Systems that promote mental health in the teeth of oppression.

Emotional distress can disproportionately disable individuals from minoritized groups, such as Black Americans, due to multiple intersecting factors. Addressing these challenges requires a comprehensive, culturally sensitive approach to mental health care that promotes inclusivity, accessibility, and representation within the field, to foster empowerment and resilience among minoritized communities. Given the weight of negative factors that can lead to psychological distress and mental illness, the wellness of Black Americans and how they support their mental health is important to acknowledge. In this Series paper, we propose that Black Americans have developed systems for managing many of these threats to their survival and wellbeing.

Escaping the Catastrophic Logic of Separation.

In the philosophical system of American Apartheid, "race" is a fact, racial hierarchy a key corollary, and "separation of races" in status, rights, and geography a logical inference. The concept of racial hierarchy proved useful in the early colonial period in Virginia and elsewhere, first begun in the 1600s to keep indentured servants and enslaved people from joining together and overthrowing the plantation oligarchy. The discourse of separation has continued to be a key tactic for gaining and maintaining power, with profound harmful consequences for the nation. This article will explore three themes that are important for these times: (1) the ongoing "redlining system" that continues to ensnare us in a geography of apartheid; (2) the paradox of apartheid that "separation" binds the parts more firmly together; and (3) the "new racism" that attacks progress with the use of such farfetched ideas as the "replacement theory." From these explorations, I propose ways in which TRUTH and RECONCILIATION can be mobilized to put us on a new path.

What We "Cannot Not Know in America": 400 Years of Inequality and Seven Sins.

The 400 Years of Inequality Project was created to call organizations to observe the 400th anniversary of the first Africans landing in Jamestown in 1619. The project focused on the broad ramifications of inequality. Used as a justification of chattel slavery, structures of inequality continue to condition the lives of many groups in the US. Over 110 organizations joined this observance and held 150 events. The highlight of the year was the homily given by Reverend William Barber II, co-chair of the Poor People's Campaign, who described the "seven sins" that link the concept of inequality to every aspect of national life, from politics to militia. These "seven sins" help us to analyze and address crises, such as the COVID pandemic.

Neighborhood Trauma Due to Violence: A Multilevel Analysis.

In Syracuse, New York the social determinants of trauma from neighborhood violence are rooted in historical processes, including urban renewal, the Rockefeller drug laws, and de-industrialization. These contributed to destabilizing Syracuse communities of color, resulting in disproportionate incarceration, family disruption, and economic devastation. Community violence, clustering in densely populated neighborhoods, creates unmanageable stress for the families who live in them. A map of gunshots and gun fatalities (2009 to 2014) illustrates the continuing onslaught of bullets being fired, often in close proximity to elementary schools. A community survey indicated that over half of respondents personally knew more than 10 murder victims. Half the respondents scored positive on the Civilian PTSD Checklist; there thus is a great deal of unaddressed traumatic stress in the community. This analysis, conducted to prepare for planning future interventions to reduce the community trauma and violence, is part of an ongoing university-community collaboration.

Hospitality Invites Sociability, Which Builds Cohesion: a Model for the Role of Main Streets in Population Mental Health.

The aim of this study was to investigate the contribution of main streets to community social cohesion, a factor important to health. Prior work suggests that casual contact in public space, which we call "sociability," facilitates more sustained social bonds in the community. We appropriate the term "hospitality" to describe a main street's propensity to support a density of such social interactions. Hospitality is a result of the integrity and complex contents of the main street and surrounding area. We examine this using a typology we term "box-circle-line" to represent the streetscape (the box), the local neighborhood (the circle), and the relationship to the regional network of streets (the line). Through field visits to 50 main streets in New Jersey and elsewhere, and a systematic qualitative investigation of main streets in a densely interconnected urban region (Essex County, New Jersey), we observed significant variation in main street hospitality, which generally correlated closely with sociability. Physical elements such as street wall, neighborhood elements such as connectivity, inter-community elements such as access and perceived welcome, and socio-political elements such as investment and racial discrimination were identified as relevant to main street hospitality. We describe the box-circle-line as a theoretical model for main street hospitality that links these various factors and provides a viable framework for further research into main street hospitality, particularly with regard to geographic health disparities.

Medicine for the City: Perspective and Solidarity as Tools for Making Urban Health.

The United States has pursued policies of urban upheaval that have undermined social organization, dispersed people, particularly African Americans, and increased rates of disease and disorder. Healthcare institutions have been, and can be, a part of this problem or a part of the solution. This essay addresses two tools that healthcare providers can use to repair the urban ecosystem-perspective and solidarity. Perspective addresses both our ability to envision solutions and our ability to see in the space in which we move. Solidarity is our ability to appreciate our fellowship with other people, a mindset that is at the heart of medical practice. These two tools lay the foundation for structurally competent healthcare providers to act in a restorative manner to create a health-giving built environment.

Ministers' perceptions of church-based programs to provide depression care for African Americans.

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.

I used to cry every day: a model of the family process of managing displacement.

