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Module Five: Health Policy Analysis Paper

Module Five: Health Policy Analysis Paper

Health policy helps make decisions, plan for, and take actions that achieve and improve specific healthcare outcomes. This article presents an analysis of health policy related to mental health in minority racial groups with a focus on S.1700 – Pursuing Equity in Mental Health Act. It presents the specific healthcare issue affecting advanced practice nurses for which the legislation has been proposed in Congress, how the legislation affects practice in mental health practice, the impact this chosen bill has on the DNP Project, and the environment that made it necessary to focus on this healthcare issue. It also identifies the difficulties encountered and tactics used to propel the legislation forward, stakeholders in the legislation, how the effects of the legislation will be evaluated, how the goal addressed in the legislation has been achieved in another country, and options for refining the programs in the legislation to improve policy outcomes.

Healthcare Issue Affecting Advanced Practice Nurses and Proposed Legislation

Racial disparities in mental health outcomes and access to mental healthcare are significant issues in health care in the United States today (Goldmann et al., 2021). These disparities in mental health care in the U.S. are driven by a combination of factors diverse socioeconomic factors, such as differences in levels of income among racial groups and diverse cultural views on mental health and health care. A related and recently proposed piece of legislation in Congress is the S.1700 – Pursuing Equity in Mental Health Act introduced to Congress by Sen. Menendez, Robert [D-NJ] on the 18 of May 2023.

The legislation aims to address disparities in mental health by focusing on mental health issues among the youth of colour and other racial minority groups through supporting grants for primary and behavioral health care programs, improving professional competence, and addressing gaps in mental health research focused on minority racial groups (S.1700 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act, 2023). It also seeks to improve funding for National Institutes of Health and National Institute on Minority Health and Health Disparities.

The piece of legislation has the potential to affect practice in mental health care for advanced practice nurses as it promotes research on mental health care disparities among racial minority groups and the need for professional competence to ensure the best practices in ethnically and racially diverse populations. It also aligns and shares a purpose with the DNP project as it explores the effects of mental health stigmatization among ethnic minority groups on their health-seeking behaviors. It also focuses on cultural competence among practitioners and suggests interventions to overcome stigma and improve mental health care utilization among racial and ethnic minority groups. The legislation, if passed and ascended into law, can support grants for this DNP project as it seeks to reduce mental health stigma and improve access to culturally competent mental health care for racial and ethnic minority groups.

Environment that Brought this Health Care Concern to the Forefront

Mental health disparities and stigma among racial and ethnic minority groups have become a priority issue of concern based on a review of the history of mental health disparities, sociocultural, ethical, economic, political, and legislative environments and their contribution to such disparities. Historically, racial and ethnic minority groups have faced significant systemic racism and marginalization in mental healthcare settings (Cook et al., 2019), which contributed to significant racial mental health disparities in access and outcomes. From a sociocultural perspective, racial and ethnic minority groups in the U.S. have diverse cultural views on mental health, which create unique challenges such as mental health stigma (Schomerus et al., 2019), language barriers, and lack of providers from these groups. Such challenges contribute to poor mental help-seeking behaviors and poor utilization of mental health services, leading to mental health disparities.

Economically, racial and ethnic minority groups have lower levels of income as compared to their White counterparts, with a significant impact on their ability to finance healthcare leading to poor health outcomes (Khullar & Chokshi, 2018), including mental health outcomes. Ethically, mental health disparities are an injustice and do not align with the principles of equitable healthcare, creating the need for inclusive mental health care. From the political and legislative environment, the post-COVID-19 period has highlighted the existing mental health disparities in racially and ethnically diverse populations, creating the need to resolve such disparities (Dwanyen et al., 2021). This has also highlighted legislative gaps in resolving such disparities, necessitating the need for targeted political support and solutions to the problem.

Difficulties Encountered and Tactics Used to Propel the Legislation Forward

The S.1700 faces various difficulties in Congress as it is with bills, including competition from other bills that are also considered priorities in Congress and a lack of bipartisan support across the major parties in Congress. There is also a research gap regarding mental health disparities among racial minority groups (S.1700 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act, 2023), which may translate to a lack of sufficient data to support evidence-based advocacy. However, sponsors of the bill have presented evidence of the need to support it, including a review of previous legislation to identify legislative gaps, suggesting amendments to current laws, and necessitating the need for culturally sensitive and preventative mental health care as a strategy to address mental health disparities.

