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Mental and Behavioral Health Services Essay

While the future of Mental and Behavioral Health Services continue to strive through many striving goals to develop continuous practices, treatments, evaluations, policies, and research, advancements are taking place to better the future of this program and its outreach to the people. Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translated to 57.7 million people.2 Even though mental disorders are common in the population, the main load of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who are suffering from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada.3 Many people suffer from more than one mental disorder at a given time. Roughly, 45 percent of those with any mental disorder meet the criteria for being strongly related to having 2 or more disorders.1 Awareness of having a disorder is very uncommon in the U.S.


Behavioral health is a state of mental/emotional being and/or choices and actions that affect wellness. Substance abuse and misuse are one set of behavioral health problems. Others include, but are not limited to, serious psychological distress, suicide, and mental illness (4. SAMHSA, 2011). Many of these problems are far-reaching and take a toll on individuals, their families and communities, and the broader society. Research allows us to get a better picture of what the future looks like and what people need to be continuing to do and improve on. By looking over research, statistics predict that by 2020, mental and substance use disorders will exceed all physical diseases as a major cause of disability worldwide.

The annual total estimated societal cost of substance abuse in the United States is $510.8 billion, with an estimated 23.5 million Americans aged 12 and older needing treatment for substance use. Along with that, every year almost 5,000 people under the age of 21 die as a result of underage drinking and more than 34,000 Americans die every year as a result of suicide, almost one every 15 minutes. Also, Half of all lifetime cases of mental and substance use disorders begin by age 14 and three-fourths by age 24—in 2008, an estimated 9.8 million adults in the U.S. had a serious mental illness.

The health and wellness of individuals in America are jeopardized and the unnecessary costs to society flow across America’s communities, schools, businesses, prisons & jails, and healthcare delivery systems. Many programs and services are working together to minimize the impact of substance abuse and mental illnesses on America’s communities.

Many practitioners have a very deep understanding approach to behavioral health and perceive prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model helps us recognize that there are multiple opportunities for addressing behavioral health problems and disorders based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes these components: ( It is important to keep in mind that interventions do not always fit neatly into one category or another)

* Promotion: These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Promotion strategies also reinforce the entire continuum of behavioral health services. * Prevention: Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use. * Treatment: These services are for people diagnosed with a substance use or other behavioral health disorder. * Maintenance: These services support individuals’ compliance with long-term treatment and aftercare.

Two strategies for promoting the more important and most effective openings in having access to mental and behavioral health services include providing education to reach the public, and the prevention and early intervention matters intertwining with the Continuum model components of treatment and maintenance. 7 The New Freedom Commission Report and Surgeon General’s Report both emphasized the importance of changing public attitudes to eliminate the stigma associated with mental illness. Advocates for the mentally ill identify stigma and discrimination as major impediments to treatment.

Stigma prevents individuals from acknowledging these conditions and erodes public confidence that mental disorders are treatable. A plurality of Americans believe that mental illnesses are just like any other illness; however, 25 percent of survey respondents would not welcome into their neighborhoods facilities that treat or house people with mental illnesses, suggesting that some level of lingering stigma persists.8 Sixty-one percent of Americans think that people with schizophrenia are likely to be dangerous to others9 despite research suggesting that these individuals are rarely violent.10

With that being said, the media plays a large role in shaping how the youth think and behave from many of the messages kids receive from television, music, magazines, billboards, and the Internet use. However, the media can be used to encourage positive behaviors as well. Four evidence based communication and education prevention approaches are through public education, social marketing, media advocacy, and media literacy that can be used to “influence community norms, increase public awareness, and attract community support for a variety of prevention issues” (SAMHSA). Public education is usually the most common strategy and is an effective way to show support to the development and success of programs and increase awareness about new or existing laws, publicizing a community based program, and reinforce instruction taught in schools or community based organizations.

