In a Nutshell:
- The Council of State Governments and The Commonwealth Fund have released a toolkit for state governments to advance mental health
- Many recommendations in this new toolkit echo past findings of Citizens Research Council publications
- Michigan has room for improvement in a variety of areas, from capacity building and data collection to a greater focus on health promotion and disease prevention
A recent joint publication from The Commonwealth Fund and the Council of State Governments brings together tools and resources for state policymakers to improve mental health. This work, informed by an interdisciplinary advisory group, focuses on four policy areas:
- Social isolation/loneliness
- Maternal mental health
- Mental health insurance parity
- The social determinants of mental health
The subsequent policy recommendations echo findings from Citizens Research Council reports and blogs on mental health and public health. Areas where our research aligns with this toolkit include capacity building, inclusive data collection and program design, payment reforms, and holistic approaches to improving health, such as mental health and primary health care integration and a “health in all policies” approach to policymaking.
States have an important role in building the necessary capacity and infrastructure to support population health (including mental and psychosocial health), as well as collecting the data necessary to understand both ongoing and emergent health needs. The publication notes that “states can support efforts to train providers, teachers, and community health workers to address mental health needs.”
In our report Meeting the Mental Health Needs of Michigan Youth with School-Based Health Services, the Research Council makes the same recommendation, suggesting both the need for training more social workers, psychologists, and other health professionals, as well as providing training to teachers and community members to address growing mental health challenges.
Inclusive Program Design and Tailored Interventions
The health needs of communities (mental or otherwise) can vary based on demographic, geographic, and cultural factors. Our past research has found similarly high proportions of health risks and needs in Michigan’s cities and rural communities, yet the same interventions may not be optimal for both the people of Kalkaska and Detroit’s Jefferson-Chalmers neighborhood.
Michigan has made admirable strides in studying race-based disparities, but more attention must be paid to other dimensions that influence health, including, but not limited to, socioeconomic status (including income, occupation, and education level), geography (urban/rural), sexual orientation, and cultural factors.
Public health and vital records data are essential both for characterizing problems and evaluating solutions. Successful policymaking, oversight, and evaluation are contingent upon improving capacity and infrastructure for data collection, evaluation, and reporting, as the Research Council noted in its report An Ounce of Prevention: What Public Health Means to Michigan.
Reconfiguring Insurance and Payment Models
Beyond enforcement of mental health parity and standards of care, existing payment models may not be uniformly equipped to adapt to innovations (e.g., mother-and-baby psychiatric units). Moreover, funding and reimbursements have generally favored intensive treatment of serious mental illness without comparable investment or incentive for preventative care, interventions, and/or programs.
Community-based programming to reduce stress and foster resilience and coping are one important area for investment. State governments must also consider strategies to address the social determinants of mental health, such as adverse early life experiences, poor education, unemployment/underemployment/job insecurity, poverty, income inequality, housing, nutrition, and social exclusion and discrimination. Investing in prevention will not only protect the public’s health, but will also reduce the demand for costly treatments and the strain on current providers struggling to meet growing mental health needs.
While it is broadly recognized that a person’s physical, mental, social, and spiritual health are deeply intertwined, our systems to support and care for people’s health remain fragmented. Mental health care integration is one important step to improve health service delivery and treatment. Policymakers can direct reimbursements to encourage this integration and to support collaborative care and value-based care models.
Addressing the societal factors that contribute to (and largely determine) our physical and mental health is not something that health providers can do alone. Because many of these determinants (whether in neighborhoods, schools, or prisons) have arisen from past and ongoing public policy choices, public policy must play a central role in shaping population health. A “health in all policies” approach (meaning applying a health lens to all policies under consideration, from education to transportation) can ensure that community- or statewide policy choices enhance (rather than harm) the wellbeing of people who are affected.
The Need for Action
Michigan’s success—from a talented, well-educated workforce and vibrant economy to the social and moral fabric of its communities—is dependent upon the wellbeing of its people. In the face of growing mental health needs and challenges, Michigan must invest in strategies to bolster health within schools and communities throughout the state. The usual incremental approach to policy change in schools and government will not keep pace with the growing behavioral health needs in our state; swift, multi-faceted actions are needed. Given the long-term social and economic costs of inactivity, swift investment is not only justified, but essential.
Permission to reprint this blog post in whole or in part is hereby granted, provided that the Citizens Research Council of Michigan is properly cited.