Community displacing events, natural or human made, are increasing in frequency. By the end of 2009, over 36 million people were known to be displaced worldwide. Displacement is a traumatic experience with significant short- and long-term health consequences. The losses and costs associated with displacement-social connections, employment, property, and economic capital-are felt not only by the displaced individuals but also the communities they have left behind, and the communities that receive displaced individuals. Many researchers have explored the link between health and reduced social, cultural, and economic capital. Most of the displacement literature focuses on the effect of displacement on the displaced individual; however, many families move as a group. In this study, we examined the family process of managing displacement and its associated capital losses by conducting interviews with 20 families. We found that families undergo a four-phase process of displacement: antecedent, uprooting, transition, and resettlement. The losses families experience impact the health and well-being of individuals, families, and communities. The degree to which the displacement process ends successfully, or ends at all, can be affected by efforts to both create connections within the new communities and rebuild economic and social capital.

Serial forced displacement in American cities, 1916-2010.

Serial forced displacement has been defined as the repetitive, coercive upheaval of groups. In this essay, we examine the history of serial forced displacement in American cities due to federal, state, and local government policies. We propose that serial forced displacement sets up a dynamic process that includes an increase in interpersonal and structural violence, an inability to react in a timely fashion to patterns of threat or opportunity, and a cycle of fragmentation as a result of the first two. We present the history of the policies as they affected one urban neighborhood, Pittsburgh's Hill District. We conclude by examining ways in which this problematic process might be addressed.

The limits of collaboration: a qualitative study of community ethical review of environmental health research.

OBJECTIVES: We assessed the effectiveness of various systems of community participation in ethical review of environmental health research. METHODS: We used situation analysis methods and a global workspace theoretical framework to conduct comparative case studies of 3 research organizations at 1 medical center. RESULTS: We found a general institutional commitment to community review as well as personal commitment from some participants in the process. However, difficulty in communicating across divides of knowledge and privilege created serious gaps in implementation, leaving research vulnerable to validity threats (such as misinterpretation of findings) and communities vulnerable to harm. The methods used in each collaboration solved some, but not all, of the problems that hindered communication. CONCLUSIONS: Researchers, community spokespersons, and institutional review boards constitute organizational groups with strong internal ties and highly developed cultures. Few cross-linkages and little knowledge of each other cause significant distortion of information and other forms of miscommunication between groups. Our data suggest that organizations designed to protect human volunteers are in the best position to take the lead in implementing community review.

Constructing peace: helping youth cope in the aftermath of 9/11.

The 9/11 terrorist attacks on New York City represented a new strain on already fractured communities with low collective efficacy. Like the majority of citizens in the greater metropolitan area, researchers at the Community Research Group of Columbia University Mailman School of Public Health wanted to "do" something to help in the aftermath of the attacks. The group proposed to promote collective recovery, that is, rebuilding social connections in the city as the foundation for individual and group recovery. After several months of organizing, New York City RECOVERS (NYCR)--a network of organizations formed to promote trauma recovery post 9/11--in conjunction with the New York University's International Trauma Studies Program, persuaded the New York City Department of Health and Mental Health and the FEMA-funded Project Liberty to sponsor a conference on collective recovery, with a focus on the first anniversary of the tragedy. Utilizing participant observation, the research team documented the outreach and dissemination efforts of NYCR, the partners' organizational engagement in collective recovery, and the recovery activities they pursued. This paper describes the work of the conference and the specific efforts for youth violence prevention that followed. In this circumstance, engaging community partners helped shift the research agenda from one driven by funders and researchers to one co-driven by the organizations and populations they aimed to influence.

Obvious and not-so-obvious strategies to disseminate research.

The findings of health disparities research will have to be disseminated to a broad public in order to influence health outcomes. Some strategies for dissemination are obvious, and these generally work for ideas that are within the mainstream of current paradigms. However, ideas that challenge existing theories and assumptions may require different, and not-so-obvious, strategies. This article discusses the use of movies and site visits as two novel strategies for research dissemination.

Remembering the lizard: reconstructing sexuality in the rooms of narcotics anonymous.

The crack epidemic was devastating to poor American communities in part because of the destruction wrought by the system of exchanging sex for drugs, which was a key feature of the crack-use culture. Sex-for-drugs exchanges were often conducted under unsafe circumstances and were linked to the spread of AIDS and other STDs, as well as unplanned pregnancies. The existence of this alternative system of sexual relationships threatened the economic viability of established commercial sex work and undermined the status and power of women. Narcotics Anonymous (NA) meetings helped men and women recover from crack addiction through a well-described 12-step process. Described as the rooms, these time- and space-specific encounters helped people become sober in the context of neighborhoods that were centers of the drug trade. Because of the key role of sex in the crack culture, transformation of sexual relationships was essential to establishing and maintaining sobriety. The manner in which the rooms of NA influence the sexuality and lifeworld of addicted people is explored using Barker's theory of ecological psychology.

Promoting collective recovery through organizational mobilization: the post-9/11 disaster relief work of NYC RECOVERS.

NYC RECOVERS, an alliance of organizations concerned with New York City's social and emotional recovery post-9/11, was formed to meet the need to rebuild social bonds strained or ruptured by the trauma to the regional system caused by the destruction of the Twin Towers. NYC RECOVERS, with minimal funding, was able to create a network of 1000 organizations spanning the five boroughs, carrying out recovery events throughout the 'Year of Recovery', September 2001 to December 2002. This paper describes the concepts, techniques and accomplishments of NYC RECOVERS, and discusses potentials of the model, as well as obstacles to its implementation.