Copyright © Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)
The high cost of behavioral health problems across the population continues to highlight the need to integrate high-quality behavioral interventions across a variety of service settings. To successfully achieve such a system-wide transformation will require supporting federal policies that invest in sustainable high-quality services. To support these efforts we provide a mixed-method study of all federal mental health legislation over the last three decades. Results indicate that mental and behavioral health policies have grown. Further, specific characteristics that comprise bills that are successfully enacted into law are identified. Finally, opportunities for the field to engage with policymakers to support widespread integration of behavioral health services are offered.
Keywords: Behavioral health policy, Evidence-based, Investment, Population Wellbeing, Scientific outreach
Practice: There is a need for practitioners to educate policymakers about the opportunities surrounding behavioral intervention, particularly in specialty settings.
Policy: Federal behavioral health legislation that directly includes cost-effectiveness, evidence-based terminology, or a prevention frame is more likely to be enacted into law than legislation that does not reference these topics.
Research: Scientists should consider how their evaluation of behavioral interventions can be successfully translated into evidence-based policy.
Every year behavioral health problems affect millions of individuals and cost over $240 billion in increased healthcare, criminal justice, child welfare, education, and labor market costs [1]. Ongoing efforts within the research and practice communities have sought to integrate evidence-based behavioral health strategies into a variety of settings and contexts (e.g., mental health clinics, rehabilitation departments, psychiatric hospitals), yet have also encountered a number of barriers to successful uptake and sustained use [2–4]. To overcome these barriers, a growing number of researchers and practice groups are seeking to inform national public policy in order to overcome barriers and facilitate increased investment in behavioral health [5,6]. While much is known about effective behavioral intervention strategies, less is known about how to craft policies that can successfully integrate behavioral services into diverse settings [7]. In particular, little work has systematically sought to understand how mental health laws do (or do not) include behavioral health, and none have considered how that inclusion is related to whether a bill becomes law.
To better inform scientific outreach, this work undertakes a mixed-methods analysis of federal mental health policy over the last 30 years. This includes systematic coding of behavioral health’s inclusion in federal legislation, quantitative analyses of that inclusion’s relationship with bills becoming law, and qualitative analyses of how behavioral health policy may be used to improve population health. First, we provide a brief background on evidence-based behavioral health services, then we describe efforts to integrate those services across settings, and finally, we provide background on the rise of evidence-based policymaking particularly as it relates to behavioral health and intervention.
There is clear evidence of the growing need for high-quality behavioral health services. The 2017 National Survey on Drug Use and Health (NSDUH) estimates that over 46 million adults in the USA now have a diagnosable behavioral health disorder, an increase of 17% since 2008 [8]. Over 50% of these adults did not receive any mental health services for these disorders in the previous year—only a fraction of which employed behavioral health strategies [9]. The cost of not treating these disorders is high, both for those personally affected and for society as a whole. Depression and anxiety, which are the most commonly diagnosed behavioral health disorders, are among the top contributors to disease burden, as measured in disability-adjusted life years (DALYs) [10]. As of 2013, behavioral health disorders became the most expensive healthcare category in the USA [11]. Ultimately, the high human and economic costs of behavioral health issues provide substantial opportunity to recognize the cost-effectiveness of behavioral interventions [12,13].
Decades of research into behavioral health have resulted in a number of effective treatments. For example, cognitive behavioral therapy has been extensively studied as a treatment for depression, anxiety, and a number of other disorders [14]. Similar to pharmaceutical intervention, behavioral interventions can have different levels of effectiveness for different individuals. Determining the right combination of therapies can be challenging, especially when behavioral services are not well integrated into primary, specialty, or community settings [15,16]. Coordination of care across diverse contexts is needed to ensure successful integration across the country.
The gap in need for behavioral services and access are linked to multiple factors. Lack of financial resources or insurance coverage remains a major barrier to accessing behavioral interventions [17]. In some areas, a lack of providers or services can cause long delays between first seeking treatment and when treatment is actually provided [18]. Further, the stigma of a behavioral health diagnosis or the belief that behavioral strategies will not be successful can deter people from seeking help in the first place [19]. People who are receiving treatment for chronic health conditions often do not get the appropriate services for any comorbid behavioral health conditions [20]. A core aspect of this gap is accessed. To overcome this, there are increasing efforts to integrate behavioral services into a variety of service settings, especially primary care, in order to improve health outcomes (and lower costs) for individuals who have behavioral health diagnoses [20–22]. While integrating behavior health into primary care is likely to increase access to behavioral health services, the challenge of providing high-quality care in these settings remain. Unfortunately, many individuals who currently receive treatment in any setting continue to not receive effective, evidence-based treatments [23].
