No population health without behavioral health

The radiant beauty of fall foliage, the enticing aroma of a fall fire, the caring feeling of Thanksgiving, and the gathering of friends and family do provide a wonderful backdrop for Rosalynn Carter’s Annual Behavioral Health Policy Symposium. This year marks the 32rd time that the former First Lady has invited her extended friends and family to this radiant, enticing, and caring event at the Carter Center in Atlanta.

Most of the issues that we work on today—parity, care access, integrated care, peer support, community participation, stigma—have their origins in the work that Carter has undertaken for more than two score years. Hence, the annual symposium is as much a celebration of our fields’ accomplishments as it is a working conference. This year’s symposium was no exception.

Over time, a broad consensus has developed that behavioral health conditions are the fundamental health problems in most settings—work, play, family, community. In fact, the World Health Organization finds that depression now is the leading cause of disability in the world. This reality is reflected in the tragic premature death of public mental health and substance use clients in the United States, as well as in the staggering morbidity associated with these conditions. As we attempt to expand the circle of health and wellness, we must address behavioral health as a central feature. The 2016 Symposium, held on November 17 and 18, explored these issues and how we can respond effectively using population health approaches.

The opening plenary was offered by Paul Summergrad, chair of psychiatry at Tufts University. He set the stage by reasoning that the broad prevalence of behavioral health conditions and their enormous personal, social, and economic cost provides an exceptional opportunity to intervene to improve health and reduce these costs. To do this, we will need to improve our care delivery and prevention and promotion interventions, as well as improve primary care service delivery. Almost two thirds of all behavioral healthcare is provided in primary care settings today.

The principal panel sessions in the symposium addressed three interrelated concerns: Population Health and Cultures of Wellness; Integration Efforts; and Behavioral Health’s Role in Population Health. Put in simple terms, we are moving rapidly toward cultures of wellness for populations in the broader health field; integrated care is bringing behavioral healthcare into play in this new context; behavioral health is key to the success of our population health efforts. Hence, successful behavioral health activities are pivotal to the entire enterprise. Paul Keckley of the Keckley Report drew an important conclusion: “The ball is in our behavioral health court to take advantage of all of these important developments.”

Other breakout sessions elaborated this basic framework. These include a session on the promising, emerging role of peer respite services as an adjunct to care. Another described the important work underway to unravel historical, social, and personal trauma. Obvious training needs exist in both of these areas.

As the symposium was drawing to a close, Mary Jane England perhaps said it best for all of us: “The Annual Symposium is a place where we all can feel secure, can rejuvenate, and can prepare to confront the critical issues of our field when we return home. For all of these reasons, we thank you Mrs. Carter.”

This year marks the final annual symposium to be hosted by the Carter Center. Next year, Carter and the Center’s Mental Health Program will undertake a series of smaller, focused summits on major issues confronting our field. Like the annual symposium, we know that these events will be characterized by the same features England described.

Once again, our hats are off to Carter and all of the Mental Health Program staff for hosting an outstanding 2016 Symposium. National administrations may change, we may change, but our mission and goal remain crystal clear.