Estimates indicate that as many as 1 in 4 Americans will experience a mental health problem or will misuse alcohol or drugs in their lifetimes. These disorders are among the most highly stigmatized health conditions in the United States, and they remain barriers to full participation in society in areas as basic as education, housing, and employment. Improving the lives of people with mental health and substance abuse disorders has been a priority in the United States for more than 50 years. The Community Mental Health Act of 1963 is considered a major turning point in America's efforts to improve behavioral healthcare. It ushered in an era of optimism and hope and laid the groundwork for the consumer movement and new models of recovery. The consumer movement gave voice to people with mental and substance use disorders and brought their perspectives and experience into national discussions about mental health. However over the same 50-year period, positive change in American public attitudes and beliefs about mental and substance use disorders has lagged behind these advances. Stigma is a complex social phenomenon based on a relationship between an attribute and a stereotype that assigns undesirable labels, qualities, and behaviors to a person with that attribute. Labeled individuals are then socially devalued, which leads to inequality and discrimination. This report contributes to national efforts to understand and change attitudes, beliefs and behaviors that can lead to stigma and discrimination. Changing stigma in a lasting way will require coordinated efforts, which are based on the best possible evidence, supported at the national level with multiyear funding, and planned and implemented by an effective coalition of representative stakeholders. Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change explores stigma and discrimination faced by individuals with mental or substance use disorders and recommends effective strategies for reducing stigma and encouraging people to seek treatment and other supportive services. It offers a set of conclusions and recommendations about successful stigma change strategies and the research needed to inform and evaluate these efforts in the United States.

Over the past four decades, the rate of incarceration in the United States has skyrocketed to unprecedented heights, both historically and in comparison to that of other developed nations. At far higher rates than the general population, those in or entering U.S. jails and prisons are prone to many health problems. This is a problem not just for them, but also for the communities from which they come and to which, in nearly all cases, they will return. Health and Incarceration is the summary of a workshop jointly sponsored by the National Academy of Sciences(NAS) Committee on Law and Justice and the Institute of Medicine(IOM) Board on Health and Select Populations in December 2012. Academics, practitioners, state officials, and nongovernmental organization representatives from the fields of healthcare, prisoner advocacy, and corrections reviewed what is known about these health issues and what appear to be the best opportunities to improve healthcare for those who are now or will be incarcerated. The workshop was designed as a roundtable with brief presentations from 16 experts and time for group discussion. Health and Incarceration reviews what is known about the health of incarcerated individuals, the healthcare they receive, and effects of incarceration on public health. This report identifies opportunities to improve healthcare for these populations and provides a platform for visions of how the world of incarceration health can be a better place.

In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.

This treatment program targets the criminal, behavioral, and mental health problems of inmates in segregated housing that prevents them from living prosocially and productively within the general prison population. The program makes use of a bi-adaptive psychoeducational and cognitive-behavioral treatment model to increase inmates’ understanding about the psychological and criminal antecedents that contributed to their current placement, and to teach them the skills necessary for managing these problem areas. This flexible intervention assists inmates with significant problem behaviors by reducing psychological impairment and improving their ability to cope with prison life. This book includes a program introduction and guide for clinicians, the inmate workbook, and accompanying eResources to assist clinicians in both successful program implementation and evaluation of treatment outcomes. Designed to account for the safety and physical limitations that make the delivery of needed mental and behavioral health services difficult, this guide is essential reading for practitioners working with high-needs, high-risk inmate populations.

This book addresses the unique sociocultural and historical systems of oppression that have alienated African-American and other racial minority patients within the mental healthcare system. This text aims to build a novel didactic curriculum addressing racism, justice, and community mental health as these issues intersect clinical practice. Unlike any other resource, this guide moves beyond an exploration of the problem of racism and its detrimental effects, to a practical, solution-oriented discussion of how to understand and approach the mental health consequences with a lens and sensitivity for contemporary justice issues. After establishing the historical context of racism within organized medicine and psychiatry, the text boldly examines contemporary issues, including clinical biases in diagnosis and treatment, addiction and incarceration, and perspectives on providing psychotherapy to racial minorities. The text concludes with chapters covering training and medical education within this sphere, approaches to supporting patients coping with racism and discrimination, and strategies for changing institutional practices in mental healthcare. Written by thought leaders in the field, Racism and Psychiatry is the only current tool for psychiatrists, psychologists, administrators, educators, medical students, social workers, and all clinicians working to treat patients dealing with issues of racism at the point of mental healthcare.