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Editor’s Note: Today’s guest contributor is Sally Raphel, a cousin and retired nurse, advocate and educator. She shares her views on why health care disparities continue, where there are promising signs and the changes needed to end these disparities.

Monumental stands on social justice have followed social upheaval. The end of World War II led to the adoption of two policy documents that make our current gaps and inequities in health care appalling. In 1948, the United Nations adopted the Universal Declaration on Human Rights and, more specific to health, the World Health Organization (WHO) Constitution (adopted in 1946) declared health and access to healthcare a fundamental human right. In 2013, the World Health Organization went further by broadening attention to the heath care rights of specific groups based on mental, gender and sexual health which led to a focus on determinants of health, including social (WHO, 2013).

While numerous gaps in adherence to these principles exist, the injustices confronting those with mental, behavioral and substance use problems demand special attention. Opportunities to promote individual and societal health, behavioral health, and well-being are widespread.

 Changing the conversation and behavior of policymakers and health care providers will be difficult. Like other aspects of social and racial justice, as I have witnessed over my six-decade involvement in health care at both a practice and policy level, attention to inclusion and following of these clear principles goes through cycles of attention and inattention, especially when assisting those with mental, behavioral and substance use disorders to actively engage and propel their voices to the forefront of policies and programs. Those committed to promoting social justice globally through addressing the social determinants of health and equity within health, mental health, behavioral, and substance use problems must maintain focus on this equity issue if we are to have long-term systemic change.

One international mental health nursing group spoke out recently for social justice and social responsibility (ISPN, 2020). This association pointed out that those most affected by unequal care are individuals of any age with mental illness and substance use disorders who have poor access to care or services. Practicing equity and parity justice designed to repair harm done to the well-being of individuals, families, and communities is critical.

One barrier to be overcome is the conscious and unconscious bias in providing care to Black and non-Black People of Color and those with mental health or substance abuse issues. Too often care providers conclude that the person in their care does not understand or have the capacity for any treatment other than a pharmacological one. It is easier to prescribe drugs than to go deeper and develop a treatment plan that includes therapy and community support. Integrating self-reflective approaches that assist individual practitioners and policymakers to explore their personal biases and advocate for policy and personal behavioral changes that transcend them are basic to achieving any sustained gains in health care outcomes generally and in mental health and substance abuse specifically.  

Our society needs culturally competent educators who are literate in social justice equity and recognize their responsibility to develop curricula inclusive of the rights of all persons. The call is for promoting participatory parity in community-generated research and practice to better meet mental health needs while expanding knowledge of and quality healthcare for diverse populations. (ISPN, 2020).

The current federal environment is tuned into recent mental health impact of the COVID 19 pandemic. Attention must be paid to how each of us can foster forward movement of legislation and agency efforts that reach the most neglected and needy individuals of all ages.  Prime cohorts are migrant and Native American children and adolescents (Galehouse, 2021), older adults living with serious mental illness, health care workers and people feeling stressed and overwhelmed with continued COVID, the Ukraine war and the U.S. economy.

For those readers with a policy interest The Consolidated Appropriations Act, 2021 (the Appropriations Act) amended the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) to provide important new protections.  The Departments of Labor (DOL), Health and Human Services (HHS), and the Treasury (collectively, “the Departments”) have jointly prepared this document to help stakeholders understand these amendments. Frequently Asked Questions (FAQs) related to MHPAEA are available at and

We must pledge to share the message of social justice and social responsibility with those unaware, uninformed or powerless about the current state of neglect and human rights violations associated with mental health parity.

When one commits to the belief that everyone deserves equal economic, political, social, human rights and opportunities, we all succeed. With this commitment in mind, all who promote social justice and equity and treat all within its context with social fairness and equity move our society forward.

We are fully aware that engaging in this conversation will be challenging. Helping those with mental, behavioral and substance use disorders bring their voices and needs to the forefront of policies and program planning is vital. This critically important social justice responsibility and work is the imperative of the next decade.


Galehouse, P. 2021. Strengthening the safety nets for child and adolescent mental health. Archives of Psychiatric Nursing. Dec 28, 2021.

International Society for Psychiatric Mental Health Nurses (ISPN), 2020. Statement on Social Justice and Social Responsibility. Archives Psychiatric Nursing 35(1), p111-112.

Pan American Health Organization (PAHO), (2017). Health in the Americans + 2017. Regional Office for the Americas of the World Health Organization. Washington, DC.

World Health Organization (WHO), (2013). Mental Health Action Plan 2013-2020. WHO Documents Production Services. Geneva, Switzerland. 


  1. Bob Zdenek

    Excellent piece. Thank you for writing it and pointing out the wholistic response to mental health issues.

    • Tom Adams

      Thnaks Bob, good to hear your voice. Be well,


  2. sally mac

    With the latest mass shooting there will be a spot light on mental health until there’s not, a cry for gun control until our broken system squelches it. I search for Hope-my red state of GA is Slowly disbursing the America Cares Act money.. a few grants at a time.
    We all need to monitor this process as we head to the polls for both the primary and general election!

    • Tom Adams

      Thanks Sally for a remidner how all these stigmas and desire to ignore people who are different for any reason are connected. Mental health, structural racism, addicitions – fear of losing something or catching something drives so much of our holding back of compassion and resources. Always good to hear your voice. Tom