Local Health Department Engagement in Access to Mental Health Services and Mental Health Policy or Advocacy Activities

Abstract

Context: Mental health is a public health concern that requires national attention at the local level. Major issues facing local health departments (LHDs) to actively engage in mental health activities include inadequate surveillance data and limited resources. Objective: To examine the levels of engagement in access to mental health services, as well as policy or advocacy activities, by LHDs characteristics. Design: The study design is cross-sectional based on the national survey of LHDs. We analyzed the survey data from the National Association of County and City Health Officials' 2019 Profile study. Logistic regression was performed with 6 levels of engagement in mental health activities as the outcome measures. Results: LHDs reported that a majority had assessed the gaps in access to mental health (57.69%), followed by other activities—had implemented strategies to increase access to mental health (48.77%), implemented strategies to target underserved populations (40.66%), evaluated strategies to target underserved populations (38.84%), engaged in policy/advocacy to address mental health (32.27%), and finally addressed gaps through provision of mental health (22.31%). LHDs' governance structure was strongly associated with engagement in all 6 mental health activities. LHDs that had performed improvement processes, had behavioral health staff, and had cross-jurisdictional sharing were more likely to be engaged in all 6 of the mental health activities. LHDs were also more likely to be engaged in 5 of the 6 mental health activities if they had some relationships with faith communities and in 4 of the 6 mental health activities if they had some relationships with community health centers. Conclusions: Levels of engagement in mental health policy or advocacy activities among LHDs were low and varied by LHD characteristics. Intervention strategies may include encouraging LHDs to actively engage in mental health activities, participating in Public Health Accreditation Board accreditation program, and incentivizing mental health workforce retention.