Increasing demand from an array of constituencies has sought to encourage policymakers’ use of scientific evidence in the creation of law—a movement often referred to as evidence-based policymaking [3,24]. Scientific evidence can take a variety of forms, including results from randomized control trials or program evaluations as well as etiological and epidemiological information on the scope of problems and the underlying mechanisms related to those problems [25,26]. The goal of evidence-based policymaking is to use this objective evidence at all stages of policy development—from defining the problem and setting priorities to enacting programs through legislation—in order to create more effective programs [3,27].
Evidence-based policymaking is especially important for behavioral health care because of the large impact public policies in this area can have on access, financing, and quality of services. For example, historical drug control policies focused on criminalizing drug use—often resulting in substance abusers being incarcerated instead of receiving treatment [28,29]. Evidence illustrating the failure of this approach to reduce drug use has led to increased recognition of addiction as a behavioral health problem needing treatment instead of a criminal justice issue [30]. This, in turn, has led to increased appropriation for behavioral health services, efforts to connect addicted individuals with available services and checks on service quality.
Evidence-based policymaking can also be an important approach for scaling effective behavioral interventions across the country. The Maternal, Infant, and Early Childhood Home Visiting Program (MIECHV) was funded by a provision in the Affordable Care Act to provide block grants to states for implementing evidence-based behavioral home visiting programs that target maternal and infant health [31]. The MIECHV program has grown from serving approximately 34,000 people in 2012 to 156,000 in 2017, and the program is now available in every state in the USA. Specifying how this program would be integrated into community settings within the Affordable Care Act provided the federal support needed to help the states grow their programs while keeping implementation fidelity high [3].
Ultimately, examples such as these offer promise for supporting the integration of behavioral health interventions into a variety of settings across the country. Yet, to better understand the opportunities of such scientific outreach, there is a need to understand how behavioral health is being supported in existing mental health policies. Further—as many mental health bills are introduced to congress, but only few become law—there is a pressing need to know what are the characteristics of behavioral health bills that actually become law.
In order to answer these pressing questions about mental and behavioral health policy, we conducted a mixed-methods review of all federal bills introduced to Congress over the last three decades (1989–2019; N = 171,861). This timeframe includes all legislation publicly available on the Library of Congress’s website (www.congress.gov). This included a summative content analysis of bills’ legislative language. Then, we conducted a quantitative analysis of how bills’ content predicted future enactment into law. Below we describe (1) how bills were identified, (2) how specific contents within bills were analyzed, (3) qualitative analysis of legislative language, and (4) quantitative analysis to understand changes in bills over time and the relationship of bill content to future enactment (becoming law).
All bills introduced to Congress between 1989 and 2019 that were identified by the Congressional Research Service as dealing with mental health were included in the analyses. The source of the bill (House or Senate), the committee to which the bill was referred, and whether the bill was enacted were all captured. The party and state affiliation of bill sponsors and co-sponsors were also collected.
The mental health bills that directly referenced behavioral intervention were coded as behavioral health bills. We took a conservative definition to avoid over counting bills considering behavior broadly and focused on those that referenced behavioral health explicitly (e.g., behavioral medicine, behavioral health, behavioral treatment, behavioral care, or behavioral healthcare). Additional key content areas in bills were also considered. This included coding bills for direct reference to (1) specialty service settings, (2) evidence-based terminology, (3) prevention framing, and (4) consideration of cost-effectiveness. These content areas are described below.
Specialty and community settings often appear to be a natural place for behavioral interventions to be implemented. In bill language, these settings can be explicitly identified. To capture this, bills were coded for direct references to these settings (e.g., mental health clinics, psychiatric hospitals, rehabilitation department, reintegration department, or mental health department).
Within practice settings, a number of terms are meant to refer to intervention strategies that are based on scientific evidence. In bill language, these terms are often used to demarcate the need for using or supporting the use of such “evidence-based” strategies. In this context, bills were coded for explicit reference to evidence-based practice (e.g., “evidence-based,” “research-based,” “science-based”).
