Behavioral Health, Local Health Department Accreditation, and Public Health 3.0: Leveraging Opportunities for Collaboration

Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities

CONTEXT

Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources.

OBJECTIVE

To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics.

DESIGN

The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures.

RESULTS

LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities-had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers.

CONCLUSIONS

Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.

Associations Between Cross-Sector Partnerships and Local Health Department Participation in Population-Based Activities to Prevent Mental Health Conditions

Objectives. To describe partnerships between US local health departments (LHDs) and community organizations and assess the relationship between the types of activities performed in these partnerships and LHD engagement in population-based activities to prevent mental health conditions.Methods. Data were derived from 457 LHDs that responded to module 1 of the 2016 Profile Study conducted by the National Association of County and City Health Officials. These data were used to assess the presence of partnerships with community organizations and examine associations between the types of activities performed in such partnerships and LHDs' participation in population-based activities to prevent mental health conditions.Results. LHDs had higher odds of participating in population-based activities to prevent mental health conditions if they shared personnel or resources or had written agreements with mental health or substance use disorder providers, held regularly scheduled meetings with hospitals, or shared personnel or resources with community health centers. Odds were reduced if they exchanged information with community health centers or shared personnel or resources with faith-based organizations.Conclusions. This study offers an improved understanding of how the types of activities performed in cross-sector partnerships affect LHDs' participation in population-based activities to prevent mental health conditions, which is important as public policies, programs, and funding initiatives continue to encourage cross-sector partnership building.

Population-Based Approaches to Mental Health: History, Strategies, and Evidence

There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.

Population Health and Trauma-Informed Practice: Implications for Programs, Systems, and Policies

Population studies indicate that trauma exposure is ubiquitous and has a significant impact on health. Trauma-informed practice seeks to address the health consequences of trauma through integrative responses that incorporate an understanding of the effects of trauma, the multiple pathways to recovery, and the potential for re-traumatization. Current trauma-informed practice considers trauma exposure an individual clinical problem rather than a societal problem with population health consequences. Population health refers to the aggregated health status of individuals who share some characteristic, such as trauma exposure, and includes the study of determinants that shape the distribution of health outcomes in specific populations. In this paper, we describe a population health perspective for trauma-informed practice that complements the current clinical perspective, and then discuss implications of that perspective for programs, systems, and policies. We summarize essential concepts about trauma over the life course and describe principles of population health science relevant to trauma-informed practice. We then discuss implications of these principles by identifying four priorities for trauma-informed practice from a population health perspective: (a) adopting trauma-informed policies to prevent trauma exposure and to foster resilience in the aftermath of trauma; (b) infusing trauma-informed practice into everyday activities so it is a routine part of interpersonal transactions; (c) incorporating trauma-informed practices into existing service systems; and (d) adapting existing treatments to incorporate trauma-informed principles for population health impact.