Statistically-speaking, a decline in mental health has pervaded the United States since the start of the COVID-19 pandemic. In fact, the prevalence of symptoms of anxiety and depression among adults is estimated to have quadrupled during the pandemic, rising from just 10% in 2019 to 40% in 2021.1 Although the pandemic’s effects had rippled across the nation at large, minority communities, particularly Black and Hispanic populations, reported anxiety and depression symptoms disproportionately more.2 Similarly, Asian and Pacific Islander (AAPI) have experienced intensified symptoms of anxiety and depression, attributed to stressors such as false accusations and anti-Asian hate regarding the pandemic’s origins.3 Aggravating matters even further are both a prevalent stigma upheld by minority communities against seeking mental health support or therapy and the discrepancies in access to psychological services among different communities.4
In response, the Institute of Clinical Bioethics (ICB) has joined the national fight against mental illnesses and challenges by incorporating a new mental health promotion station into its Health Promoter Program (HPP). Throughout the past summer, Courtney Ann Trohn (2nd year PsyD. candidate at Chestnut Hill College), Fredy Abboud (ICB Undergraduate Research Fellow), and Christopher Antoniello (2nd year D.O. candidate at PCOM) designed the station while accounting for differences in mental health needs across the Asian, Hispanic, BIPOC, and African communities the HPP serves.
Mental Health Station Design
As of today, the mental health station offers screenings for Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), and risk of suicide, in addition to psychoeducational materials published by the National Institute of Mental Health. Among the screening tools used are the GAD-7 for assessing the intensity of a patient’s anxiety symptoms and the Patient Health Questionnaire-9 (PHQ-9) for evaluating the severity of a patient’s depression symptoms. Both the GAD-7 and PHQ-9 are multi-itemed self-administration tools that have been proven consistent in assessing anxiety and depression symptomatology. Patients interested in the mental health screenings may opt for either or both screenings. Volunteers at the mental health station often encourage patients to sit for the GAD-7 before the PHQ-9, given the more intense nature of questions on the PHQ-9. Patients whose PHQ-9 and GAD-7 scores suggest moderate anxiety and/or depression are referred to either gratis or discounted psychiatric services in the Philadelphia area. However, patients who score either higher than “20” on the PHQ-9 or at least “1” on the question pertaining to suicidal ideations further undergo the Columbia-Suicide Risk Severity Scale (C-SSRS) – a screening for gauging the intensity of patients’ suicidal ideations and suicidal behavior, while evaluating the lethality of past suicide attempts, if applicable. Courtney, Chris, and Fredy have also devised a protocol for dealing with patients showing active suicidal intents.
Given the complexities of mental health screenings and discussion, graduate psychology students, medical students, and ICB Undergraduate Fellows staff the mental health station. Undergraduate Fellows interested in administering screenings are required to complete an eight-hour-long Mental Health First Aid course offered by the National Council for Mental Wellbeing so that they gain literacy in spotting and communicating with people who may be struggling with an underlying mental health challenge or illness. Undergraduates are also required to complete the “Recognizing and Reporting Child Abuse: Mandated and Permissive Reporting in Pennsylvania Online Training” offered by the University of Pittsburgh and endorsed by the Pennsylvania Department of Human Services and Department of State. Lastly, undergraduates attend a mental health language sensitivity training and shadow medical students and PsyD. candidates running the station.
Implementation of the Mental Health Station
Between August 3, 2024, and September 21, 2024, the mental health station was implemented into two Hispanic, one Asian, one African, and one Mobile Health Promoters. Although data collection was not among the station’s objectives, volunteers at the station kept track of patient engagement by calculating the percentage of patients at Health Promoters who participate in the mental health screenings. The percentages reported in Courtney et al.’s paper reflected a hesitancy among minority communities to be screened for mental illnesses and have assured Courtney, Chris and Fredy of the importance of expanding the mental health station’s services.5
Future Directions
Recently, Independence Blue Cross has awarded the ICB a $175,000 grant, of which around $12,000 has been allotted to support the expansion of the mental health station’s services and objectives. Furthermore, the ICB seeks to partner with Philadelphia-local psychiatry residency and graduate psychology programs to offer Health Promoter patients more advanced screenings and comprehensive psychoeducation.
The mental health station complements the services offered at Health Promoters, serving as a basic yet much needed intervention in communities to whom both physical and mental healthcare seems elusive.
- Adams, D., & Grupač, M. (2021). Stress-related psychiatric disorders, clinically significant depression, and elevated anxiety symptoms among medical personnel providing care to COVID-19 patients. Psychosociological Issues in Human Resource Management, 9(2), 133. https://doi.org/10.22381/pihrm92202110
- Grooms, J., Ortega, A., Rubalcaba, J. A., & Vargas, E. (2021). Racial and ethnic disparities: Essential workers, mental health, and the coronavirus pandemic. The Review of Black Political Economy, 49(4), 363-380. https://doi.org/10.1177/00346446211034226
- Zhou, S., Banawa, R., & Oh, H. (2021). The mental health impact of COVID-19 racial and ethnic discrimination against Asian American and Pacific Islanders. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.708426
- Cénat, J. M. (2020). How to provide anti-racist mental health care. The Lancet Psychiatry, 7(11), 929-931. https://doi.org/10.1016/s2215-0366(20)30309-6
- Trohn, C.A., Abboud, F.J., Clark, P.A., & Antoniello, C. (2024). Designing and Implementing a Mental Health Promotion Station into a Preventive Medical Clinic. The Internet Journal of Mental Health,10(1). https://doi.org/10.5580/IJMH.57191