Frequent Mental Distress

        Frequent mental distress is measured by the percentage of adults who reported that their mental health was not good or poor for 14 or more days during the past 30 days. These data are gathered from the Behavioral Risk Factor Surveillance Survey (BRFSS).  

        In 2017, 13.7% of Tennessee adults self-reported frequent mental distress. In the past three years, this percentage has shown little to no change in the state. However, studies have indicated that only 17% of Americans experience optimal mental health. 

        On the BRFSS, Respondents are asked to rate their overall health and to report the number of days in the past month that they experienced poor physical health, poor mental health, or were unable to participate in their usual activities. These self-reported metrics are linked to stress, depression, anxiety, and difficulty coping with emotions, as well as chronic health conditions, health care utilization, and mortality risk.  

        Mental health is essential to physical health, personal well-being, interpersonal relations, and one’s ability to contribute to community or society. The burden of mental illness in the Unites States is among the highest of all diseases, and mental disorders are among the most common causes of disability.  Approximately one in five adults will experience any mental illness over the course of a year, with depression being the most common type of mental illness.  

        Poor mental health correlated with poor sleep habits, poor nutrition, alcohol abuse, substance abuse, self-harm, and a lack of physical activity. Mental health disorders are also associated with the prevalence, progression, and outcome of some of today’s most pressing chronic diseases including diabetes, heart disease, and cancer. Prolonged mental distress can disable an individual and result in substantial social and economic cost−not only for people living with the distress, but also for their families, schools, workplaces, and communities.  Nationally, mental illness contributes $193.3 billion in lost earnings per year. 

        Additionally, poor mental health is linked to “diseases of despair” which can lead to suicides, drug overdoses, and liver disease as a result of alcohol abuse.  Suicide is the 10th leading cause of death in the United States and the 2nd leading cause of death for people aged 10-34. The annual cost of suicide attempts and suicides is over $90 billion in the nation.  

        Adverse Childhood Experiences (ACE’s) are one of the key drivers of poor mental health over the life-span. ACEs are traumatic events that disrupt the safe, stable nurturing relationships and environments children need to thrive. Children who have experienced multiple ACEs are at risk of poor socio-economic and health outcomes, including mental illness. Other high-risk groups include those experiencing homelessness and/or poverty, those who have been incarcerated, military veterans, and LGBTQ+ individuals.  

        Disparities and inequities in mental health and mental health care have been a persistent and unremitting issue despite concerted efforts on multiple fronts to address the problem. African Americans, Hispanic Americans, American Indians/Alaska Natives, and Asian Americans are over-represented in populations that are particularly at risk for mental health distress. Additionally, minority individuals may experience symptoms that are undiagnosed, under-diagnosed, or misdiagnosed for cultural, linguistic, or historical reasons. African American and Hispanic American populations both utilize mental health services at about one-half the rate of Caucasian Americans and Asian Americans at about one-third the rate, highlighting the challenges to accessing mental healthcare.  

        Higher rates of frequent mental distress were found between female-to-male (FTM) transgender populations and gender nonconforming populations, compared with the male-to-female (MTF) transgender populations. Overall, these groups were associated with increased odds of frequent mental distress compared with non-transgender individuals.

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address frequent mental distress in your community.  


1. Community Anti-Drug Coalition

Community coalitions organize a group of stakeholders and organizations with the common goal of reducing substance use disorders and overdoses. Mental distress can be both a driver of substance abuse and a health outcome of sustained substance use disorder. The Tennessee Department of Mental Health and Substance Abuse Services offers resouces and recommendations on creating an effective coalition in your county or community. Additionally, partnering with existing Anti-Drug Coalitions in programming and educational campaigns is a great way to increase community outreach. 


2. "Count It! Lock It! Drop It!" 

The “Count It! Lock It! Drop It!” campaign seeks to educate patients with prescription drugs about the proper storage and disposal of their medications. One component of this program is community run drug take-back events. Drug take-backs are events organized by local police departments and the Tennessee Bureau of Investigation in which people can drop off prescription medications, as well as over-the-counter medications, which are no longer needed by the patient. Similarly, drug take-back boxes are permanent receptacles available for people to properly dispose of their medications. “Count It! Lock It! Drop It!” also seeks to educate individuals about making sure to count prescription pills once every two weeks, and to lock up any prescription drugs so friends and relatives aren’t able to reach them. By preventing prescription medication from getting into the wrong hands, this program may decrease the chances of drug abuse which is associated with mental distress, and may also decrease access to lethal means that may be used in suicide.



