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The National Academy of Medicine (NAM) is proud to present a documentary video series that spotlights local organizations across the U.S. advancing health equity for their communities by addressing the environmental, social, economic, and structural challenges that may impact residents’ health. The videos show that, while challenges are numerous, progress is possible when community members, organizations, funders, and policy makers work together to drive local-level solutions that improve health equity and well-being for all.

Our nation’s health depends largely on the health and well-being of its communities, but many of them don’t have adequate access to jobs, safe and affordable housing, health care, green space, healthy food options, and other things they need to thrive. While biology, genetics, and individual behaviors play a role in people’s health, the socially-driven conditions in which one lives—often referred to as “social determinants of health”—influence and limit individuals’ choices. By taking on these health-limiting factors and developing solutions with partners, communities can help empower residents to grasp their full health potential.

NAM is presents the stories of three diverse communities that face complex, pervasive challenges but are all making progress in advancing health equity—meaning everyone has the same shot at living a healthy life. While each community needs to develop an approach suited to its own unique needs, the hope is that in sharing these stories, communities facing similar challenges might be inspired and informed to build solutions that are right for them.

View the whole video series, or click on the individual community videos:

• People United for Sustainable Housing (PUSH Buffalo) is fighting to make affordable housing a reality on Buffalo’s West side. View the video.
• Indianapolis Congregation Action Network (IndyCAN), now Faith in Indiana is acting collectively for racial and economic equity in Indiana. View the video.
• Kokua Kalihi Valley Comprehensive Family Services (KKV) is fostering physical, mental, emotional, and spiritual health in Honolulu, Hawaii. View the video.

View the full NNEDshare resource to learn more and find the conceptual model, infographics, a report, and more for community-driven solutions for health equity.

Each year, Mental Health America (MHA) recognizes outstanding work by the media, its affiliates, young people, adult mental health consumers, and those working in the mental health field at MHA’s Annual Conference.

This year, MHA will be distributing the Clifford W. Beers Award, the Media Award, the mPower Award, the George Goodman and Ruth P. Brudney Social Work Award, the Innovation in Programming Award, and the brand-new Mental Health Corporate Excellence Award during events held at MHA’s 2018 Annual Conference: Fit for the Future, June 14-16, in Washington, DC.

Who is eligible?

• Each award has different eligibility criteria, which are outlined in this brochure
• Self-nominations will be accepted
• Previous nominees who did not receive an award may be nominated again

Clifford W. Beers Award

MHA’s highest award is given in honor of Clifford W. Beers, the founder of MHA and the country’s volunteer mental health advocacy movement. Created in 1976, the Clifford W. Beers Award has been presented annually to a consumer of mental health and/ or substance abuse services who best reflects the example set by Beers in his efforts to improve conditions for, and attitudes toward, people with mental illnesses.

Mental Health Corporate Excellence Award

The Mental Health Corporate Excellence Award will be given to an exemplary corporation that promotes the mental health of its employees, stakeholders, and community.

George Goodman and Ruth P. Brudney Social Work Award

The George Goodman and Ruth P. Brudney Social Work Award was established by the Board of Directors of MHA in November 1986. The award’s establishment was made possible through a gift by George Brudney, a member of the MHA Board of Directors, in memory of his wife Ruth, a psychiatric social worker.

Innovation in Programming Award

This award recognizes the continuing innovation and creativity of the MHA affiliate network in program development and implementation. 

mPower Award

The mPower Award celebrates the life and work of a teen or young adult who has spoken out about mental health issues to educate his or her peers and fight stigma.

Media Award

Each year, MHA recognizes journalists, media outlets, television and film programs who excel in their coverage and portrayal of mental health issues in news and entertainment media. The media is vital in educating Americans about mental health and mental illnesses. Accurate and responsible coverage is critical in breaking down stereotypes and stigma surrounding mental illness and substance use. Original, thought-provoking journalism and entertainment not only work to raise general awareness and shape public opinion, but help all people live mentally healthier lives and teach the country to address mental illness before Stage 4. 

Do you know of someone improving the world of mental health? Does your employer set the bar on how to address mental health in the workplace?

MHA encourages you to nominate them, or anyone else you think deserves to be recognized for their outstanding work (multiple nominations are allowed). You are also allowed to self-nominate, and previous nominees who did not receive an award may be nominated again.

