How psychology practices population health

An estimated 1 in 5 U.S. adultsopens in new window is living with a mental health condition—and psychologists are keenly aware that traditional services cannot reach everyone in need. For practitioners across the field, a paradigm shift toward population health is offering new opportunities to close that gap.

“We all know there aren’t enough providers to meet current needs with one-on-one services, so we are having to be creative in how we train the general public to help identify and talk about behavioral health conditions,” said health psychologist Elizabeth McKune, EdD, chief operating officer at Seven Counties Services, which provides community mental health care in Louisville, Kentucky.

A public health, or population-level, framework can address the high need for care that currently overwhelms the nation’s mental health workforce. While cultural, structural, and systemic barriers must also be addressed, population health approaches are one promising way to help. It means that wellness-promoting services such as support groups, public health campaigns, and mental health education are just as much a part of psychological care as treatment for a mental health diagnosis.

“A population health approach assumes that everyone needs to be concerned with both their physical and mental health, which means that psychology is relevant to the entire population—not just those with diagnoses,” said Nicole Barnes, PhD, APA’s senior director for child and adolescent learning and well-being and a key contributor to APA’s population health efforts, which include a science summit and member town hall around the topic. Rather than placing that burden solely on individual patients, this approach acknowledges the role of societal systems and structures in helping people stay well.

Those systems and structures must be both tailored and scalable to effect meaningful change. Practicing psychologists are well equipped for this work. Many are leading research and policymaking efforts that can help a broad swath of the nation. Equally important, solo practitioners are integrating population health strategies—such as annual mental health screenings and brief interventions—into their individual care, expanding the reach and relevance of psychological services.

“Traditionally, clinicians focus on the person, while public health focuses on the population,” said psychologist Perry Halkitis, PhD, MPH, dean and the Hunterdon Professor of Public Health and Health Equity at the Rutgers School of Public Health in New Jersey. “The best work we can do is broad enough that it can be applied at the population level but tailored enough to meet people’s individual needs.”

With a population health approach to mental health, care can be seen as a pyramid that includes the entire continuum of needs, from people who are thriving to those experiencing serious mental health challenges. Unlike traditional models that focus on treating those with diagnosed conditions, a population health approach provides support at every level. The 75% of the population that is generally well benefits from efforts to keep people healthy—everything from workplace and state policies that support well-being, such as universal paid family leave, to mental health wellness exams in primary care clinics.

One step up, at-risk individuals or those with subclinical mental health symptoms are identified and helped as early as possible before mental health problems can develop or worsen. That can be done through early screenings and referrals for things like problematic alcohol use, smoking, stress, trauma, depression, suicidal ideation, and anxiety and through psychotherapy for people without a diagnosis, for instance, to address work issues or relationship stress. For example, research suggests that yearly depression screenings are an affordable way to protect adolescent mental health (Doan, T. T., et al., JAMA Health Forum, Vol. 6, No. 5, 2025opens in new window). Vulnerable individuals can also benefit from efforts to reduce risk, such as better child welfare policies that lower the prevalence of trauma.

At the top of the pyramid, individual and group therapy, crisis intervention, and inpatient services are available for individuals currently experiencing mental health difficulties (roughly 25% of the population at any given time): those meeting diagnostic criteria who need more extensive care.

The boundaries between these levels are not fixed. People can move up or down throughout their entire lives depending on their needs, experiences, and the contexts in which they find themselves.

Family Connectsopens in new window, a program developed by psychologists in Durham, North Carolina, shows how a population-level approach can simultaneously help families at each layer of the pyramid by offering support at a critical time. Kenneth Dodge, PhD, a professor of psychology and neuroscience and public policy at Duke University, and his colleagues built what he calls a “universal system of primary psychosocial care” for families, akin to the primary health care provided by a pediatrician.

“We realized that we needed to create a universal intervention to reach all families, but we also needed to tailor it to a particular family’s needs and to identify what those needs are,” Dodge said.

Dodge and his colleagues developed a directory of more than 400 community resources across Durham to help new parents with common challenges, such as managing postpartum depression and sleep issues or buying essential baby items. Then, a team of nurses conducted home visits shortly after babies were born to identify family needs and connect them to relevant agencies. In a randomized controlled trial that included nearly every newborn in the county, the intervention improved maternal mental health, reduced emergency room care, and lowered Child Protective Services investigations for abuse and neglect by nearly 40%. The program is now active in 22 states and is on track to reach 10% of U.S. newborns within 5 years.

In Seattle, psychologists are also working to build a community infrastructure that can better support children and families after the spike in mental health concerns triggered by the pandemic.

“The idea is that we should not be gatekeeping mental health services, especially for youth and their families, because the need is too great to be met by one-on-one services,” said Janine Jones, PhD, a licensed psychologist and associate vice chancellor for graduate affairs at the University of California, Santa Barbara.

Jones helped launch Reach Out Seattleopens in new window, which trains anyone who interacts with children—including parents, teachers, summer camp counselors, and community center workers—in psychological first aid. Pitching it like a form of mental health CPR training that anyone can take, the organization trains adults to recognize when a child needs support, as well as where to find it. Last year, Reach Out Seattle launched a partnership with community organization Erika’s Lighthouse to educate the community about depression in teenagers.

