The Relationship Between Mental Health and Behavioral Health

A Whole Health Story June 28, 2022

Though the terms are often used interchangeably, mental health and behavioral health are two distinct facets of whole health. Mental health regards one’s thoughts and feelings that influence our emotional, psychological, and social well-being. Behavioral health refers to how our health behaviors, which can include eating a healthy diet, exercising regularly, getting adequate sleep, and maintaining social connections, impact our mental and physical health. Behavioral drivers of health are the genetic, familial, cultural, and societal factors that impact a person’s overall mental and physical health and wellness. These include psychological factors such as mental health and substance use disorders, as well as reactions to external factors.

“Good mental health and behavioral health are both essential for positive health. Positive health is a newer term used in psychology to talk about that which is beyond the lack of signs and symptoms of disease,” said Beth Frates, MD, director of lifestyle medicine and wellness in the department of surgery at Harvard-affiliated Massachusetts General Hospital and president-elect of the American College of Lifestyle Medicine. “Some people equate positive health to well-being and a sense of vitality or flourishing.”
 

Each Influences the Other

For decades, we have known that our behavioral and physical health can have a direct impact on our mental health. For example, exercise releases endorphins in our brain that make us feel good. And research has demonstrated that in some people with depression, routine exercise can lead to improvements similar to those seen from an antidepressant.

On the flip side, unhealthy behaviors, including lack of sleep, can increase feelings of fatigue, stress, and depression. Extreme sleep insufficiency has also been associated with suicidal ideation. Even seemingly neutral activities, like eating, can impact mood and mental health. Many people over-eat or reach for hyperpalatable foods like those layered in fat, salt, and sugar when they are feeling stressed. Foods high in sugar can lead to spikes and troughs in mood; the sugar cycle becomes like a rollercoaster ride for our emotions.

Intervention studies have revealed that when we alter our behaviors to incorporate healthy lifestyle habits like exercise, nutritious foods, sound sleep, and high-quality connections, we can have a positive impact on mental and physical health. 
 

Primary Care Is a Good Place to Start

For those who have a close relationship with their primary care provider (PCP), that can be a good place to bring together behavioral and mental health. PCPs can often offer help for depression and anxiety and will refer a person to other mental health professionals when needed.

“In primary care, we are often focused on finding and fixing problems,” said Dr. Frates. People come into the clinic with acute care issues that need to be addressed immediately. Or they may require frequent visits for more chronic conditions.

“In either case, these individuals may be open to interventions addressing any underlying behavioral or mental health concerns through the assistance of a PCP, and this takes time and training in behavioral medicine,” said Dr. Frates. The U.S. Department of Health and Human Service’s Substance Abuse and Mental Health Services Administration offers resources to help integrate behavioral health services and primary care.

Another option is for a PCP to refer someone to a health practitioner trained in behavioral medicine or specific behavioral interventions, such as those targeting substance use disorder, an unhealthy diet, or poor sleep habits. While there is no social stigma about going to a primary care provider, stigma still remains surrounding mental health. Reducing that stigma is essential to optimizing mental and behavioral health.
 

Looking at Lifestyle Medicine Interventions to Enhance Wellbeing

As chronic diseases and conditions like diabetes, cardiovascular disease, dementia, and obesity continue to rise despite the development of new medications, procedures, and devices, many people are interested in taking more control of their physical, mental, or behavioral health. As a result, lifestyle medicine programs, such as those at Harvard-affiliated Massachusetts General Hospital Cancer Center and Spaulding Rehabilitation Hospital are rapidly gaining popularity.

Whether a person has cancer, is recovering from surgery, or has a chronic illness or mental health diagnosis, these programs focus on changing behaviors—such as increasing exercise, improving nutrition, adopting restorative sleep strategies, and practicing stress management techniques—to help improve mood, reduce chronic disease burden, and enhance personal wellbeing. “People are longing for solutions that work,” said Dr. Frates. “Lifestyle medicine adds years to your life and life to your years.” 

Organizations interested in launching lifestyle medicine programs can find support at the American College of Lifestyle Medicine, which provides evidence-based education and certification in Lifestyle Medicine.
 

The Potential of Smartphone Apps to Influence Behavioral and Mental Health

Finally, as people increasingly seek care and health information outside of a healthcare provider’s office, mobile apps represent a scalable method to influence behavioral and mental health. While clear results are not yet available to support the effectiveness of mobile apps in improving mental health and health behaviors or outcomes, they represent a rapidly growing, forward-looking, scalable approach, especially if integrated with one’s electronic health record. These apps have the potential to improve communication with doctors, gather health data, and potentially reduce costs, while encouraging healthy behaviors and empowering individuals to take an active role in their healthcare.

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