NURS 450: Public/Community Health Experiential Nursing Learning Course
Political Advocacy
30 points
Assignment: This assignment will give students the opportunity to operationalize primary functions of public health including policy development. Students will assume the role of advocating for policy change and researching healthcare policy by identifying one healthcare policy that contributes to health problems, disparities, injustices, etc., in the community. Students will research public healthcare policy and write a 1–2-page editorial (but not actually send the letter) supporting knowledge in the areas of person-centered care, teamwork and interprofessional collaboration, evidence-based practice, quality improvement, and safety. The objective is to advocate for healthcare policies that will improve the health of the community. Editorial is due in the D2L assignment box by the date indicated on the course calendar.
Outcomes: This assignment helps to meet the following student learning outcomes and end of program student learning outcomes.
SLO: #7 Function as a nurse leader and change agent using the Scope and Standards of Public Health Nursing to advocate for policy changes that promote population-based health.
EOPSLO: #1 Build the knowledge, skills, and attitudes of the baccalaureate prepared nurse as described within the Scope and Standards of Practice and Nursing Code of Ethics.
Directions:
• Read “Shows Evidence of Commitment to Social Justice, the Greater Good, and the Public Health Principles” by Schoon, P. M., Porta, C. M., & Schaffer, M. A.
• Create a 1-2 page political advocacy brief to a decision making body, school board, city council, county government, state or federal legislature or influential committee that focuses on an important public health issue.
• Develop three messages from message triangle. Be succinct and attention getting.
• Use grading rubric found in the D2L course.
Resources:
1. Schoon, P. M., Porta, C. M., & Schaffer, M. A. (2019). Population-based public health clinical manual: The henry street model for nurses (3rd ed.). Sigma. https://ssuproxy.mnpals.net/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=e680sww&AN=1917387&scope=site
2. Review Healthy People 2030 website to help you identify populations at risk (will help you identify populations at risk and will also use for your reflection).
3. Locate credible reference to understand root causes, priority health issues, interventions
• Centers for Disease Control and Prevention
• U.S. Department of Health and Human Services
• MN Department of Health
• Library Services
Grading Rubric:
TOPIC POINTS COMMENTS
Introduce yourself
Introduce the issue you want action take on.
Why you are interested in this issue
/5
Identify the decision-making body (who is the recipient/audience)
Why would they care about this issue? /5
Complete the message triangle: (see below)
-Develop three messages you want to communicate to support the action
-Defimne the issue in a way that connects with the audience’s beliefs/values (key points may be different depending on the audience)
-Short, succinct, and logical flow
-Supportive evidence (personal stories, statistics, research, referenced at the end) /10
Final message; clearly state what action you are askimng /2.5
Identify your supporters (partners) and possible opponents. /2.5
Correct grammar and Help write my thesis – APA formatting; References at end of article /5
TOTAL /30
Improving Mental Health Among Homeless Populations Through Policy Change
Introduction
Homelessness continues to be a major public health concern in the United States, with over 580,000 people experiencing homelessness on any given night (Henry et al., 2022). Individuals experiencing homelessness have significantly higher rates of mental illness compared to the general population. According to the Substance Abuse and Mental Health Services Administration (2020), 20-25% of homeless individuals live with a severe mental illness such as schizophrenia, bipolar disorder or major depression. In comparison, only 4.2% of the general United States population lives with a serious mental illness (National Institute of Mental Health, 2021).
The high prevalence of mental illness among homeless populations can be attributed to many factors. Mental illness can contribute to an individual’s loss of housing, while the stress, trauma and lack of stability associated with homelessness can also trigger or exacerbate underlying mental health conditions (Fazel et al., 2014). Those with mental illness also face additional barriers to accessing housing, employment and healthcare resources necessary for recovery and stability. As a result, many remain trapped in a cycle of homelessness and mental illness that is difficult to break free from without appropriate interventions and support.
Improving mental health outcomes among homeless populations requires a multifaceted policy approach focused on increasing access to stable housing, community-based treatment services, and integrated care. The following essay will analyze current gaps in mental health policy impacting homeless populations and propose evidence-based policy solutions at the state and federal level. Specifically, policies aimed at increasing funding for supportive housing programs, expanding Medicaid reimbursement for community care, and integrating primary and behavioral healthcare for homeless individuals will be discussed.
