APNA Position: Whole Health Begins With Mental Health

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Mental health and substance use problems continue to negatively impact our productivity as a nation. Mental health drives wellness. Sound mental health provides the stable foundation upon which a person can build, in partnership with providers of care as needed, their own long-term physical health and well-being. This in turn leads to healthy communities which meaningfully contribute to society.

Burden of Mental Health Problems under Current System

  • Approximately 56 million American adults experience mental illness and/or a substance use disorder in a given year.1
  • 75% of chronic mental health conditions begin by age 24, yet the delay between the first appearance of symptoms and intervention is an average of almost a decade.2
  • Persons living with serious mental illness die on average 25 years sooner than the rest of the American population, in large part due to treatable medical conditions.3
  • Approximately 46% of homeless adults staying in shelters live with severe mental illness and/or substance use disorders and about 20% of state prisoners have a recent history of a mental health condition.4
  • Serious mental illness costs America $193.2 billion in lost earnings per year.4
  • Currently one third of Medicaid recipients have a mental health or substance use disorder.5

APNA Position: Whole Health Begins with Mental Health

The American Psychiatric Nurses Association, an organization representing all levels of psychiatric-mental health nursing, asserts that whole health begins with mental health. APNA takes the position that mental health promotion, through prevention, recognition and adequate care and treatment, must be at the starting point of and comprehensively woven throughout the delivery of services within the American health care system. Further, our definition of health must be transformed to one which recognizes mental health as foundational for all health.

This position is supported by the following points:

  • Health is a “state of complete physical, mental, and social well-being and not merely the absence of a disease or infirmity”6
  • There is a broad consensus amongst experts in health care that transforming America’s system to a proactive one that promotes health and wellness, rather than reactively treating illness, is a necessity.7
  • Mental illnesses are risk factors that affect the incidence and prognosis of ‘noncommunicable’ diseases and addressing mental illnesses delays progression, improves survival outcomes, and reduces health care costs associated with noncommunicable diseases.8
  • Research shows a strong link between adverse childhood experiences and long-term negative health and well-being outcomes.9

Recommendations for the Future

  • Health care systems should be structured to address mental health and substance use both at the first point of contact as well as throughout the patient’s journey within the system.
  • All providers should have facility with mental health and substance use screenings to allow for prevention, early identification, brief intervention, and referral to treatment.
  • National, state, and local policies and regulations must ensure universal access to affordable services that promote mental health, prevent mental illness and substance use disorders, and offer care and treatment as necessary, which are provided by qualified health care professionals.


A successful and healthy society depends upon the mental health of its constituents. As it stands now, the prevalence of mental illness and substance use disorders continues to exact a toll across our communities. National, state, and local policies and regulations must take immediate action to ensure that policies are put into place which promote a proactive approach to wellness. The American Psychiatric Nurses Association believes that this proactive approach must recognize that mental health serves as the foundation for overall health and therefore mental health and substance use services must be affordable, accessible, and integrated throughout the continuum of care.

Approved by the APNA Board of Directors March 15, 2017.

  1. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from http://www.samhsa.gov/ data/
  2. National Alliance on Mental Illness (n.d.). Mental Health Screening. Retrieved from http://www.nami.org/Learn-More/Mental-Health-Public-Policy/Mental-Health-Screening
  3. Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council25.
  4. National Alliance on Mental Illness. (n.d.). Mental health by the numbers. Retrieved from http://www.nami.org/Learn-More/Mental-Health-By-the-Numbers
  5. Japsen, Bruce (March 6, 2017). House GOP Obamacare replacement hurts mental health, Republican Senators say. Forbes. Retrieved from https://www.forbes.com/sites/brucejapsen/2017/03/06/house-gop-obamacare-replacement-hurts-mental-health-republican-senators-say/#339b29532b54
  6. World Health Organization. (n.d.). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. Geneva, Switzerland: Author.
  7. Murphey, D., Stratford, B., Gooze, R., Bringewatt, E., Cooper, P., Carney, R., & Rojas, A. (2014). Are the children well? A model and recommendations for promoting the mental wellness of the nation’s young people. Robert Wood Johnson Foundation (Ed.), Policy brief, 1-53.
  8. Kolappa, K., Henderson, D. C., & Kishore, S. P. (2013). No physical health without mental health: lessons unlearned?. Bulletin of the World Health Organization91(1), 3-3a.
  9. Felitti V. J., Anda R. F., Nordenberg D., Williamson D. F., Spitz A. M., Edwards V., Marks J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14, 245-258.
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The American Psychiatric Nurses Association is accredited with distinction as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.