Through social marketing, practitioners use advertising philosophies to change social norms and promote healthy behaviors. Social marketing campaigns do more than just provide information and tries to convince people to adopt a new behavior by showing them a benefit they will receive in return.11 Social marketing campaigns are being used in a variety of social services and public health settings. Media advocacy involves shaping the way social issues are discussed in the media to build support for changes in public policy. By working directly with local newspapers, television, and radio to change both the amount of coverage the media provide and the content of that coverage, media advocates hope to influence the way people talk and think about a social or public policy12. Media literacy is a newer communications strategy aimed at teaching young people critical-viewing skills. Media literacy programs teach kids how to analyze and understand the media messages they encounter so they can better understand what they’re really being asked to do and think.

Inferences about a program effectiveness relies on three things: (1) measures of key constructs, such as risk and protective factors or processes, symptoms, disorders, or other outcomes, and program implementation, fidelity, or participation; (2) a study design that determines which participants are being examined, how and when they will be assessed, and what interventions they will receive; and (3) statistical analyses that model how those given an intervention differ on outcomes compared with those in a comparison condition 19

In the past, practitioners and researchers saw substance abuse prevention different from the prevention of other behavioral health problems. But evidence indicates that the populations are significantly affected by these overlapping problems as well as factors that contribute to these problems. Therefore, improvements in one area usually have direct impacts on the other.

According to the Substance Abuse and National Health Services Administration, not all people or populations are at the same risk of developing behavioral health problems. Many young people have more than one behavioral disorder. These disorders can interact and contribute to the presence of other disorders. Besides extensive research documenting strong relations between multiple problems, it’s not always clear what leads to what. Mental and physical health is also connected. Good mental health often contributes to good physical health. In the same way, the presence of mental health disorders, including substance abuse and dependence, is often associated with physical health disorders as well (O’Connell, 2009).

One major advancement that has been recently made is from The Substance Abuse and Mental Health Services Administration, adding a new search feature to its National Registry of Evidence-based Programs and Practices (NREPP) Web site. The feature allows users to identify NREPP interventions that have been evaluated in comparative effectiveness research studies.

Both the Obama Administration and the U.S. Congress have championed additional investments in comparative effectiveness research to enhance public understanding about which healthcare interventions are most effective in different circumstances and with different patients. The new NREPP feature can provide added information for States and communities seeking to determine which mental health and substance abuse prevention and treatment interventions may best address their needs.

The Surgeon General’s notes that “effective interventions help people to understand that mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions.” (7) The two major influences that are targeted upon are risk and protective factors. According to SAMHSAs levels of risk and interventions, some risk factors are causal; others act as “proxies”, or markers of an underlying problem. Some risk and protective factors, such as gender and ethnicity, are fixed, meaning they don’t change over time. Other risk and protective factors are considered variable: these can change over time. Variable risk factors include income level, peer group, and employment status. Many factors influence a person’s likeliness to develop a substance abuse or related behavioral health problem. Effective prevention focuses on reducing those risk factors, and strengthening those protective factors, that are most closely related to the problem being addressed.

Taken into consideration that preventive interventions are most effective when they are appropriately matched to their target population’s level of risk, The Institute of Medicine defines three broad types of prevention interventions, universal, selective, and indicated. Universal preventive interventions take the broadest approach, targeting “the general public or a whole population that has not been identified on the basis of individual risk” (O’Connell, 2009). Universal prevention interventions might target schools, whole communities, or workplaces.

Selective preventive interventions target “individuals or a population sub-group whose risk of developing mental disorders [or substance abuse disorders] is significantly higher than average”, prior to the diagnosis of a disorder (5. O’Connell, 2009). Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population. Indicated preventive interventions target “high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder” prior to the diagnosis of a disorder (6. IOM, 2009). Interventions focus on the immediate risk and protective factors present in the environments surrounding individuals.

A more harsher or serious way of approaching prevention is through policy adoption and enforcement. Policy can be broadly defined as “standards for behavior that are formalized to some degree (that is, written) and embodied in rules, regulations, and procedures.”13 In order to work, these standards must reflect the accepted norms and intentions of a particular community. There are six major types of policy SAMHSA uses to prevent alcohol and other drug use through economic policies, restrictions on access and availability, restrictions on location and density, deterrence, restricting use, and limiting the marketing of alcohol products.

