Tackling behavioral and public health joint endeavors

We know it to be true that good health cannot exist without good behavioral health. Now, we must add that good behavioral health cannot exist without good public health. Let me provide some details.

A very important headline from the 2016 Annual Meeting of the American Public Health Association (APHA) is the growing collaboration and partnership between the behavioral health and public health fields. Ever since the enactment of the Affordable Care Act (ACA), behavioral healthcare has been warming to the notion that our field must learn and adopt the strategies and techniques of public health. Similar sentiments have been growing in public health that it must incorporate behavioral healthcare practices and interventions.

What factors underlie these developments? The ACA places great emphasis upon upstream disease prevention and health promotion interventions, as part of population health management. If behavioral healthcare programs are to prevent/promote and to manage the health of populations, they must adopt the tools of public health.

These public health tools can be used to promote the good health of those who do not have any disease, as well as to mitigate health status and care problems caused by the negative social and physical determinants of health. As we all have known for decades, these concerns traditionally have not been addressed by behavioral healthcare.

At the same time, public health programs must adopt the tools of behavioral healthcare. Since behavioral health conditions, such as depression and opioid addiction, have become pronounced in all corners of American society, from our schools to our jails, public health programs frequently are called upon to offer solutions that require behavioral healthcare skills and interventions.

This compelling combination of circumstances led the APHA Mental Health Section to organize a headliner session at the recent national meeting in Denver. This session was designed to open a dialogue between behavioral healthcare and public health, share perspectives, and identify a path of joint activities going forward. Participants in the session included about 100 leaders from the Mental Health Section, the Alcohol, Tobacco and Other Drugs Section, the National Association of County and City Health Officials (NACCHO), and the Association of State and Territorial Health Officials (ASTHO).  

Major action themes developed in roundtable discussions conducted during the session include the following steps:

 > Introduce behavioral health-public health collaboration as a focused agenda throughout APHA.
 > Dramatically improve and expand cross training between the two fields.
 > Modify public health certification and accreditation standards to incorporate behavioral healthcare skills and practices.
 > Modify behavioral healthcare certification and accreditation standards to incorporate public health skills and practices.
 > Adopt a small set of performance measures that can reflect and assess improved personal outcomes as a result of these changes.
 > Continue to collaborate to develop and implement this agenda over the coming year and report progress at the 2017 Annual APHA Meeting in Atlanta.

The fundamental tenets of social justice—good health for all and value all equally—
offer both a framework and a rationale for this work. Both behavioral healthcare and public health seek to reduce disparities and promote equity in health status and care. If these efforts are to be effective and bear fruit, then these two fields must join together in seeking these improved personal outcomes.

The final chapter of Public Mental Health (Oxford, 2012), a text published by the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, establishes the vision and necessity for behavioral healthcare to become a public health field. The recent work at the 2016 Annual APHA Meeting has begun to fulfill that vision with very practical steps.