Print Page   |   Contact Us   |   Your Cart   |   Sign In
CFHA Blog
Blog Home All Blogs
Search all posts for:   

 

View all (281) posts »

Mental Health vs. Behavioral Health

Posted By Peter Fifield, Monday, September 21, 2009
Updated: Wednesday, June 01, 2011

In a past CBC blog there was a brief discussion around the difference between "Collaborate and Integrate”. Although to some it may only appear to be an issue of semantics, to others there is a need to create consistent definitions in our profession. A reliable discourse within our profession could facilitate the relay of ideas concerning policy, process and practice.

As the concepts of Integrated Care become more and more familiar within the medical landscape, there is a potential need for a universal discourse. On occasion I interact within our local and state-wide communities here in New Hampshire spreading the word of integrated medicine and collaborative care. Naturally, two phrases that are often used during conversations are "Integrated Care” and "Behavioral Health”. Shortly after these words leave my mouth, a look of inquisitiveness often arrives on the faces of anyone lending an ear.

Dr. Ben Miller asked an important question in a prior blog: "Where is Mental Health”? As I read the blog, I thought that before we can identify where "it” is we actually need to know what "it” is. I have a request of you all. Please post your opinion related to the difference between Mental Health and Behavioral Health. I have my own operational definition but quite often I find myself attempting to discern between them and I’m sure my resultant answer is rarely the same. Questions I find myself asking are: "Is it more than just a way to euphemize a service being sold to an unwitting patient?”, "Is there a core practical difference between the two or is it merely a philosophical difference?”, "Does behavioral health only occur in a medical setting and mental health in a specialty clinic?” and "Does anyone really care about the difference aside from the Medicaid/Medicare billing departments?”. I hope that there are some Behaviorists, Gestaltists and Psychoanalysts out there, from a range of professions, ready to respond to this topic.

This post has not been tagged.

Share |
Permalink | Comments (11)
 

Comments on this post...

Randall Reitz says...
Posted Friday, July 08, 2011
Pete,



You ask great questions. In my perspective, preference for the term mental health, behavioral health, or (I’ll add) emotional health have historically come down to one’s training and bias. If psychology is considered a 3-legged stool made up of emotions, cognitions, and behaviors, then each leg has its own branch. Perhaps due to the early dominance of psychoanalysis, the term mental health has long been the preferred term in our field.



Psychologists and other mental health professionals chafed against behaviorism due to the perception that it reduced humans to rats and reduced clinicians to Skinner box drivers. I believe this perception was not shared by the medical field because they were early adopters of rigorous science and animal studies. They have a low tolerance for the immeasurable and behavior is the most outwardly measurable aspect of psychology.



It would seem behaviorism is winning the day (reference the proliferation of B's in NCCBH, PCBH, IBH, etc) and many community mental health centers are changing their names to replace mental health with behavior health. I support this change for a number of reasons:





It is a more broad term that easily encompasses psychopathology, addiction, and coaching



It is a better description for the lifestyle interventions that primary care clinicians offer for people with diabetes, heart disease, tobacco addiction, etc



It helps move beyond the stigma identified with mental health.
Permalink to this Comment }

Tattiana Romo says...
Posted Friday, July 08, 2011
Hmm... I have always seen these two as separate areas under psychology. Mental Health consisting of psychopathology. Behavioral Health concerns issues that can have an actual outcomes by changing "behavior" such as addictions. You cant really change your outcome if you have something like schizophrenia by changing your behavior you can only control it with medication. That's just how I see it
Permalink to this Comment }

Peter Y. Fifield says...
Posted Friday, July 08, 2011
Primary Care pragmatism tells us that we need to use best practice and have measurable outcomes. Out of the trio of cognitions, emotions and behaviors, the latter of the three seems to be the most measurable. The question is, how do we take out one of the legs on this three legged stool with out tipping it over. Or do we not have to? I think most would agree that it is almost impossible to separate these concepts. Maybe we just attend to the body in a holistic manner--combining the three when needed, but come up with an entire new name for the process.



Behavioral health appears too isolative regarding human actions and tends to disregard (at least in its title) the other two legs of the stool. Although mental Health has the most fitting title, it does have a marred reputation. It tends to carry a considerable stigma; it may imply that medications are necessitated for successful outcomes; it may imply that a severe and persistent issue is at hand and it leaves patients thinking long term psychotherapy is necessary. What if we call it something so ambiguous no one knows what it means? How about Health Stratification Treatment?
Permalink to this Comment }

Guest says...
Posted Friday, July 08, 2011
It's an interesting topic for discussion. Back in the day, Albert Ellis was booted from the APA for asserting that the three legged stool can be treated all at once, fairly quickly without all the psychoanalytic baloney. Now everybody does "cognitive-behavioral therapy". Insurance companies want therapists to use "cognitive-behavioral" techniques (but never bother to check what the heck they're really doing). Mental health sounds like it's for crazy people. It still scares my mother, what I do for a living. The term "behavioral health" sounds more user-friendly. However, the term has already been co-opted by the substance abuse megatopolis. They even have a trade magazine named Behavioral Health. My concern with changing the name is, it's helping the addiction treatment folks in their quest to integrate the whole shabang..mental health and substance abuse. And they are control freaks whose main qualification to treat is they are/were a drunk or addict. They need to make money like everyone else. So do their suppliers. Maybe introduce legislation to test your hair before giving you a driver's license?

They're currently working on the term "recovery". They want to get that word in the mental health lexicon. Check it out. It's already happening.
Permalink to this Comment }

Randall Reitz says...
Posted Friday, July 08, 2011
Dear Guest,



Please introduce yourself when you use the guest login. We would love to get to know you better.