3. Depression Care Management for Older Adults 

The CDC Community Guide recommends implementing home-based or clinic-based depression care management to effectively reduce depression among older adults. These care management programs involve screening for depression, measurement-based outcomes, trained care managers and case management, patient education, and a supervising psychiatrist. 


4. Individual Placement and Support (IPS) Supported Employment

Work can be a big boost to a person’s recovery.  Not only does a job help pay the bills, it can also provide a person with a sense of pride and belonging. Having a job adds structure to daily life, increases social contacts and support, and enhances opportunities for personal achievement. The Tennessee Department of Mental Health and Substance Abuse Services has partnered with the Department of Human Services - Vocational Rehabilitation and community providers to offer services in the Individual Placement and Support (IPS) Supported Employment model.  People receive assistance in obtaining employment, and once employed, supports are provided to assist in maintaining the job. Visit the TDMHSAS website for alist of community providers that offer IPS Supported Empoyment and to contact the Department for more information on IPS Supported Employment in your community. 


5. Good Behavior Game

The Good Behavior game is an intervention that can be implemented in the classroom to improve behavior and academics. This program is recommended by the Substances Abuse and Mental Health Service Administration (SAMHSA). Evaluation shows that Good Behavior Game participants show fewer behavioral problems, fewer symptoms of aggression, reduced bullying, and decreased suicide thoughts and attempts.


6. Increasing Social Cohesion through Community Service/Stewardship 

One way to increase social cohesion and usage of greenspaces is by organizing stewardship activities such as a park cleanup day or a community build day. Social cohesion is an important aspect of an individual’s mental health and the perceived social ties of a community. Further, research shows that access to greenspaces is beneficial for an individual’s mental health. Groups to engage may include faith-based organizations, schools, Boy Scouts and Girl Scouts, among other community organizations.  


7. Mental Health First Aid

Mental Health First Aid is an 8-hour course that gives people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it builds mental health literacy, helping the public identify, understand, and respond to signs of mental illness. This program is intended for any community member who is interested in taking a Mental Health First aid Course, but especially recommended for first responders, primary/secondary school and college staff, faith-based organization members, and friends or family members of those struggling with mental illness or addiction. 


8. Play Nicely 

Proper discipline techniques are one way to mitigate Adverse Childhood Experiences and future aggressive behaviors or mental distress. Play Nicely is an efficient and effective program for everyone to learn appropriate parenting strategies. The program utilizes a public health approach and is offered in both English and Spanish in three separate versions for parents, teachers, and healthcare professionals. Research shows that parents who were given the Play Nicely curriculum were 12 times more likely to plan on utilizing appropriate discipline methods in the future.


9. Question, Persuade, Refer (QPR) Training 

“Question, Persuade, Refer” refers to three steps that an individuals can take to help prevent suicide. The training curriculum includes causes of suicidal behavior, warning signs of suicide, and how to react to and how to get help for someone in crisis. QPR training is an evidence-based that increases participants’ knowledge and skills related to suicide prevention tactics. 


10. Strengthening Families

The Strengthening Families Program (SFP) is a nationally and internationally recognized parenting and family strengthening program for high-risk and general population families. SFP is an evidence-based family skills training program found to significantly improve parenting skills and family relationships, reduce problem behaviors, delinquency and alcohol and drug abuse in children and to improve social competencies and school performance. Child maltreatment also decreases as parents strengthen bonds with their children and learn more effective parenting skills.


11. Talk With Me Baby (TWMB) 

Talking to babies, even when they can’t talk back, improves a child’s brain development and language skills before they reach kindergarten. The TWMB initiative aims to build a strong foundation for social-emotional and cognitive development and language and literacy ability, placing babies on a pathway toward third grade reading proficiency, high school graduation, and lifelong success. The Talk With Me Baby website has tips for talking to babies, printable advertising material, and a free app for parents and caregivers. 


