A Look Back at 100 Years of Behavioral Health

For centuries, healthcare providers have offered behavioral health treatments for a variety of mental and physical conditions. Today, we often equate behavioral health only with mental health, but the term is broader than that, both historically and at the moment.

It may also encompass any treatment for behavior-affected conditions such as hypertension, prediabetes and substance abuse. Many such physical disorders treated under behavioral health, such as type 2 diabetes, strongly influence mental health (and vice-versa), demonstrating the wide range of interrelated afflictions that can be comfortably grouped under this umbrella.

According to the U.S. Centers for Disease Control, major depression raises the risk of type 2 diabetes onset by 60 percent, while diagnosis with either type 1 or type 2 diabetes is often accompanied by depressive episodes. Accordingly, modern behavioral treatments are diverse and can include psychotherapy as well as medications, exercise regimens and dietary recommendations.

For our purposes here, we will define behavioral health as the segment of medicine dedicated to preventing and intervening in mental and physical illnesses that can be consciously influenced by behavior. This field has a long history that has culminated in today’s comprehensive and largely inpatient approach to treatment, so let’s look back at the last century of behavioral health.

 

Early behavioral health overview: Institutionalization and hospitalization

Starting in the 1800s, it was common for behavioral health patients to be institutionalized in long-stay psychiatric hospitals. As a result, medical care for these individuals was predominantly inpatient.

Many of the facilities in which patients stayed were state-owned and operated. Activists such as Dorothea Dix, who founded the first public mental health hospital in Pennsylvania, were instrumental in winning the involvement of both state and federal governments in early behavioral health programs.

Eventually, the medical community became concerned about the quality of living conditions in behavioral health institutions. A national wave of deinstitutionalization followed, beginning in the 1940s.

 

Understanding the shift to deinstitutionalization in behavioral health practice

In the wake of the Second World War, rising awareness of the scope of mental illnesses – and their effects on physical health, including fitness for potential military service – led to the passage of several crucial pieces of legislation that reshaped behavioral health:

 

  • In 1946, the U.S. Congress and President Harry Truman passed the National Mental Health Act, which established the National Institute of Mental Health primarily in response to the demands of recent veterans for better psychiatric facilities and treatments.
  • In 1963, the same body and President John F. Kennedy passed the Community Mental Health Act. This law provided federal funding for community mental health centers and as a result spurred substantial deinstitutionalization over the next two decades.

 

Alongside these important political actions, behavioral health treatments were also progressing significantly. These key developments continue to be felt in present-day approaches to behavioral health.

Behavior therapy finally entered the mainstream, having started as a technique in experimental psychology, and turned into a common treatment for anxiety, depression and many other conditions. Breakthrough early medications such as lithium and chlorpromazine also became available to behavioral health patients for the first time.

 

History of behavioral health: The present day

Current behavioral health therapies often target mental and physical conditions, seeking to address the close relationship between the two. A prime example of how this approach has evolved is the recent push by the U.S. Veterans Administration (VA) for the use of cognitive behavior therapy in the treatment of chronic pain, a practice it calls CBT-CP.

Building on a wide body of academic research, the VA has outlined how CBT-CP might be adapted specifically for physical ailments (including migraines, back pain and arthritis, among other conditions), via components such as:

 

  • Walking programs and other exercise initiatives that may improve mood.
  • Relaxation trainings to alleviate muscle tension and stress.
  • Cognitive restructuring to encourage sustainable, balanced thinking.

 

These techniques align closely with the biopsychosocial theory of understanding chronic pain. Under this framework, different experiences of pain are understood based on physical, psychological and social factors. For example, depression is more likely in individuals with chronic pain and can profoundly shape how they handle their conditions. CBT-CP is a treatment tailor-made for the intersection of mental and physical therapies in modern modes of behavioral health.

Behavioral health is now mostly outpatient, having completely reversed its origins in inpatient medicine. The diversity of possible treatments, paired with the varying experiences of patients in response to them, makes utilization review a valuable tool in evaluating the quality and necessity of behavioral health treatments.

 

The role of independent medical review in behavioral health

Advanced Medical Reviews (AMR), an independent review organization, understands the importance of a diverse and licensed network of physician reviewers for utilization review in behavioral health. “Our physician recruitment focuses on licensed and credentialed professionals who are familiar with the latest research and treatment guidelines,” notes Leah Williams, Reviewer Relations Coordinator at AMR. “Peer review and utilization review are also a great opportunity for Physicians to ensure they are well-versed in state and federal regulations.”

The future of behavioral health continues to evolve as technology and healthcare delivery are offering new opportunities for treatment. The healthcare industry is also fostering more integrated solutions for behavioral health conditions to ensure patients receive adequate and quality care. In another 100 years, it may be hard to believe how far behavioral health has come from the early 21st Century.

 

https://www.va.gov/PAINMANAGEMENT/docs/CBT-CP_Therapist_Manual.pdf

https://store.samhsa.gov/shin/content/SMA13-4780/SMA13-4780.pdf

http://statemuseumpa.org/dorothea-dix-early-champion-for-mentally-ill/

http://www.npr.org/templates/story/story.php?storyId=122017757

http://www.healthline.com/health/behavioral-therapy#overview1