Click here to learn more about the awards and nominate someone online!

Alika Maunakea is leading a study to scientifically prove what seems apparent to many: Social and economic forces in a community can impact health.  Maunakea, assistant professor at the John A. Burns School of Medicine at the University of Hawaiʻi at Mānoa, is conducting the study in a place he knows well: Waiʻanae, where he was born and raised.

The community, situated on a beautiful stretch of the Leeward Oʻahu Coast, also has its challenges. Maunakea’s hometown has the largest proportion of health disparities in the state.

The study aims to scientifically prove what seems apparent to many: that social and economic forces in a community can impact health. Obesity, diabetes, smoking and alcoholism are all more prevalent within places like Waiʻanae, with high populations of Native Hawaiians or Pacific Islanders. Incomes there are below the median and the way of life (which generations ago centered on harvesting food from the land and the sea) has been disrupted by rapid change and urbanization.

Dr. Maunakea’s specialty is Epigenetics. He is seeking to understand the molecular interaction between the environment and genes, and how changes in this interaction are involved in diseases which are disproportionately prevalent in Native Hawaiian and Pacific Island populations–changes which are not due to differences in DNA sequence (i.e. genetics).

Maunakea’s colleague in the study is Ruben Juarez, an associate professor in the UH Mānoa Department of Economics and UH Economic Research Organization. He is a mathematical economist researcher with expertise in social networks and behavior.

Maunakea and Juarez believe social and economic forces can push people toward unhealthy lifestyles. Their study won’t be confined to the walls of the University. MA‘O Organic Farms, a nonprofit, 25-acre farm in Waiʻanae is a key partner in the project. MAʻO is an acronym which stands for the Native Hawaiian terms Mala (garden), ʻAi (food) and ʻOpio (young). It was founded in 2001 with the goal of producing organic foods and plants used in Native Hawaiian healing traditions, while also reconnecting the people of the Leeward Oʻahu coast — especially the young — to their Native Hawaiian cultural roots. Youth employment and educational programs are centered on the farm.

“MAʻO has a large impact in Waiʻanae,” said Dr. Maunakea, a biomedical researcher in the Epigenomics Research Program at the UH John A. Burns School of Medicine (JABSOM) Department of Native Hawaiian Health.

“Communities like MAʻO are grassroots organizations, and we have a strong belief that in order to effectively address health disparities, these organizations should be part of the mix of academics, health practitioners, and the government,” said Dr. Juarez. “While we expect this project will create valuable information for MAʻO, our collaboration may provide a model for other organizations to fund their programs in a more sustainable way.”

The study is being funded by HMSA Foundation, which was established in 1986 by health insurer HMSA to stimulate research of issues that confront Hawaiʻi’s health care industry.

Juarez says the study represents a start of a new line of research in Hawaiʻi that could enable community organizations to optimize their programs to more intentionally improve health and reduce health disparities for their constituents.

“The impact of socioeconomic networks on diseases of health disparities in Hawaiʻi has never before been measured,” said Dr. Maunakea. “We hope to provide the first measure in the state of Hawaiʻi.”

Learn more at Jabsom.Hawaii.edu.

The following guide was written by and from the perspective of Louise Theodosiou, a child and adolescent psychiatrist.

The parents and care takers I meet through my job as a child and adolescent psychiatrist often tell me about young people in their lives who are suffering from anxiety or low mood. I can sometimes hear an element of desperation or hopelessness in their voice, which may come from the fact they have no idea what to do or how to seek help. They want to be able to support the young person in their life, but without having the tools to do so, their confidence as care-givers diminishes and that can have an enormous impact on the whole family unit.

Schools and community centres have taken steps to ensure that children and parents recognise the value of physical health, from the promotion of fresh fruit and vegetables to the need for regular exercise. But where are the messages about mental health?

This Children’s Mental Health Week we need to do several things: advocate for ways to improve child mental health, encourage children to have time to talk to parents and care takers, as well as encourage them to make friendships and develop interests. There is also a need to understand the signs that children may be experiencing mental health issues in the first place.

These might include feeling anxious or unhappy, concerns about eating or weight and struggling to manage one’s behaviour. Age and maturity are obviously important factors, but signs to watch out for at any age include behaving like a younger child, withdrawing socially, losing interest in activities, struggling to learn or complete schoolwork, tearfulness and not eating or drinking. We know that children need to be safeguarded at all times, and providing a space for a child to say that they are experiencing neglect, bullying or abuse is a key part of maintaining wellbeing. 

