Laura Choi, Community Development Research Manager at the Federal Reserve Bank of San Francisco
This column originally appeared in Shelterforce.
The first time I became acutely aware of the importance of mental health was in high school, when I lost a friend to suicide. It remains one of the most defining experiences of my youth, both in terms of the immediate shock and grief, as well as what I learned by observing the reactions of others.
In our tight-knit immigrant community, the prevailing response was to actively avoid the issue. I assumed everyone stayed silent to minimize the family’s shame, but looking back, I now realize that we were woefully unequipped to respond. We lacked a fundamental understanding of mental health and how to talk about mental health challenges in productive ways, largely driven by cultural stigma. Adults also missed a critical opportunity to change the narrative and shine a light on the importance of proactive mental health promotion. That experience taught me an important lesson: mental health is foundational to every aspect of a healthy, productive life and it must be actively and openly cultivated.
Expanding the Healthy Communities Conversation to Include Mental Health
Over the past decade, the community development field has made great progress in bringing a health lens to its work, and exciting new partnerships between the health and community development sectors are taking shape across the country. These efforts have tended to focus on the connections between place and physical health, with a focus on neighborhood revitalization as a strategy for reducing rates of preventable chronic disease like asthma, diabetes, and obesity. However, the healthy communities movement has been less explicit about mental, emotional, and behavioral health, and it’s time for that to change. The stunning increase in suicide, alcohol- and drug-induced death, coupled with rising rates of anxiety and depression, particularly among youth, demands our collective attention and action.
Promoting mental health and well-being throughout a lifetime is critical for supporting the economic resilience and mobility of low-income people, a key aim of community development efforts. For example, there is clear evidence that poor mental health is associated with reductions in labor force participation and employment. Mental health problems among children have a severe negative impact on educational outcomes, which can limit future economic well-being. Approximately 50 percent of students age 14 and older who are living with a mental illness drop out of high school, the highest dropout rate of any disability group. Perhaps most critically, adverse childhood experiences, which include abuse, neglect, having an incarcerated household member, or substance misuse within the household, are risk factors for poor mental health and have been linked to a number of negative health and well-being outcomes, including risky health behaviors, chronic health conditions, and early death.
The community development field has the opportunity to explicitly recognize the relationship between mental health and physical health, and the role that social factors play in both aspects of overall well-being. “Upstream” conditions, such as neighborhood quality or household financial well-being, are important determinants of mental health and can influence factors such as emotional resilience, social connectedness, and self-efficacy. Poverty is a major risk factor for poor mental health. Research shows that community-development-related issues such as unstable housing and unemployment are connected in a complex negative cycle with poor mental health (see figure below). The pursuit of improved population health and expanded economic opportunity for all should include upstream strategies that address community conditions and their underlying structural drivers as a means of promoting good mental health.
Positive and Negative Factors that Influence Mental Health
Partnerships as the Way Forward
In his recent book Lost Connections, journalist Johan Hari synthesizes decades of social science and medical research and finds that poor mental health is driven by a range of factors outside of individual genetic and biochemical factors, which in addition to unresolved childhood trauma, include disconnection from:
Meaningful work
Other people
Status and respect
The natural world
A hopeful or secure future
Reflecting on these drivers of poor mental health, it becomes clear that the community development field has a meaningful role to play in addressing these root causes. The community development and mental health fields have a critical opportunity to work together, leveraging each other’s strengths, in supporting the mental health of low income communities. Some examples include:
Expanding trauma-informed practices, including critical interventions for young children
Considering mental health promotion in community design, which includes community gathering spaces and natural elements
Designing interventions that increase social connections and foster a sense of belonging
Facilitating opportunities for communities to work on violence prevention
Partnering to offer community-based mental health and behavioral health services
Developing community-driven mental health campaigns and arts and cultural strategies to reduce stigma and shame
Raising awareness of mental health issues among frontline staff and providing resources such as training on mental health first aid
As with all complex challenges, no single organization or even sector can do it alone; improving mental health at the population level requires strategic partnerships across disciplines and sectors. To help advance the conversation, the Federal Reserve Bank of San Francisco recently released a publication dedicated to the topic of mental health and community development, recognizing that good mental health helps to contribute to a healthy and inclusive economy. This collection of essays brings a mental health lens to important community development issues like climate change and resilience, racial equity, and affordable housing. It also explores emerging strategies to promote mental health including arts and culture, resident community action, and community-driven solutions in rural areas. Read the full issue here.
As designer and urbanist Liz Ogbu says, “When we work in low-income communities, we tend to focus on need because the lack of resources is so readily apparent and visible. We don’t focus enough on aspiration. In fact, having an aspiration is a luxury we rarely ascribe to poor people, but they’re human; they have hopes and dreams.” Ultimately, this work is about ensuring that every community can be a place of healing and connectedness, where aspiration is a given, and building hope for the future is as central to our field as building housing.
Let’s bring mental health into the open and keep the conversation going. How are mental health issues impacting your community, and what is working to address them?
The views are those of the author and do not necessarily represent those of the Federal Reserve Bank of San Francisco or the Federal Reserve System.
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Laura Choi is community development research manager at the Federal Reserve Bank of San Francisco, where she works with a team to expand economic opportunity for low-income communities and communities of color. She is co-editor of the Community Development Innovation Review and was an editor of What It’s Worth: Strengthening the Financial Future of Families, Communities, and the Nation, a book jointly published by the SF Fed and Prosperity Now.
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Articles in “From the Field” represent the opinions of the author only and do not represent the views of the Community Builders Network of Metro St. Louis or the University of Missouri-St. Louis.
We invite readers to contribute to the civic conversation about community development in St. Louis by writing an op-ed for the Community Builders Exchange. Op-eds should be short (400-700 words) and provocative. If you have an idea for an op-ed, contact Todd Swanstrom at swanstromt@umsl.edu.