Behavioral interventions can be considered solely in terms of the immediate treatment needs of patients but can also be framed as a form of preventive service that aims to avoid negative outcomes in the future (e.g., behavioral intervention to treat depression vs prevent suicidality, job loss, or future service use). In this context, bills were coded for any explicit reference to prevention as part of the bill within the title or bill text (e.g., “prevention,” “preventive,” or “preventative”). This seeks to provide a conservative estimate of bills that frame prevention, recognizing nonexplicit prevention framing will not be included.
Resource considerations are omnipresent in federal policy and are often directly referenced in bill language. For the purposes of this work, we consider bills that directly referenced common terms related to the explicit consideration of the cost of services and the potential impact of those services in terms of their cost (e.g., (“cost,” “cost-effectiveness,” “benefit-cost,” or “cost–benefit”). These are meant to flag bills that are directly considering cost and cost-effectiveness.
This work included not only identification of bill language but also latent content analysis aimed at exploring how behavioral health is included or excluded from mental health bills’ legislative text [32]. All behavioral health bills were included in this analysis to identify themes for contextualizing the existing codes and provide examples of how different bill language is used to craft public policy. This ultimately was used to identify opportunities for supporting the integration of behavioral interventions into practice.
The likelihood of mental health bills’ enactment (becoming law) was examined (the number of bills enacted divided by the total number of bills). Further, the differential rates of enactment of mental health bills with and without references to behavioral health were compared. In addition, the relationship between specific content from behavioral health bills and future enactment were modeled. This included modeling trends in mental health legislation’s explicit reference to behavioral health, which we examined over time and used to predict the enactment of the bill. Specifically, in addition to change over time, we sought to understand how the content of the bill influenced its probability of being enacted.
Analyses revealed that from 1989 to 2019, 4,574 mental health bills have been introduced to Congress (2.7% of the total number of bills). Of those mental health bills, 484 directly reference behavioral health (152 of these directly name depression, anxiety, bipolar or posttraumatic stress disorders). When considering the source of a bill, 46.40% of the behavioral health bills were introduced by the Senate, with most brought to the Senate Committee on Health, Education, Labor, and Pensions, the Senate Committee on Finance, the House Subcommittee on Health, and the House Committee on Energy and Commerce.
In terms of party affiliation, 79.20% of behavioral health bills were sponsored or co-sponsored by Democrats, 20.16% were Republican, and 0.61% by Independents. The greatest number of sponsors or co-sponsors of behavioral health bills were from California (N = 1,239), New York (N = 767), Illinois (N = 414), and Texas (N = 407; Fig. 1 ). Of all behavioral health bills introduced, 69.10% included content related to prevention framing, 58.03% included content related to cost-effectiveness, 76.71% included content related to evidence-based terminology, and 57.83% included content related to community of specialty settings.
Sponsors and co-sponsors of behavioral health legislation by state
In the 101st Congress (January 3, 1989 to January 3, 1991), only 14 mental health bills were introduced, comprising only 0.001% of all bills introduced. By the 115th Congress (January 3, 2017 to January 3, 2019), over 4% of all bills of any type included mental health provisions (N = 590; Fig. 2 ). This reflects a significant increase in the proportion of bills referencing mental health, with a 0.35% (SE = 0.03%) increase in the absolute proportion of mental health bills introduced to each passing Congress (F(1,15) = 108.50, p < .01).
Mental health legislation as a proportion of all federal bills (1988–2018)
While there were mental health bills introduced in the 101st Congress, behavioral health was not explicitly referenced until the 103rd Congress (January 3, 1993 to January 3, 1995) and comprised 4% of all mental health bills introduced in those two years. By the 115th Congress (January 3, 2017 to January 3, 2019), over 16% of mental health bills included direct reference to behavioral health ( Fig. 3 ). This reflects a significant increase in the proportion of mental health bills referencing behavioral health with a 1.12% (SE = 0.11%) increase in the absolute proportion of behavioral health bills with each passing Congress (F(1,15) = 108.53, p < .01).
