Positive Approaches Journal, Volume 13, Issue 4
Fox | 11-17
Volume 13 ► Issue 4 ►March 2025
Applying Public Health Principles to Health Psychology
Kate Fox, DrPH (c), MPH
Introduction
Health psychology refers to a field of study that examines how psychological factors influence health and illness, including thoughts, emotions, and actions1. Framing health and wellness as an individual responsibility overlooks the broader systemic and social drivers that shape health and mental health outcomes. A public health approach to psychological and mental health is desperately needed. Public health principles emphasize population-level interventions and structural changes, offering valuable insights to improve health and wellness. This article explores how systemic factors influence mental health and discusses public health policy solutions aimed at addressing systemic trauma to promote population wellness.
Systemic and Social Drivers of Mental Health
In the latter half of the twentieth century, mental health as a field has made significant advances in scientific understanding of mental disorders, focusing primarily on disease pathways such as neurotransmitters and hormones (e.g. serotonin, dopamine). The advent of pharmacological options to treat mental illness such as depression, anxiety, bipolar disorder, and schizophrenia marked a significant transition in the field to psychopharmacology, neurological approaches, and the pathologization of mental illness. As recently as 1977, 64% of psychiatric visits were exclusively for psychotherapy without an accompanying prescribed medication; in 2002, this was true for less than 10% of psychiatric visits2.
Despite these scientific advancements, the population’s mental health has continued to decline. The number of people receiving mental health treatment has increased by 15 million people since 2002 3. One in eight U.S. adults is currently taking an antidepressant 4. The COVID-19 pandemic ignited national conversation about mental health, with the Surgeon General issuing a warning around youth mental health and workplace mental health in 2021 and 2022 respectively5,6.
Despite significant shifts in the scientific knowledge base underpinning the mental health field, America's mental health crisis has only worsened. Almost a third of United States (U.S.) adults report symptoms of depression or anxiety, which is three times higher than those reporting symptoms in 20197. In 2022, only 31% of U.S. adults considered their mental health “excellent,” a decrease of 43% from the same report in 20028. In 2022, the Centers for Disease Control and Prevention (CDC) recorded the highest rate of suicides in the nation’s history, an increase of over 30% since 20009. While efforts to increase access to evidence-based treatments, therapeutic interventions, and tech-based solutions have advanced, the field is falling short in addressing the mental health needs of the population.
This is where public health comes in. To date, approaches to solving the mental health crisis have been targeted primarily at the individual level, adhering to the traditional medical model of diagnosing and treating illness. A public health approach focuses on preventing disease among a whole population by addressing risk factors at the community level.
Consider the single mother I interviewed living in Delaware County, PA. She has a full-time job, a part-time job, and is raising a daughter with significant mental health challenges. Despite recognizing the importance of mental health and self-care, she has neither the time nor the resources to engage in wellness activities such as therapy, exercise, or even regular medical check-ups. The expectation that she should just “manage stress better” or “take a bubble bath” disregards the systemic factors that create and sustain these conditions. Instead of placing the burden of wellness solely on the individual, policies should focus on systemic reforms that alleviate these pressures.
Lack of Preventative Care in Mental Health
Public health has made significant advancements in the physical health care system that have yet to be made in mental health care. In primary care, individuals can seek treatment for minor ailments like colds or infections without requiring a formal diagnosis. Preventative measures such as vaccinations, routine screenings, and general wellness check-ups serve as the first line of defense against more severe illnesses. These proactive interventions reduce the burden on emergency services and improve long-term health outcomes.
Mental health care, however, lacks the equivalent first line of defense. Access to mental health care typically requires a formal diagnosis, insurance approvals, and other barriers that make early intervention difficult. Instead of a system designed to provide proactive support, mental health services are typically responsive – only available once symptoms become severe enough to warrant intervention. This gap in early access causes worsened health outcomes and places unnecessary strain on an already overburdened crisis system.
By applying a public health approach to mental health care, preventative care could be expanded, mirroring successful strategies in primary care. Community-based mental wellness programs, workplace mental health screenings, and school-based access to counseling could build a preventive care system to address mental health challenges before they escalate. Just as vaccines help prevent illness in physical health, mental health interventions can serve as population-level protective factors against more severe mental health conditions.