Evaluation of the Legislation

The impact of the S.1700 will focus majorly on outcome measures. These include utilization rates for mental healthcare services among racial minority groups, especially the youth, professional cultural competence, and patient satisfaction with provided services.  The most notable positive effects of the bill include improved access to culturally competent care among minority groups, reduction of negative mental health views, an improvement of mental health help-seeking behaviours among minority groups, including youth of colour, and a reduction in mental health disparities. However, the bill, as it proposes funding allocation to NIH and the National Institute on Minority Health and Health Disparities, may increase government spending, add an unplanned financial burden on Americans and disrupt mental health service delivery as professionals are required to comply with cultural competence standards.

Policy Goal Comparison with Another Country

The policy goals and efforts in the S.1700 have been successfully implemented in Europe to support and improve the mental health of migrant and ethnic minorities. Europe has implemented interventions that focus on systematic adaptations that design interventions to be culturally sensitive, use participatory approaches, and tailor such interventions to address structural inequities, including systemic discrimination, racism, language, and mental stigma (Apers et al., 2023).

Identification and Activities or Stakeholders

The main supporters of the bill are majorly Democrats including Sen. Menendez, Robert [D-NJ] who introduced the bill cosponsored by Sen. Carper, Thomas R. [D-DE], Sen. Padilla, Alex [D-CA], Sen. Stabenow, Debbie [D-MI], Sen. Smith, Tina [D-MN], Sen. Blumenthal, Richard [D-CT], Sen. Booker, Cory A. [D-NJ], Sen. Heinrich, Martin [D-NM], Sen. Murphy, Christopher [D-CT], Sen. Warren, Elizabeth [D-MA], and Sen. Butler, Laphonza R. [D-CA]. The bill has no direct opposers.

Options for Refining the Bill to Improve Outcomes

The S.1700 can be refined to further achieve improved policy outcomes in addressing racial and ethnic mental health disparities. The suggested major options for refinement include:

  1. Pushing for improved and equitable insurance coverage for mental healthcare among racial and ethnic minority groups. The bill can be redesigned to support coverage programs for mental health care as it is with coverage for other medical services targeted among minority and racial groups. Such coverage programs for mental health care can help eliminate socio-economic barriers that exist in the insurance marketplace
  2. Providing incentives for mental health providers especially advanced practice nurses who complete training programs in cultural competency. Such incentives for completing training in the best practices for mental healthcare in ethnically and racially diverse populations, combined with other programs supported by the bill, such as behavioral mental health outreach and education strategy, can further help ensure minorities have access to culturally sensitive care, which can further address mental health stigma

Conclusion

This S.1700 aligns with the goals of the DNP project of understanding and addressing mental health stigma in racial and ethnic minority groups as a strategy for addressing racial disparities in mental health care in the U.S. Both the bill and the DNP project focus on training mental health professionals to improve cultural competency, and improving access to culturally competent mental health care as a way to improving equitable mental health outcomes. Analysis of the bill shows it has the potential to further improve policy outcomes by improving coverage programs for racial and ethnic minority groups and incentivizing training to improve cultural competency among mental health professionals.

References

Apers, H., Van Praag, L., Nöstlinger, C., & Agyemang, C. (2023). Interventions to improve the mental health or mental well-being of migrants and ethnic minority groups in Europe: A scoping review. Global Mental Health (Cambridge, England), 10. https://doi.org/10.1017/GMH.2023.15

Cook, B. L., Hou, S. S. Y., Lee-Tauler, S. Y., Progovac, A. M., Samson, F., & Sanchez, M. J. (2019). A Review of Mental Health and Mental Health Care Disparities Research: 2011-2014. Medical Care Research and Review: MCRR, 76(6), 683–710. https://doi.org/10.1177/1077558718780592

Dwanyen, L., Holtrop, K., & Parra-Cardona, R. (2021). Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010–2019). Journal of Marital and Family Therapy, 48(1), 346. https://doi.org/10.1111/JMFT.12573