12. Telehealth 

The Health Resources and Services Administration supports the expansion of telehealth in improving access to and coordination of care delivery. Telehealth is especially critical in rural and other remote areas that lack sufficient health care services, including specialty care. This type of healthcare can include video conferencing, internet resources, imaging and media streaming, and other communication technology. Telehealth increases access to care in rural communities that often face greater challenges with geography and transportation to clinical services and can be applied to mental health and substance abuse services. 


13. Expand Pocket Parks in Residential Neighborhoods 

A pocket park is a small outdoor space, usually no more than a quarter of an acre, most often located in an urban area surrounded by commercial buildings or houses on small lots with few places for people to gather, relax, or to enjoy the outdoors. This type of space can be used for community gatherings, organized physical activity, or individual leisure time. These mini-parks benefit the mental health of individuals in a community through increased access to greenspaces. 


1. Appalachian Regional Commission 

Purpose: Grants and funding are awarded by the Appalachian Regional Commission (ARC) focusing on economic opportunities, ready workforce, critical infrastructure, natural and cultural assets, and leadership and community capacity. Tennessee (Eastern Appalachian region) is among 12 other states that are eligible to receive funding from ARC.

Duration: Varies

Amount: $0 - $4,000,000; varies


2. Community Foundations 

Purpose: Community Foundations offer small grants that focus on community-driven change in Tennessee. The Community Foundations in Tennessee include Appalachian Community Fund, The Community Foundation of Greater Chattanooga, Community Foundation of Greater Memphis, Community Foundation of Middle Tennessee, Knox County Community Foundation, and East Tennessee Foundation. Most of these foundations consider healthy youth development as a focus area of grant funding.

Duration: Varies

Amount: Varies


3. Federal Grants 

Purpose: Many large national organizations (i.e. SAMSHA, NIH, HRSA, and CDC) give out additional funding for mental health and substance abuse related programming. For more information on these funds, please contact the Opioids Response Coordination Office at the Tennessee Department of Health.


4. Telehealth Network Grant Program 

Purpose: The Health Resources and Services Administration (HRSA) support telehealth initiatives for medically underserved populations. The goals of this grant program are to expand access to, coordinate, and improve the quality of healthcare services, expand training, and improve the quality of health information.  HRSA also supports the Substance Abuse Treatment Telehealth Network Grant Program and the Evidence-Based Tele-Behavioral Health Network Program to increase access to mental health and substance abuse services. 

Duration: Varies 

Amount: Varies 


5. Tennessee Arts Commission 

Purpose: The Tennessee Arts Commission supports community design through the Creative Placemaking Grant. Through placemaking, communities can rethink the use of public spaces in order to encourage collaboration and shared values. Examples of public spaces that can maximize placemaking include parks, downtown squares, waterfronts, markets, and college campuses. Research shows that this type of community design supports good mental health through social cohesion and community stewardship.  

Duration: 1 year 

Amount: $5,000-$8,000 or $10,000 (two + towns together) 


6. Tennessee Commission on Children and Youth, Juvenile Justice Grants 

Purpose: The Tennessee Commission on Children and Youth awards funding through the Office of Juvenile Justice and Delinquency Prevention Federal Formula Grant. Organizations may apply for grants that address delinquency prevention, and substance and alcohol abuse services. Any public or nonprofit entity (e.g. governmental, educational, law enforcement) that serves children is eligible to apply. There is no matching requirement for these grants. 

Duration: One year with possibility of two years' extension 

Amount: Up to $60,000 


7. Tennessee Department of Children's Services

Purpose: The Tennessee Department of Children’s Services has announced a funding opportunity for programs, projects, and activities related to Tennessee’s Building Strong Brains initiative. This initiative aims to address Adverse Childhood Experiences (ACEs) by promoting safe, stable and nurturing relationships between infants/children and their care takers. ACEs are a strong predictor of adult health and prosperity later in life, affecting many of the socioeconomic drivers of drug overdose.  

Duration: One year, with opportunity to renew

Amount: Up to $200,000


8. Tennessee Department of Mental Health and Substance Abuse Services 

Purpose: The Tennessee Department of Mental Health and Substance Abuse Services offers grant funding periodically to local organizations. Some examples of funding include Community Anti-Drug Coalitions and Juvenile Justice Diversion programming. Check the site below for funding opportunity announcements.  

