Health and Wellness for Adolescent Girls and Women with Mental and Behavioral Health Conditions
This professional resource guide 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 professional resource guide 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 professional resource guide 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 professional resource guide 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 professional resource guide is diverse and includes health and social service professionals, program administrators, educators, policymakers, and researchers. A primary goal of this professional resource guide 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 professional resource guide has been developed by the Women’s Integrated Systems for Health (WISH) Project at the University of North Carolina at Chapel Hill and MCH Digital 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 the Women’s 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 together experts 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 include Engaging Women in Trauma-Informed Peer Support: A Guidebook (2012). [Substance Abuse and Mental Health Services Administration (SAMHSA)].
- National Center on Domestic Violence, Trauma and Mental Health. Background reading, webinars, fact sheets, tips, conversation guides, model policies, and other 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 Council.
- National State Mental Health Program Directors (NASMHPD) Prevention Center. Reports, 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 emotional health.
- SAMHSA-HRSA 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 monthly electronic 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 companion issue 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 Health].
- Smoking 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 strategies.
- Substance 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 increase life expectancy for people with mental health 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.
- National Alliance on Mental Illness (NAMI): Hearts and Minds. Online, interactive, educational initiative promoting the idea of wellness in 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 Program?”
- 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 the challenges 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 webinars.
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 equal access 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 community integration.
Data and Statistics
- Centers 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, and well-being.
- Women's 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 MCH Digital Libary professional resource guide, 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, and Quality.
Journal Articles and Other Literature and Research
- Boston 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 and reality of recovery.
- Child 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 additional searches.
- See Life Course and Social Determinants, a professional resource of materials from MCH Digital Library.
- PubMed. 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 in 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. MCH Digital Library resource guide, Maternal
and Child Health Literature and Research Databases describes these
databases and offers tips for searching them.
Maternal and Child Health Research Program: Funded Projects Search
MCH Digital Library 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
- Children and Adolescents Exposed to Violence resource brief
- Community Services Locator: An Online Directory for Finding Community Services for Children and Families professional resource guide
- Depression During and After Pregnancy professional resource guide, family resource brief
- Emotional, Behavioral, and Mental Health Challenges in Children and Adolescents professional resource guide, family resource brief, school resource brief
- Health Insurance and Access to Care for Children and Adolescents professional resource guide, family resource brief
- Home Visiting resource brief
- Infant Mortality and Pregnancy Loss professional resource guide, family resource brief
- Intimate Partner Violence professional resource guide, family resource brief
- Life Course and Social Determinants resource brief
- Maternal Distress in the Perinatal Period and Child Outcomes professional resource guide, family resource brief
- Medications resource brief
- Preconception and Pregnancy professional resource guide, family resource brief
- Racial and Ethnic Disparities in Health professional resource guide, 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 MCH Digital Library 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: Professional Resource Guide. (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 for Public 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.