APNA Position: Whole Health Begins with Mental Health

Introduction

Sound mental health is foundational to physical health and allows people to build and strengthen their own long-term physical health and well-being in partnership with providers of care. Improved mental health ensures resilient, healthy communities which meaningfully contribute to society as a whole.

Burden of Mental Health Problems under Current System

• 61.5 million American adults (23.4%) experience mental illness in a given year (SAMHSA, 2025).
• About half of all lifetime mental health conditions begin by age 14, and approximately 75% begin by age 24, yet the delay between the first appearance of symptoms and intervention is approximately 11 years (NAMI, 2025).
• On a worldwide basis, life expectancy for those with mental health disorders is substantially reduced (Chan et al., 2023).
• 18% of adults experiencing homelessness have a mental illness and 37% of adult state and federal prisoners have a diagnosed mental illness (NAMI, 2025).
• Across the U.S. economy, serious mental illness causes $193.2 billion in lost earnings per year (NAMI, n.d.).
• Medicaid covers nearly one in three nonelderly adults with mental illness (Saunders et al., 2025).

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.⁷ 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” (WHO, n.d.).
• 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 (Murphey et al., 2014).
• 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 (Kolappa et al., 2013).
• Research shows a strong link between adverse childhood experiences and long-term negative health and well-being outcomes (Felitti et al., 1998).

Recommendations

• 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 proficiency 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 culturally sensitive, 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.

Conclusion

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 promote a proactive approach to wellness. The American Psychiatric Nurses Association endorses this proactive approach to promote mental health as the foundation for overall health. Therefore, mental health and substance use services must be culturally sensitive, affordable, accessible, and integrated throughout the continuum of care.

Approved by the APNA Board of Directors March 15, 2017. Revised April 14, 2020; February 17, 2023; April 2026.

References

Chan, J. K. N., Correll, C. U., Wong, C. S. M., Chu, R. S. T., Fung, V. S. C., Wong, G. H. S., … & Chang, W. C. (2023). Life expectancy and years of potential life lost in people with mental disorders: a systematic review and meta-analysis. EClinicalMedicine, 65.

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.

Kolappa, K., Henderson, D. C., & Kishore, S. P. (2013). No physical health without mental health: lessons unlearned?. Bulletin of the World Health Organization, 91(1), 3-3a.

McLoughin, K. A. (2016). Whole health begins with mental health. Journal of the American Psychiatric Nurses Association, 22(6), 508-508.

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.

National Alliance on Mental Illness. (2025). Mental health by the numbers. (2025 update). https://www.nami.org/mental-health-by-the-numbers

Saunders, H., Euhus, R., Burns, A., Rudowitz, R. (February 21, 2025). 5 Key Facts About Medicaid Coverage for Adults with Mental Illness. Kaiser Family Foundation. Retrieved from https://www.kff.org/mental-health/5-key-facts-about-medicaid-coverage-for-adults-with-mental-illness

Substance Abuse and Mental Health Services Administration. (2025). Key substance use and mental health indicators in the United States: Results from the 2024 National Survey on Drug Use and Health (HHS Publication No. PEP25-07-007, NSDUH Series H-60). Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases

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.