Health and Wellness for Adolescent
Girls and Women with Mental and Behavioral Health Conditions
This knowledge path aims to bridge the public health and mental health information
needs of professionals with regard to promising, practical intervention
approaches to promote optimal health and wellness among women of childbearing age who experience
a mental, emotional, or behavioral health condition. The knowledge path covers topics of particular relevance to health promotion
and disease prevention for all women, with content specific to those with mental and behavioral health disorders: reproductive and maternal health,
intentional injury, chronic conditions, healthy behaviors, and health disparities.
This knowledge path is shaped by the literature acknowledging limited training resources and educational materials
responsive to the complex health-related needs of adolescent girls and women with mental health and/or substance use disorders. A selection of current resources
is presented that offer data useful for framing the issues, describing integrative approaches, and reporting on key policies and best practices aimed at improving
access to health promotion and disease prevention for this segment of the MCH population. While the overall goal of this knowledge path is to advance health
and health access for young women, it is also intended to serve as a resource for efforts to integrate women’s mental, emotional, and behavioral health into
a life course perspective.
The audience for this knowledge path is diverse and includes health and social service professionals, program administrators, educators, policymakers, and researchers. A primary goal of this knowledge path is for public health practitioners to better understand links between physical and mental health outcomes and
how to effectively intervene on behalf of adolescent girls and women with mental and behavioral health conditions. Likewise, given the high prevalence of physical health conditions among women with mental health and substance use disorders, the mental health community can benefit from a greater appreciation as to how to effectively intervene and partner in the prevention, treatment, and control of chronic conditions and injury, especially as they relate to women’s health and wellness. Finally, policymakers can help frame how a life course perspective can focus attention on the unique physical, mental, and emotional health issues and needs of women during the childbearing years. A separate brief presents resources for women and their families.
This knowledge path has been developed by the Women’s
Integrated Systems for Health (WISH) Project at the University of North
Carolina at Chapel Hill and MCH
Library at Georgetown University, both of whom are funded by the Maternal
and Child Health Bureau (MCHB). It will be updated periodically.
Resources for Professionals
Integrated Systems for Health (WISH) initiative, was awarded a 3-year
distance learning grant from the Maternal
and Child Health Bureau (MCHB) in 2010 to translate
knowledge to practice in the areas of gender-specific, evidence-based approaches
mental health and chronic disease prevention during the reproductive years.
In approaching this project, the need for improved integration of public
health and mental health systems was quickly identified, particularly in
the area of workforce development. The intent of WISH was to contribute to
competency-based training for applying a public health, population-based,
social-ecological approach to the design of women's health policies, programs,
and service delivery systems for this underserved and high-risk population.
The WISH project was part of the Southeast Public Health Training Center,
housed at the UNC Institute for Public Health. Collaborators included the
school's Department of Maternal and Child Health and UNC School of Medicine's
Center for Maternal and Infant Health.
A growing commitment to interdisciplinary workforce preparation is evident
at the federal, state, and local levels. The need for accelerated sharing of
information across the public health and mental health sectors is an essential
first step. The initial issue of the Women’s Health Prevention Brief,
a joint publication of the Association of Maternal
and Child Health Programs (AMCHP) and CityMatCH through
Health Partnership (WHP), was dedicated
to women’s mental health (See Women’s
Mental Health (2009) Women’s Health Prevention Brief,
Issue 1). Improving mental health prevention efforts is an AMCHP and CityMatCH
priority, reflecting an area of challenge to states and communities experiencing
limited resources dedicated toward the achievement of core MCH goals and
functions. This brief stresses the
importance of prevention as a key component of building comprehensive systems of support and service to improve the overall status of women’s health
and highlights examples of promising programs and a set of recommendations at the national, state, and local levels to improve women's mental wellbeing.
In 1999, the Surgeon General issued
a call for collaborative action to integrate primary prevention and treatment,
health, and behavioral health, and bring
together policymakers, researchers, practitioners, and communities in creating
a shared vision for a comprehensive system of care that supports women’s recovery
from mental illness and substance abuse (See Mental
Health: A Report of the Surgeon General (1999)). Research has shown that integrated
approaches can improve quality and outcomes of care in clinical settings, laying
groundwork for a broader strategy to integrate mental health and public health
at the population level. The passage of the Paul
Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of
2008 was a step toward this
goal. New mandates that further integrate mental health and addiction services
into primary care settings also fuel this movement. In January 2010, the Centers
for Disease Control and Prevention (CDC) dedicated the online journal, Preventing
Chronic Disease Public Health Research, Practice, and Policy,
to a collection of articles, Mental
Health and Public Health at the Crossroads (Vol. 7, No. 1, January 2010).