Proportion of federal mental health bills directly referencing behavioral health (1988–2018)
Analysis of bill enactment revealed that mental health bills have a 9.1% chance of becoming law. The subset of mental health bills that directly reference behavioral health only has a 6.1% chance of being enacted. Analysis of the behavioral health bills revealed that of the four key bill content areas, cost-effectiveness was most related to a bill becoming law. Behavioral health bills that included cost and cost-effectiveness had a 10.03% chance of being enacted and were 76.20% (SE = 2.28%) more likely than behavioral health bills that did not directly reference cost-effectiveness to become law (F(1,483) = 11.11, p < .0009). Behavioral health bills that referenced prevention frames had an 8.72% chance of being enacted and were 60.94% (SE = 2.04%) more likely than behavioral health bills that did not directly reference prevention frames to become law (F(1,483) = 6.21, p = .013). Inclusion of evidence-based terminology was related to an 8.38% chance of enactment and were 76.94% (SE = 2.68%) more likely that behavioral health bills that did not reference evidence-based terminology to become law (F(1,483) = 8.22, p = .0043). Further, 7.99% of bills that referenced specialty and community settings were eventually enacted but were not significantly more likely than bills that did not reference specialty settings to become law (F(1,483) = 1.91, p = .1672); Fig. 4 ).
Bill content predicting behavioral health bill enactmentNote: Bill content categories were directly referenced as part of bill language.
Complementary content analyses further illustrated legislative opportunities to better support integrating behavioral health services into an array of settings. For instance, when considering the use of evidence-based terminology, a common theme across bills revealed how this terminology is often used instrumentally to indicate an expectation of the type or quality of intervention. For instance, the S. 756: First Step Act of 2018, a bill addressing federal prison reform introduced by Senators Dan Sullivan (R, AK) and Sheldon Whitehouse (D,RI), states:
The Attorney General shall—(1) conduct a review of the existing prisoner risk and needs assessment systems in operation on the date of enactment of this subchapter; (2) develop recommendations regarding evidence-based recidivism reduction programs and productive activities in accordance with section 3633; (3) conduct ongoing research and data analysis on—(A) evidence-based recidivism reduction programs relating to the use of prisoner risk and needs assessment tools; (B) the most effective and efficient uses of such programs; (C) which evidence-based recidivism reduction programs are the most effective at reducing recidivism, and the type, amount, and intensity of programming that most effectively reduce the risk of recidivism;…
In this manner, bill language is directly referring to a specific type of recidivism reduction program (i.e., “evidence-based”). It also congressionally mandates the Attorney General to undertake an evidence review to set criteria for what programs meet these criteria. Such reviews provide agencies or other designated bodies authority to identify, study, or restrict funding to services or programs that are based on scientific evidence.
The First Step Act of 2018 also provides insight into how language related to cost-effectiveness is used in behavioral health legislation. For instance, it amends the Omnibus Crime Control and Safe Streets Act of 1968 to add that
facilities, including a cost-benefit analysis to determine the cost effectiveness of the reentry program.
Functionally, this amendment requires consideration of not only the costs of behavioral reentry programs, but the costs relative to their benefits. While benefit-cost analyses are less common in U.S. primary care settings, legislation such as this reveals its common usage in community contexts where behavioral services may be able to reach specific support of populations that lack the ability to access traditional primary care contexts.
Quantitative findings revealed that references related to a prevention framing of behavioral health legislation appear to be relatively common. These references often point to a specific behavioral outcome that should be prevented. For instance, in S. 192: Older Americans Act Reauthorization Act of 2016, introduced on January 20, 2015 by Lamar Alexander (R,TN), Sen Patty Murray (D, WA) and Senator Bernie Sanders (I, VT), we see a prevention focus being brought to abuse, neglect, and exploitation of older individuals. Specifically, it mandates that
(g) The Assistant Secretary shall, as appropriate, ensure that programs authorized under this Act include appropriate training in the prevention of abuse, neglect, and exploitation and provision of services that address elder justice and the exploitation of older individuals.
This bill, which became law on April 19, 2016, directs the agency to ensure the inclusion of behavioral education services that can prevent specific outcomes. In this manner, a prevention frame is being used to justify upstream services for those caregiving for older adults.
Inclusion of community and specialty settings in legislation often consider areas that new policies can be implemented. For instance, in H.R. 6: SUPPORT for Patients and Communities Act sets forth the rule for consideration of the Senate amendment to H.R. 6 (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT for Patients and Communities Act).
(xxv) Providing, for the adoption and use of certified EHR technology (as defined in section 1848(o)(4)) to improve the quality and coordination of care through the electronic documentation and exchange of health information, incentive payments to behavioral health providers (such as psychiatric hospitals (as defined in section 1861(f)), community mental health centers (as defined in section 1861(ff)(3)(B)), hospitals that participate in a State plan under title XIX or a waiver of such plan, treatment facilities that participate in such a State plan or such a waiver, mental health or substance use disorder providers that participate in such a State plan or such a waiver, clinical psychologists (as defined in section 1861(ii)), nurse practitioners (as defined in section 1861(aa)(5)) with respect to the provision of psychiatric services, and clinical social workers (as defined in section 1861(hh)(1))).
