Taking a public health approach to mental health care

Earlier this month, the ACMHA – The College of Behavioral Health Leadership hosted a public policy forum on Capitol Hill, reports Behavioral Healthcare. The opening message: Behavioral, environmental and social factors all must be considered when addressing a person’s health.

Their briefing addressed the following four points, advocating to “shift a balance” that is heavy on treatment and light on prevention when it comes to America’s health care system:

  1. A research base exists in support of a sustained prevention initiative;
  2. Family and community factors are an essential component to the long-term health of the individual and greater population;
  3. Key to any preventive measure is the active engagement of families, including children, in community educational/prevention programs;
  4. More resources should be directed toward disease prevention efforts

In support of ACMHA’s larger argument, presenter Dr. Vincent Felitti, a clinical professor of Medicine at the University of California, explored the close relationship between public health issues and the life experiences of individuals by discussing the results of the Adverse Childhood Experiences (ACE) study. The ACE study is an ongoing collaborative initiative between the Centers for Disease Control and Prevention and Kaiser Permanente. The researchers have found strong evidence of childhood trauma’s impact on health, social and economic/employment risks.

The initial ACE study, of which Felitti was a co-author, focused on 10 experiences in childhood that were prevalent among the participants; the study has since expanded to include more than 17,000 patients in the Kaiser health care system. 

Felitti discussed some of the original findings, including that two out of every three individuals reported at least one ACE and that these experiences increased the likelihood of engaging in risky health behaviors and contributed to chronic stress. He pointed out that, unfortunately, ACEs are often not identified and consequently remain unaddressed. This in turn makes it more likely that treatment will be less effective:

“These patients tend to be difficult to treat because their histories of trauma affect the way that they see health problems and solutions. Often … what appears to a provider to be the patient’s problem (e.g., smoking, obesity, teenage sex) is really the patient’s solution—the patient’s way of coping with the lingering impact of their adverse experiences …  [W]ithout a thorough understanding of each patient’s ACE history conventional treatment of common public health problems is bound to fail. To make progress in care, … the provider must appreciate the patient’s trauma history and incorporate it into any effective treatment approach.”

Learn more about a collaborative effort between Polaris Health Directions and Kaiser Permanente on using technology to better detect interpersonal violence among chemically dependent adults.