The following is an excerpt adapted from A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being. The guide features recommendations for health care systems to improve mental health and well-being in the communities they serve, focusing specifically on saving lives from “deaths of despair.”

In support of Well Being Trust’s (WBT) strategic goal to save 100,000 lives from deaths of despair (i.e., deaths due to drugs, alcohol, and suicide) and dramatically increase healthy life years in the next 10 years, IHI partnered with WBT to evolve a set of recommendations and guidance to help propel the field to action by leveraging the role of health care systems to impact the health and well-being of the populations they serve within their walls and across their communities. The recommendations presented in A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being are informed by themes identified to date from a literature scan, the existing work of Well Being Trust, key informant interviews conducted by IHI, an expert stakeholder engagement meeting held via videoconference on March 31–April 1, 2020, and the experience and expertise of IHI.

Throughout this process, it has been clear that Well Being Trust and partners in the field are fostering a movement that can transform mental health and well-being in the US. Partners spoke of fundamental shifts in narratives, systems design, and use of aligned metrics as well as changes to public policy, organizational practices, and private sector investments. Indeed, such a movement is required to transform systems that can produce flourishing, thriving, equity, and associated vital community conditions rather than producing despair, suffering, and inequity.

The 1967 Folsom Report initially shared the theory that populations and communities can improve their health outcomes by leveraging explicit partnerships of “the boundaries within which a problem can be defined, dealt with, and solved.” This concept of “communities of solution” has evolved over decades to cement several principles that demonstrate how engaging a community wherever they may be on their transformation journey can lead to improved systems and processes and sustain outcomes in health, well-being, and equity. It is essential to acknowledge that transformational, system-level improvement requires a socioecological approach that introduces changes to relationships, networks, culture, and mindsets operating within complex dynamic systems. This transformational, asset-based improvement begins with the community articulating what matters to them, listening and partnering with people with lived experience (PWLE), forming effective stakeholder partnerships, building core improvement skills to ensure sustainability, and constructing core functions to support facilitation of the work. Built on the learnings from the literature, expert interviews, and stakeholder engagement, A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being describes a recommended population-based approach, based on the Pathways to Population Health Framework, that outlines “who” (potential partners and communities to engage as we consider, “Whose lives will get better because of this work?”), “how” (methods to employ), and “what” (interventions to focus on) for health systems to affect deep change in communities that will save lives, improve well-being, and advance equity.

• Who: In the population-based approach, key stakeholders start by identifying the “who” — whose lives will be improved? This section of A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being offers three suggested populations or population segments who bear a disproportionate burden of despair and with whom health systems might work to drive change. Once a population is identified, this becomes the focus around which to build partnerships and organize efforts to save lives from deaths of despair.
• How: The methods used to affect change matter. Not all change is improvement and not all improvement is improvement for all. Without intention, inequities persist or worsen. IHI recommends equity-centering methods that are relevant across the specific “who” and “what.” These methods are anchored in the science of improvement and demonstrated techniques to center equity. Not only does IHI expect the approaches to lead to measurable improvements in outcomes toward preventing deaths of despair, we have also witnessed that organizations and communities utilizing these approaches build longstanding, sustainable, and renewable capacity and capability to impact change over time and to continue creating the vital community conditions for well-being.

• What: Regardless of the population identified, the primary drivers of change are similar and can be thought of in these four general categories:
• Contribute to an environment that promotes flourishing
• Prevention and recovery
• Early identification
• Treatment

As health care systems and their partners engage in work to save lives from deaths of despair by organizing their efforts around the “who,” they will also need to prioritize the activities, solutions, innovations, and improvements that matter most within their contexts. Central to the overarching goal of saving 100,000 lives from deaths of despair is moving toward a system where all people and places thrive. Making this shift requires building on existing assets, incorporating new models into traditional structures, and creating space for new thinking related to equity, flourishing, and the associated vital conditions.

For more detailed guidance — including “start here” suggestions for making incremental improvements — please download A Guide for Health Systems to Save Lives from “Deaths of Despair” and Improve Community Well-Being.

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