This bill was introduced on June 13, 2018 and became law on October 24, 2018. In particular, we see the designation of both specialty healthcare (e.g., psychiatric hospitals) and community settings (e.g., mental health centers). In this example, the bill is seeking to incentivize the use of electronic health records (i.e., EHR) systems in behavioral health settings in an effort to increase quality of behavioral services in specialty and community contexts.
This work illustrates that not only has activity around federal mental health policy in general grown over the last three decades, but the number of mental health bills considering behavioral health in particular has also increased. This analysis provides support that many policymakers are not only aware of pressing behavioral health issues facing society but are also seeking to craft policy to address the persistent treatment gap in this area. Below, we discuss the direct implications of findings here and then consider opportunities for improving behavioral health policy.
Not only are mental health bills being introduced at an increasing rate, but they also are likely to become law. With a 9.10% chance of enactment, mental health bills have a higher enactment rate than general health bills introduced over the last three decades (6.83%). Interestingly, despite the overall success of mental health bills becoming law, those that reference behavioral health were less likely to be enacted than general health bills (6.10%). This has important implications for scientific outreach efforts seeking to support the development of policies that can facilitate integration of behavioral interventions at a national level. An important factor to consider as a focus of outreach is that the legislative content of behavioral health bills can impact the chances of becoming law.
When considering how bill content relates to the successful enactment of behavioral health legislation, a couple of key trends emerged from this mixed-methods work. Content related to cost-effectiveness, prevention frames, and evidence-based terminology appears to be important characteristics of behavioral health bills that successfully become law. These content areas should be further considered for both future studies as well as behavioral health outreach and advocacy efforts.
Interestingly, a direct reference to community and specialty settings was related to bills being only about 32.02% more likely to become law compared to bills not explicitly referencing specialized settings. This sheds further light on the persistent difficulties around getting behavioral services into specialty and community settings. Whether due to a lack of infrastructure or resistance from existing practitioners, even at the level of federal policymaking, specifying these settings is not as promising an area of focus as other content areas.
This work illustrates a number of opportunities for the field to support the national integration of behavioral interventions in diverse settings through improved federal policymaking. This includes (1) increasing policymaker education and outreach, (2) greater consideration of the cost-effectiveness of behavioral interventions, and (3) expanding prevention framing when supporting behavioral intervention integration.
A key takeaway from this work is the need to educate policymakers about the opportunities surrounding behavioral intervention. A number of efforts in the last few years have sought to connect with policymakers on these issues. One model for such outreach is known as the Research-to-Policy Collaboration. This model trains researchers to work with legislative staff around engaging in evidence-based policymaking from early priority identification through crafting legislative language. Recent work found the model to successfully increase researchers’ efficacy for working with legislative staff as well as successfully elicits requests for scientific evidence from congressional offices [7]. Models such as this offer a platform for the scientific and practice communities to engage in strategic and appropriate outreach with legislative audiences to translate their research and experience into enactable policies.
Resource considerations are omnipresent in public policymaking. The growing potential for behavioral interventions to be highly cost-effective in an observable and measurable manner is key [12,13]. As policy audiences increasingly recognize the high cost of behavioral problems, the willingness to invest in solutions has grown [33]. Bills that reference the cost or cost-effectiveness of behavioral interventions may resonate with key political constituencies and better align with policymaking groups that have not historically supported behavioral interventions. In this context, having accurate information on the costs of programs and the potential return-on-investing in behavioral intervention may become increasingly important as our field works to support policies that facilitate integration of behavioral interventions.
Describing behavioral interventions within a prevention frame, which focuses not only on the immediate benefits of service delivery but also on how those benefits cascade across developmental pathways to avert negative outcomes across domains, has promise. A number of scientific and professional groups have sought to bring this frame to policy audiences. Among others, the Coalition for Behavioral Health and the authors of the Unleashing the Power of Prevention report from the National Academy of Medicine have sought to engage in promotion and outreach to a number of state and federal policy audiences. The Society for Prevention Research and National Prevention Science Coalition have also engaged in strategic education and outreach that leverages a prevention frame to make the case for behavioral health interventions across a broad array of domains. Others have sought to engage in specific substantive areas (e.g., child welfare, social work, psychology).
