Promoting equitable access to health care is critical to better mental health across the lifespan. But we must also understand the many nonmedical forces that affect health and well-being outside of the health system, based on societal norms and practices and resulting in racial and ethnic discrimination and ageism. Strategies to promote cognitive well-being must address the social and environmental context in which individuals make decisions and maintain long-term habits. Government policy and private sector innovation are part of the answer. Technology, environmental design, environmental services, zoning, and access to many resources that promote health and longevity all contribute to perceived well-being.
For these reasons, GCBH believes that efforts to improve brain health must be a comprehensive, coordinated and interdependent approach involving a variety of sectors, including public, private, faith-based and non-profit advocacy groups. Communities must engage in ways that build on their current strengths and build new approaches to maintaining mental health across the lifespan. None of this is to diminish the importance of individual choice. Rather, it is a way to build a foundation for health-promoting actions in all communities and to sustain those actions at the individual level.
The natural and built environment in the area is an important factor10. Neighborhood design and planning can impact mental health for better or worse. Consider the importance of schools, parks and recreation areas, transportation, and businesses that provide products and services. Are they affordable, accessible and attractive? Do they encourage participation and active living? Architects, urban and rural planners, and other local authorities can have a significant impact on shaping an environment that supports cognitive recovery.
Technology is another underutilized solution to improving mental health and promoting equity. Consider all the people in the world who have smartphones. At their fingertips, they have access to videos like YouTube and TikTok that raise awareness of mental health issues in an educational and entertaining way. The simple ability to push a message may be all someone needs to remind them to move instead of sitting.
Continued efforts are needed to promote basic mental health. At the same time, common misconceptions – such as the misconception that dementia is an inevitable feature of aging – need to be addressed. Greater community involvement must be part of the answer. Community leaders can play an important role in increasing their advocacy for mental health and increasing brain health awareness in their constituencies. They may also serve as resources for information and links to services. Innovations, campaigns, and partnerships are needed to increase public awareness and knowledge—efforts that are culturally appropriate and science-based.
However, to be effective, initiatives in education, outreach and communication must be designed and delivered in a way that suits the target audience. Messages should be simple and straightforward, avoiding language that sounds like gobbledygook to the general public. Communications about mental health and cognitive impairments also need to be culturally sensitive. The content should address important societal values such as how a society wants to treat older individuals, how it views the responsibilities of family members, and whether it is seen as disrespectful or disrespectful to those receiving care.
Within the health care system, providers should prioritize prevention and establish brain health baselines and assessment as part of routine screenings for older adults and other at-risk populations. People who need long-term care support due to cognitive impairment often don’t know where to turn for help, even when services are available. Health care providers working with social workers should be aware of community-based resources so they can make referrals. And those community-based resources need adequate funding.
Empowering family caregivers is another underutilized way to strengthen mental health and support individuals seeking care. In many cultures, concerns of stigma and shame may prevent families from seeking outside help with cognitive decline or mental illness. Community leaders and influencers can be of great service in trying to counter these harmful stereotypes.
As family caregivers interact with the health care system, providers should treat them as important members of the health care team. Employers can continue to work for family caregivers through leave policies and flexible work arrangements that allow them to help at home.
Achieving equity requires changing the paradigm of how society thinks about mental health challenges. Public policy and cultural values must change. Scientific research must be adapted in a way that recognizes the diversity of the population – awareness regarding funding opportunities and participation in clinical trials. Scientists should establish standard health equity and quality measures that provide meaningful data on mental health in communities. Although we have considerable scientific knowledge about mental health, we still have much to learn about the barriers to cognitive well-being experienced in different societies and how to address them.