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Perspectives

Behavioral Health Should Be Guided by the 10 Essential Public Health Services

March 26, 2021

Originally developed in 1994 by a federal workgroup, the 10 Essential Public Health Services (10 EPHS) outlined below were revised in 2020 by the Public Health National Center for Innovations | PHNCI and the de Beaumont Foundation. These revised 10 EPHS serve as a guide to the public health functions that are necessary for any community. Further, the 10 essential services can be employed as standards not only at the community level, but also at county, state and national levels. They also are used to evaluate local health departments and to determine what technical assistance is necessary when public health performance is deficient in a community.

The goal of the 10 EPHS is to promote equity in health status, service access and care outcomes in a community. Stated simply: Everyone should have a fair and just opportunity to achieve good health and well-being.

The 10 EPHS are divided into three areas:

  • Assessment — Define problems and causes
  • Policy Development — Foster consensus, mobilize the community, implement and enforce policies and laws
  • Assurance — Build a strong infrastructure and workforce, enable equitable access, and improve and innovate

Here, I would like to convince you that the 10 EPHS also should be applied to community behavioral health and I/DD services. This framework could give us a common yardstick to apply across different communities to assess quality and promote needed improvements in care and equity.

Here is a brief analysis of the 10 EPHS and their applicability to the behavioral health and I/DD fields:

Assessment

  1. Assess and monitor population health.
  2. Investigate, diagnose, and address health hazards and root causes.

A huge new agenda for behavioral health and I/DD care is the implementation of population health management strategies. This will require subdividing entire community populations into smaller groups that are homogeneous with respect to health status—from very healthy to very ill. Subsequently, these subgroups can be offered different combinations of prevention, treatment and rehabilitation services, depending upon need.

Also new for the behavioral health and I/DD fields will be investigation and remediation of health hazards and root causes. Clearly, the negative social and physical determinants of health (SPDOH) are root causes of trauma and behavioral health conditions, and they can exacerbate I/DD. To effectively prevent disorders and disabilities, our fields must become active to alter these negative SPDOH.

Policy Development

  1. Communicate effectively to inform and educate.
  2. Strengthen, support, and mobilize communities and partnerships.
  3. Create, champion and implement policies, plans and laws.
  4. Utilize legal and regulatory actions.

Like the tasks for Assessment, many of the tasks in this domain will be new for the behavioral health and I/DD fields. These tasks begin with efforts to inform and educate children, adolescents, adults and seniors about behavioral health and I/DD conditions, their causes and care; about resilience and well-being; and about the care system. Good knowledge can dispel fear and stigma, as well as promote prevention.

Now that we have become aware of the deleterious effects of negative SPDOH, including structural racism, it is very important for us to work with local communities so that they can self-organize to address these negative factors. Several key actions are involved: always listen to community members; include historically excluded groups; identify informal community leaders; and follow solutions suggested by community members. Self-organizing communities can be very effective in addressing their local problems.

Behavioral health and I/DD programs, providers and consumers also need to be attentive to policies, plans and laws. This will require active participation in city and county work groups, legislative briefings and hearings, and policy implementation. The principle of good health in all policies should be followed, irrespective of whether the topic is transportation or schools.

Sometimes, it will become necessary to engage in regulatory or legal actions to obtain a positive outcome for the good health and well-being of community members. Behavioral health and I/DD providers will need to develop confidence and skill in implementing such approaches.

 Assurance

  1. Enable equitable access.
  2. Build a diverse and skilled workforce.
  3. Improve and innovate through evaluation, research, and quality improvement.
  4. Build and maintain a strong organizational infrastructure for public health.

Rather than focus on services per se, this domain addresses those factors that make the delivery of quality services possible. Build infrastructure, build workforce, and improve/innovate are tasks that generally have received very little attention in the behavioral health and I/DD fields. Clearly, they are essential to our mission.

As one example, due to lack of attention over the past decade, our workforce problems have descended from an issue into a crisis, now made even worse by COVID-19. We are experiencing many retirements and departures, while at the same time an insufficient number of new workers are entering our fields. Clearly, this crisis deserves our attention now.

A further implication of this domain is that these tasks must be addressed not only at the national level, but also at the state, county and local levels. For the most part, this effort will be new to many of us. We will need to learn as we begin to develop these areas.

Core to success in this domain is ensuring equitable access. This task is currently on our agenda and is being given high priority. A number of counties already have defined racism as a public health crisis, and more are in the process of doing so.

* * *

It is very clear from this short analysis that the 10 EPHS focus attention on tasks that receive very little effort in the behavioral health and I/DD fields. It also is clear that our field could benefit considerably if we did devote more attention to these tasks. We should adopt the 10 EPHS as a set of standards for our field, and undertake the related tasks at the local, county, state and national levels.

Ron Manderscheid, PhD, is president and CEO of NACBHDD and NARMH.

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