Comprehensive Behavioral Health
Comprehensive Approaches to Behavioral Health
Advancing comprehensive mental and
behavioral health means promoting
prevention and treatment strategies before
an individual reaches a time of crisis. State
and local public health agencies are leading
the charge to better understand behavioral
health within the context of a person’s
overall health and wellbeing and within the
context of an individual’s community. In the
coming years, states will be working to Source: SAMHSA, Risk and Protective Factors, 2015.
strengthen their ability to consider the whole person rather than seeking to address behavioral
health in silos. Importantly, this work includes increasing public health outreach, education, and
services to promote the protective factors and to moderate the risk factors that most closely
influence substance use and mental health. States have a central role in discovering how mental
health and substance use influence each other, as they often do not operate in isolation. This will
be a central component of ASTHO’s 2017 President’s Challenge.
The Impact of Behavioral Health
Every American is affected by mental health and substance abuse disorders, whether directly or
indirectly. Data from the nation’s leading health experts show that:
 Roughly 1 in 4 adult Americans suffers from a mental disorder in a given year. i
 Depression is the third most common reason for visiting a health center after diabetes
and hypertension.ii
 Suicide is the 10th leading cause of death in the U.S.iii
 Substance abuse accounts for more than $700 billion annually in health care costs and
costs related to crime and lost work productivity.iv
Expanding Access to Behavioral Health Services and Integrating with Primary Care
All Americans should have access to behavioral health services. Adequate access to prevention
and treatment can lead to higher productivity and better health, and help individuals avoid selfmedication, self-harm, or other injury. People living with mental illness often experience higher
rates of chronic diseases compared to the general population and are often in need of more
preventive services. State public health departments are working to promote the integration of
behavioral health with primary health care. Good health includes good behavioral health.
The Indiana Family and Social Services Administration, in partnership with the Indiana State
Department of Health, uses the federal Primary Care and Behavioral Health Integration (PCBHI)
grant program to develop a statewide plan to integrate primary and behavioral health care
services. The plan focuses on 6 areas: policy, funding, data/technology, workforce development,
quality assurance, and future opportunities. This collaboration has led to the establishment of
billing codes for integrated primary care and behavioral health services, easing a major
impediment to integrated care.
© 2016 Association of State and Territorial Health Officials
2231 Crystal Drive, Suite 450, Arlington, VA 22202
202-371-9090 www.astho.org
Comprehensive Mental & Behavioral Health
Comprehensive Behavioral Health
Living conditions also impact one’s mental well-being. Primary prevention of mental health
problems will require a focus on the social determinants of health.
Substance Abuse
Substance abuse impacts Americans in every state and across every age, race, and economic
group. In 2014, an estimated 22.5 million Americans age 12 and over reported needing treatment
for alcohol or illicit drug use.v Left untreated, substance abuse devastates physical, mental and
economic well-being. Drug and alcohol use also contribute to the development of chronic
diseases like heart disease and diabetes. The growing prescription drug epidemic is particularly
deadly.
Prescription Drug Abuse & Overdose
From 1999 to 2014, more than 165,000 Americans died
from prescription opioid overdoses.vi Overdose deaths
have quadrupled, and with the opioid epidemic, are now
the leading cause of accidental death.vii Comprehensive
public health approaches are necessary to address the
nation’s escalating prescription opioid epidemic.
Congress took a commendable first step in passing the
bipartisan Comprehensive Addiction and Recovery Act
(CARA). While lawmakers did not reach an agreement on
funding in 2016, additional resources will be critical to
achieving its goals. States work daily to curb the
magnitude of the opioid epidemic. The New York State
Department of Health documented a 75 percent
decrease in doctor shopping after the state required
providers to check the PDMP before prescribing opioids.
Getting this epidemic under control will take the full
effort of federal, state, and local governments, in
addition to those individuals closest to it.
Comprehensive Approaches to
Combatting Opioid Abuse
Community. Supporting evidence-based
initiatives in community settings.
Prescribers. Training prescribers in pain
management and safe prescribing.
Data Tracking. Providing resources to
Prescription Drug Monitoring Programs.
Life-saving Interventions. Equipping
families with prevention tools and
emergency Naloxone intervention.
Partnerships. Strengthening public health
and public safety partnerships, such as
with law enforcement and social services.
Treatment. Expanding access to
appropriate medical services.
Adverse Childhood Experiences (ACEs)
Originating with a Kaiser Permanente study in 1995, the exploration of adverse childhood
experiences or events (ACEs) provides much-needed insight into behavioral health prevention
and resilience. ACEs are stressors during the first 18 years of life, such as emotional, sexual or
physical abuse; witnessing violence or mental illness; parental divorce or separation; and physical
or emotional neglect. Study findings suggest a relationship between the number ACEs and the
intensity of negative outcomes. As the number of ACEs increase so does the risk of alcoholism,
illicit drug use, teenage pregnancy, heart disease, chronic obstructive pulmonary disease (COPD),
depression, and more. Unfortunately, ACES are common, with two-thirds experiencing at least
one ACE and one in five experiencing three or more.
© 2016 Association of State and Territorial Health Officials
2231 Crystal Drive, Suite 450, Arlington, VA 22202
202-371-9090 www.astho.org
Comprehensive Mental & Behavioral Health
Comprehensive Behavioral Health
ACEs can be prevented, and their negative outcomes can be mitigated by supporting resilience
and protective factors. States and CDC are leading the way in translating this promising and
developing research into implementation frameworks. Iowa’s Department of Public Health has
also built public-private partnerships to reach and screen over 130,000 children for ACEs in
primary care settings. The Virginia Department of Health has incorporated a strong start for
children in its 2016-2020 Plan for Well-being by engaging families, business, communities, and
health care providers as partners.
i
HRSA, “Behavioral Health,” http://www.hrsa.gov/publichealth/clinical/behavioralhealth/, Accessed Jul. 22, 2016.
Ibid.
iii CDC, “Ten Leading Causes of Death by Age Group, United States - 2014,”
http://www.cdc.gov/violenceprevention/suicide/statistics/, Accessed Jul. 22, 2016.
iv NIH, National Institute on Drug Abuse, https://www.drugabuse.gov/related-topics/trends-statistics, Accessed Jul. 22, 2016.
v SAMHSA, “Prevention of Substance Abuse and Mental Illness,” http://www.samhsa.gov/prevention, Accessed Jul. 22, 2016.
vi CDC, “Prescription Opioid Overdose Data,” http://www.cdc.gov/drugoverdose/data/overdose.html, Accessed Jul. 22, 2016.
vii FDA, “FDA Commissioner Margaret A. Hamburg Statement on Prescription Opioid Abuse,”
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm391590.htm, Accessed Jul. 22, 2016.
ii
© 2016 Association of State and Territorial Health Officials
2231 Crystal Drive, Suite 450, Arlington, VA 22202
202-371-9090 www.astho.org
Comprehensive Mental & Behavioral Health