Long journeys always start with a first step. One in four of us has a family member with brain disease. Maybe we've even been treated ourselves. What challenges were faced as the proper diagnosis and treatment were sought? What would have made our search easier? Others less familiar with, and trusting of, the human services system have a harder time than we. In our Role as governmental public health officials, the path to a better public health system might begin by inviting the director of a local mental health agency to lunch to talk things over and then, as a second step, considering who else might be invited to another meeting. Next steps will become clearer and confident as each one is taken.
Robert M. Pestronk, President, NACCHO
Mental illness affects an estimated 26.2 percent of adults aged 18 years and older in a given year.1 Latest estimates of the global burden of disease for 15- to 44-year-olds indicate that mental and behavioral disorders Represent 5 of the top 10 leading disease burdens. These disorders, which include depression, alcohol use disorders, self-inflicted injuries, schizophrenia, and bipolar disorder, create enormous costs in terms of suffering, disability, and economic loss.2 In addition, mental illnesses affect and are affected by a growing epidemic of chronic diseases such as heart disease, cancer, diabetes, and acquired immunodeficiency syndrome. Undiagnosed or untreated mental illnesses are significant, preventable contributors to the nation's poor health outcomes. A comprehensive, systematic public health approach is needed to improve mental health. The population-based public health approach is concerned with the health of an entire population, including its Relationships with physical, social, and psychological environments.3 This approach identifies modifiable Risk and protective factors and develops health promotion models, with the overall goal of preventing mental illness and promoting mental wellness.
According to the Operational Definition of a Functional Local Health Department from the National Association of County and City Health Officials (NACCHO), all local health departments (LHDs), as governmental entities, derive their authority and Responsibility from the state and local laws that govern them. Accordingly, all LHDs exist for the common good and are Responsible for demonstrating strong leadership in the promotion of physical, behavioral, environmental, social, and economic conditions that improve health and well-being; prevent illness, disease, injury, and premature death; and eliminate health disparities. Regardless of an LHD's specific capacity, authority, and Resources and Regardless of the particular local public health system, the LHD has a consistent Responsibility to coordinate intentionally all public health activities and lead efforts to meet standards.4 Increasingly, mental health is seen as an important public health issue, and LHDs are mobilizing to develop partnerships with public and private healthcare providers and institutions, community-based organizations, and other governmental agencies (eg, mental health, criminal justice, education) to collectively improve mental health promotion, prevention, early identification and intervention, and treatment service delivery. NACCHO plays an important Role in supporting their efforts.
Local Health Departments Integrate Mental Health
In 2006, NACCHO distributed the electronic version of “Integrating Mental Health and Public Health in Local Health Departments Survey” to assess the extent to which LHDs integrate mental health into existing public health program areas. The 249 Respondents consisted primarily of health department directors, public health nurses, administrators, health educators, and health promotion and planning specialists from 27 states across the country.
The survey found that 69 percent of Respondents have taken steps to integrate mental health and public health in their communities. Primarily, integration occurs in the areas of emergency preparedness (74%) and maternal and child health (47%). For example, many LHDs are training community mental healthcare practitioners to manage grief and loss issues associated with bioterrorism activity, and various maternal and child home visiting programs are incorporating mental health components into the curriculum. Integration also occurs in chronic disease prevention (23%), primary care (18%), and other program areas such as school health. In fact, 65 percent of Respondents wanted to expand mental health prevention and promotion into additional public health programs in the future. However, successful public health approaches to community mental health must involve multiple partners to ensure that initiatives are systematic, community-based, and ultimately sustainable. The survey found that 74 percent of Respondents have collaborated with community-based mental health organizations.
Local Health Departments Collaborate Around Mental Health
In spring 2004, NACCHO and Mental Health America (formerly known as the National Mental Health Association), a nonprofit agency dedicated to helping all people live mentally healthier lives, met with Representatives from the mental health and public health communities. Participants identified barriers to collaboration and developed plans and Recommendations to enhance policy and programming collaboration between mental health and public health at the local level. As a Result of this meeting, two documents, Guiding Principles for Collaboration Between Mental Health and Public Health and Supporting Collaboration Between Mental Health and Public Health Issue Brief, were produced. The first document was Recently included in the American Academy of Pediatrics' Strategies for System Change in Children's Mental Health: A Chapter Action Kit.
NACCHO further supported collaboration efforts through a demonstration site project in 2006. The project focused on the partnership and communication between local mental health and public health partners as the first step in enhancing collaboration. The demonstration sites established strategic planning coalitions to address mental health from a clinical and public health approach. The strategic planning and coalition-building processes were valuable because they created an opportunity for a diverse group of agencies to work together. Throughout the 9-month process, the demonstration sites successfully created strategic plans and models for the integration of mental health services, comprehensive screening tools, training materials for health department staff and primary care providers, and health education materials.
When Reviewing the demonstration sites' experiences, NACCHO found that successful collaborations shared certain characteristics. These include involvement of diverse community partners, Regular communication with local policy makers, education of primary care and mental health staff, strong Relationships with private providers, and attention to special populations. The following document was developed at the end of the demonstration site process: Lessons Learned: Mental Health, Public Health, and Primary Care Collaboration.
Current NACCHO Activities
Various Resources developed by NACCHO for LHDs address mental health. For example, the Medical Reserve Corps Training Matrix lists mental health as a core competency, encouraging the Medical Reserve Corps to train its volunteers in Psychological First Aid. Also, Project Public Health Ready contains two measures in its criteria (Goal 1) specifically Related to disaster behavioral health planning. The Maternal and Child Health Project at NACCHO has also developed Resources to promote mental wellness. The issue brief Women's Mental Health: Local Health Department Strategies in Addressing Depression Among Pregnant and Parenting Women was published in September 2007. This publication highlights the efforts of three LHDs working to integrate women's mental health activities into existing services. The brief also describes challenges LHDs experience and discusses steps LHDs can undertake to ensure the mental health of the women they serve.
NACCHO's Chronic Disease project is also working to address mental health. By spring 2008, NACCHO plans to Release volume 4 of its Building Healthier Communities series, Integrating Mental Health and Public Health in Local Health Departments. This compendium will provide LHDs with case studies of peers who have developed strong Relationships with community partners to address mental health in public health programming. Areas include depression, suicide prevention, and acute mental health during public health emergencies. Each case study includes lessons that LHDs have learned through their collaborative efforts as well as success stories and challenges faced during the development and implementation of their programs and interventions.
LHDs are uniquely positioned to address modern mental health challenges by integrating mental health into their program planning and coordinating Resources and services with other community stakeholders. NACCHO has created various tools and Resources to facilitate local efforts and has convened an advisory group of LHD officials who are working together to grow the initiative. NACCHO Recognizes that mental health is an essential component of overall health and well-being and supports local, state, and national efforts to bridge this gap through effective collaboration and service integration.
For more information about the publications mentioned in this article, please visit NACCHO's Web site at www.naccho.org/.
1. National Institute on Mental Health. Mental disorders in America.http://www.nimh.nih.gov/health/publications/the-numbers-count-mental-disorders-in-america.shtml
. Accessed October 23, 2007.
2. World Health Organization. Mental Health Policy Project Executive Summary
. Washington, DC: World Health Organization; 2001.
3. US Public Health Service. Mental Health: A Report of the Surgeon General.
Washington, DC: US Department of Health and Human Services; 1999.
4. National Association of County and City Health Officials. The Operational Definition of a Functional Local Health Department
. Washington, DC: National Association of County and City Health Officials; 2005.