Each child has unique strengths and needs that can impact on how they function at home or at school. If a child or young person is displaying signs that they are struggling, it is helpful to consider several different dimensions. Addressing these difficulties at an early stage can reduce secondary difficulties, for example, an impact on self-esteem, learning or school attendance.

Can the child explain that they feel sad or anxious? Listen when they talk to you. These are sensitive topics and words are important. Children may talk about feeling stressed or “not right”: use the language they do to show that you understand. Talking to a teacher, a parent or carer about emotions can be a great relief. There is information available about anxiety and low mood for teachers, parents and care takers in sources such as MindEd, which offers free online training, or the free information sheets on the Royal College of Psychiatrists website.

If difficulties remain, parents can talk to GPs and teachers. Schools are working increasingly closely with mental health and wellbeing services. Often there are counsellors in school, and teachers and GPs can signpost families to voluntary sector counselling and to child and adolescent mental health services if difficulties are severe. Signs that children may be more unwell include struggling to leave the house, losing interest in their appearance, losing weight, hurting themselves or talking about not wanting to be alive. 

Does the child have a specific difficulty with learning or concentration or social understanding? 

There are situations where learning needs are not picked up and children can develop coping mechanisms that may stop working as they move into high school. The same is true for children who struggle to concentrate or who are very active. Children with social communication difficulties may manage in primary school but struggle as they get older and relationships become more nuanced. 

For difficulties with learning there are often educational psychology services to assess the needs a child may have in school. Many schools and GPs will now have training in how to recognise problems with concentration, overactivity or social communication difficulties. This will include when to refer to paediatrics or child mental health services for a more detailed assessment.

Parents, care takers and teachers know the children in their lives well and will be instinctive in their caring through years of experience. Often, they will know when something is not right and should feel empowered to act on their instincts.

Learn more at Independent.co.uk.

Elisia Manuel remembers when she and her husband Tecumseh received their first foster child. “We had to go buy the boy some clothes,” she told Vice. “We had to get him everything, because he came with nothing. The agency even had to lend us a car seat to bring him home.” Elisia, who comes from the Mescalero Apache and Yaqui tribes, and Tecumseh, an Akimel O’odham from the Gila River Indian Community located just south of Phoenix, were thrilled to get a Native child to care for—even if it meant completely outfitting the little boy, purchasing a heavy-duty washer, and finding other supplies.

But state and tribal child welfare agencies say that Native foster families like the Manuels are hard to find. And that shortage can cause havoc when non-Native foster families wishing to adopt a Native child try to circumvent a law designed to keep tribal kids in their communities. Nationwide, American Indian and Alaska Native children are placed into foster care at a rate 2.7 times greater than their proportion in the general population, according to the National Indian Child Welfare Association (NICWA). With a disproportionate number of Native kids removed from their homes each year, the need for Native foster homes is huge—and there aren’t enough to meet the need. That shortage leads to non-Native foster parents taking in kids from tribal communities. Sometimes, those foster parents decide they want to adopt the foster child even though the law is supposed to prevent virtually all such non-Native adoptions.

This has led to nasty fights over custody; one highly publicized dispute was over Lexi, a young Choctaw girl whose foster parents sued to prevent her being given to the girl’s paternal family. The case stretched over four years and attracted international media attention until 2016, when the case was resolved in favor of her father’s family. In 2013, a little girl known as Baby Veronica was at the center of yet another maelstrom, this time after her non-Native mother turned her over for adoption leaving her Native father to fight for her return. This time, the outcome was different: The non-Indian adoptive family got to keep the girl.

To understand these disputes, you have to know the painful history behind them. Before the enactment of the 1978 Indian Child Welfare Act (ICWA), the law that governs removal and placements of Native kids, 25 to 35 percent of Native children nationwide were being removed from their families, according to NICWA.

Montana’s Department of Health and Human Services’ Child and Family Division found that prior to ICWA’s enactment, nearly 80 percent of all Native families had lost at least one child to the foster care system, thus posing the real risk of tribal extinction. Minnesota’s Department of Human Services found that the children who were removed were “at great risk for experiencing psychological trauma leading to long-term emotional and psychological problems as adults” due to losing cultural and family connections.