Duration: Varies 

Amount: Varies


1. Promote TDMHSAS Services 

The Tennessee Department of Mental Health and Substance Abuse Services offers different services to Tennesseans who are experiencing a mental health crisis. These services include the crisis phone line, safety net care services for uninsured adults with a serious mental illness, mobile crisis services, crisis respite services, peer support centers, employment services, homelessness assistance, children and youth services, and more. These services are available state-wide. 


2. Promote The Tennessee Redline

The Tennessee REDLINE (1-800-889-9789) is a toll-free information and referral line coordinated by TAADAS and funded by the Tennessee Department of Mental Health Substance Abuse Services. The purpose of the REDLINE is to provide accurate, up-to-date alcohol, drug, problem gambling, and other addiction information and referrals to all citizens of Tennessee at their request. Marketing this resource to the public could save lives and help those struggling with addiction to seek help. 


3. Promote TN Respite Coalition Services

The Tennessee Respite Coalition provides resources to individuals who provide care for friends or family members in order to reclaim time and restore balance to their lives. Caretakers may often feel overwhelmed and experience stress-related mental distress. Promoting these materials may help to give caretakers rest.


4. TN Crisis Phone Line/National Suicide Prevention Lifeline/Veteran's Crisis Line 

The Tennessee Crisis Phone Line, National Suicide Prevention Lifeline, and Veteran’s Crisis Line are all free resources available to individuals experiencing a serious mental health emergency. These services focus on preventing suicides during a critical moment for an individual struggling with suicidal thoughts. 


5. Means Matter Campaign 

The Means Matter campaign is supported by the Harvard T.H. Chan School of Public Health. This campaign seeks to educate the public on the importance of lethal means, and how to decrease access to lethal means for individuals with suicidal thoughts. Because most suicide attempts occur during an immediate crisis with little planning, access to lethal means, particularly fire arms, plays an important role in whether an individual will attempt suicide. 


6. Mental Health Awareness Month/Children's Mental Health Awareness Day 

Mental Health Month is held each year in May. The theme for 2019 is #4Mind4Body, and incorporates aspects of mental health such as animal companionship, work-life balance, spirituality, humor, and social connections and recreation. Children’s Mental Health Awareness Day is a part of Mental Health Awareness Month and occurs on May 9.


7. Minority Mental Health Awareness Month 

Individuals with minority identities and backgrounds may experience certain additional challenges associated with mental health, and it’s important for communities to recognize and understand these challenges. Toxic stress is a primary driver of mental distress in minority populations while access to quality mental health care is often limited for minority communities. Minority Mental Health Awareness Month seeks to spread awareness of the challenges that minorities face when dealing with mental distress. 


8. Moms' Mental Health Matters Campaign 

The Moms’ Mental Health Matters initiative is designed to educate consumers and healthcare providers about who is at risk for depression and anxiety during and after pregnancy, the signs of these problems, and how to get help.


9. National Suicide Prevention Month

September is National Suicide Prevention Month, and National Suicide Prevention Day is September 10 each year. This is an opportunity to share information regarding risks and signs of suicidal thoughts, suicide prevention strategies, and the suicide lifeline number.


10. Project Respect Tennessee

Protect Respect Tennessee is a project of the TN Coalition that aims to end domestic and sexual violence. This campaign focuses on educating students on college campuses. See the site below for resources and projects in Tennessee, Tennessee including the TN Bystander Project and Safe Bar Program.


11. Be The One/Be The Difference Campaign 

Be the one to save a life.  #BeThe1To is a national campaign to prevent suicide. This campaign is supported by the National Suicide Prevention Lifeline. See the source below for graphics, printable materials, and social media materials.


12. Building Strong Brains ACE Awareness

The Tennessee Commission on Children and Youth’s Building Strong Brains initiative seeks to educate individuals about Adverse Childhood Experiences’ risk factors and long-term effects, and to mitigate childhood trauma. The Building Strong Brains website provides sources for scientific research supporting ACEs, information for families, and current initiatives in Tennessee. 


