We Need a Unifying Approach to Mental Health Care

Editor’s Note: This piece was originally submitted by Dr. Miceli as a comment to JAMA Health Forum in response to “How Anti-DEI Policies Adversely Affect Mental Health,” an article authored by Ruth Shim, MD, MPH. Dr. Miceli disclosed his affiliation with Do No Harm when submitting the comment; JAMA Health Forum rejected the submission. 

In the midst of a mental health crisis in the United States it is myopic and mistaken to claim that policies seeking to end DEI’s divisive, discriminatory excesses are adversely affecting mental health. We need to acknowledge the state of behavioral health and address these challenges in their entirety, not through the polarizing lens of structural discrimination.

Unfortunately, mental health in America has declined over time. It is misguided, however, to argue that DEI is “crucial to ensure the emotional well-being of the entire US population.”  The New York Times Magazine, for example, highlighted how DEI created a more negative atmosphere at the University of Michigan even after the school spent roughly $250 million building a bureaucracy trying to make it work. DEI is no panacea.

The evidence Shim offers for DEI’s mental health benefits is shaky as well, with more nuance than her conclusions suggest. In one study cited, state immigration policies labeled as “exclusionary” were “not associated with psychological distress.” In another, used by Shim to argue that state policies have led to fewer discriminatory experiences, the authors plainly state they “cannot claim that the policies themselves created an environment where [trans and nonbinary] people are less likely to experience discrimination.” Moreover, a third paper comments that causality of policies and their potential implications on mental health “cannot be inferred.”

While the relationship between policy and mental health is more tenuous than portrayed, it is also clear that some of the article’s claims overstate the totality of evidence. In one referenced study, reported concern regarding discrimination was “not associated with alcohol use, depression, or ADHD at follow up.” In another, there was no statistically significant reduction in suicidality, as related to state-level nondiscrimination policies, for “gender minority children and adults” in three of four cohorts by the study’s concluding year. And, in another, income may have played a factor in biasing results, compounded by the limited number of respondents with psychiatric disorders in select states.  The authors write, “the results must be interpreted with caution.”

Yet, caution is far removed in the case of DEI advocacy. Shim advances the narrative whereby “our underlying beliefs about people from different racial backgrounds” are shaped by “structural racism.” Such a pessimistic view of mankind ignores the progress America has made and loses sight of our individuality. This view has also spurred the development of harmful DEI programs and policy that prioritize the recruitment and admission of select groups, impose racial quotas, and solely offer racism as the driver of health disparities.

Now, more than ever, is not the time for division. Mental illness is a serious problem in America. To conflate it with policies that aim to correct DEI’s illiberal tyranny is simply wrong. We must take a unifying approach when examining the root causes of the behavioral health ailments facing our nation, rather than placing blame on policies restoring merit, fairness, and equality.