Policy Solutions for Systemic Change
To move beyond the traditional individual-centered approach to mental health, policymakers and public health professionals must implement strategic, systemic interventions that address the root causes of poor mental health. Key strategies include:
- Economic policies to reduce financial stress: Policies such as a living wage, paid family leave, and guaranteed minimum income can help reduce the financial stress on working families, allowing individuals the stability needed to prioritize mental health and physical health.
- Community-based mental health services: Mental health services must be re-imagined as services that support mental well-being, not just clinical services that respond to mental illness. Expanding access to community-centered mental health care could include programs such as youth mentoring and recreational programming, school-based counseling, and peer support initiatives that increase accessibility to mental well-being supports.
- Ensure appropriate access to community-based mental health services: Every individual in need of mental wellness support does not meet the clinical diagnostic criteria necessary to receive services. Policymakers can ensure that the definition of medical necessity is interpreted broadly to authorize mental well-being services and payments for a broad range of individuals.
- Increase availability of dyadic care models: Mental health and well-being is driven by a family’s health. Parents and caregivers need support to reduce stress and be the best caregivers they can be. Dyadic care refers to care that is provided to children and their families together. Increasing access to dyadic care models ensures that families can heal together.
For a detailed analysis of policy recommendations for Pennsylvania’s Medicaid HealthChoices program, please see the Children First report Optimizing Medicaid to Improve Child and Youth Mental Health in Pennsylvania.
Conclusion
Public health principles offer a critical framework for addressing mental health and well-being at a systemic level. Rather than placing the responsibility for well-being solely on an individual, a population-level approach recognizes the role of social and systemic drivers in shaping health outcomes. By implementing policies that address economic stress, expand community-based solutions, and integrate trauma-informed practices, we can create healthy environments that support long-term wellness for all. Health psychology must evolve beyond personal responsibility narratives and embrace systemic change as a necessary foundation to promote population health.
References
1. Hariharan M. The Textbook of Health Psychology. 1st ed. Routledge; 2024. doi:10.4324/9781003438908.
2. Mojtabai R, Olfson M. National Trends in Psychotherapy by Office-Based Psychiatrists. Arch Gen Psychiatry. 2008;65(8):962-970. doi:10.1001/archpsyc.65.8.962.
3. Mental health treatment or therapy among American adults 2002-2021. Statista. Accessed January 14, 2024. Number of U.S. Adults who Received Mental Health Treatment or Counseling in the Past Year from 2002 to 2023.
4. Products - Data Briefs - Number 377 - September 2020. September 8, 2020. Accessed January 14, 2024. Antidepressant Use Among Adults: United States, 2015-2018.
5. Office of the Surgeon General (OSG). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory. U.S. Department of Health and Human Services; 2021. Accessed January 14, 2024. Protecting Youth Mental Health.
6. Surgeon General. Workplace Mental Health and Well-being. U.S. Surgeon General; 2022.
7. Mental Health - Household Pulse Survey - COVID-19. November 6, 2023. Accessed January 14, 2024. National Center for Health Statistics - Anxiety and Depression.
8. Inc G. Americans’ Reported Mental Health at New Low; More Seek Help. Gallup.com. December 21, 2022. Accessed January 14, 2024. Americans' Reported Mental Health at New Low; More Seek Help.
9. CDC. Underlying Cause of Death, 2018-2021. CDC WONDER Database. 2021 2018. Accessed January 14, 2024. The Underlying Cause of Death Database.
Biography
Kate Fox is a daughter, a mother, a partner, a sister, and an advocate for social change in mental health systems. In her work at Children First, Kate leads efforts to improve school-based mental health, increase access to services, and promote healing-centered approaches to children’s mental health. Prior to Children First, Kate spent ten years working in public service at Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). Kate is also a doctoral candidate in health management and policy at Drexel University’s Dornsife School of Public Health, where she is working on a dissertation on establishing mental health justice principles in practice and in policy. Outside of work, Kate likes to focus on raising the next generation of socially conscious leaders by spending time with her young daughter.