Local and personal factors, such as neighborhood, race, gender, and age, significantly influence our mental health status. Between 2000 and 2020, for example, rural communities experienced a 46 percent rise in suicide rates compared to a smaller, though still concerning, 27 percent rise in metro areas. And it is well known that communities of color experience less access to mental health services than white communities despite similar levels of need.

Current mental health policymaking tends to be insufficiently sensitive to these differences. Policy bodies like the National Governor’s Association are calling for more tailored mental health planning. However, state, county, and city governments are inconsistently skilled at developing local solutions. A recent study by the university policy research center I direct, CoLab for Community and Behavioral Health Policy, confirmed this capacity gap among mental health “policy intermediaries”—nongovernmental organizations that work closely with government to inform policy development. Among the more than 80 organizations in the United States, Canada, Britain, and Australia we surveyed, working with local communities was one of the least endorsed activities. Only 10 percent of organizations reported community engagement as a core activity of their policy support strategies. Information management capacities, such as reviewing and synthesizing the relevant research evidence, were much more common.

To be sure, the use of research evidence in policymaking is also valuable. Taxpayers should expect governments to steward resources responsibly and in a way that maximizes benefit to all citizens. However, in social policy, academics and policy makers can use the rhetoric of evidence-based policy in policy deliberations to dismiss rather than resolve the complex ways that community values and research evidence interact. After nearly 20 years of experience developing and studying mental health policy, I see the need for governments to use mental health and social science differently. Adequately addressing the local mental health needs of states, counties, and cities requires that governments and their partner organizations develop three interrelated competencies: 1) the ability to integrate research evidence with local information, 2) the ability to design solutions from the ground up to respond to local values, and 3) the ability to maintain trust and relationships within a political network over time.

Developing the capacity to integrate knowledge from research with knowledge of local needs, preferences, and system capacities requires that policy makers value multiple types of information equally. For the last 20 years or so, philanthropic and academic advocates for better social policymaking have emphasized the use of evidence-based practices. In this narrative, community engagement is not maligned, but it is framed as a “nice if you can do it” activity. For example, the World Health Organization’s guide for evidence-informed decision-making outlines hierarchies of evidence beginning with systematic reviews and ending with “colloquial” evidence such as citizen panels. However, underestimating the importance of local context and values when applying evidence can result in inelegant, blunt applications of the research. A 2013 study of 10 structured programs implemented by the State of Pennsylvania to prevent youth substance misuse and crime found that 44 percent of workers delivering these programs made on-the-fly adaptations because they lacked the time, resources, or interest in delivering the program exactly as written. Policies that lack input from citizens and service providers are likely to fail in implementation.

Read the full article about mental health policy by Sarah Cusworth Walker at Stanford Social Innovation Review.