While I don't share your dismissive perspective of our brothers and sisters in the substance use field, I do think you make some valid points. By moving to one term (behavior) to describe all of mental health and one title (behaviorist) we are conflating things that aren't exactly the same. The signifcant and subtle differences can be lost.



However, Primary care physicians are jacks-of-all-trades. Mental health clinicians are a better fit in primary care when they reflect this generalist nature. It is helpful to have a little cognitive behavioral, a little systems thinking, a little motivational enhancement, and yes, a little substance use treatment ability.
Permalink to this Comment }

Peter Y. Fifield says...
Posted Friday, July 08, 2011
Randall, I agree with your generalist approach to mental/behavioral health treatment in the primary care setting. Anecdotally speaking that is, the jack of all trades approach--addressing, behaviors, cognition and emotions (with a sprinkle of MI) is what has proven most effective for most of the practitioners I am familiar with. Regarding the integration of the "whole shabang"...mental health and substance abuse treatments--I'm not convinced that isolationism is the correct approach here either. Aside from the PTSD Dx, most of the recent literature I have read, leans towards co-occurring substance and mental health treatment. In my opinion, separating the two would be a regression regarding the movement towards seeing and treating the person as a whole.
Permalink to this Comment }

Sandy Blount says...
Posted Friday, July 08, 2011
I think of behavioral health as being the overarching term for mental health, substance abuse and behavioral medicine. Behavioral medicine is changing the body with words (well, really they all are), but behavioral medicine is health behavior change on one side and the relaxation response approaches on the other (relaxation, visualization, bio-feedback, mindfulness, hypnosis). In fact, I have no idea how anyone in primary care, (or anywhere else) works without being in all of these areas.



I worked with a guy this week. He is temporarily currently sober from an OTC and prescription pill addiction. We talked about what he was learning at NA (SA) and how he stays sober day to day. We looked at what he thinks and how that can better support his sobriety (CBT). We looked at how he calms himself and uses breating to stay of track (RR/CBT). We went into detail about how he got sober before and the times he thought he would fall off the wagon but didn't (Solution Focused). We talked about how his wife has been inducted into the role of monitor for him and how their relationship when it is stuck like that holds on to the old bad boy/good gal interaction (family systems). I asked him how much of his identity was taken up with the identy of drug addict now. He said well over 50%. I asked him what his goal was for the amount of his identity that would be drug addict in the future. He said 10% (0 is not one of the options, NA). We imagined the day when drug addict would be about as much of his identity as fisherman (all this is Narrative Therapy, a la White and Epston). I asked him what part of his identity he would hope was taking up more space when we meet again and he said athlete. He is going to the gym (Beh Med). I asked him to look for times when he and his wife are having an interaction where drug addict/monitor is not in evidence. What are the roles they like better? (Family systems, solution focused).



Why would you want to work in something as complex as human problems without a full tool box?

Permalink to this Comment }

Randall Reitz says...
Posted Friday, July 08, 2011
Sandy, Amen!
Permalink to this Comment }

Randall Reitz says...
Posted Friday, July 08, 2011
Sandy, Amen!
Permalink to this Comment }

Guest says...
Posted Friday, July 08, 2011
My ins. switched to a different carrier for Behavioral Health coverage, which does not cover any hospitals which offer both physical and mental care facilities (only ones that are mental only). I am bipolar, and don't really see it as a 'behavioral' issue, as if I just have to behave better and then I will be well? When I have a breakdown and depression for 6mo where I am almost dead, is that because I need to behave differently? I am offended, and frankly scared by the terms and the misrepresentation/ grouping together of these two things. Also, I read there were laws passed about parity of coverage for physical and mental illnesses. Separate but equal didn't work with races, and it's about the same here. It's not equal when the good drs and hospitals are not in network. I would LOVE to get off lithium one day and just adjust my behavior. Then I will happily accept them referring to my condition as behavioral. as long as I am dutifully taking meds every day and working very hard to be well, I do not deserve to be termed 'behavioral'. I AM behaving.
Permalink to this Comment }

Norman Rasmussen says...
Posted Thursday, January 17, 2013
Many many years ago in graduate school, I learned that the "mental health" focus is on helping the patient gain insight first and, second, then guide, and not too directly, the patient in translating that insight into behavioral changes consistent with her/his values and goals. "Behavioral health" by comparison I was told focuses on assisting/directing the patient in making behavioral changes ostensibly consistent with values and health goals and without therapeutic actions that would directly promote insight.

Likely this view was common where I attended graduate school as their were 2 competing factions within the psychology department. One was humanistic and promoted Rogerian client-centered psychotherapy and the other was behavioral.

Of course, I quickly learned in post-graduate clinical practice that this differential was narrow and not very useful. Today I make the differentiation based on the setting where the psychology is being applied, i.e., mental health practice occurs in the community mental health centers and psychology specialty clinics in 60-90 minute sessions where insight and psychodynamic approaches are prominent whereas behavioral health practice takes place in primary care medical settings in curbside and 15-30 minute brief consultations that promote behavioral change today.

I understand that my view is also narrow but as of today it works for me. I also understand that both behavioral health and mental health is practiced to varying degrees in virtually every clinical setting.

Permalink to this Comment }

Community Search
Sign In


Forgot your password?

Haven't registered yet?

CFHA Calendar

10/13/2016 » 10/15/2016
CFHA 2016 Conference: "Celebrating the Many Faces and Places of Integration"