This work offer key insights into the current state of mental and behavioral health policy. In an effort to avoid inflating the growing presence of behavioral intervention in mental health bills we took a more conservative view, focusing only on bills that directly reference behavioral intervention broadly. Future work should consider specific forms of behavioral interventions in order to understand the specific interests and support of policymakers (behavioral analysis, home visiting, medically assisted, etc.). Further, as a result of this work’s focus on efforts to support national integration of behavioral services, we focused exclusively on federal bills and law. Future work should seek to consider trends in state legislation and whether the characteristics of successful behavioral legislation identified here extend to bills introduced in state legislatures.
This work brings new insight into the growth of mental and behavioral health policy. Further, it provides new insights about characteristics of bills in this area that successfully become law—offering opportunities for scientific outreach and education. Ultimately, future work should consider how to facilitate the use of scientific evidence in behavioral health policy to encourage federal laws supportive of integrating behavioral health interventions into diversity for service settings.
The research reported in this publication was supported by the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development under Award Number P50HD089922, the William T. Grant Foundation, the PSU Social Science Research Institute and was supported in part by a training grant from the Institute of Education Sciences (R305B090007). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Conflict of Interest: None declared.
Authors’ Contributions: M.C. led the conceptualization and analysis of the article and contributing to drafting the manuscript. L.G. led the drafting of the manuscript. E.L. and T.S. contributed to the analytic model and coding strategy.
1. O’Connell ME, Boat TF, Warner KE.. Preventing Mental, Emotional, and Behavioral Disorders among Young People : Progress and Possibilities . Washington, DC: National Academies Press; 2009. [PubMed] [Google Scholar]
2. CDC. The Power of Prevention . Atlanta, GA: Centers for Disease Control and Prevention; 2009. [Google Scholar]
3. Haskins R, Margolis G.. Show Me the Evidence: Obama’s Fight for Rigor and Evidence in Social Policy . Washington, DC: Brookings Institution Press; 2015. [Google Scholar]
4. Baron J, Haskins R.. The Obama Administration’s Evidence-Based Social Policy Initiatives: An Overview . London: NESTA; 2011. Available at https://www.brookings.edu/articles/the-obama-administrations-evidence-based-social-policy-initiatives-an-overview/. Accessibility verified December 10, 2019. [Google Scholar]
5. Lynch JP, Sabol WJ. Assessing the effects of mass incarceration on informal social control in communities . Criminal Public Policy . 2004; 3 ( 2 ):267–294. [Google Scholar]
6. Ratzliff A, Phillips KE, Sugarman JR, Unützer J, Wagner EH. Practical approaches for achieving integrated behavioral health care in primary care settings . Am J Med Qual. 2017; 32 ( 2 ):117–121. [PMC free article] [PubMed] [Google Scholar]
7. Crowley M, Scott T, Fishbein DH. Translating prevention research for evidence-based policymaking: results from the research-to-policy collaboration pilot . Prev Sci . 2017; 19 :260–270. [PMC free article] [PubMed] [Google Scholar]
8. Substance Abuse and Mental Health Services Administration. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health . Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services; 2018. [Google Scholar]
9. Substance Abuse and Mental Health Services Administration. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings . Rockville, MD: Substance Abuse and Mental Health Services Administration; 2012. [Google Scholar]
10. Greenberg PE, Fournier A-A, Sisitsky T, Pike CT, Kessler RC. The economic burden of adults with major depressive disorder in the United States (2005 and 2010) . J Clin Psychiatry . 2015; 76 ( 2 ):155–162. doi:10.4088/JCP.14m09298 [PubMed] [Google Scholar]
11. Roehrig C. Mental disorders top the list of the most costly conditions in the United States: $201 billion . Health Aff (Millwood). 2016; 35 ( 6 ):1130–1135. [PubMed] [Google Scholar]