13. Campaign to Change Direction

The goal of the Campaign to Change Direction is to change the culture of mental health so that all of those in need receive the care and support they deserve. The Campaign encourages everyone to pay attention to their emotional well-being – and it reminds individuals that emotional well-being is just as important as physical well-being. The Campaign to Change Direction is the second week in June. See the source for information on the Five Signs of emotional pain and for campaign outreach tools.  


14. Earned Income Tax Credit for ACE Prevention 

The Earned Income Tax Credit is a federal program that benefits low-income families. The program is designed to incentivize work and reduce the tax burden on certain individuals. This supplemental income is shown to reduce risk factors of Adverse Childhood Experiences for children of low-income families. Click on the soure for a toolkit to promote this program.


1. Community Disaster Response Plan

Research shows that natural disasters often cause much greater detriment to low-income communities. These neighborhoods typically lack the resources to prevent damage and recover quickly, and are often located in geographical areas that are subject to more severe weather. By creating or updating an existing community response plan, a county can bring social services together to provide for these low-income communities in times of natural disasters. A comprehensive plan should involve coordination of clinical services, mental health care, food support, emergency housing, and other social services in the community. 


2. Community Strategic Plan for Suicide Prevention 

A community that wishes to address suicide and how to prevent it should consider creating a community strategic plan. A strategic plan should involve various stakeholders across the community, identify current resources and strategies, and set out goals for the future. Communities can also consider updating existing strategic plans to reflect current initiatives and challenges. 


3. Create a Strategic Plan for Parks and Greenways 

Creating or updating a city’s strategic plan for parks and greenways is a great way to assess the local demographics of a community, what parks and greenways already exist, and what groups or areas lack adequate outdoor space. A strategic plan for a community should include experts and stakeholders from various fields (some ideas include the local Health Department, School Board, local MPO, Chamber of Commerce, the housing sector, parks and recreation, and more). Furthermore, public engagement is an integral part of the planning process to ensure that the people being served have a voice in the development of community assets.  See the Nashville Parks and Greenways Master Plan in the source below for an example of a strategic plan and the process. 


4. Recovery Courts

Individuals with serious mental illness or substance use disorder are often further stigmatized by involvement with the criminal justice system. Recovery courts aim to divert individuals with serious mental illnesses away from prisons and jails and into appropriate treatment. Research shows that mental health courts can reduce recidivism, improve mental health outcomes, and reduce the length of incarceration for individuals who are diverted into the program.


5. Trauma Informed School Policies

Students who are subject to any kind of trauma at home are more likely to be chronically absent from school, missing important instruction and class time and adversely affecting future physical and mental health. Schools can also be mindful of students struggling with their home lives by engaging in trauma informed policies and training. By training staff to handle students with trauma-informed care, the effects of Adverse Childhood Experiences and mental distress later in life can be lessened. 


6. Workplace Mental Health Policies 

Workplace wellness policies should reflect a commitment to improving the mental health of an organization’s employees. Individuals often spend the majority of their day at work, which can influence their mental health. Policies can include reasonable accommodation for mental health issues, management accountability and open communication, and fitness incentives. See the Mental Health America resource below for more recommendations.


1. Postpartum/Maternal Depression Screening 

Maternal and postpartum depression is a serious mental health disorder that is commonly diagnosed within the months following the birth of a child. When parents are depressed it can negatively impact a child’s development, impede their ability to learn, and have effects that can last into adulthood as well as negatively impacting the mother’s health. Health care organizations should incorporate policy to screen mothers for postpartum depression during well-child visits. 


2. Screening for Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are stressful or traumatic events, such as neglect or abuse, that occur during the formative stages of adolescence. It’s important that health care providers screen their patients for ACEs in order to refer them to services or provide better care in the clinical setting. 


3. Suicide Prevention in Primary Care Settings

Primary care providers can play a large role in preventing suicide for their patients. Research has shown that as much as 45% of victims of suicide had visited their primary care physician less than one month before their death. Clinical policies should include suicide screening, and referral to mental health care practitioners. For a toolkit on suicide prevention in the primary care setting, see the link below. 


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This document is not a Department endorsement of legislative policy.