Public health is characterized by concern for the health of a population in its entirety and by awareness of the linkage between health and the physical and psychosocial environments. 1 Each year, nearly 44 million Americans, 26 percent of the population, 2 experience mental health problems. This means that mental health problems affect a larger proportion of the public than do diabetes or cancer (6.6% and 7% of adults in 2002, respectively) 3,4 and roughly the same proportion as do obesity (30% percent of adults older than 20 years of age in 2000). 5 However, public policy and funding in the United States continue to separate mental and physical illnesses in regard to treatment and funding, and to underfund mental health services and infrastructure. There is growing awareness that this separation and lack of resources has resulted in public health emergency for many communities.
Since the early 19th century, mental health services have evolved from the provision of care in a state-run institutional setting to the provision of a range of services that are integrated into a larger healthcare and community-based system. 6 The 19th century social reform, which brought forth new ideas about disease and social responsibility, occurred during the development of the mental health system. Together with the introduction of improvements in bacteriology and sanitary health measures, the movement provided the basis for public health in America. 7 The mental health system is rooted in the creation of the public health system; however, it has since evolved into a professional specialty independent, in many respects, from public health. This divergence has created challenges in the effort to offer a truly comprehensive and holistic public healthcare system.
Although most mental health programs are not implemented within the public health system, they remain rooted in a population-based public health model. Public health strategies focus on the health of a population in its entirety 8 and are designed to promote the prevention and treatment of mental illness throughout the United States. Faced with challenges such as combating stigma and discrimination, a population-based approach to mental health can aim to affect policies and access to care, while assuring quality treatment and incorporating stronger assessment techniques for monitoring the mental health of communities. 9 Because mental illnesses affect and are affected by chronic conditions, such as cancer, heart disease, diabetes, and HIV/AIDS, public health programs must incorporate support for mental health services. Untreated, mental illnesses often trigger unhealthy behavior, diminished immune functioning, and poor prognoses. 2
Through the collaboration of mental and public health, we can ensure comprehensive care and prevent the possibility of poor health behaviors and negative disease outcomes associated with untreated mental illness.
In 1999, the landmark Surgeon General's Report on Mental Health highlighted mental health as essential to achieving prosperity and reducing disability. In the efforts to promote the public's health, mental health promotion and the prevention of mental illness must be included as part of the overall health of the community. Subsequent reports, by the President's New Freedom Commission on Mental Health and the Institute of Medicine (Crossing the Quality Chasm), have highlighted the need for accessible high-quality health services. As noted by the President's New Freedom Commission on Mental Health, “as future opportunities emerge to transform health care in America, mental health care must be considered part of the reform necessary to achieve optimal health benefits for the American public.” 10 All of these factors speak to the need for stronger collaboration between public health and mental health authorities, providers, and interest groups.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. 11
Encouraging understanding of and collaboration between mental health and public health issues and communities resulted in the coming together of the National Association of County and City Health Officials (NACCHO) and the National Mental Health Association (NMHA) for a consensus meeting in April 2004. Participants identified key opportunities for incorporating public health practices into mental health services and exchanging resources and expertise to achieve the goal of improving the public's health. These guiding principles are based on the results of the consensus meeting and recommendations for increasing collaboration.
1. Education and Collaboration: Health promotion, through mental health and public health system collaboration, must be acknowledged and integrated into program planning and practice in the areas of chronic disease, environmental health, and maternal and child health. Mental health and public health policy makers and practitioners must promote increased awareness and collaboration at all levels, among federal, national, state, and local public health and mental health partners.
2. Comprehensive Planning: There is a need for collaborative and comprehensive plans at the local, state, and national levels that address the health and mental health needs of individuals, families, and communities. Strategic activities must respond to issues identified in community needs assessments and work toward Healthy People 2010 and New Freedom Commission priorities.
3. Partnership: Mental health and public health communities must create and foster partnerships to promote health and prevent adverse conditions. Partnerships must occur in all activities and situations, such as education, screening, and emergency/disaster response, and for all target populations, including prison and jail populations.
4. Communication: Communication between the mental health and public health professions and among community groups, policy makers, and the public is fundamental. Communication is essential for effective collaboration, planning, and partnership. Forums can encourage dialogue and improve communication among mental health and public health service providers. Sharing information about funding streams, service providers, and best practices can facilitate increased collaboration and support.
5. Workforce Development: As the nation's population becomes increasingly diverse, the composition of the health professional workforce must follow suit, drawing mental health and public health professionals from all races and ethnicities and all types of backgrounds. Mental health and public health have a mutual need for a highly trained and diverse workforce, and professionals must have opportunities for training and workforce development in each other's fields. Joint conferences, cross-trainings, and dialogue opportunities will enhance knowledge and practice of both mental health and public health professionals.
6. Data Collection: In the attempt to improve epidemiological data for mental health at the local, state, and national level, investments must be made in infrastructure development. Public health's knowledge of and capacity for epidemiology must be used to assist the assessment and enhancement of the surveillance and epidemiological capacity of mental health systems. Epidemiology can be used to profile mental health systems, similar to the way epidemiology is used to explain infectious disease.
7. Access: Early efforts at planning, partnership, workforce development, and communication will help make increased access and integrated services a reality. Integration of mental health and public health services will improve access to mental health services, and both the public health and mental health communities must advocate for more comprehensive insurance coverage for mental health services. Individuals must no longer settle for simply a medical home, but the mental health and public health communities should strive to provide access to a comprehensive “health home.”
Using these principles as a guide, NACCHO plans
* Utilize its unique role as representing local public health agencies to encourage other national organizations to facilitate collaboration and communication between federal, national, state, local, and community partners;
* Integrate the concept of mental health and public health into program planning and practice and advocate for significant and sustained funding to support these efforts;
* Identify best practices of mental health and public health communities that already work together;
* Share the work it is currently engaged in with constituents and stakeholders;
* Support more comprehensive insurance coverage for mental health services; and
* Share information with members on funding opportunities and resources that emphasize mental health.
NACCHO recently released Guiding Principles for Collaboration Between Mental Health and Public Health and an issue brief, Supporting Collaboration Between Mental Health and Public Health. For more information and copies of these publications, visit http://www.naccho.org/topics/HPDP/mentalhealth.cfm or contact: Julie Nelson Ingoglia at firstname.lastname@example.org.
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