The Catholic University of America
State Commitment to Mental Health Promotion and Mental Illness Prevention: The Impact on Health and Behavioral Health Outcomes
Dr. Sarah M. Steverman
               

             Despite evidence that mental health can be promoted and many mental illnesses can be prevented, investment and research in promotion and prevention lags behind treatment efforts. Utilizing Rawls’ egalitarian theory, this study examines a measure of state commitment to mental health promotion and mental illness prevention and its impact on mental health and general health outcomes. Mounting evidence and recent changes in health care require researchers, policy makers, and other stakeholders to better understand state activities related to mental health promotion and mental illness prevention.  This study utilized secondary data sources to create a new data set with the state as the unit of analysis. The independent variables are a subset of questions asked of state mental health agencies. The control variables were derived from Census data and the dependent variables were derived from The National Survey on Drug Use and Health and the Behavioral Risk Factor Surveillance System. The study has one major research question: Controlling for population size, percentage of minority residents, percentage of residents in poverty, and percentage of residents without health insurance, what is the relationship between state-level of commitment to mental health promotion and mental illness prevention and mental health and general health outcomes? Multiple regression analysis demonstrated that state characteristics were the best predictors of mental health and general health outcomes. State-level commitment to mental health promotion and mental illness prevention were not predictive. Four of the five promotion and prevention commitment indicators were predictors of at least one dependent variable. Having public campaigns predicted fewer days with poor mental health, investment in evidence-based practices predicted lower levels of depression and serious mental illness, investment in systems collaboration predicted lower levels of serious mental illness, and having services for special populations predicted lower levels of poor mental health. Further research is needed to develop a valid and reliable measure of state-level commitment to mental health promotion and mental illness prevention and to determine the relationship between state-level activities and mental health and general health outcomes. Social workers can be an integral part of advancing research, systems change, and program implementation related to promotion and prevention.

Community-based mental health organizations epitomize the diverse settings in which efforts are underway to understand the implementation of evidence-based practices. The organizational complexities associated with the implementation process attempt to explain the challenges encountered by many agencies to adhere to fidelity protocols and requirements. Yet, the context in which implementation occurs requires exploration. Important dimensions of the context are organizational culture that serves as a guide to understand the behaviors of organizational members, absorptive capacity, and the change process. In light of the urgency to move empirically based psychosocial mental health interventions into usual-care settings, it is necessary to understand the context in which such organizational dimensions influence fidelity to implementation.
                This exploratory study utilizes a mixed-methods research design to conduct a secondary analysis of a national study on the implementation of evidence-based practices. The study focused on 11 community based mental health organizations that were involved in implementing the Integrated Dual Disorder Treatment (IDDT) protocol. The primary purpose of the research was to explore factors such as organizational culture, absorptive capacity, and the change process that influence the fidelity of implementation of the Integrated Dual Disorder Treatment model.
                Findings show critical to organization culture is a recovery vision central to consumer-based mental health treatment. Important dimensions of the change process focus on leadership, organizational adaptability, processes that foster knowledge transfer, and supervision. There was no relationship between organizational culture typology and fidelity to implementation. Absorptive capacity indicated moderate to strong relationship with fidelity. Leadership collaboration and values-innovation fit for the Integrated Dual Disorder model were found to have a strong relationship to fidelity. The findings suggest understanding the contextual aspects of organizational culture and the change process are important to fidelity. This knowledge enhances a more effective implementation process for community-based mental health agencies to promote client outcomes based in recovery and rehabilitation.