Eighty-five percent of those children removed from their homes were placed outside of their families and communities by state courts, welfare agencies, and private adoption agencies, despite many “fit and willing relatives” who could have taken in those children. In fact, family fostering is the norm in Indian Country, but states did not realize, or recognize, that fact. This can still be an issue, although after 40 years of educating state child welfare workers, it’s starting to change. Over the past decade, the federal government has finally issued compliance guidelines for ICWA for states and other entities. That’s helped to reduce the number of placements outside tribal communities, although more needs to be done, according to author Shanna Knight in the publication ABA Child Law Practice.

But now, with a perceived increase in legal challenges to ICWA, including a challenge by the Goldwater Institute that the US Supreme Court declined to hear last year, the need for tribal foster homes to prevent these agonizing battles grows ever greater.

The Manuels, who now have six kids in their home—three of whom they’ve adopted—are one of just a few foster homes in tribal communities.

The lack of Native foster families across the nation is “a serious issue,” David Simmons, the director of government affairs and advocacy for NICWA, told Vice. “Recruitment and retention of foster parents isn’t there.”

Simmons regularly advises state child welfare systems, “Don’t assume mainstream methods will work with Native American families—you need a cultural approach, based on relationships.” Care by kin is “very big” in tribal communities, Simmons said.

Then, there’s the matter of trust. “There’s a historic distrust [of state and federal government] in Native communities,” Simmons told me.

Native families also can have trouble meeting strict care home standards. “For example, the child’s room must be a certain size to qualify the home as a foster home,” Simmons said. But ICWA contains a provision that states should treat tribal foster homes according to the tribes’ standards of cultural norms, such as extended families raising children. Also, the law trumps state regulations such as the home structure or how many people reside in the home. Arizona is home to 22 tribal communities, and nearly 28 percent of the state is tribal lands.

Despite this, Kenneth Poocha, the tribal liaison for the Arizona Department of Child Safety, told Vice that there is a shortage of Native foster homes in Arizona for the 1,500 Native kids in the state’s system—about 10 percent of the state’s current total foster child population. “There are a variety of reasons as to why this may be,” Poocha, a member of the Hopi Tribe, said. For one thing, “Many Native American families that may be willing to be a foster home are simply not aware of the process or even how to begin.”

Poocha and his office are actively recruiting foster families, but it’s not an easy proposition, even though families operating homes licensed by the Arizona Department of Child Safety receive payments up to nearly $29 a day, and more for children requiring more medical and/or behavioral care. Poocha also says that in Arizona, tribally certified foster homes are considered to meet state regulations.

When Native foster families can’t be found, state child welfare staff must place them with non-Native parents, creating a complicated situation for the foster and birth families and the child’s tribe. A non-Native foster mother living in Phoenix Vice spoke to requested that her name not be used because she’s fearful of harassment from Native activists upset that non-Indians are caring for tribal children. The single working mom has had the boy, now nearly four years old, for a year.

“I was his third home in two months,” she told Vice. “I wouldn’t have taken him if I had known how many needs he had.” But she added that after some time, she realized that “this is the child I was meant to have.”

The boy had been severely neglected and “completely deprived of attention,” she told Vice. His separation anxiety is so bad, “I go to the bathroom, and his fingers go under the door.” The boy had no words when he first came to the mom’s home, he was suffering from post-traumatic stress disorder from witnessing domestic violence, he had severe social and behavioral issues and developmental delays, and his immune system wasn’t well developed. “He had chronic fevers,” the mother told Vice.

All these issues are symptoms of toxic stress caused by adverse childhood experiences, which if not corrected by putting the child in a better environment can result in cognitive and health deficits that last a lifetime. The Phoenix foster mom thinks that the boy’s birth mother “probably suffered from adverse childhood experiences herself.”

The mom said that the child’s tribe, which is peripherally involved, would like for him and his three siblings to be reunited. However, “there are no placements that can handle all four of them,” the foster mom told Vice. “I think it would be cool to do cultural things with him, but we’ve been in survival mode all this time.” The foster mom supports eventually sending the boy home, once the birth mom “gets her act together,” she said.

There’s widespread agreement that the best solution would be to place Native children in Native homes, but there are material obstacles in the way that the ICWA can’t solve.

