One System for Community Mental Health

Mental health shows up as a top need in community health assessments and community health improvement plans across the country. The harder question for local health departments is how to make a measurable, lasting impact with a limited budget.

There aren’t enough behavioral health clinicians to meet demand, and many people wait months to start therapy.

“The bottom line, in one sentence, is that we cannot clinically treat our way out of this crisis. Period,” said Deryk Van Brunt, co-founder and CEO of CredibleMind.

We explored what communities can do in a recent NACCHO webinar with Peyton Brock, performance management director at the Oldham County Health Department in Kentucky. One theme ran through the conversation: lasting impact comes when public health and behavioral health work as one system, providing early intervention and evidence-based self-care for most people with mental distress and offering a clear path to clinical care for those who need it. 

With the right community partners, that system can be funded for the long term and provide measurable outcomes for many different community stakeholders.

Early Intervention Works

Compare mental health with heart disease. Over the past two decades, deaths from heart disease have fallen sharply. Better treatment helped, and so did population health. This brought emphasis on more awareness, earlier attention to warning signs, and behavior changes like quitting smoking. Over the same period, depression rates have gone up.

“It’s multifactorial, but there is a role for public health and population behavioral health in addressing this problem,” said Jon Adler, chief medical officer of CredibleMind.

CredibleMind’s clinical team has reviewed more than 1,000 studies to match specific mental health interventions to the needs they address (like depression, anxiety, sleep, etc.), and that research lays the foundation for which resources the platform recommends. In one randomized study published in JAMA, a mindfulness program worked as well as a common first-line medication for anxiety, without the medication’s side effects.

Prevention and Clinical Care Belong in the Same System

Behavioral health departments are built to provide clinical treatment, and they often think of their population as the people already receiving care or waiting for care. Prevention and early intervention are the realm of public health. When public health steps back from addressing mental health, that early intervention gap often goes unfilled.

About 3 in 4 people experiencing mental distress prefer to start with self-care: what they can do on their own to feel better, for themselves or for a child, parent, or friend. Without a trusted place to start, many turn to search engines and AI chatbots and have to sort good information from bad on their own.

In a population behavioral health model, most people get evidence-based self-care and early support, and the roughly 1 in 4 who need or want clinical care get a clear path to it.

“It’s all one thing. We’re not trying to replace any professional services,” Van Brunt said. “We need to continue to expand and enhance our professional services, but we need to augment that with early intervention. That’s the population behavioral health model.”

Behavioral Health 360°, the nationwide initiative NACCHO and CredibleMind created in 2023, uses that model. It now supports nearly 20 million people across more than 200 communities. Each community launches the platform for its residents and its own workforce and adds local resources, from walking groups to clinicians. Aggregated, de-identified data shows leaders what’s happening with their community’s mental health over time.

Build on the Structures You Already Have

Oldham County folded its mental health work into structures it already had.

The county’s community coalition has been around for about 15 years and now draws more than 40 people each month from health care, mental health, government, and public health. When the 2024 community health assessment named mental health services a top-five need, that priority carried into the community health improvement plan, complete with a behavioral health subcommittee.

A separate mental health task force, launched in 2022, worked well for about a year and a half. But many of the same people sat in both groups, so they were attending two meetings to talk about the same issues. The county merged the task force into the coalition, where mental health became one of its focus areas.

The health department tracks the plan’s goals and keeps the work moving, while partners lead their own pieces.

“It means that we are the convener, not solely the owner,” Oldham County’s Peyton Brock said. “It’s truly this systems approach, with our goals and objectives going forward.”

Launching a Resource Is Only the Beginning

In its first year, Oldham County reached more than 19,000 unique users in a population of about 70,000. Most users who reported their age were 13 to 17, an audience public health programs often struggle to reach.

Getting there took promotion money. Opioid abatement funds covered the platform and its first year of promotion. When a request for continued promotion funding was denied, the county went about eight months without it, and engagement dropped. A partner later used leftover Mental Health First Aid grant funds to restart promotion.

“People don’t just find a resource because you put it on the internet,” Brock said. “We had to invest in getting people there. This is really where we started to learn that having the platform was just one piece of the work, but keeping it visible and connected to our community is completely another.”

At launch, the county offered a gift card drawing for completing a mental health check-in assessment. More people took an assessment on depression.

“They were coming because they were looking for something that felt relevant to what they were experiencing,” Brock said.

Other communities put the platform where people already are. A QR code on the back of a student ID opens resources on issues students commonly face. A card about grief and loss is offered when a family picks up a death certificate. Faith-based organizations and sheriff’s department diversion programs hand out materials, too. We keep a library of these materials so communities don’t have to start from scratch.

Sustainable Funding Comes From Many Partners

Funding is one of the biggest concerns we hear from local health departments. Most communities piece it together from several partners who care about the same outcome.

Not-for-profit hospitals must complete a community health needs assessment every three years. Mental health is often a priority there, too, and hospitals usually have money for their annual implementation strategies. Banks and credit unions have community reinvestment obligations and a stake in a productive community with a growing tax base. Schools, chambers of commerce, and faith-based organizations can be partners as well.

Each partner cares about different things. Our sustainability toolkit, based on MAPP 2.0 and collective impact methods, lists potential partners, what each one cares about, and email templates for starting the conversation.

Measure Change, Not Just Activity

Grant reports usually ask for activity counts. We also measure whether people change what they do. Across our platform, 94% of users give the resources a thumbs-up, and 57% report making a positive behavior change, such as sleeping better, drinking less, or getting along better with others.

Among users who screen at low risk, 77% choose evidence-based self-care, and 71% of those at higher risk navigate to a higher level of care. That leaves therapist appointments open for people with greater need.

Monterey County, California, had a behavioral health department that was struggling to reach youth and Spanish-speaking residents and could not hire its way out of growing demand. After the county launched the program, an independent, UC Berkeley-led evaluation found it tripled access to mental health support. A large share of users were youth and Spanish speakers, the result of outreach designed to reach them.

Where to Start

Three questions to bring to your next coalition meeting:

• Is behavioral health at the table?
• Where do your priorities overlap with those of hospitals, banks, schools, and other potential funders?
• Are you measuring behavior change, or only activity?

Take the Next Step

If you want to bring public health and behavioral health together in your community, we can help.

• • Watch the full webinar on demand. 
  • Download a free copy of our sustainability toolkit. 
  • Read the three-page summary of the Monterey County evaluation.
  • Learn more about Behavioral Health 360°, our partnership with NACCHO.
  • Connect with us to explore what this could look like in your community.