity column of April 2, “American Rescue Plan Act offers City opportunity to meet critical behavioral health needs,” we outlined the dire need for resources to address the behavioral health consequences of the Coronavirus pandemic.
Critical to helping our city cope with, recover from, and grow beyond COVID-19 and its ripple effects, the American Rescue Plan provides an opportunity to improve behavioral health. In Philadelphia, the influx of dollars can not only fill budget gaps left by the pandemic, but can allow us to think broadly about supporting mental health and emotional wellbeing throughout city programs.
What the article did not address was what exactly the City should be funding and who will be responsible for implementing funded programs.
Addressing the behavioral health needs of all Philadelphians will require robust, cross-sector interventions across a spectrum of health promotion, prevention and early intervention, treatment, and maintenance. In an attempt to provide more specificity, the Scattergood Foundation recommends the following:
Programs that promote health and wellness are vastly underfunded. Integrating behavioral health throughout all City programs is necessary for improving lives.
For instance, in last year’s round of budget cuts, the Office of Arts, Culture and the Creative Economy, as well as the City’s Cultural Fund were completely eliminated despite their deep and multi-faceted importance. Not only can public art improve a neighborhood aesthetically, it can also inspire and uplift people, build community, and improve collective efficacy, all of which serve to improve wellbeing.
Arts programming can also provide meaningful outlets for healing. The Bartol Foundation has offered a training program that provides education and skills to teaching artists in trauma-informed care. The City and philanthropy should invest in programs like this to ensure that arts professionals have the skills necessary to promote healing and resilience through their programs.
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The City and philanthropy should invest in programs (that) ensure that arts professionals have the skills necessary to promote healing and resilience.
Schools can also be important forums for promoting health and wellbeing. With a direct investment of $1.3 billion in the School District of Philadelphia, there are tremendous opportunities for schools to adopt evidence-based practices like social-emotional learning, which provide explicit instruction in social and emotional skills.
Additionally, investment in community-based, grassroots organizations that build civic engagement and social cohesion can meaningfully improve people’s lives. Philadelphia has a robust network of community development corporations that can be mobilized to engage whole neighborhoods in dialogues about behavioral health.
Impact Services Corporation and New Kensington CDC recently released Connected Community: A Trauma-Informed Community Engagement Curriculum. This train-the-trainer curriculum was co-designed with community members and provides myriad skills and tools for engagement that promotes healing and resilience.
Prevention and early intervention
The stressors of the past year require significant investment in prevention and early intervention.
The City must ensure that individuals who work in community-facing positions have access to training that will equip them with the skills they need to de-escalate conflicts and identify and respond to behavioral health crises. The Department of Behavioral Health and Intellectual disAbility Services’ (DBHIDS) Healthy Minds Philly provides the infrastructure to support the expansion of such programs in systems like SEPTA and the School District.
With a $650 million investment from the American Rescue Plan, SEPTA should continue to build toward enhancing the capacity of their workforce to support riders and other community members. Some of these dollars can go toward training in practices like Mental Health First Aid, Crisis Intervention Training, de-escalation, and Narcan administration, which will better equip SEPTA workers to attend to behavioral health needs. As Philadelphians return to work, these enhancements, in addition to infrastructure improvements, can also improve the experience of all riders.
Every person who works in the School District (of Philadelphia) should have access to Mental Health First Aid training..
Additionally, every person who works in the School District should have access to Mental Health First Aid training. The Coatesville Area School District implemented Youth Mental Health First Aid district-wide and saw increases in mental health knowledge, confidence interacting or helping youth experiencing mental health challenges, and referrals to local mental health agencies.
School faculty and staff could also partake in trauma-informed training and Motivational Interviewing to better understand student needs and support students and their families. Building a supportive school environment should be prioritized, as it will provide the necessary foundation for addressing the learning loss that occurred over the course of the pandemic.
Anti-poverty efforts, which will likely see an additional funding boost through federal and state dollars for programs like rental assistance and SNAP benefits, can also be bolstered by interventions that provide mental health support. Programs like the Building Wealth and Health Network can be a roadmap for ensuring that financial benefits are coupled with supports that address the emotional stressors associated with living in poverty.
Access to affordable, high-quality, culturally-responsive treatment must be expanded.
In the spring of 2020, the CARES Act reduced restrictions on telehealth services, which in turn increased access to mental health treatment. DBHIDS and Community Behavioral Health (CBH), the administrator of mental health and substance use services for the Medicaid recipients of Philadelphia County, must assess how to effectively deliver high-quality telebehavioral health services, including fair reimbursement structures.
Better understanding true cost and outcomes can aid in the expansion of telebehavioral health.
Expanding access will also require DBHIDS and CBH to ensure that treatment options are culturally-responsive and linguistically-accessible. This will mean expanding the behavioral health workforce with special attention toward increasing the diversity of providers and investing in treatment modalities that draw on various cultural practices.
There is an additional opportunity for the School District to meet the needs of students, their families, and faculty and staff by ensuring access to School-Based Intensive Behavioral Health Services (IBHS). The Children’s Crisis Treatment Center has a model of IBHS that provides care well beyond the student by extending supports to their families and school staff.
City leaders must also continue to work toward ending the opioid epidemic in Philadelphia. Supporting organizations like Prevention Point, which has been at the forefront of this crisis, is critical to developing solutions. Expanding access to Medication Assisted Treatment and establishing an Overdose Prevention site will also go a long way in saving lives and moving individuals toward recovery.
As mental health disorders have been exacerbated by the pandemic, it has become increasingly clear that our mental health crisis system is in dire need of complete transformation. A Philadelphia Inquirer article this spring examined the system’s overwhelming shortfalls.
Funding is desperately needed to build capacity in hospitals and community organizations.
Currently, law enforcement plays a significant role in responding to mental health crises and this past fall, we saw just how detrimental that can be with the killing of Walter Wallace Jr. at the hands of police. Yet the City has done little to reform the crisis system.
The City must be transparent in developing its 988 line to ensure that dispatchers are well-equipped to address mental health crises.
The 988 crisis line is currently in development as an alternative to 911. The City must be transparent in developing its 988 line to ensure that dispatchers are well-equipped to address mental health crises and that the inequities of the 911 system aren’t replicated.
Finally, essential workers, and particularly those in caring professions, have experienced unimaginable stress, trauma, and burnout this year. Our health care institutions must work closely with DBHIDS to ensure that these individuals have access to care and support.
Maintenance to transformation
The American Rescue Plan dollars can help Philadelphians cope with the stressors they’ve faced and provide resources to build toward a brighter future. Ultimately, we’ll need local, state, and federal funding to invest long-term in the kinds of program expansions and systems changes that are needed to improve behavioral health.
Philadelphia will need government, civic, and business leaders to come together with residents to advocate for brave and intentional action to create sustainable and equitable solutions that are in community, by community, and for community.-30-
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