An expert panel, in examining how mental health should fit within the mission
of the CDC, recommended that a spectrum of public health activities
be adopted, including surveillance, prevention, and promotion, and the system
and policy context for these changes to be actualized.
The Surgeon General's Workshop on Women's Mental Health in 2005 brought
from the consumer, academic, advocacy, health care delivery, health insurance,
program planning, and policy planning communities to address critical mental
health issues affecting girls and women and make recommendations for materials
that could be produced by the Surgeon General to advance knowledge, understanding,
and behaviors regarding women's mental health issues. Topics included biological
and development factors; specific mental disorders; trauma, violence, and abuse;
social stress factors and stigma; identification and intervention issues; treatment
access and insurance; health system issues; and protective and resilience factors.
See the workshop report, Surgeon
General’s Workshop on Women’s Mental Health (2006).
- American Psychiatric Association (APA): Women’s Mental Health.Topic information, blog posts, upcoming events, expert Q&A, patient stories and resources for health professionals and families about women and mental health issues and disorders.
- Centers for Disease
Control and Prevention (CDC): Mental Health. Public
health information about mental health to support full integration
of mental health promotion and mental illness prevention and treatment
with other disease prevention programs. An expert workgroup assisted
in the development and evaluation of a strategic plan to advance
public health and mental
health promotion through surveillance and epidemiology and by translating
research into prevention programs, policies, and systems; see Public
Health Action Plan to Integrate Mental Health Promotion and Mental
Illness Prevention with Chronic Disease Prevention, 2011-2015 (2011)
and the January
2010 issue of Chronic Disease Prevention (Vol. 7, No. 1) which
focused on mental health. Also see CDC's mental health data and statistics which highlights CDC
research and surveillance on this topic.
- Massachusetts General Hospital Center for Women’s Mental Health: Reproductive Psychiatry Resource and Information Center. Research and program information, bibliographies, and a blog about the evaluation and treatment of perinatal psychiatric disorders. Topics include medication use during pregnancy and breastfeeding. Includes information about the National Pregnancy Registry for Psychiatric Medications, a repository of information about the safety of psychiatric medications that may be taken by women during pregnancy to treat a wide range of mood, anxiety, or psychiatric disorders.
- National Center for
Trauma-Informed Care and Alternatives to Seclusion and Restraint (NCTIC).
Resources to build
awareness of trauma-informed care and promote the implementation of
trauma-informed practices in programs and services. The interrelation
between violence, trauma, and co-occurring mental health and substance
use disorders in women emphasizes the need for trauma-informed approaches
throughout health, behavioral health, and related systems. Publications
Women in Trauma-Informed Peer Support: A Guidebook (2012). [Substance
Abuse and Mental Health Services Administration (SAMHSA)].
Center on Domestic Violence, Trauma and Mental Health.
Background reading, webinars, fact sheets, tips, conversation guides,
tools for advocates, mental health and substance abuse
professionals, legal professionals, and policymakers as they work to improve
agency- and systems-level responses to the traumatic effects of abuse on
survivors and their children. Includes tools and information for mental
health professionals on how to be responsive to domestic violence.
Publications include Prevalence
of Intimate Partner Violence and Other Lifetime Trauma Among Women
Seen in Mental Health Settings (2011). [Supported by the Administration
on Children, Youth and Families (ACYF)].
- National Council
for Behavioral Health. Advocates for policies that
ensure that people with mental illnesses and addiction disorders
can access comprehensive
healthcare services. Offers state-of-the-science education and practice
improvement resources and infographics, including, Health
is Mental (2013) (Press the command and + keys at the
same time several times to make the image larger), Addiction
is a Disease (2012), and How
to Manage Trauma (2013).
Presents information about Mental
Health First Aid, a public education program that helps people identify,
understand, and respond to signs of mental illness and substance use disorders.
