Monday September 16th 2019

No health without mental health

Pamela Cipriano

More than half a century ago psychiatrist Brock Chisholm, the first director-general of the World Health Organization, professed that without mental health there can be no true physical health. Today evidence illustrates a bidirectional relationship between mental illness and physical health outcomes which affects not only quality of life but also can contribute to decreased life expectancy.

We cannot improve population health without addressing the mental and behavioral health needs of the nation. The old adage, “you get what you pay for” rings true as we reconcile the disassociation of mental health from physical health and years of reduced payments for these services. The National Institute of Mental Health estimates 1 in 5 children are affected by a serious debilitating mental illness at some time in their life. Just over 18 percent of adults suffered from acute mental illness excluding substance abuse in 2014. One in 10 young people have had a serious episode of depression, and suicide is now the 10th leading cause of death in the United States. Substance abuse affects more than 23 million Americans aged 12 and older. By 2020, mental and substance use disorders are projected to surpass all physical diseases as a major cause of disability worldwide.

These alarming trends have begged for action, but pervasive shortages in the mental health workforce persist. Core mental health professionals — clinical social workers, clinical psychologists, marriage and family therapists, psychiatrists and advanced practice psychiatric nurses — are joined by many others to provide care in a workforce projected to grow as insurance coverage increases for mental health and substance use disorders as a result of health care reform and parity legislation.

The onus of treating behavioral health issues has fallen to primary health care providers given that physical and behavioral health issues commonly occur together. Some estimate that a third of the U.S. population seeks care from their primary health care provider for a behavioral health-related problem. This resulting “integrated care” is now accepted as a sustainable model that can reunite physical and mental health, but resources are strained.

Additionally the use of telehealth is improving access to mental health services. The good news is that people prefer these electronic visits, but telehealth is only a partial answer. Gail Stuart, PhD, RN, FAAN, dean of the Medical University of South Carolina College of Nursing and president of The Annapolis Coalition, a nonprofit dedicated to improving all aspects of the mental health and addictions workforce, recently keynoted the 31st Annual Rosalynn Carter Symposium on Mental Health Policy. She challenged the group to devise revolutionary strategies to have mental health care available in all settings, acknowledge task sharing and task shifting, scale up the workforce, especially RNs, enhance the use of emerging technologies, and build a continuously learning health system.

Nursing curricula have evolved with behavioral health integrated into the care of patients across the lifespan and the continuum of health care environments. With a bias toward meeting physical needs, nurses unintentionally have become less skilled and confident addressing behavioral health issues in general-care settings. To meet the rising demand for nursing capacity, the American Psychiatric Nurses Association offers an online continuing education certificate program, “APNA’s Transitions in Practice,” designed to provide a foundation for new graduates, as well as nurses moving from other services to inpatient psychiatric nursing units.  (Visit

Nurses are also mobilizing to address the opioid addiction epidemic. The American Nurses Association responded to a call from the White House to join the awareness campaign on this issue and disseminate information to nurses about improved prescribing practices and treatment of opioid use and abuse. APNA will offer free e-learning courses tailored to all RNs and APRNs with and without psychiatric-mental health experience to boost identification- and treatment-knowledge. And, in conjunction with ANA’s yearlong focus on a culture of safety, ANA is planning a webinar, “Practicing Prevention: Safely Engaging Patients in Mental Health Crises,” on April 20.

We must come together across disciplines to ensure that we provide behavioral health and substance abuse prevention, first aid and ongoing recovery care for those in need. It’s time to reconnect body, mind and spirit — our nation’s health depends upon it.

— Pamela F. Cipriano

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