Using Photovoice to Codesign Strategies for Increasing Access to Behavioral Health Services in Community Health Improvement Planning

The essential public health services of community health assessment (CHA) and community health improvement planning (CHIP) entailed in Healthy People 2030 and Public Health Accreditation Board standards and measures for local health departments are underused in practice-based research. Innovative approaches are particularly needed to improve access to evidence-based behavioral health prevention and treatment services, given the persistent stigmatization of behavioral health conditions. We present a new way of thinking about community development in which other public health agencies can leverage their own CHA and CHIP processes for cross-sector, participatory codesign with behavioral health service providers and users to improve access to support, resources, and treatment. Codesign entails collaborative inquiry with providers and users to frame and reframe their collective understanding of challenges to accessing services and iteratively test solutions. In 2023-2024, we implemented the codesign process using photovoice to engage community members in Lexington, Kentucky, including those who had received behavioral health services, in identifying barriers (eg, stigma, transportation, financial constraints) to accessing behavioral health services. Photovoice insights led to the development of a comprehensive, coalition-sourced directory of local behavioral health resources and strategies to connect people in need with local services and promote cross-sector collaboration. These strategies included the design of media campaigns and training programs targeting the priority areas of financial stability, mental well-being, knowledge empowerment, and access to care. This study provides preliminary evidence that situating codesign methods and tools in CHA/CHIP processes is a feasible, effective, and replicable way to improve access to behavioral health services.