If you break your arm, you go to a doctor to seek treatment.
But if you’re experiencing symptoms of mental illness, the next step isn’t always as clear, especially for minority populations.
With language barriers, insurance concerns and cultural stigma against discussing mental illness, it’s not surprising that among Latinos with a mental disorder, fewer than 1 in 11 (approximately 9%) contact a mental health specialist.
There is a clear need for tailored mental health treatments that cater to the unique needs of underserved communities.
Integrating research and practice with PRIDE
Community Psychiatry PRIDE (Program for Research in Implementation and Dissemination of Evidence-Based Treatments) is aiming to address this need.
Luana Marques, PhD, a clinical psychologist in the Department of Psychiatry at Massachusetts General Hospital and associate professor in psychiatry at Harvard Medical School, founded Community Psychiatry PRIDE to help minority and at-risk communities get state of the art mental health care and treatment.
“We want to bring the ivory tower to the streets,” says Dr. Marques. “Our program is bridging the gap between science and practice by delivering evidence-based treatments for psychiatric disorders in under-resourced communities.”
The program’s treatments utilize cognitive behavioral therapy (CBT), a practical and solutions-oriented technique for changing patterns of thinking or behavior. The treatments have been tested in randomized control trials — considered the gold standard in research — and have been shown to be effective in both controlled and community settings.
Marques and her team work with and train community-based providers to deliver tailored versions of these evidence-based treatments for mental health problems including trauma, anxiety and mood disorders.
“Instead of going to community clinics and telling them ‘this is what we’re going to teach you,’ we meet with the organizations and ask what their patients need and how can we be most helpful. From there, we design a study with both the patient and provider in mind so we can have the best chance for success.”
Reaching marginalized populations
Marques is currently involved in a number of research projects in the Boston area in in which she and her team work with partner organizations and community clinics.
Over the past four years, they have been working with a local nonprofit to create a CBT life skills curriculum for young men recently released from prison. They are now training workers at the community organization to deliver the intervention. Given the diverse backgrounds of the participating individuals, the team wants to ensure the program is both culturally appropriate and language appropriate.
“We’re on the ground working with individuals, such as young African American men coming out of the prison system, who are marginalized and aren’t frequently involved in research,” says Marques. “I think we’re really finding ways to overcome that disparity.”
The impact of her work is notable, as Dr. Marques describes: “We had a young man who went to a park where a member of a rival gang ‘gave him a look.’ He called up a friend and asked his friend to bring him a gun so he could confront the other man. During the time it took his friend to arrive, this young man engaged with one of the skills he learned in our curriculum and thought of alternative explanations for the man’s look, and ultimately decided to not act on his original instinct. This most basic application of a cognitive behavioral technique shows that our program can make the difference between life and death.”
Marques is also working with Boston Healthcare for the Homeless Program to create shorter forms of therapy that could be delivered by different mental health providers.
“Individuals experiencing homelessness may have trouble engaging in therapy because, rightfully so, it’s not their first priority,” says Marques. “So we’re trying to see if one therapist could deliver something like mindfulness therapy one week and when that same patient comes in maybe three weeks later, could another therapist train them on changing their thoughts?”
Marques takes a multi-tier approach to measure the success of Community Psychiatry PRIDE’s diverse programs.
“At the patient level, we’re looking at a decrease in clinical symptoms but most importantly, we’re looking at quality of life,” explains Marques. “At the provider level, we measure success by uptake and sustainability to the extent that they learn the treatment protocol and continue to use it even when the trial ends.”
During her 12-year tenure at Mass General, Marques says the psychiatry department has remained supportive of community-based initiatives like Community Psychiatry PRIDE and her innovative vision for improved mental health treatment.
“It makes me feel like I can move the needle,” says Marques.
With her recent appointment as president-elect at the Anxiety and Depression Association of America (ADAA), Marques is excited to help mold the field and also make a national impact.
“I’m hoping I can bring the lens of diversity to the ADAA and ensure communities and diverse populations are cared for at the same level as the majority.”