Goldmann, E., Hagen, D., Khoury, E. El, Owens, M., Misra, S., & Thrul, J. (2021). An examination of racial and ethnic disparities in mental health during the Covid-19 pandemic in the U.S. South. Journal of Affective Disorders, 295(1), 471. https://doi.org/10.1016/J.JAD.2021.08.047

Khullar, D., & Chokshi, D. (2018). Health, Income, & Poverty: Where We Are & What Could Help. https://doi.org/10.1377/HPB20180817.901935

S.1700 – 118th Congress (2023-2024): Pursuing Equity in Mental Health Act (2023). https://www.congress.gov/bill/118th-congress/senate-bill/1700/text

Schomerus, G., Stolzenburg, S., Freitag, S., Speerforck, S., Janowitz, D., Evans-Lacko, S., Muehlan, H., & Schmidt, S. (2019). Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. European Archives of Psychiatry and Clinical Neuroscience, 269(4), 469–479. https://doi.org/10.1007/S00406-018-0896-0/METRICS

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Question 

This health policy paper is a formal paper and should be written according to APA (2020), 7th edition professional format style. All items in the rubric must be fully addressed.

Written analysis of a policy issue currently or recently addressed as legislation (a bill) within the last 18 months in a state legislature or in Congress addressing a healthcare concern

  1. Identify a health care issue affecting advanced practice nurses for which legislation has currently or recently been proposed or passed in a state legislature or in Congress. The bill should be no older than 18 months old. The bills should relate to your DNP project. For this question number one (#1) you must also specifically address 1a., 1b., and 1c.
    • 1a. Provide the number of the bill, the title of the bill, and the date of the bill.
    • 1b. Describe how the chosen piece of legislation will specifically affect your practice as an advanced practice nurse.
    • 1c. Expand ‘1b’ by sharing the purpose of your DNP project and the relationship and/or impact this chosen bill has on your DNP Project.
  2. Describe the environment that brought this health care concern to the forefront: Each of the five aspects of Environment should be specifically described: a. historical, b. sociocultural, c. ethical, d. economic, e. political, and f. legislative. Address each item (a, b, c, d, e, f) individually.
  3. Identify difficulties encountered and tactics used to propel the legislation forward. Please identify difficulties and tactics. Include identification and activities of stakeholder group(s) opposed to or supportive of the legislation including such as bill sponsors [include name(s) of bill sponsor(s)], industries manufacturing healthcare products or technology, consumers of health care, and provider of care – both professionals and institutions. If the legislation has not been passed, discuss pessimistic and optimistic timelines set to achieve the goal.
  4. Indicate how the legislation will be or has been evaluated for effect on consumers and providers of care. Include both positive and negative effects.
  5. Compare the policy goal addressed by the bill with how the same goal is achieved in another country.
  6. Suggest options for refining/changing the measures/programs in the legislation to improve policy outcomes.
  7. A minimum of six references including at least two scholarly journal articles must be used.
  8. Some notes to keep in mind when writing the health policy analysis paper…
    • Entire paper (includes title page, abstract, headings, body of paper, citations, references, use of paragraphs, and such) should be written APA Professional format style following the 7th edition of the Publication Manual of the American Psychological Association.
    • Paper should not exceed 9 pages in length (excluding title page, abstract, and reference page). A title page, abstract, and reference page should be included–these are not included in the 9 pages.
    • Headings must be used in the paper. It is suggested headings relate to the criteria for this assignment.
    • Paper should be typed in 12 point type
    • Papers are expected to be of publishable quality. The DNP Writing rubric will be applied as a component of the grading of this paper.

      Module Five: Health Policy Analysis Paper

      Module Five: Health Policy Analysis Paper

The information needed to write this paper is found in your textbook readings, the actual bill, and through your synthesis of the knowledge from this course. This paper is a graduate (i.e. doctoral) analysis of a piece of legislation. Take the time necessary to write a professional paper–this paper may take 20-30 hours to write including the research time.

The Health Policy Analysis Paper will be graded with the grading rubric listed below. If you have any questions or concerns about the rubric, please reach out early.

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