The program features courses about
adult and youth mental health first aid. Also see the SAMHSA-HRSA
Center for Integrated Health Solutions which is operated by the National
National State Mental Health Program Directors (NASMHPD) Prevention
fact sheets, webinars and other tools for state mental health
and substance abuse
program directors and
mental and behavioral health professionals about implementing prevention-based
behavioral health initiatives for
families. Includes a list of organizations and projects that focus
on preventing behavioral health problems and promoting positive
Center for Integrated Health Solutions (CIHS). Models
for the development of integrated primary and behavioral health
services to better address the needs of individuals with mental
health and substance use
conditions, whether seen in specialty behavioral health or primary care settings.
Includes resources and tools for workforce development, financing, clinical practice,
and operations and administration. Also includes resources about general
health and wellness on topics such as tobacco cessation, mental
health first aid, wellness strategies, stress management, and peer
support training for resiliency, wellness, and self-management
of health and behavioral health. Offers a
newsletter for news and perspectives on primary care and behavioral
health integration. See the white paper, Health
Promotion Programs for People with Serious Mental Illness: What
Works?—A Systematic Review and Analysis of the Evidence Base in Published
Research Literature on Exercise and Nutrition Programs (2012) and its
brief. [Funded by the Substance
Abuse and Mental Health Services Administration (SAMHSA)
and Health Resources and Services Administration
(HRSA), and run
by the National Council for Behavioral
Cessation Leadership Center (SCLC): Behavioral Health. Presentations,
articles, curricula, toolkits, and other resources about tobacco dependence
treatment for people with mental illness and substance use disorders
who consume approximately 44% of all cigarettes sold in the United States.
SCLC provides training and technical assistance to behavioral health professionals
and consumers about the benefits of smoking cessation
efforts and effective smoking cessation
Abuse and Mental Health Services Administration (SAMHSA): Wellness Initiative.
Information and materials for health professionals and consumers
about the many ways wellness can improve the quality of life and
life expectancy for people
and substance use disorders. Features the eight dimensions of wellness
and training webinars and teleconferences on topics such as smoking
cessation, safe medication use, and the impact of trauma on wellness. Also see SAMHSA's Peer Support and Social Inclusion.
Alliance on Mental Illness (NAMI): Hearts and Minds. Online,
interactive, educational initiative promoting the idea of wellness
mind and body for women and men. Includes a video clip,
fact sheets, facilitators guide, and Native American wellness resources.
Topics include getting active, eating healthy, avoiding smoking, alcohol and drug use, and healthy sleeping habits.
Integrated Systems for Health (WISH). Integrative community
approaches to optimize mental and physical health among women of
reproductive age. Resources include a 6-part
learning module series:
Module 1: Introduction
to an Integrated Approach
Module 2: Defining the Challenge
Module 3: Principles and Frameworks Guiding the Integrated Approach
Module 4: Developing Evidence-Based Programs
Module 5: Building and Supporting Partnerships and Community Engagement
Module 6: Bringing
It All Together: An Integrated Approach
- Chamberlin J, Farkas M. 2006. Recovery
202. Boston, MA: Boston
University Center for Psychiatric Rehabilitation. This webinar responds
to the questions, “What Is Recovery?” and “What Is a a Recovery Oriented
- Hyde PS. 2011. Behavioral
Health: Public Health Challenge, Public Health Opportunity. Rockville, MD: Substance
Abuse and Mental Health Services Administration (SAMHSA). This PowerPoint presentation describes
and opportunities in creating a public health approach to improved
behavioral health. The presentation includes SAMHSA’s eight
strategic initiatives toward advancing support systems and community-wide
strategies that improve health status and well-being.
- University of Colorado Anschutz Medical Campus, Behavioral Health and
Wellness Program. 2013. DIMENSIONS:
Tobacco Free Toolkit for Healthcare Providers—Supplement—Priority
Populations: Behavioral Health. Aurora, CO: University of Colorado Anschutz
Medical Campus. This toolkit is designed to train peers and health professionals
to assist people with mental health and substance use disorders to live
a tobacco-free life.
- Also see the SAMHSA-HRSA
Center for Integrated Health Solutions (CIHS) collection of training
Reports and Other Electronic Resources
- Centers for Disease Control and Prevention (CDC), Division of Reproductive
Health. 2011. Preventing
and Managing Chronic Disease to Improve the Health of Women and Infants: Chronic
Disease and Reproductive Health. Atlanta, GA: Centers for Disease Control
and Prevention (CDC). [Fact sheet].
- Federal Partners Committee on Women and Trauma. 2011. Women
and Trauma: Report of the Federal Partners Committee on Women and Trauma—A
Federal Intergovernmental Partnership on Mental Health Transformation.
