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Health impact assessment (HIA) is a systematic research and public engagement tool used to elevate health and equity in public policies. However, HIA practitioners often overlook potential mental health impacts. The purpose of this paper is to review the degree to which mental health is included in HIAs in the USA.

The authors conducted a systematic review of 156 HIAs that were completed between 1993 and 2013 for their inclusion of mental health. HIAs were subdivided to assess if mental health conditions or their determinants were measured, and if predictions or mitigation strategies were made in the scoping, assessment, or recommendations phases.

Overall, 73.1 percent of HIAs included mental health. Of the HIAs that included mental health (n=114), 85.1 percent also included the determinants of mental health and 67.6 percent included mental health outcomes. 37.7 percent of HIAs measured baseline mental health conditions and 64.0 percent predicted changes in mental health as the result of implementing the proposed policy, plan, or program. Among the HIAs that made predictions about mental health, 79.5 percent included recommendations for potential changes in mental health, while only 46.6 percent had measured mental health at baseline.

Although many HIAs included mental health in some capacity, this paper quantifies that mental health is not included in a robust way in HIAs in the USA. This presents a difficulty for efforts to address the growing issues of mental health and mental health inequities in the populations.

This paper represents the first academic endeavor to systematically assess the state of the field of HIA for its inclusion of mental health.