“People are part of many different communities,” Dr. Clay Johnston says. “Not just their physical community, but also the communities in which they work, and in which they share religion and other cultural commonalities.”
This week, Dell Medical School director Dr. Clay Johnston and Hogg Foundation executive director Dr. Octavio Martinez join us to discuss the utility and viability of community health care. Their combined experience as educators, practitioners and civic leaders makes for an illuminating exchange of ideas.
Mental Health in the Lived Environment
When it comes to addressing mental health issues at the community level, Dr. Martinez and Dr. Johnston agree on the necessity of situating clinical spaces in a broader context of care.
“At the Hogg Foundation, when we look at a community, we do concentrate a lot on what’s outside the medical setting,” Dr. Martinez says. “Where everyone lives, learns, plays and prays.”
Public health care paradigms that account for the social determinants of mental health don’t just expand the size and capacity of a community’s support networks. They also lengthen the time window for potential stewardship and aid, creating more opportunities for interventions that are preventative in nature, rather than prescriptive.
Unfortunately, as Dr. Johnston points out, prevention efforts are presently far more underfunded and underutilized than in-hospital care. “We’re waiting for things to get really bad,” he says. “We’re not actually upstream about how to get people out of that system.”
Constraining the boundaries of mental health treatment to medical settings, however, ultimately excludes facets of community life that can be equally vital to an individual’s well-being, and even recovery.
“It’s not just that interaction with your doctor, or the medication, or other non-pharmacological interventions,” Dr. Martinez says. “It’s also our lived environment.”
Building a Healthy City Means Building Connections
According to Dr. Martinez, improving the quality and availability of public services within a lived environment is one way to promote the well-being of its inhabitants. In a city like Austin, civic projects in this vein might aim to optimize transportation systems or incorporate more greenspace into urban areas.
Development executed from the top down, however, can falter if the base perceives itself as far-removed from potential impacts. Simple human-to-human connection thereby has a key role in making communities more livable, and thus, healthier.
“Engagement is very, very important to health, including—and especially—mental health,” Dr. Martinez says. “We’re human beings. We’re emotional beings.”
In order to achieve that baseline of humanity and connectivity, no population should be expected to conform to a lesser standard of care than another. “If we want to make Austin a model healthy city, the easiest and most appropriate way to do that is to focus on where we have inequities,” Dr. Johnston says.
“When you don’t examine how things impact the entire community,” Dr. Johnston continues, “you lose sight of what needs to get done.”