The term "behavioral health" is often used loosely. Understanding its components and distinguishing it from mental health is vital for positive patient and administrative outcomes.
Behavioral health is the medical field that examines how behaviors, or factors that influence behaviors, affect overall wellness and quality of life. But this definition is implied, and organizations differ on where the edges of behavioral health disorders sit.
This piece helps specialized clinicians and practitioners working across behavioral health to draw these boundaries. It also illustrates how a modern behavioral health care workflow, based on objective, measurable data, benefits patients and their clinicians.
Article Highlights
- Behavioral health is a broad term covering how behaviors or factors that influence behaviors impact overall well-being.
- The terms behavioral health and mental health overlap, but mental health is one subset of behavioral health.
- Knowledge of the distinction between behavioral health and mental health is essential for patient-centered treatment and for administrative processes such as coding, funding, and referrals.
- Digitized cognitive assessments give clinicians objective, measurable information to use alongside clinical judgment when assessing conditions such as ADHD, mood disorders, and anxiety disorders.
How major organizations view behavioral health disorders
Viewpoints vary on what falls under the behavioral health umbrella:
- The American Academy of Child and Adolescent Psychiatry (AACAP): The AACAP simply lists mental health disorders and substance use disorders (SUDs).
- The Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA includes mental health disorders and SUDs, while further specifying that mental health includes emotional, psychological, and social well-being.
- The American Medical Association (AMA): The AMA adds chronic stress and crises, and stress-related physical symptoms, to mental health, SUDs, and social factors.
- The Centers for Disease Control and Prevention (CDC): The CDC describes mental well-being, emotional states, behaviors and actions, and social well-being.
Behavioral health vs. mental health: What's the difference?
Organizations agree that although mental health and behavioral health overlap, behavioral health is the broader and more inclusive category.
- Mental health, which centers on emotional factors and psychological states, is a subset of behavioral health, and not the only one.
- Behavioral health adds other circumstances and behaviors that cause mental distress or have physical health consequences.
The spectrum of behavioral health conditions
Because behavioral health encompasses behaviors that affect overall health and well-being, it includes health conditions or circumstances that impact behavior.
Mental health conditions
Although only one part of behavioral health, behaviors associated with mental health conditions can markedly impact professional and academic performance, social functioning, and physical health.
| Mental Health Diagnosis | Associated Behaviors |
|---|---|
| Depression |
|
| Anxiety |
|
| Bipolar disorder (manic episode) |
|
| Attention-deficit/hyperactivity disorder (ADHD) |
|
People with mental illness, such as depression, also often have an increased risk for suicide or self-destructive coping behaviors such as self-harm, abnormal eating, and substance use.
Substance use disorders
Substance use disorders, such as alcohol and drug use disorders, involve changes in the brain's reward pathways that can drive addictive behavior patterns and make substance use compulsive and hard to control. Depending on the substance and severity, this can affect physical health and, in some cases, contribute to challenges at work, financial strain, or relationship breakdowns.
Substance use disorders vs. mental health disorders
SUDs are often listed separately from mental health disorders under descriptions of behavioral health, despite SUDs being categorized as mental health disorders in the DSM-5.
Behavioral health recognizes them as distinct but related domains. They are comorbidities in up to half of patients with either diagnosis. However, the separation is necessary because the primary diagnosis often requires specialized treatment approaches and separate funding and administration systems.
Everyday behaviors that affect mental and physical health
Certain behaviors might have a compounding effect on overall health and well-being when they co-occur with mental health disorders and SUDs:
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Inadequate sleep quality or quantity: Insomnia contributes to, and can be made worse by, the following conditions: (a) physical illness: hypertension, cardiovascular disease, and heart failure; and (b) mental health disorders: depression, anxiety, bipolar disorder, and ADHD.
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Suboptimal diet and eating patterns: Dietary links to physical illness are well known. But food quality can also impact mental health.
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Low levels of physical activity: Physical inactivity is a well-established risk factor for chronic physical health issues, as well as depression and anxiety.
Behavioral health issues are often interconnected
Behavioral health factors rarely act in isolation. The examples below illustrate how they can interact for some people.
| Starting factor | One possible pathway |
|---|---|
| Mental health | ADHD → difficulty keeping up at work → financial stress → less time for healthy habits → higher risk of chronic health issues |
| Social determinant | Low income → crowded or unstable housing → disrupted sleep → higher risk of depression |
| Crisis | A serious accident → pain during recovery → using substances to cope → risk of developing an addiction |
| Everyday behavior | Ongoing stress at home → strained relationships → low mood and worsening depression |
Behavioral health's inclusive framework reflects the reality of population health: psychiatric conditions, substance use, and other behavioral risk factors are intertwined.
