Reimagining Equity: New Ethical Approaches in Mental Health Research, Treatment, and Policy

Joanne C. Suarez^1*Julia Knopes²Lexi C. White³Virginia A Brown⁴Edmund Howe⁵

• ¹Prospera Institute, Boston, United States
• ²Case Western Reserve University School of Medicine, Cleveland, United States
• ³Banner Health, Phoenix, United States
• ⁴Hastings Center, Garrison, United States
• ⁵Uniformed Services University of the Health Sciences, Bethesda, United States

In line with the focus of this issue-New Approaches for Improving Equity in Mental Health Research, Treatment, and Policy-we bring forward scholarship that not only engages with underrepresented experiences but also challenges the norms of who participates in, benefits from, and leads mental health research. This vision resonates with broader efforts to push the boundaries of who defines ethical inquiry and to build frameworks that are braver, broader, and more attuned to social justice (Suarez, 2022). Such approaches demand that we not only include underrepresented communities but also reshape the ethical foundations of mental health research to reflect their lived realities. Grounded in a commitment to ethical rigor and community relevance, this collectiontes authors to help reimagine a research landscape that centers those most affected by psychiatric systems-particularly persons living with conditions that are underacknowledged to others; from underrepresented communities such as Black, Latinx, and LGBTQ+ populations; whose values and experiences are shaped by cultural beliefs beyond biomedicine; and whose access to care is limited by geography or constrained by broader structural inequities. Here we provide an overview of selected articles to prime your reading experience.In the French context, Fond et al. (2023) found that people with schizophrenia living in povertydespite having access to medical care-still experienced worse health outcomes, inconsistent housing, and fewer opportunities for social engagement. Notably, one unexpected and positive finding from this same study was that poverty was not associated with diminished social functioning or quality of life. "Surprisingly," the authors write, "individuals in poverty reported higher self-esteem levels compared to their wealthier counterparts." This counterintuitive result suggests important new directions for inquiry and emphasizes the importance of examining protective psychological and cultural factors within low-income populations.Contributions by Edalati, Katan, and Taha (2023) direct attention to the intersection of substance use and mental health concerns, especially within Indigenous and other underserved populations in Canada. The authors emphasize that the grip of physiological dependence from substance use may be even harder to overcome than the mental illness itself, and argue for the need to integrate treatment structures across systems to effectively support individuals with co-occurring conditions. Across several articles, the literature calls us to carefully assess justice in mental health-both within and beyond clinical settings (Knopes & Guidry-Grimes 2023). The issue also surfaces urgent ethical dilemmas, such as those surrounding involuntary hospitalization. Aguirre (2023) and Howe (2023) explore how patients with severe suicidal ideation may resist hospitalization, while providers, fearing liability, may default to hospitalization even when other forms of support are viable. The authors argue that although hospitalization can offer short-term safety, it can also increase long-term trauma and risk. Howe proposes that providers consider strategies rooted in patient autonomy-such as scheduled check-ins and affirming patient selfknowledge-as alternatives to premature hospitalization. These approaches encourage patients to signal when they feel safe versus when additional support is needed, helping to build trust and preserve dignity in the treatment process.Articles in this issue also offer additional context for understanding how mental health conditions intersect with other identities and social locations. Osman et al. ( 2024), for instance, highlight the co-occurrence of anxiety and depression during the postnatal period and challenge the tendency to silo these conditions. Their findings underscore the need for care models that reflect the complexity of lived experience, especially among birthing people whose symptoms may be overlooked or minimized. Meanwhile, contributions by Fu (2024) focus on aging populations, specifically those experiencing dementia, and emphasize the critical role of community health systems in supporting recovery and stability over time. Camacho et al. (2023) present a compelling example of participatory social network research in Colombia, mapping gaps in the mental health service landscape through community collaboration. Their approach mirrors broader calls to integrate structural and intersectional competencies into care delivery (Howe 2025). In practical terms, this means providers are encouraged to ask not only about symptoms but also about external stressors-like whether a patient has transportation to the clinic or access to childcare. The articles collectively assert that equitable treatment must also account for how structural barriers and cultural values influence access to care.Stigma remains a pervasive and harmful force across all contexts. The historical exclusion of women from research is now broadly acknowledged, and increasing attention is being paid to the mental health needs of pregnant persons. Yu (2024) reminds us that ableism continues to shape assumptions about capacity and worth, especially for people with disabilities and psychiatric diagnoses. Often unconsciously, systems treat difference as deficit, limiting patients' agency and potential. In response, this issue includes calls for affirmative, anti-ableist models of care and scholarship. Conversely, gender and sexual identity also emerge as powerful dimensions of analysis. Hambruch (2025) and Alibudbud (2024) address mental health among LGBTQ+ individuals and advocate for affirmative psychotherapy practices that validate identity, reduce internalized stigma, and acknowledge the compounding effects of minority stress. For instance, the use of inclusive language-like "pregnant persons"-is emphasized as a deliberate act of recognition for individuals who may not identify within traditional gender categories. Heinze (2024) explores mental health outcomes among visually impaired populations, revealing that approximately nine out of ten Black participants expressed feelings of determination and resilience in the face of their visual impairment. This highlights that black participants, despite systemic challenges encountered with visual limitations, report higher levels of optimism and selfacceptance compared to other groups. While the basis for this optimism remains unclear, the study suggests that cultural and community-based factors may play a protective role-another area ripe for future exploration.Despite the serious challenges highlighted across the issue, many of the authors propose tangible, hopeful solutions. Lei (2025) argues that burnout in academic and professional spaces can be mitigated through thoughtful hiring practices and attention to role fit. Ding (2024) expands cancer treatment models to consider the emotional needs of patients' partners, offering a dyadic coping framework that could improve medical outcomes through relational care. These ideas reflect a broader paradigm shift: one that embraces holistic, interconnected understandings of health. Authors also highlight the importance of training and systems-level adaptation. In Turkey, primary care providers with in-service psychiatric training were significantly more confident and effective in prescribing psychotropic medications. As antidepressants, mood stabilizers, and benzodiazepines become more commonly used, this training is increasingly vital. Articles recommend expanded telepsychiatry programs and cross-disciplinary collaborations with pharmacies to increase access and medication literacy, particularly in rural and underserved areas. Elsewhere, innovations include low-tech solutions such as disseminating mental health information via radios during emergencies or leveraging smartphones to expand treatment access in resource-limited settings. Collectively, these strategies demonstrate that impactful change doesn't always require high-tech interventions-just thoughtful, human-centered design. The overall ethical thrust of this issue is to prioritize those who have historically been excluded or underserved. From the structurally marginalized to those navigating conditions, this collection calls for a research and treatment paradigm grounded in collaboration, dignity, and justice. Authors remind us that in order to improve equity in mental health, we must reflect on what kinds of knowledge are valued, whose voices are invited in, and how we design systems that meet people where they are. This issue ultimately asks mental health professionals, researchers, and policymakers to reimagine what's possible when those most affected by psychiatric systems are seen not just as subjects of research, but as co-creators of solutions. We hope the work shared here sparks new insights and shared commitment to advancing a more just, inclusive, and healing mental health future.As you read through this collection, we invite you to consider the variety of voices, practice perspectives, and themes that emerge-particularly as this issue highlights how intersecting factors render individuals with serious mental illnesses more vulnerable.