Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders (2025) / Chapter Skim
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5 Governance and Partnerships
5 Governance and Partnerships
Pages 153-180
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From page 153... ...
disorder prevention infrastructure is embedded in existing systems, including the public health, health care, and human services infrastructures (the latter includes 1 Governance, as defined by the United Nations, is "participatory, consensus oriented, ac countable, transparent, responsive, effective and efficient, equitable and inclusive, and following the rule of law" (WHO, 2021)
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Governance of the prevention infrastructure for MEB disorders is primarily shared by U.S. federal and state government agencies, although a wide range of public-sector entities at the federal, state and territorial, tribal, and local levels perform functions that include funding, providing oversight, regulating, setting standards and holding accountable, and collaborating with varied private-sector entities.
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. Examining the prevention infrastructure highlights the many levels of authority and responsibility characterizing federal, state, and local governance and difficulties in bringing them into coordinated, long-term efforts.
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. The infrastructure for preventing MEB disorders overlaps with the public health infrastructure and parts of the human services infrastructure (e.g., child welfare systems at the state and local levels, aging services)
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. The 1965 launch of the first neighborhood health centers, later community health centers, supported by President Johnson's War on Poverty, funded by the Office of Economic Opportunity, and offering comprehensive, community-based health care (including MH and SUD care)
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Interagency Coordination There are several examples, both historic and current, of interagency entities established for the purpose of furthering aspects of prevention or well-being. Federal interagency coordinating entities on behavioral health, such as the Federal Executive Steering Committee for Mental Health, last active in 2009, can play an essential role in improving coordination (GAO, 2014)
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In the broader prevention domain, the ACA established the National Prevention, Health Promotion, and Public Health Council (National Prevention Council or NPC) , which, with its National Prevention Strategy and led by the U.S.
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to respond to social, emotional, and physical needs of children and their families Related to Physical and Mental Health - Enhance policies and programs that increase availability and inte gration of patient- and family-centered primary care and behavioral health (BH) services - Expand family-centered and multigenerational approaches across federal agency programs and resources (e.g., policy, funding, pro grams, technical assistance, and research)
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An earlier iteration of the BHCC was in existence in 2009 and 2011, with indications that it included subcommittees, such as a subcommittee on primary care and behavioral health integration.7 In 2023, CDC established a Behavioral Health Coordinating Unit, whose mission is to "elevate, advance, and coordinate CDC's public health approach to promote mental well-being and prevent mental distress, substance use, 4 https://www.samhsa.gov/newsroom/press-announcements/202105181200 (accessed January 13, 2025)
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From page 162... ...
. Department of Housing and Urban Development The evaluation of the Indian Housing Block Grant Competitive Program "would include an assessment of community-level impacts from the resulting units built and rehabilitated, including the number of families assisted, the impact on homelessness and overcrowding, physical and mental health, accessible housing provided for persons with disabilities, and economic and educational outcomes" (HUD, 2022, p.
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In the current structure, the governance for MEB disorder prevention is uneven, with greater attention in SAMHSA and elsewhere in the ecosystem to prevention of substance use than to promotion of mental health. An integrated prevention infrastructure requires similar level of attention to substance use and mental health along with greater collaboration and ideally integration, with better interagency coordination among all agencies working on aspects of MEB disorder prevention, and with top federal leadership to drive change.
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ability to support state, tribal, and local MEB disorder prevention efforts by either establishing a Center for Prevention of Behavioral Disorders that integrates the agency's prevention activities, or by establishing a Center for Mental Health Promotion (equal to and working closely with the existing Center for Substance Abuse Prevention)
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The CMHS11 has a division of Children and School Mental Health which includes a Mental Health Promotion Branch, but there is no other mental health promotion unit, suggesting limited capacity to support mental health focused prevention for other age groups and settings. Establishing a CSAP-equivalent Center for Mental Health Promotion or a joint Center for Behavioral Disorder Prevention would help ensure that prevention of mental illnesses is being at least well-coordinated with prevention of substance use, and ideally, that these are integrated.
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Dialogue among all partners and constituencies could address concerns, but it must be emphasized that the status quo is suboptimal for a coherent and well-coordinated national prevention infrastructure.
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and the National Association of State Mental Health Program Directors highlighted those differences. The former's remarks highlighted aspects of a robust multilevel prevention infrastructure for SUD, while the latter reflected a focus on mental illness (including community and carceral care settings)
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These models include the network of PTTCs13 that can provide implementation support and technical assistance on SUD prevention and the network of CDC-funded prevention research centers,14 some of which have an MEB health promotion focus. In government–academic partnerships, universities support state efforts to promote MEB health -- providing research support and using state funding to provide training and technical assistance.
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The Division's National Tribal Advisory Committee on Behavioral Health convenes regularly to make recommendations based on the input IHS receives from the Tribal Consultation and Urban Confer. In 2016, SAMHSA and IHS developed a National Tribal Behavioral Health Agenda (NTBHA)
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For example, the Oregon Health Authority partners with tribes to support and expand access to behavioral health services, and to an array of resources that include Tribal Behavioral Health Resource Networks (Gooding et al., 2024)
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Table 5-1 offers examples of governance approaches among these partnerships. Models of Shared Governance Models of governance articulated by various experts are applicable to the prevention infrastructure for MEB disorders.
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The Bipartisan Policy Center has made recommendations related to public health governance, and many have relevance to the prevention infrastructure for MEB disorders. The report defined governance as the "legal authority and responsibility to protect and promote the health of populations" that sets "the structure and boundaries in which public health interventions and policies are developed, implemented, and evaluated"
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. The committee notes that engaging with tribes in consultation also applies to the behavioral health context, as discussed above.
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along with conducting a triennial community health needs assessment. Long-standing models and frameworks from the public health and population health fields outline the structure and processes for communitybased health planning and population health improvement efforts.
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It includes community partnerships and people with lived expertise, and, as noted, there are many models and examples of community governance in health promotion, public health, and community health settings, ranging from state-level advisory councils that include community members and people with lived expertise to federally qualified health centers that are required to have at least 51 percent of board members drawn from their patients. The Youth Wellness Hub is a "community governance model for integrating delivery and financing systems for youth behavioral health and wellness services" using three social policy tools that are evidence-based or promising: community governance, public health education campaigns, and blending of funding sources for service delivery (SFA, 2023)
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2024. CDC's behavioral health coordinating unit: Mental health is public health: CDC's strategic approach to mental health.
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2024. How states and tribes can partner to improve the access of American Indians and Alaska Natives to behavioral health Care Services.
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n.d. Maryland behavioral health advisory council.
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2015. National Tribal Behavioral Health Agenda.
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https://www. businessofgovernment.org/sites/default/files/Getting%20It%20Done.pdf (accessed January 13, 2025)
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