As Arthur Evans Jr., Ph.D., Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS), spoke earlier this year in a conference room full of behavioral health treatment providers, one of the key topics in which he dedicated his presentation to was what he calls “The five truisms involved with a public health approach to mental health.”
1. Population Health. “Healing individuals is good; healing communities is better”
“I think it’s wonderful that we work with individuals and we work to heal individuals. But at the end of the day, I think it’s much better if we can heal communities,” he remarked to the group.
Psychologists are trained to work with individuals in therapy and psychiatrists work with medications for an individual. “But the issue is, we have a whole population out there,” he said.
“Only 25% of the people in people in our communities have a diagnosable mental health condition. In fact, most of these people don’t even come into specialty care—only 1/10 if it’s a substance abuse issue, 40% if it’s a mental health issue,” Evans continued.
When looking at the other 75%, “it’s not like you get to this threshold where there are behavioral health problems or challenges and before that, there are none. It’s really a continuum,” he stressed.
Therefore, there are people out in the community who need help who are pre-clinical or haven’t been diagnosed.
2. Moving upstream. Evans admitted that he feels the field is much better prepared with specific strategies for preventing substance abuse than it is for mental health challenges. However, he acknowledged that it’s “way more efficient” to attempt to prevent or put in place early intervention strategies than it is to treat people.
Speaking about recent research, he said, “For people who have, say schizophrenia or another major mental illness, we as a field have become pretty good at predicting who is likely to develop schizophrenia. But what we know is that many people who have schizophrenia, for example, are coming into treatment way late into their condition. And we know that when people come in late, it’s much harder to treat them.”
He believes that if we can intervene early, we can actually change the trajectory for individuals who have even the most serious mental illnesses. “So rather than spending all of our energy at the back end, how do we start to shift resources towards the front end?” he asked.
3. Broader Range of Responses. “Social and economic factors are the most powerful health predictors.”
He explained to the crowd that “where and how people live, learn, work and play greatly affects people’s health.”
He estimated that healthcare probably accounts for about 10% of people’s health status. “Think of how much money we pour into healthcare but then when you look at what effects peoples’ health status, it’s all these other things,” he said.
Although it is known that that’s true for physical health, is that also true for behavioral health? Evans says yes. Then the question becomes, “What does that mean for us in terms of how we as behavioral health professionals begin to impact upon some of those other areas.”
For example, on the physical health side, there are policy-strategies that people employ to make the public healthier or safer, like adding fluoride to the water.