picAs the pace of change in healthcare accelerates, leaders increasingly recognize the need to dramatically improve health outcomes for people at risk for, or living with, chronic illnesses in the United States. Chronic conditions are the biggest drivers of health care and disability costs, and behavioral health conditions are increasingly recognized as major contributing factors to these costs.

Current treatment approaches are necessary but not sufficient. Community support and development strategies are needed to foster prevention and health promotion.

For decades, the federal government has recognized the importance of preventing substance use conditions in our communities through comprehensive community interventions. Similarly, we have proven public health initiatives in tobacco control, HIV/AIDS, obesity, and maternal health. While prevention was part of the vision of the landmark Community Mental Health Centers Act in 1963, more recently the promotion of positive mental health has not been an explicit part of federal health policy.[i] Instead, we have focused primarily on treatment. Mental health and substance use providers need support to collaborate with other community health leaders to improve our capacity to promote health and wellness in communities where people live, learn, work, and play.[ii]

A growing body of evidence supports the effectiveness of community capacity building to improve health outcomes.[iii] Health promotion and prevention of adverse health conditions, including mental illness and substance use, must be part of broader community health goals. Building community capacity requires the adoption of an array of “community development tools” including but not limited to health education, social marketing, community health needs assessments, participant-based research, community planning days, coalition building, and mobilizing self-help and peer services, including peer to peer and family centered services and supports. Community goals will vary depending on the priorities they establish and communities will differ in the levels of external support they will need.

Trauma prevention, particularly in children, is an area that needs immediate attention in most of our communities. Trauma and adverse childhood experiences have an extraordinary impact on health status.[iv] For example, 70% of adults in the United States, approximately 220 million Americans, have experienced some kind of adverse or traumatic event at least once in their lives. With each additional adverse childhood experience, the risk increases for some of the most disabling and costly health problems.[v] These include alcoholism, depression, chronic obstructive pulmonary disease (COPD), liver disease, smoking, adolescent pregnancy and risk for intimate partner violence. Reducing the prevalence of adverse childhood experiences and its associated chronic diseases must be a priority.

The social interventions needed to improve community health and reduce disability status are not billable interventions. They do not take place in an office or exam room. They require “community organizing” activities that are unique to each community and that build on and enhance each community’s strengths, including businesses, schools, community health centers, and faith communities. As a place to begin, the CDC’s CHANGE Action Guide is a proven community health planning tool; however it should be augmented to include behavioral health conditions.[vi]

To reap the benefits of better health and reduced healthcare costs, health promotion needs to be explicitly incorporated into all policies, including community development, education and law enforcement, as well as healthcare. Behavioral health needs to be an explicit part of each of these efforts. Thus, whenever spending or policies for treatment and support are considered, specific focus also should be given to improving health and reducing the incidence of disease, including addictions, depression, anxiety and other behavioral health conditions. The nation’s communities are ready and willing to participate. Law enforcement, clergy, educators, health professionals, and businessmen and women recognize that health and economic development are related. They need the right supports and incentives to spark and guide their actions. Reducing the incidence of trauma and adverse childhood experiences are important places to begin.


The complete article can be found at www.acmha.org.
Richard H. Dougherty Ph.D.

[i] National Institutes of Health: The Office of Communications and Public Liaison. The NIH Almanac. Retrieved October 7, 2012, from http://www.nih.gov/about/almanac/organization/ NIMH.htm
[ii] Milstein, B., Homer, J., Briss, P., Burton, D. and Pechacek, T. (2011). Why Behavioral And Environmental Interventions Are Needed To Improve Health At Lower Cost. Health Affairs, 30(5), 823-832. Retrieved October 11, 2012, from http://content.healthaffairs.org/content/30/5/ 823.full.pdf+html
[iii] Recommendations from the Robert Wood Johnson Foundation Commission to Build a Healthier America. (2009). Beyond Health Care: New Directions to a Healthier America. Retrieved September 19, 2012, from http://www.commissiononhealth.org/ Recommendations.aspx
[iv] Felitti, V.J. and Anda, R.F. et al (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258.
[v] Felitti, V.J. and Anda, R.F. et al (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245-258.
[vi] Center for Disease Control and Prevention. Community Health Assessment and Group Evaluation: Building a Foundation of Knowledge to Prioritize Community Needs, An Action Guide. Atlanta: U.S. Department of Health and Human Services. Retrieved October 2, 2012, from http://www.cdc.gov/healthycommunitiesprogram/tools/change/pdf/changeactionguide.pdf.


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