Behavioral health services
Although organizations differ in their stance on which issues constitute behavioral health, all generally agree that behavioral health care should extend beyond a single clinician's responsibility and deliver whole-person care through a coordinated network.
All organizations — the AACAP, SAMHSA, the AMA, and the CDC — advocate for behavioral health care services, including prevention and health promotion, diagnosis, treatment, and ongoing support.
Prevention and health promotion
Generalized screening for risk factors
All behavioral health assessments should be biopsychosocially focused:
- Biological factors (e.g., genetics, physical health status)
- Psychological factors (e.g., beliefs, interests, emotional functioning)
- Social factors (e.g., family and community structure, culture, neighborhood, social determinants of health)
Encouraging healthy behaviors
Primary prevention aims to reinforce protective behaviors when risk factors are identified, before pathology sets in, and includes:
- Education on why the current behavior is a risk factor for a particular physical or mental condition, and how this will affect the patient's quality of life.
- Brief action plans or point-of-care behavioral lifestyle prescriptions about sleep hygiene, nutrition, physical activity, and substance moderation.
Teaching emotional coping mechanisms
Adaptive coping strategies can help reduce the risk of distress escalating into crisis and include:
- Setting personal and professional boundaries
- Having realistic goals and expectations
- Structured problem solving
- Maintaining a healthy support network
- Practicing mindfulness, e.g., breathing techniques or guided imagery
- Being educated on early symptom recognition
Directed screening and diagnosis of chronic disease and mental illness
Clinicians use their expertise, patient interviews, and examination to form a differential diagnosis. Validated psychiatric symptom and cognitive assessments may be used in tandem to confirm mental health disorders.
Behavioral health treatment and ongoing support
Healthcare professionals consider the biopsychosocial context and adopt a patient-guided approach when choosing treatment options: medication, therapy, or a combination.
Behavioral treatment success relies on regular follow-up to assess treatment efficacy and ongoing support. Additionally, SAMHSA believes that supporting families and communities is as important as patient support.
Behavioral health providers
Because mental health disorders and SUDs are subsets of behavioral health disorders, the role of specialty mental health services is clear. This behavioral health team consists of psychiatrists, psychologists, mental health nurses, social workers, and licensed counselors.
However, the behavioral healthcare workforce extends beyond mental health professionals and includes:
- Primary care services: clinicians, behavioral health consultants, and care referral managers
- Peer support, community, and school-based providers
Primary care's role in behavioral health integration
Behavioral health is a core component of general health. Therefore, behavioral health care integration should complement general health care, to which primary care providers are often the gatekeepers:
- In one study, about 55% of patients had more than 6 unhealthy behaviors and mental health risk factors.
- The most common was inadequate fruit and vegetable consumption
- Patients most wanted to discuss depression, anxiety, or worry
- Around 20% to 30% of all primary care physicians include some mental health indicator in their visits, such as screening, counseling, diagnosis, or treatment.
- General practitioners, nurse practitioners, and physician assistants already prescribe 60% of psychotropic medications.
The role of objective data in behavioral health disorders
Historically, clinicians relied on subjective, time-consuming interviews and rating scales. Currently, the shift is toward obtaining objective, quantifiable data to use alongside the validated but subjective symptom assessments and clinical judgment.
The concept of measurement-based care means repeating structured assessments of psychiatric symptoms that inform an evidence-based care process, thereby improving patient care and outcomes.
Digitized cognitive tools add value to modern behavioral health workflows. They provide the clinician with objective, measurable information when assessing ADHD, mood disorders, anxiety disorders, and other conditions.
Behavioral health in practice
In reality, the category boundaries matter less in the exam room than in the administrator's office. What matters is that behavioral health care can be provided in a way that improves patient outcomes without increasing clinician workload and burnout.
Written by Dr. Dorianne Green, Medical Writer
Dr. Green is a physician-turned-medical writer with over two decades of clinical experience in primary care and as chief clinician for a geriatric and dementia care unit. Her special interests are mental health and trauma-informed care.