Scope of Mental and Behavioral Health Challenges
Stories like these play out tragically all across the USA, often with connections to wider global trends. Nearly 1 in 5 people,19% of U.S. adults, experience mental illness in a given year.Of those 46.6 million people,11.2 million -- 4.5% of the adult population--experience aserious mental illness that interferes with major life activities.Social and economic disruptions of the Covid-19 pandemic are expected todramatically increase mental illness and addictions(as of May 2020)Health professionals and others who care for people experiencing mental health distress face distinctive ethical challenges.
Although there is increasing recognition that the conceptual dichotomy between physical and mental health is a false one, it remains true that mental health afflictions create special conditions of vulnerability. Conditions that affect the workings of the mind particularly acutely affect people’s perceptions, personalities, emotions, memory, and behavior. Health care professionals treating behavioral health patients must cultivate perceptive sensitivity to associated vulnerabilities.
What are “mental health” and “behavioral health?”
This resource treats mental and behavioral health as one general area of healthcare, summarizing the two as “behavioral health.”
Often used interchangeably, the terms “mental health” and “behavioral health” subtly imply different emphases. Behavioral health focuses on personal habits either helpful or unhelpful to mental health. Behavioral health, for example, includes treatment for compulsive disorders and substance abuse.Substance abuse is one of the largest and fastest growing problems in the American landscape of mental health.While it falls within the spectrum of behavioral health, substance abuse also poses some unique ethical challenges beyond the scope of this general resource.
Behavioral health also addresses habitual behaviors that can either contribute to or protect from chronic health challenges such as obesity, diabetes, and cardiovascular disease.Mental health encompasses emotional, psychological, and social well-being, andall the factors that impact such well-being.These factors include genetic, physiological, family, and trauma histories.
Mental health treatment includes addressing illnesses such as schizophrenia and bipolar disorder, and conditions such as depression and anxiety. Because these conditions impact behavior, there is no clear line between mental and behavioral health. Moreover, “mental health” has historical connections to a dichotomous view of physical and mental health that has been repudiated scientifically. Physiological factors affect behavioral health and behavioral health affects physiology.
Behavioral health and mental health issues are usually inter-linked in people’s lives. Both can be impacted significantly by social, economic, and environmental factors. While using the term “behavioral health” as an umbrella term, this resource resists individualistic interpretations of “behavior” that fail to attend the full array of factors that can challenge good behavioral health.
Consequences: For the Patient and Beyond
Mental and behavioral health disorders, especially left untreated or improperly treated, can have severe consequences not only for the individuals suffering from them but also for family members, friends, schools, workplaces, the health care system, the community, and the economy.Suicide is the 10th leading cause of death in the United States and the second leading cause of death of young people.Mental illness among prisoners is so prevalent that critics of American incarceration practices have begun calling prisons “the new asylums.” As of 2014, it was estimated that20% of jail inmatesand 14% of prison inmates had a serious mental illness.Studies estimatingthe cost of unaddressed mental illness in the American workplace have concluded ranges from 80 to 190billiondollars.
Whose job is it?
Conversations about who should respond to mental health needs are changing. In early American history, many who suffered from severely stigmatized mental illness were treated as demonically possessed or as criminals.From the mid-19th to mid-20th centuries, large government psychiatric hospitals were a primary locus of care that advanced a medical model of care while seeking to segregate those with mental health challenges from the general community.A de-institutionalization movement began after the Civil Rights movement, as many formerly marginalized groups sought integration into common society. Deinstitutionalization coincided with a period of increasing specialization in American medicine, and an associated decline in the relative number of primary care practitioners. (Primary care practitioners are those trained widely to be both the initial point of contact for patients, and to develop long-term therapeutic relationships with them, facilitating care for their unique arrays of medical needs.Primary care providers include general practitioners, internists, family medicine physicians, pediatricians, and some categories of nurse practitioners.)Referral of patients with mental and behavioral health challenges to psychiatrists, psychologists, social workers, and counselors became the norm.
However, in recent decades American health policy has advocated improving and expanding primary care as a foundation of the health system. Accordingly, many mental health advocates now call for betterintegrationofprimary carewith mental andbehavioral health care. Such integration can occur bilaterally. Most commonly, it includes increased mental health assessment and treatment in primary care clinics, especially for the most common forms of depression, anxiety disorders, and substance abuse. While less common, it can also include morechronic disease treatment in mental health settingsserving the seriously mentally ill--since there is evidence thatsignificant chronic diseases such as diabetes and cardio-pulmonary disease disproportionately go undiagnosedin those who have been labeled as mentally ill, resulting in higher mortality. While integrative strategies are being deployed,critics voice concerns about whether associated provider training, systems structures, and insurance practice are currently adequate to support such integration.
An initial major government study conducted in 2000 found that approximately 25 percent of all primary care patients have diagnosable psychiatric disorders--most commonly, anxiety and depression--while primary care providers now deliver over half of the treatment for these conditions nationwide. However, still, only about 10% of patients with depression receive standard-of-care treatment from their primary care physician.1
Community advocates call foran integration of behavioral health support in the wider community. In particular, they focus onhow non-health-professionals can support mental healthin families, schools, workplaces, prisons, and faith communities.
1Mechanic, D. (2014). More people than ever before are receiving behavioral health care in the United States, but gaps and challenges remain. Health Affairs, 33(8), 1416-1424.
