There is sufficient evidence to indicate that both children and adults who suffer from mental health and substance abuse problems are also more likely to have a great prevalence of unhealthy behaviors. Integrating efforts across public health, behavioral health and primary care has the potential to improve quality of life and produce economic benefits throughout the state. Making healthcare, including behavioral healthcare, a priority will improve the health and happiness of individual Nebraskans, improve the income and wellbeing of families, enhance community living, accelerate educational achievement, and elevate Nebraska’s businesses and economy. Public health has an important leadership role in creating this vision of whole-health and facilitating a cross-system approach toward achieving this vision. Achieving this goal will require visionary leadership through executive and legislative commitment to make this effort one of the highest priorities of the State.

Although state and local public health agencies have implemented or partnered to implement and integrate some mental health and substance abuse programs, the future role of these agencies is unclear as more emphasis on integration approaches is encouraged. A study to consider the current environment and provide recommendations as well as opportunities for collaborative relationships is likely to be of benefit.

Nebraska SHIP Priority 4: Nebraska has improved integration among public health, behavioral health and healthcare services.

For this SHIP goal, several activities were planned for implementation:

• Complete a report outlining opportunities and recommendations to integrate public health and mental health/substance abuse.

The principal goal of this project was to identify areas of opportunity to address behavioral health within the spectrum of Nebraska’s public health system, and how integrative approaches are applicable. The University of Nebraska Public Policy Center facilitated a study and produced a final report summarizing the components of the study, and outlining a series of recommendations to obtain that goal. There were four components of the study:

1. Perform an environmental scan of the primary care, public health and behavioral health landscape to identify opportunities for connections between policies, practice and partners. The environmental scan includes an inventory of Nebraska public health and behavioral health practices/programs to identify opportunities for connections. To help in organizing the initiatives, a conceptual framework for integration was developed and can be found in Appendix A. The environmental scan can be found in Appendix B along with a list of individuals interviewed as part of the scan.

2. Perform a review of literature, studies, policies, practices or programs to identify examples of activities and strategies that could be considered to promote and support integration within Nebraska’s public health, primary care and behavioral health environment. The literature review can be found in Appendix C.

3. Facilitate workgroup meetings to engage partners within primary care, public health and behavioral health in the study of integration opportunities in Nebraska. The workgroup provided oversight for a) the environmental scan report and practices review report; b) discussion of possible roles and responsibilities of public health and behavioral health integration; c) consideration of opportunities to progress and prioritizing key strategies to further review; d) compilation of a final report summarizing findings and recommendations for Nebraska.

4. Prepare a final report summarizing the discoveries and recommendations from the scan, review and workgroup process.

A final report was published in September 2015.

The State Health Improvement Plan Initiative, particularly the goal to integrate public health and behavioral health, is a significant indicator that the State of Nebraska recognizes the value of integration. There are rich and varied integration efforts currently underway across state agencies, local public health and behavioral health agencies, private foundations, and community coalitions. However, there is no central point of collaboration and leadership tying these efforts together. The following are some recommended next steps:

1. Enhance state-level leadership for public health/behavioral health integration.

2. As part of state-level leadership, develop a common framework for whole-health care, encompassing public health, behavioral health, and primary care.

3. Address Public Health and Behavioral Health Workforce deficiencies.

4. Use data collected by the Division of Public Health and other databases (e.g., EMRs) to highlight and target behavioral health needs.

5. Enhance integration across public health areas.

6. Build on national models and local initiatives to expand integration in Nebraska communities.