To serve a broader range of students, APA’s Coalition for Psychology in Schools and Education is developing a framework called Healthy Habits for School Communities that uses a population health approach to integrate supports into schools across the country. The model, to be released later this year, will include specific evidence-based guidance—such as how to create peer mentoring programs—for the classroom, school, district, state, and federal levels.

Health psychologists, too, are finding that a population health approach is an effective—perhaps even indispensable—way to meet the widespread need for support. According to a 2023 study from the National Institutes of Healthopens in new window, an estimated 21% of U.S. adults are living with chronic pain. Of those, more than one-third have “high-impact chronic pain,” which limits daily activities for 3 months or more.

“This information makes it clear that while individual treatment is important, we have to take a population approach to more effectively address the problem, or we won’t make any headway,” said pain psychologist Ravi Prasad, PhD, director of behavioral health in the division of pain medicine at the University of California Davis Medical Center.

To reach more patients, Prasad mainly provides group therapy, which also serves a secondary goal: helping patients with an invisible condition feel less isolated.

McKune, in her work with Passport Health Plan, a Medicaid-sponsored care plan in Kentucky, also sought a creative way to tackle physical and behavioral health needs at the same time. Her team’s solution flipped a familiar practice on its head: Instead of integrating behavioral care into primary care settings, they tried the reverse. Passport Health paid behavioral health providers to collect medical data, such as asking patients when they last had a dental checkup.

“We know that people with severe mental illness have a higher comorbidity of other physical health conditions and die much sooner, so we continued to look at where there were opportunities to address both behavioral and physical health needs simultaneously,” McKune said.

A public health intervention is strongest when it can reach a broad population while adapting to individual social and cognitive needs, Halkitis said. At Seven Counties, McKune is working to launch a drop-in crisis center with input from more than 200 community partners. The center will house licensed behavioral health professionals as well as various forms of community support (such as help with housing and employment) to address the full spectrum of needs that arise during a behavioral health crisis.

“There’s not a one-size-fits-all approach, but we can be ready with multiple interventions that speak to different groups within a population,” Halkitis said.

In shifting toward a population health framework, it’s critical to determine how psychology practitioners—many of whom are already doing this type of work through screenings, brief interventions, and integration with other providers—can be paid for work that often falls outside traditional reimbursement models, Dodge said.

“Our profession has a large number of individuals who are in practice and rely on that revenue to make a living. Can these individuals be salaried, reimbursed, or paid consulting fees for activities like community-wide intervention planning?” he said.

Recent national and state-level changes in reimbursement models are allowing a growing number of practitioners to weave a population health approach into their one-on-one work. Kentucky, for example, adopted a Certified Community Behavioral Health Clinic model in 2022. That approach reimburses integrated care community clinics at a daily rate, rather than paying a fee for each service provided.

“For one, that allows us to do more thorough intake screenings of new clients entering our system, including physical health, mental health, and social determinants of health,” said psychologist Elizabeth Jackson, PhD, who oversees a team of interdisciplinary providers at Seven Counties Services, the community mental health provider in Louisville, Kentucky.

Providers in Jackson’s unit use a social determinants screener that includes questions about food and housing insecurity, childcare needs, companionship, and more, which helps flag challenges that could complicate treatment early on. The new payment structure also allows Seven Counties to provide transportation, case management, peer support, and other services typically not covered by Medicare and Medicaid.

Over in Europe, a pilot program in Belgium is testing whether reimbursing private practitioners for population-level interventions through mental health networks is a better use of mental health care funds than the country’s current approach, which reimburses practitioners through a simple fee-for-service model. Psychologist Koen Lowet of Beringen, Belgium, delivers workshops on managing stress at a large children’s football club and provides brief interventions to children with early signs of anxiety or depression. Similar programs are freely available to all Belgians through schools, nursing homes, and welfare centers.

“With the limited resources we have, we can either hire more psychologists—or we can ask psychologists to retrain and focus more on primary care,” said Lowet, who also works as a strategic policy expert for Belgium’s largest social health insurer. “The hope is that focusing on early detection and intervention will be a more efficient use of psychologists’ skills,” he added, and the program’s early results are promising.

Since 2022, the U.S. Centers for Medicare and Medicaid Services (CMS) has released billing codes that allow psychologists to be reimbursed for screenings related to social determinants of health, including housing and food security. CMS also reimburses providers for principal illness navigation—support services for people with serious conditions—such as guidance for navigating health care systems. In addition, psychologists can use CMS codes to conduct screenings and brief interventions for tobacco, alcohol, and opioid use, providing essential care even if they do not specialize in addiction services.

State-level policy changes also reflect the shift toward population mental health. In Ohio and Colorado, psychologists in integrated care settings can now be reimbursed for conducting annual mental wellness screenings. New York is one of several states that has changed medical necessity criteria so patients can access short-term psychological care without a diagnosis.

“We will never have enough therapists to treat everybody, so solely investing in one-on-one services is not an efficient way to use public money,” Lowet said. “Population health approaches are key to scaling our impact and getting mental health services to many more people.”