Bolstering behavioral health | Nature Mental Health

Defining what constitutes ‘behavioral health’ is not straightforward. In some frameworks, mental health and behavioral health are treated as closely interrelated concepts; in others, mental health is understood as a component of behavioral health. Under this latter interpretation, mental health refers specifically to an individual’s psychological and emotional state, whereas behavioral health encompasses a broader set of behaviors and habits that shape, enhance or interact with mental health and overall wellbeing.

Credit: Malte Mueller / fStop / Getty Images Plus

Depression provides a useful illustration of this distinction. Its emotional and cognitive features, such as persistent sadness, anhedonia and difficulty concentrating, are typically situated within the domain of mental health. Behavioral health, by contrast, extends the lens to include associated patterns of physical activity, diet and sleep. In this context, attention is paid not only to self-reported sleep disturbances, for example, but also to interventions that reinforce sleep hygiene and daily routines. In practice, these domains are rarely separable. Cognitive behavioral therapy, which blends cognitive restructuring and behavioral activation techniques, is widely considered a first-line psychotherapy treatment for depression and other mental health conditions such as anxiety disorders and obsessive-compulsive disorder, specifically because it targets aspects of cognition and behavior.

Attempts to distinguish between the mental and behavioral manifestations of depression can also feel arbitrary, given the complex and reciprocal relationships among symptoms, behaviors, and comorbid conditions. A person living with both depression and alcohol-use disorder, for example, may withdraw socially, intensifying feelings of worthlessness, reinforcing isolation, and leading to heavier drinking. Such patterns are common rather than exceptional. Roughly one-third of individuals with a mental health condition have at least one co-occurring disorder; among people with substance-use disorders, that proportion exceeds 50%. Comorbidity is associated with greater illness severity, increased functional impairment and suicide risk, and lower quality of life.

The rationale for emphasizing a distinction between mental health and behavioral health, however, has less to do with taxonomy or ontology than with the clinical and health-care contexts in which these concepts have evolved. Behavioral health emerged as a health systems-oriented construct, shaped by the need to address chronicity, complexity and fragmentation in care. In the USA, mental health and behavioral health are used widely, and often interchangeably, across academic research, health policy and clinical practice. Behavioral health in the USA, however, typically refers to the prevention and treatment of mental health conditions, with particular emphasis on substance-use disorders, delivered across a continuum of services. This continuum spans acute interventions, such as crisis services, inpatient care and medication management, to longer-term recovery supports, including outpatient treatment, peer programs, and assistance with employment and housing.

As such, it offers an aspirational framework for treating mental health conditions, particularly those that are severe, chronic and co-occurring, by emphasizing continuity of care, integration across services, and attention to social and behavioral determinants of mental and physical health. Yet there is a deep disconnect between how behavioral health is envisioned and how it is delivered and, crucially, how it is accessed.

With more than one in five people in the USA experiencing a mental health or substance-use disorder each year and nearly half at risk of developing a diagnosable mental health condition in their lifetime, the public health burden and need for service is immense. Most American citizens were insured in 2024, with coverage extending to approximately 92% of the population. Roughly two-thirds of insured individuals are covered by private plans, most of which include some degree of bundled mental and behavioral health coverage, often with behavioral health effectively serving as shorthand for substance-use treatment. Nevertheless, treatment coverage can be largely inadequate, with consumers shouldering high deductibles or copays with limited options for providers.

For those insured through public programs, including Medicaid, Medicare and the Veterans Health Administration, coverage typically includes medically necessary inpatient and outpatient services, nursing facility care, and home health services. At the same time, these systems face mounting strain, including workforce shortages and proposed staffing and funding reductions, raising concerns about their capacity to meet growing behavioral health needs.

In the January 2026 issue of Nature Mental Health, we feature two pieces that address the challenges and propose solutions for bolstering behavioral health. In a Comment by Benzreki et al., the authors highlight that a major factor in perpetuating the US behavioral health crisis is entrenched social inequities, especially for people from minority racial and ethnic groups. Hispanic, Black and Asian populations are historically the least likely to access behavioral health services, which is compounded by the low representation of behavioral health providers from these groups. It is here the authors suggest the most progress can be made — simultaneously cultivating a representative behavioral health workforce can increase engagement and the treatment of underserved communities.

Against a backdrop of increasing interest in using artificial intelligence (AI) to increase access to services, a Perspective by Last and Khazanov urges for the need to democratize the implementation of AI by expanding stakeholder involvement. The authors make the case for greater inclusion of service users and providers in the development and deployment of AI-based behavioral health tools to mitigate against risks and better alignment with therapeutic needs.

As these two pieces underscore, the promise of integrated and accessible behavioral care frequently collides with siloed systems, disparities and discontinuities in services and support. The utility of behavioral health lies in its application to health systems and the communities and people that it serves and through its capacity to knit together prevention, treatment, recovery and social services.

Importantly, behavioral health does not and should not supplant mental health as a discipline or a priority; instead, it depends on mental health expertise as a foundational component. An ideal relationship between mental health and behavioral health, then, is not one of competition but of collaboration. These domains function best as complementary and interdependent approaches, each informing the other in service of more comprehensive, more representative and more humane care.