As our nation grapples with a mental health and substance use (behavioral health) crisis stemming in part from decades of insufficient funding for services and research, it is time for a significant investment in behavioral health treatment. However, the key to successfully digging our way out of this crisis will be to rethink our approach to behavioral health and expand our current paradigm to work from a population health framework.
The traditional paradigm for behavioral health treatment in the United States can be characterized as a “black box” model, which is based on the notion that “sick” people go to treatment in a hospital or mental health clinic, they are diagnosed and “fixed,” and then they leave well. While this approach has helped many people, it has several key shortcomings resulting in far too many people continuing to suffer because of a lack of access to appropriate services.
In September, a group of the nation’s leading behavioral scientists met at the headquarters of the American Psychological Association (APA) in Washington, DC, to reevaluate the way we address behavioral health problems. There was strong agreement that, while investing in and changing treatment services and systems is necessary, that alone is insufficient. Our approach needs to go beyond traditional clinical care and utilize a broad array of strategies that are informed by psychological and other areas of science. This approach is best encapsulated within a population health framework, which requires rethinking:
Leading scientists are calling for a ‘moonshot’ to change the nation’s approach to behavioral health.
Who can provide and receive help. Currently, we focus on helping those with a diagnosis, often after they are in crisis, which means we are not intervening at the earliest moments of psychological distress when we could minimize the impact of, or even prevent, the development of behavioral health conditions. We should utilize various strategies, ranging from preventative interventions for people who are not experiencing distress, to early interventions for people who are at risk of developing more significant problems, to highly effective treatments for those experiencing a behavioral health disorder. This approach aims to optimize the psychological health of everyone in the population. Additionally, the workforce should not be limited only to licensed mental health professionals but should include others who are equipped with the knowledge and tools to improve people’s psychological health. For example, this can include paraprofessionals, people with lived experience, and community stakeholders.
What our overarching health goals are. Our goal for behavioral health should not be limited to the absence of illness, but rather it should move individuals toward greater psychological health and well-being. This is essential for living a full and healthy life for all people, including those with the most serious conditions.
When and where people can get help. Currently, our diagnostically driven approach means we are too often intervening in the later stages of people’s behavioral conditions. We need to reach people at the earliest point to prevent suffering and improve outcomes. We also need to place services and form partnerships in natural community settings to improve access. This will require embedding behavioral health treatment services and support in the settings where people live, work, learn, play, and worship.
How help is provided. We must utilize science and the voice of communities to expand our strategies so that we can reach more people and improve health outcomes. Examples include changing public policy, addressing social determinants of health, and making work and school environments psychologically healthy.
We’ve reached a tipping point. APA is working with a growing number of individuals, organizations, and systems that are promoting a paradigm shift to population health. Many describe this work as a “moonshot” given the complex and massive undertaking required. Like President Kennedy’s 1961 declaration to send people to the moon, no one individual can make population health a reality. It will take all of us doing our part, challenging long-held beliefs about behavioral health, forming new partnerships, developing new interventions, and helping shape public policy.
Everyone has a role to play in this movement to achieve optimal psychological health for all people. Given the magnitude of the current behavioral health crisis, it is worth the effort.