Policy can be an effective prevention strategy—as long as the laws and regulations you put in place are consistent with community norms and beliefs about the “rightness” or “wrongness” of the behavior you want to legislate14. “The key to effective enforcement is visibility: People need to see that substance use prevention is a community priority and that violations of related laws and regulations will not be tolerated.” 6 Strategies that we use today for Enforcement are through surveillance, community policing, having incentives, and penalties, fines, and detentions.

There have been many areas of progress in preventive intervention research since the 1994 Institute of Medicine (IOM) report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Experimental research has greatly improved mainly due to the advances in the methodological approaches applied to intervention research. For a range of outcomes, while the different types of intervention research has increased, so has the number of studies providing economic analyses in the costs and benefits of these interventions.

As the 2001 U.S. Surgeon General’s report on children’s mental health indicated, there is a current need for improved and expanded mental health services for children and adolescents (15). There is a greater need for greater access to a variety of mental health services for children including both medication for emotional or behavioral difficulties and treatments other than medication. Recent research studies have documented the increased use of psychotropic medications (16).

Less is known, though, about the use of nonmedication treatments for the emotional and behavioral difficulties of U.S. children. These treatments may include community-based services such as behavioral and family therapy provided by mental health professionals in clinic and office settings and school-based services such as assessments of mental health problems, individual counseling, and crisis intervention services for students (17,18). With the information collected by the mental health service questions in the National Health Interview Survey (NHIS), it will be possible to monitor future trends in the use of both medication and other treatments for the emotional and behavioral difficulties of children.

Recommended changes by the Surgeon General include:
• improve geographic access;
• integrate mental health and primary care;
• ensure language access;
• coordinate and integrate mental health services for high-need populations. (U.S. Department of Health and Human Services, 2001)

1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27.

2. U.S. Census Bureau Population Estimates by Demographic Characteristics.
Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005.

3. The World Health Organization. The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008.

4. Substance Abuse and Mental Health Services Administration. (2011). Leading change: A plan for SAMHSA’s roles and actions 2011-2014. Rockville, MD: SAMHSA.

5. O’Connell, M. E., Boat, T., & Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National Research Council and Institute of Medicine of the National Academies. Washington, D.C.: The National Academies Press.

6. Compton, M. T. (2009). Clinical Manual of Prevention in Mental Health (1st ed.). American Psychiatric Publishing, Inc.

7.. U.S. DHHS. 1999. Mental Health: A Report of the Surgeon General. 8. Pescosolido, B. et al. 2000.Americans’ Views of Mental Health and Illness at the Century’s End: Continuity and Change. Public Report on the MacArthur Mental Health Module, 1996 General Social Survey. Bloomington, Indiana.

9. Steadman, H.J. et al. 1998.Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Archives of General Psychiatry 55 (5): 393–401.

10. Borinstein,A.B. 1992. Public Attitudes Toward Persons with Mental Illness. Health Affairs 11 (3): 186–96.

11. Kotler, P. and Roberto, E. (1989). Social marketing: Strategies for changing pubic behavior. New York: Free Press.

12. Wallack, L., Dorfman, L., Jernigan, D., and Themba, M. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications.

13. Bruner, C. and Chavez, M. (1996). Getting to the grassroots: Neighborhood organizing and mobilization. Des Moines, IA: NCSI Clearinghouse. CSAP Community Partnerships (unpublished document).
14. Bruner, C. (1991). Thinking collaboratively: Ten questions and answers to help policy makers improve children’s services. Washington, DC: Education and Human Services Consortium

15. U.S. Public Health Service. Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services. 2000. 16. Martin A, Leslie D. Trends in psychotropic medication costs for children and adolescents, 1997–2000. Arch Pediatr Adolesc Med. 157:997–1004. 2003. 17. Steele RG, Roberts MC (Eds.). Handbook of mental health services for children, adolescents, and families. New York: Springer, 2005.

18. Foster S, Rollefson M, Doksum T, Noonan D, Robinson G, Teich J. School Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05–4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 2005

19. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions, Institute of Medicine, National Research Council. “10 Advances in Prevention Methodology.” Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.

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