Washington, DC: Substance
Abuse and Mental Health Administration (SAMHSA). This report illustrates
the importance of listening to and incorporating the voices of people who
have been directly impacted by trauma and describes "trauma-informed care",
an approach that can be implemented in any setting and supports resilience,
self-care, and self-healing.
- Institute of Medicine. 2012. Living
Well with Chronic Illness: A Call for Public Health Action. Washington,
DC: National Academy of Sciences. This report describes findings
from a study of chronic illness among
Americans. The concept of living well reflects the best achievable
state of health that encompasses all dimensions of physical, mental,
and social well-being.
- Maternal and Child Health
Bureau (MCHB). 2013. Comprehensive
Approach for Community-Based Programs to Address Intimate Partner Violence
and Perinatal Depression. Rockville, MD: Department of Health and Human
Services (DHHS). [Toolkit].
- Office on Women's Health (OWH). 2009. Action
Steps for Improving Mental Health. Washington, DC: Department of
Health and Human Services. This report outlines specific action steps
for health care professionals
to address the burden of mental illness on women and girls and
to address the stigma associated with mental health. It provides
information on the signs and
symptoms of mental illness and solutions for preventing and coping
with mental illness. A booklet for consumers accompanies the report, Women's
Mental Health: What It Means to You (2009).
- Primm AB, Vasquez MJT, Mays RA, Sammons-Posey D, McKnight-Eily LR, Presley-Cantrell LR, McGuire LC, Chapman DP, Perry GS. 2010. Role of Public Health in Addressing Racial and Ethnic Disparities in
Mental Health and Mental Illness. Preventing Chronic Disease. 7(1):A20.
- Sanchez K, Chapa T, Ybarra R, Martinez ON. 2012. Enhancing
the Delivery of Health Care: Eliminating Health Disparities through
a Culturally and Linguistically Centered Integrated Health Care
Approach: Consensus Statements and Recommendations. Austin, TX: Hogg
Foundation for Mental Health. This report focuses on ways to integrate health care services in culturally and linguistically appropriate ways to promote health equity and eliminate behavioral health disparities.
- St. Pierre C with Hutchinson
D, Goldfarb D, Johnson D, eds. 2008. Wellness
and Recovery—The Vision and the Pledge. Boston, MA: Boston
University Center for Psychiatric Rehabilitation. Recovery and
Rehabilitation 4(3). This newsletter describes the health crisis
facing people with mental illness, barriers to wellness, a model
for incorporating wellness into mental health systems, and initiatives
to address health disparities for people with mental illness.
- Substance Abuse and Mental Health Services
Administration (SAMHSA) 2011. Addressing
the Needs of Women and Girls: Developing Core Competencies for
Mental Health and Substance Abuse Service Professionals. Rockville,
MD: Substance Abuse and Mental Health Services Administration.
This report arms mental health and substance
abuse professionals with a comprehensive overview of unique prevention, treatment
and recovery skills and practices to effectively serve women and girls.
- Substance Abuse and Mental Health Services
Administration (SAMHSA). 2012. SAMHSA's
Working Definition of Recovery: 10 Guiding Principles of Recovery. Rockville,
MD: Substance Abuse and Mental Health Services Administration (SAMHSA). [Brochure].
- UPenn Collaborative on Community Integration and National Alliance
on Mental Illness (NAMI). 2009. GLBTQI
Mental Health: Recommendations for Policies and Services. Arlington,
VA: National Alliance on Mental Illness (NAMI). This guide makes
recommendations for policymakers and service providers to ensure
to quality services for people with mental and behavioral health
conditions who are lesbian, gay, bisexual, transgender, questioning,
and intersex and to promote recovery and
Data and Statistics
for Disease Control and Prevention (CDC): Mental
Health Data and Statistics. Surveillance data sources
and statistics on depression, mental illness,
non-specific psychological distress, stigma of mental illness,
Health USA. Annual collection of current and historical
data on health challenges facing women, their families, and
their communities. The book includes sections about health
behaviors (e.g., alcohol use, cigarette smoking, illicit drug
use, nutrition, and physical activity) and mental illness. Women's Health USA 2013 is the latest volume. (Health Resources
and Services Administration (HRSA)).