Background
Before analyzing policy solutions, it is important to understand the current landscape of mental health policy in the United States and how it contributes to disproportionate rates of mental illness among homeless populations.
Federal Policies
At the federal level, policies like the Olmstead Act and Medicaid provide critical protections and services for individuals with mental illness. The Olmstead Act affirms the right of those with mental and physical disabilities to live and receive services in the least restrictive, community-based setting possible (US Department of Justice, 2020). Medicaid expansion under the Affordable Care Act has also increased access to mental health treatment by expanding eligibility to low-income adults that make up a significant proportion of the homeless population (CBPP, 2022).
However, major gaps still remain when it comes to serving individuals with mental illness experiencing homelessness. Medicaid enrollment can still be difficult for those without an address or documentation, and many states have still refused expansion leaving coverage gaps (CBPP, 2022). The Federal Task Force on Homelessness and Severe Mental Illness also recently declared the current mental health system inadequate for serving homeless populations, citing fragmentation across federal agencies like HUD, HHS and VA that provide essential housing and treatment services (United States Interagency Council on Homelessness, 2022).
State and Local Policies
At the state and local levels, policies around involuntary commitment laws, housing regulations and community care standards also directly impact outcomes among homeless populations with mental illness.
Firstly, involuntary commitment laws that make it easier to compel treatment for those unable to recognize their own illness have been shown to reduce homelessness and hospitalization rates (Morabito et al., 2012). However, controversies around civil liberties and reports of inadequate discharge planning from institutions have made expansion of these policies difficult in recent years (Stefan, 2022).
Secondly, certain housing regulations like sobriety requirements, credit checks and eviction histories can make affordable housing inaccessible to homeless individuals even when subsidized units are available (Doran et al., 2013). Outdated zoning laws restricting construction of single resident occupancy units and group homes also reduce available affordable housing stock for vulnerable populations (Matsui, 2022).
Finally, uneven funding, reimbursement and eligibility standards across states and municipalities impact accessibility of community-based mental healthcare. Rural areas in particular suffer from shortages of community mental health centers and providers willing to accept state medical assistance plans that serve low-income populations (National Council for Mental Wellbeing, 2022). This forces many struggling with homelessness and mental illness into EDs and jails rather than the dedicated care they need.
Policy Solutions
The below policy solutions at both state and federal levels would help address identified gaps by improving accessibility, coordination and funding across housing and mental healthcare sectors supporting homeless populations:
Federal Solutions
Increase funding for Section 8 housing vouchers and supportive housing programs like Housing First that prioritize stable, affordable housing for the chronically homeless with disabilities through HUD (Henry et al., 2022).
Provide expanded Medicaid reimbursement for provision of community care services like ACT teams, intensive case management and integrated treatment facilities serving those experiencing homelessness (CBPP, 2022).
Develop joint federal task force between HUD, HHS, VA and USICH to improve coordination across housing, healthcare and income assistance programs supporting those experiencing homelessness.
State Solutions
Reform involuntary commitment statutes to promote early intervention while still protecting civil liberties of those struggling with untreated mental illness. Provide increased funding for transitional programs post-discharge (Morabito et al., 2012).
Implement state low-income housing tax credits similar to federal LIHTC to incentivize affordable housing development through public-private partnerships (Schwartz, 2015).
Increase Medicaid reimbursement rates and expand provider eligibility for community mental health services to improve access in rural and underserved areas through state medical assistance plans (National Council for Mental Wellbeing, 2022).
These solutions support a multifaceted, bipartisan policy approach focused on expanding funding, access and coordination across all levels of government while protecting civil rights. Research shows investment in supportive housing not only dramatically improves mental health, but also yields cost savings by reducing expensive emergency department visits, hospital stays, and incarceration among homeless populations (Ly & Latimer, 2015). Given this win-win potential, building political will for compromise around contentious issues like involuntary commitment is essential.
Overcoming Opposition
While evidence firmly supports the proposed policy changes, securing necessary bipartisan support across partisan lines and levels of government remains challenging. Conservative critics argue expanded government intervention in housing and healthcare sectors represents government overreach and exacerbates dependence on social services (Fraser & Estacio, 2021). On the other hand, progressive advocates express concerns around erosion of civil liberties through loosened commitment statutes and forced institutionalization (Stefan, 2022).