12. Crowley DM, Dodge KA, Barnett WS, et al.. Standards of evidence for conducting and reporting economic evaluations in prevention science . Prev Sci. 2018; 19 ( 3 ):366–390. [PMC free article] [PubMed] [Google Scholar]
13. Crowley DM, Hill LG, Kuklinski MR, Jones DE. Research priorities for economic analyses of prevention: current issues and future directions . Prev Sci. 2014; 15 ( 6 ):789–798. [PMC free article] [PubMed] [Google Scholar]
14. Hoffmann C, Stoykova BA, Nixon J, Glanville JM, Misso K, Drummond MF. Do health care decision makers find economic evaluations useful? The findings of focus group research in UK health authorities . Value Health. 2002; 5 ( 2 ):71–78. [PubMed] [Google Scholar]
15. Wagner EH, Austin BT, Von Korff M. Organizing care for patients with chronic illness . Milbank Q. 1996; 74 ( 4 ):511–544. [PubMed] [Google Scholar]
16. Katon W, Unützer J, Wells K, Jones L. Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability . Gen Hosp Psychiatry. 2010; 32 ( 5 ):456–464. [PMC free article] [PubMed] [Google Scholar]
17. Cunningham PJ. Beyond parity: primary care physicians’ perspectives on access to mental health care . Health Aff (Millwood). 2009; 28 ( 3 ):w490–w501. [PubMed] [Google Scholar]
18. Roberts LW, Battaglia J, Epstein RS. Frontier ethics: mental health care needs and ethical dilemmas in rural communities . Psychiatr Serv. 1999; 50 ( 4 ):497–503. [PubMed] [Google Scholar]
19. Corrigan P. How stigma interferes with mental health care . Am Psychol. 2004; 59 ( 7 ):614–625. [PubMed] [Google Scholar]
20. Manderscheid R, Kathol R. Fostering sustainable, integrated medical and behavioral health services in medical settings . Ann Intern Med. 2014; 160 ( 1 ):61–65. [PubMed] [Google Scholar]
21. National Academy of Medicine, Board on Children, Youth, and Families, Division of Behavioral and Social Sciences and Education, National Academies of Sciences, Engineering, and Medicine. Advancing the power of economic evidence to inform investments in children, youth, and families . (Steuerle E, Jackson LM, eds.) Washington, DC: National Academies Press; 2016. doi:10.17226/23481 [PubMed] [Google Scholar]
22. Shapiro VB, Bender K. Seven action steps to unleash the power of prevention . J Soc Social Work Res . 2018; 9 ( 4 ):499–509. [Google Scholar]
23. Jorm AF, Patten SB, Brugha TS, Mojtabai R. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries . World Psychiatry. 2017; 16 ( 1 ):90–99. [PMC free article] [PubMed] [Google Scholar]
24. Commission on Evidence-Based Policymaking. The Promise of Evidence-Based Policymaking . Washington, DC; 2017. Available at https://www.cep.gov/content/dam/cep/report/cep-final-report.pdf. [Google Scholar]
25. Brownson RC, Baker EA, Deshpande AD, Gillespie KN. Evidence-Based Public Health . Oxford, NY: Oxford University Press; 2011. Available at http://site.ebrary.com/id/10432488. Accessibility verified November 18, 2015. [Google Scholar]
26. Brownson RC, Chriqui JF, Stamatakis KA. Understanding evidence-based public health policy . Am J Public Health. 2009; 99 ( 9 ):1576–1583. [PMC free article] [PubMed] [Google Scholar]
27. Crowley DM, Scott JT. Bringing rigor to the use of evidence in policy making: translating early evidence . Public Admin Rev . 2017; 77 ( 5 ):650–655. [Google Scholar]
28. Koh HK, Sebelius KG. Promoting prevention through the Affordable Care Act . N Engl J Med. 2010; 363 ( 14 ):1296–1299. [PubMed] [Google Scholar]
29. Koh HK, Kerlikowske RG, Botticelli MP. A smarter war on drugs . JAMA. 2018; 320 ( 22 ):2301–2302. [PubMed] [Google Scholar]
30. Werb D. Post-war prevention: emerging frameworks to prevent drug use after the War on Drugs . Int J Drug Policy. 2018; 51 :160–164. [PMC free article] [PubMed] [Google Scholar]
31. Adirim T, Supplee L. Overview of the federal home visiting program . Pediatrics. 2013; 132 ( Suppl 2 ):S59–S64. [PubMed] [Google Scholar]
32. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis . Qual Health Res. 2005; 15 ( 9 ):1277–1288. [PubMed] [Google Scholar]
33. Crowley DM. The role of social impact bonds in pediatric health care . Pediatrics. 2014; 134 ( 2 ):e331–e333. [PMC free article] [PubMed] [Google Scholar]
Articles from Translational Behavioral Medicine are provided here courtesy of Oxford University Press