- See NCEMCH resource brief, Maternal and Child Health Data and Statistics, and in particular, the Office
of Adolescent Health (OAH): National and State Facts, the Pregnancy
Risk Assessment Monitoring System (PRAMS), and the Substance
Abuse and Mental Health Services Administration (SAMHSA): Data, Outcomes,
Journal Articles and Other Literature and Research
University Center for Psychiatric Rehabilitation: Repository
of Recovery Resources.
Collection of articles, books, reports, and other resources that
can be used to promote and create recovery-oriented mental health
systems and increase awareness and understanding of the concept
Welfare Information Gateway Library. Online catalog of publications about child welfare. For materials on the topic, go to the Library
Advanced Search page. In the Key Word field, type (women, girls) & (mental, behavioral, alcohol,
substance, drug) & (wellness, nutrition, physical activity).
Click on Search to get your results. View the Library
Search Tips to inform
- NCEMCH. See Life
Course and Social Determinants, a resource of materials from NCEMCH.
Citations and abstracts for biomedical articles indexed by the National
Library of Medicine (NLM), with links to full-text articles when available. Conduct an automated
search of PubMed for a broad selection of English-language articles published in the last 10 years about promoting the health and wellness of adolescent girls and women with mental and behavioral health conditions.
Use the filters
the left sidebar to narrow your search by article type, among other
limits. Or, use the MeSH
(Medical Subject Headings) database to identify additional
search terms (e.g., tobacco use cessation).
the following databases for access to additional literature
and research on the topic. NCEMCH resource brief, Maternal
and Child Health Literature and Research Databases describes these
databases and offers tips for searching them.
Child Health Research Program: Funded Projects Search
NCEMCH Guides on Related Topics
These guides contain information related to women's and girls' mental and
behavioral health in specific areas.
- Adolescent Pregnancy and Parenting resource brief
- Breastfeeding resource brief
and Adolescents Exposed to Violence resource brief
- Community Services Locator: An Online Directory for Finding Community Services for Children and Families knowledge path
- Depression During and After Pregnancy knowledge path, family resource brief
- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents knowledge path, family resource brief, school resource brief
- Health Insurance and Access to Care for Children and Adolescents knowledge path, family resource brief
- Home Visiting resource brief
- Infant Mortality and Pregnancy Loss knowledge
path, family resource brief
- Intimate Partner Violence knowledge
path, family resource brief
- Life Course and Social Determinants resource brief
- Maternal Distress in the Perinatal Period and Child Outcomes knowledge
path, family resource brief
- Medications resource brief
- Preconception and Pregnancy knowledge
path, family resource brief
- Racial and Ethnic Disparities in Health knowledge path, family resource brief
- Suicide resource brief
- Tobacco, Alcohol, and Substance Use During Preconception and Pregnancy resource brief
- Tobacco, Alcohol, and Substance Use in Children and Adolescents resource brief
Resources for Families
See NCEMCH family resource
brief, Health and Wellness for Teen Girls and Women
with Mental Health and Substance Use Disorders.
Health and Wellness for Adolescent Girls and Women
with Mental and Behavioral Health Conditions: Knowledge Path. (August
2014) (Updated: March 2017).
Authors: Marcia S. Roth, M.P.H., University of North Carolina at Chapel
Hill Department of Maternal and Child Health; Amanda Allman,
LCSWA, M.P.H., M.S.W., Hope Services, LLC and North Carolina Institute
Health, Breanne C. Wilhite, B.S.
Contributors: Dorothy Cilenti, DrPH, M.P.H., M.S.W., University of North Carolina at Chapel
Hill Department of Maternal and Child Health and National MCH Workforce Development Center; Sarah Verbiest, DrPH, M.P.H., M.S.W., University of North Carolina at Chapel
Hill Center for Maternal and Infant Health and Every Woman Southeast; Mellanye Lackey, M.S.I., University of North Carolina at Chapel
Hill Health Sciences Library; Susan Brune Lorenzo, M.L.S., NCEMCH
Reviewers: Tarsha Cavanaugh, Ph.D., Health Resources and Services Administration Office of Women's Health; Women's Integrated Systems for Health (WISH) Technical Expert Panel, including several members with lived experience with a mental, emotional, or behavioral health condition; Jolene Bertness, M.Ed., NCEMCH; Rochelle Mayer, Ed.D., National Center for Education in Maternal and Child Health; Olivia K. Pickett, M.A., M.L.S., NCEMCH.