However, framing housing and treatment programs for those experiencing homelessness as a bipartisan public health emergency rather than partisan welfare reform is paramount to overcoming opposition (Fraser & Estacio, 2021). Highlighting shared values of compassion, fiscal responsibility, and personal agency can help find common ground. The policy solutions proposed emphasize voluntary enrollment, public-private partnerships and local coordination rather than federally mandated programs to help appease skeptics of government expansion. Personal stories and data illustrating the current humanitarian crisis and economic costs of inaction are also powerful advocacy tools to demonstrate urgent need for reform. A multifaceted information campaign targeting both voters and legislators emphasizing shared values and measurable policy impacts will be essential to build support.
Conclusion
In conclusion, individuals struggling with chronic homeless face alarming rates of untreated mental illness due to gaps in access to affordable housing, community-based care, and care coordination resources. Implementing the supportive housing, Medicaid reform and integrated healthcare policies proposed at federal and state levels represents a evidence-based approach shown to significantly improve public health outcomes while yielding long-term public savings. However, overcoming partisan divides by emphasizing shared values and bipartisan compromise around the current humanitarian and economic costs of inaction is paramount to translate demonstrated need into policy change. Addressing this major public health crisis requires commitment across government, nonprofit and private sectors to prioritize the health and housing security of our most vulnerable populations.
References
Centers for Medicare and Medicaid Services. (2022). Medicaid expansion & what it means for you. https://www.healthcare.gov/medicaid-chip/medicaid-expansion-and-you/
Doran, K. M., Ragins, K. T., Gross, C. P., & Zerger, S. (2013). Medical respite programs for homeless patients: a systematic review. Journal of health care for the poor and underserved, 24(2), 499–524. https://doi.org/10.1353/hpu.2013.0077
Fazel S., Geddes J.R., Kushel M. (2014). The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet, 384(9953), 1529-1540. https://doi.org/10.1016/S0140- 6736(14)61132-6
Fraser, J. & Estacio, E. V. (2021). Homelessness and the politics of social welfare. The Foundation for Government Accountability. https://thefga.org/wp-content/uploads/2021/03/Homelessness-and-The-Politics-of-Social-Welfare-Policy.pdf
Henry, M., de Sousa, T., Roddey, C., Gayen, S.T., & Bednar, T.J. (2022). The 2020 annual homelessness assessment report (AHAR) to Congress. U.S. Department of Housing and Urban Development. https://www.huduser.gov/portal/sites/default/files/pdf/2020-AHAR-Part-1.pdf
Ly A., & Latimer E. (2015). Housing first impact on costs and associated cost offsets: a review of the literature. Canadian Journal of Psychiatry, 60(11), 475-487. https://doi.org/10.1177/070674371506001103
Matsui, K. (2022). Local zoning and housing supply. Brookings Institute. https://www.brookings.edu/research/local-zoning-has-had-a-major-impact-on-u-s-housing-supply/
Morabito M.S., Pyne J., Fortney J., Currier P.A., & Bruckn C.T. (2012). The effectiveness of outpatient civil commitment. Psychiatric Services, 63(3), 250-256. https://doi.org/10.1176/appi.ps.201100491
National Council for Mental Wellbeing. (2022). Medicaid for mental health and addiction: state profiles and innovative strategies. https://www.thenationalcouncil.org/wp-content/uploads/2022/09/09122022_Medicaid_Profiles_Full_F2-web.pdf?daf=375ateTbd56
National Institute of Mental Health. (2021). Mental illness. https://www.nimh.nih.gov/health/statistics/mental-illness.shtml
Schwartz, H. (2015). Housing policy is school policy: Economically integrative housing promotes academic success in Montgomery County, MD. The Education Digest, 6-12.
Stefan, S. (2022). Beyond prisons: Freedom, decarceration and justice disability issues in critical race theory. Yale University Press.
Substance Abuse and Mental Health Services Administration. (2022). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health. https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases-https://www.samhsa.gov/data/release/2020-national-survey-drug-use-and-health-nsduh-releases-
United States Interagency Council on Homelessness. (2022). Report of the Federal Task Force on Homelessness Among Persons with Severe Mental Illness. https://www.usich.gov/news/report-of-the-federal-task-force-on-homelessness-among-persons-with-severe-mental-illness/
US Department of Justice. (2020). Olmstead: Community integration for everyone. https://www.ada.gov/olmstead/olmstead_about.htm
