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Respond to this Discussion by supporting or expanding on the ideas identified or sharing additional perspectives on the population, advocacy priorities, and/or policies described . Reference within Five years in APA Advocacy Priorities for African American Adults with Depression in Underserved Communities As a mental health nurse who has been involved in diverse mental health initiatives designed for minority groups, I am well-positioned to advocate for African American adults aged 45-65 living in underserved areas who face unparalleled and persistent challenges in accessing equitable mental health care, especially for the treatment of depression (Pederson, 2023; Lee et al., 2021). Depression in this population is oftentimes underdiagnosed and undertreated due to structural inequities, provider bias, and poor access to culturally competent services (Jimenez et al., 2022). The primary advocacy priority for this group is improving access to affordable and culturally responsive mental health care, with a specific emphasis on upholding an already existing health policy: the Mental Health Parity and Addiction Equity Act (MHPAEA). Defining the Health Need and Outcome The specific need of this population is centered on timely, affordable, and effective identification of the condition (depression), effective diagnoses, and treatment of depression that is accessible within the underserved community. This definition of these needs must conform and align with cultural and aligned with cultural values and linguistic preferences. Depression in African Americans is oftentimes stated differently, with somatic symptoms or spiritual distress rather than conventional mood symptoms, contributing to misdiagnosis or dismissal by healthcare providers (Thacore & Dharwadkar, 2024; DeJoseph, 2021). The specific goal is to heighten equity in depression care, resulting in elevated rates of diagnosis, treatment adherence, and enhanced mental health outcomes. How Disparities are Reflected in Policy and Policy is Reflected in the Disparities Disparities are both reflected in health policy and perpetuated by it. This two-way relationship can be witnessed in the mental health care experiences of African American adults aged 45-65 living in underserved communities. These individuals face significant barriers to receiving timely, affordable, and culturally appropriate treatment for depression. While policies such as the Mental Health Parity and Addiction Equity Act (MHPAEA) are designed to ensure equal coverage for mental health and physical health conditions, their implementation often falls short in communities of color. This inconsistency in enforcement reflects a broader neglect in policy development, where racial and socioeconomic inequities are embedded in the very structure of the healthcare system (Williams & Cooper, 2019). One way disparities are reflected in policy is through the chronic underfunding of mental health services in predominantly African American neighborhoods (McGorry et al., 2022). When state and federal health budgets allocate fewer resources to these communities, it signals a lack of commitment to equity. Policies may technically exist, but they do little to address real-world disparities without targeted investment, proper enforcement, or cultural relevance. For instance, African American patients relying on Medicaid often struggle to find providers who accept their insurance, mainly due to low reimbursement rates (Bailey et al., 2019). This policy-induced financial barrier mirrors and sustains existing racial and economic inequities in mental health access. Conversely, health policy decisions can also serve to reinforce disparities. In many states that have not expanded Medicaid under the Affordable Care Act, a disproportionate number of uninsured individuals are African American. This lack of coverage severely limits access to necessary mental health services, including therapy and medication management (Smedley & Seligman, 2019). Furthermore, the lack of policy incentives to recruit and retain diverse mental health professionals contributes to a lack of culturally competent care. Patients who do not see themselves reflected in the providers available to them may feel misunderstood or stigmatized, which can discourage treatment adherence and further worsen outcomes. In my clinical experience working with African American patients, I have witnessed firsthand how policy failures manifest in real life. Many of my patients have reported long delays for care or difficulty continuing therapy due to cost or poor provider fit. I have had patients discontinue treatment because they did not feel culturally understood, or because they could not find transportation to distant providers who accepted their insurance. These challenges are not personal shortcomings—they are the consequences of systemic policy decisions that fail to address the specific needs of underserved communities. Role of Nursing in Policy Advocacy As a frontline health care professional, who has observed firsthand how policies influence decisions, I have realized that advanced practice nurses and other healthcare professionals in the psychiatry domain must utilize clinical data to identify disparities in access, health outcomes, and satisfaction with care. Healthcare professionals can publish op-eds and fully engage with stakeholders and policymakers to push for more vigorous enforcement of MHPAEA. Healthcare professionals in mental health settings can also ensure that screening instruments such as PHQ-9 are used in daily routines within the underserved communities. Collectively, advanced nurses and health care leaders who head nursing organizations such as the National Black Nurses Association (NBNA) can play an integral role in influencing health policy (National Black Nurses Association, 2025). Through well-designed advocacy campaigns, policy briefs, and collaboration with civil rights organizations, these leaders can foster the increase of funding for community-based mental health services and the enforcement of MHPAEA in managed care plans and Medicaid, as well as cultural competency training and workshops for mental health care providers and professionals. Nurse leaders can also advocate for mental health parity audits in clinical settings that render services to Black communities, guaranteeing that compliance is checked and gaps are addressed.

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