One of those obstacles is supplies. Recalling their early struggles with obtaining needed supplies for their first foster child, Elisia and Tecumseh Manuel decided that other Native foster parents needed support with basic needs like diapers and clothing. The couple established a nonprofit called Three Precious Miracles in the hopes of making it easier for Native families to foster children.

Today the organization provides clothing, cribs, car seats, and a support group for parents. Elisia says she’s received calls for help from as far away as South Dakota, although most of her work is done in Arizona.

Read more on VICE.com

Thomas Burke Jr., a Marine who returned from tours in Afghanistan and Iraq to attend Yale Divinity School, has also done three tours in the Veterans Health Administration for mental health care and says he’s experienced mixed results.

Burke, 28, served in the infantry. He said his first counselor, in 2011, didn’t have much experience with combat veterans and wasn’t much help. In 2012, he clicked with his second counselor, who “really cared and took time to get to know me and gave me enough of a baseline to productively go through my academics.”

Before becoming a minister and providing mental care of his own, he tried to get back into counseling. But it was a “very negative experience,” he said.

“I went in, being vulnerable and laying out my problems, and they were dismissive and condescended to me and treated me like I am some victim and were not getting to the bottom of the problem and essentially said ‘thanks for telling us,’ ” Burke said.

“Imagine what damage that can do to veterans who seek help. It’s hard for me to badmouth the VA, because there are a lot of good people there who are trying to help and do care about vets, but a lot of people I talk with do badmouth them,” Burke said.

Many Americans who served in the Iraq and Afghanistan wars need mental health care, but they aren’t always getting enough from the Department of Veterans Affairs’ Veterans Health Administration, according to the results of a congressionally mandated investigation released Wednesday.

About 4 million people have served in Iraq and Afghanistan, the longest sustained US military operations in history. A disproportionate number have come back with mental health challenges like anxiety, depression and post-traumatic stress disorder, research shows. The number of suicides for veterans of these wars has reached a record. The VA has not always been able to handle this crushing need for services.

But when veterans get mental health care from the VA, it is of “comparable or superior quality” to the kinds of care available elsewhere.

According to the new study, nearly half of American veterans who need mental health care don’t get it. Also, more than half of those who would benefit from care don’t know they need it, the research by the National Academies of Sciences, Engineering, and Medicine found.

The majority of those who could use these services don’t know whether they are eligible, don’t know how to get the services and don’t even know that the VA provides mental health care, according to the report.

That’s “one of the things the report pointed out that I found the most distressing,” said Louis Celli, national director of the American Legion’s veterans affairs and rehabilitation division, which was not involved in the new report.

Celli said the VA does a “herculean job through social media campaigns and outreach with their partners” to let veterans know about the care it provides. “It’s hard to imagine more you could do, short of knocking on everyone’s door,” but he believes the lack of care is a “failure on the community’s part.”

One workaround that the American Legion has found successful is enlisting veterans’ families to help them get the care they need.

That’s what helped Seth Robbins. An Army veteran who was stationed predominantly in Korea, the 40-year-old has gotten his health care through the VA for more than a decade, but he sought help for anxiety only after his wife gave him an ultimatum.

“As soldiers, sailors, Marines and airmen, we are taught to ‘suck it up and drive on.’ We heard that on a regular basis, and it gets into your head,” Robbins said.

He also hesitated to seek treatment because he had concerns that were shared by veterans in the report.

For instance, Robbins worried that his rifles would be taken away if he talked about his anxiety. “There’s also the stigma or the feeling that something is broken and I’m not the normal one or that they’ll lock you up,” he said. “But I’ve got a job and a family to support and a house.” The VA has helped him “get to a place where I can manage.”

Veterans also find the VA’s appointment system “burdensome” and “unsatisfying,” the report said. Robbins agrees and says he’s lucky his father, a Vietnam veteran, showed him how to navigate the system.

He also feels lucky to have a federal job that gives him the freedom to go to appointments that can take hours out of his day. Other veterans said transportation challenges and the distance to the VA from their homes can be a huge obstacle to getting care, according to the report.

For veterans like Robbins who succeed in getting treatment, the report found that they encounter “tremendous mental health care expertise” and that the system can deliver care in a “truly integrated and strategic manner.” But the report added that chronic staffing challenges and confusing procedures and policies continue to be a challenge.

Read more on CNN.com.