Spiritual_Wellness_Holistic_Health_and_the_Practic

Behavioral Health and Health Education 141
inverts all that. Local taxes (sometimes mixed with state money) fund the schools;
local boards make the important decisions. In public health the state Medicaid agency
is a major player, in education, there is rarely a state agency with comparable muscle
(or money).
The common alarming thread for health educators, regardless of where they
work, is managed care and, in particular, its application of the term behavioral health
to define mental health and substance abuse programs and services without the voice
of health educators. Our effort for evidence - based education, programs, and services
to promote health for individuals, families, and communities seemed threatened in
the push for cost containment, utilization review, and quality assurance. Another reason
that I changed my mind about behavioral health was because I realized that all of
my work in trying to prevent substance abuse and to promote mental health among
teenagers seemed for naught, if most children and teenagers in need of services never
receive them (U.S. Department of Health and Human Services, 2001). I wondered
how I was doing as an educator if the people I served lacked the information,
attitudes, and skills necessary to access programs and services. It was even more
distressing to consider that the environment could be so hostile to allow such misery
to continue. In my exploration of behavioral health, I now find myself grappling to
understand current behavioral health practices and to determine what, if any, opportunity
lies ahead for the field of health education to shape and refine the behavioral
health arena.
What I found as I began to explore behavioral health and managed care is that the
managed care industry is now well established in the United States and continues to
grow at a rapid pace. It is no longer an experiment, an emerging trend, or an anomaly
distinguishing certain regions of the country. Managed care is the primary mode of
insuring Americans in the twenty - first century. Health professionals, including health
educators, now work in an environment that is radically different from that of just ten
years ago. There are new rules, new funding mechanisms, and new incentives for
health professionals — incentives that have many health professionals angry, or at least
confused.
In the year 2002, the mental health and substance abuse benefit packages that
cover most privately insured Americans involve some form of managed behavioral
health care. Likewise, the public sector mental health and substance abuse programs
and services are in the midst of a dramatic revolution. Virtually all states are implementing
managed behavioral health programs. Most uncertain is how managed care is
providing services for people with the most severe illnesses and how managed care
and the privatization of public mental health affect people with serious mental health
problems. The private sector experience of behavioral health is very different from the
public sector experience of behavioral health (Sturm, 1999).
My exploration of behavioral health left me excited about the potential of health
educators to shape and refine what is meant by the term behavioral health . Standing at
the intersection of so many arenas, health educators need to be poised for action, to
seize the opportunity to shape and refine the concept of behavioral health.