Deborah Altschul

Bio: Deborah Altschul is an academic researcher from University of New Mexico. The author has contributed to research in topics: Rural area & Mental health. The author has an hindex of 6, co-authored 9 publications receiving 481 citations.

Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations

Abstract: Indigenous Peoples of the Americas have experienced devastating collective, intergenerational massive group trauma and compounding discrimination, racism, and oppression. There is increasing evidence of emotional responses to collective trauma and losses among Indigenous Peoples, which may help to inform ways of alleviating psychological suffering and unresolved grief. Tribal cultural and regional differences exist which may impact how the wounding across generations and within an individual's lifespan are experienced and addressed. This article will review the conceptual framework of historical trauma, current efforts to measure the impact of historical trauma upon emotional distress, and research as well as clinical innovations aimed at addressing historical trauma among American Indians/Alaska Natives and other Indigenous Peoples of the Americas. We will discuss assessment of historical trauma and implications for research and clinical as well as community interventions, and conclude with recommendations.

Capacity for delivering culturally competent mental health services in New Mexico: results of a statewide agency survey.

Abstract: The Federal government has promoted National Standards for Culturally and Linguistically Appropriate Services (CLAS) to reduce mental health disparities among Hispanic and Native American populations. In 2005, the State of New Mexico embarked upon a comprehensive reform of its behavioral health system with an emphasis on improving cultural competency. Using survey methods, we examine which language access services (i.e., capacity for bilingual care, interpretation, and translated written materials) and organizational supports (i.e., training, self-assessments of cultural competency, and collection of cultural data) mental health agencies in New Mexico had at the onset of a public sector mental health reform (Office of Minority Health 2001).

A longitudinal analysis of peer-delivered permanent supportive housing: Impact of housing on mental and overall health in an ethnically diverse population.

Abstract: Permanent supportive housing (PSH) is an evidence-based health intervention for persons experiencing homelessness, but the impact of individual mechanisms within this intervention on health requires further research. This study examines the longitudinal impact of the mechanism of supportive housing within a peer-delivered PSH model on overall health and mental health (as measured by psychological distress and self-report of bothersome symptoms) outcomes in an ethnically diverse population. The 237 participants in the study included persons who were homeless or at risk of homelessness and who also had been diagnosed with a serious mental illness. Sixty-one percent of all participants received supportive housing. All 3 outcomes were significantly associated with quality of life indicators, recovery, and social connectedness. In addition, overall health was significantly associated with employment, age, and psychological distress. Psychological distress was associated with gender, type of housing, and history of violence or trauma. Experiencing bothersome symptoms was associated with drug use, history of violence or trauma, and psychological distress. Longitudinal models of these 3 outcomes showed that supportive housing was significantly associated with good to excellent health 6 months after baseline (odds ratio = 3.11, 95% confidence interval [1.12, 8.66]). The models also demonstrated that the supportive housing and comparison groups experienced decreased psychological distress after baseline. The results of this study demonstrate the importance of supportive housing within the context of PSH, particularly for the overall health of participants, and the positive overall impact of PSH on mental health in a diverse population. (PsycINFO Database Record

Workforce Capacity for Reducing Rural Disparities in Public Mental Health Services for Adults with Severe Mental Illness.

Abstract: The President's New Freedom Commission (2003) called for the elimination of service disparities in rural areas by addressing barriers in access, acceptability and availability. Barriers to accessibility include unemployment, poverty, inability to pay for services, inadequate insurance, transportation, and lack of knowledge of the need for and availability of care (Fortney et al., 2001; Merwin, Snyder, & Katz, 2006). Barriers to acceptability include stigma, confidentiality concerns, attitudes of self-reliance, and lack of cultural competence among providers (Willging, Waitzkin, & Nicdao, 2008). This article focuses on the third barrier--availability of services related to rural disparities in workforce capacity. General disparities between rural and urban workforce capacities are well documented (Fortney et al., 2001; Merwin, Snyder, & Katz, 2006; Ellis et al., 2009; Konrad et al., 2009; Thomas et al., 2009). Disparities between different rural and urban environments and the impact of these disparities on service planning and program development remain an issue. Language: en

The Impact of Mental Illness Stigma on Seeking and Participating in Mental Health Care

Abstract: Treatments have been developed and tested to successfully reduce the symptoms and disabilities of many mental illnesses. Unfortunately, people distressed by these illnesses often do not seek out services or choose to fully engage in them. One factor that impedes care seeking and undermines the service system is mental illness stigma. In this article, we review the complex elements of stigma in order to understand its impact on participating in care. We then summarize public policy considerations in seeking to tackle stigma in order to improve treatment engagement. Stigma is a complex construct that includes public, self, and structural components. It directly affects people with mental illness, as well as their support system, provider network, and community resources. The effects of stigma are moderated by knowledge of mental illness and cultural relevance. Understanding stigma is central to reducing its negative impact on care seeking and treatment engagement. Separate strategies have evolved for counteracting the effects of public, self, and structural stigma. Programs for mental health providers may be especially fruitful for promoting care engagement. Mental health literacy, cultural competence, and family engagement campaigns also mitigate stigma's adverse impact on care seeking. Policy change is essential to overcome the structural stigma that undermines government agendas meant to promote mental health care. Implications for expanding the research program on the connection between stigma and care seeking are discussed.

Association of poor housing conditions with COVID-19 incidence and mortality across US counties.

Abstract: Objective Poor housing conditions have been linked with worse health outcomes and infectious disease spread. Since the relationship of poor housing conditions with incidence and mortality of COVID-19 is unknown, we investigated the association between poor housing condition and COVID-19 incidence and mortality in US counties. Methods We conducted cross-sectional analysis of county-level data from the US Centers for Disease Control, US Census Bureau and John Hopkins Coronavirus Resource Center for 3135 US counties. The exposure of interest was percentage of households with poor housing conditions (one or greater of: overcrowding, high housing cost, incomplete kitchen facilities, or incomplete plumbing facilities). Outcomes were incidence rate ratios (IRR) and mortality rate ratios (MRR) of COVID-19 across US counties through 4/21/2020. Multilevel generalized linear modeling (with total population of each county as a denominator) was utilized to estimate relative risk of incidence and mortality related to poor housing conditions with adjustment for population density and county characteristics including demographics, income, education, prevalence of medical comorbidities, access to healthcare insurance and emergency rooms, and state-level COVID-19 test density. We report incidence rate ratios (IRRs) and mortality ratios (MRRs) for a 5% increase in prevalence in households with poor housing conditions. Results Across 3135 US counties, the mean percentage of households with poor housing conditions was 14.2% (range 2.7% to 60.2%). On April 21st, the mean (SD) number of cases and deaths of COVID-19 were 255.68 (2877.03) cases and 13.90 (272.22) deaths per county, respectively. In the adjusted models standardized by county population, with each 5% increase in percent households with poor housing conditions, there was a 50% higher risk of COVID-19 incidence (IRR 1.50, 95% CI: 1.38–1.62) and a 42% higher risk of COVID-19 mortality (MRR 1.42, 95% CI: 1.25–1.61). Results remained similar using earlier timepoints (3/31/2020 and 4/10/2020). Conclusions and relevance Counties with a higher percentage of households with poor housing had higher incidence of, and mortality associated with, COVID-19. These findings suggest targeted health policies to support individuals living in poor housing conditions should be considered in further efforts to mitigate adverse outcomes associated with COVID-19.

Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy.

Abstract: Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action.