TABLE OF CONTENTS

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ii

Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Why Action Steps for Improving Women’s Mental Health? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Rationale for Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5

Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

Appendix A: Detailed Conceptual Framework . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Appendix B: Women’s Mental Health Resources, Products, and Tools . . . . . . . . . . . . . . . . . . .27

Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .56

i

Action Steps for Improving Women’s Mental Health
ii

Action Steps for Improving Women’s Mental Health

EXECUTIVE SUMMARY

Since the publication of Mental Health: A Report of the Surgeon General in 1999, an increasing

body of evidence from the research base, public policy analysis, consumer advocacy, and health

care practice has underscored the critical importance of mental health to the overall health of

women—and to our Nation as a whole. Many advances have been made in our understanding

of mental illnesses, effective treatments, and promising approaches for promoting mental

health, resilience, and fulfilling lives for those living with mental illnesses. A key component of

this progress has been the increased understanding of the critical role of gender in the risks,

course, and treatment of mental illnesses. New research findings also have pointed to the effectiveness of a growing array of treatment options for mental illnesses and of a new model of

treatment that is recovery-oriented, strengths-based, and includes the active participation of

individuals in their treatment. 

The recent advances in the science and practice of women’s mental health provide an unprecedented opportunity to address the burden of mental illnesses on women’s lives and increase the

capacity for recovery. However, for this knowledge to be effective, it must be translated into

tangible actions that can promote change and support progress to improve the mental and overall health of our Nation’s women and girls. Thus, this report proposes the following actions:

Promote the widespread understanding that women’s mental health is 

an essential part of their overall health.

Improve the interface of primary care and mental health services for

women.

Accelerate research to increase the knowledge base of the role of gender in 

mental health and to reduce the burden of mental illnesses in both women 

and men.

Increase gender and cultural diversity in academic research and medicine.

Support efforts to track the mental health, distress, and well-being of women 

and girls in national, State, and large community-based surveillance systems.
Decrease the amount of time it requires to translate research findings on 

women’s mental health into practice.

Recognize the unique prevalence of trauma, violence, and abuse in the lives 

and mental health of girls, women, and female veterans. Address their effects 

and support promising new approaches that enhance recovery.

Address the cultural and social disparities that place women at greater risk 

for certain mental illnesses by including considerations of these disparities in 

diagnosis and intervention and by investigating ways to increase cultural 

competence in treatment approaches.

Promote a recovery-oriented, strengths-based approach to treatment for

women promulgated by the recommendations of the President’s New 

Freedom Commission.

Build resilience and protective factors to promote the mental health of girls 

and women and aid recovery.

Meet the mental health needs of girls and young women as part of overall 

health care.

Incorporate gender issues and considerations in emergency preparedness and 

disaster planning, including mental health issues.

The Action Steps for Improving Women’s Mental Health represent a collaborative effort of women’s

health experts across multiple agencies and offices of the US Department of Health and Human

Services (HHS) including the HHS Office on Women’s Health, Office of the Surgeon General,

Substance Abuse and Mental Health Services Administration, Office of Minority Health, National

Institute of Mental Health, National Institute on Drug Abuse, Indian Health Service, and Office of the

Assistant Secretary for Policy and Evaluation. Its purpose is to spur positive changes. The hope is that

policy planners, healthcare providers, researchers, and others will take up its suggested actions and

help translate them into reality. In this way, we can promote improved mental health and a healthier

future for the women and girls of America. 

iii

Action Steps for Improving Women’s Mental Health

VISION

The Office on Women’s Health’s Action Steps for Improving Women’s Mental Health are based

on a vision of optimal mental health and well-being for women and girls in the United States.

They use a public health approach that addresses the mental health needs and concerns of

women and girls and incorporates the newest advances in prevention and treatment. Thus, these

Action Steps seek to integrate mental health into mainstream health, promote positive mental

health and resilience, and advance access to quality services that are recovery-focused and

women and family-centered.

OBJECTIVES

The purpose of these Action Steps is to spur positive changes through tangible actions. Those

actions are meant to advance the overarching goal of the Office on Women’s Health's Mental

Health Initiative, which is to improve the mental health of girls and women in the United

States. The actions put forth in this report also represent realistic steps toward the achievement

of specific objectives that can further efforts to advance this goal. The objectives include: 

Increasing the understanding of the importance of improved mental health for women

and girls in our Nation

Reducing the personal, economic, and societal tolls of mental illnesses

Expanding the accessibility of quality mental health services for women and girls

Increasing the number of activities that promote mental wellness in culturally 

competent and gender appropriate ways

Expanding the knowledge base and use of evidence-based practices to address 

mental health issues affecting the lives of women and girls

Increasing the ability of women and girls to promote their own mental health and 

foster resilience in the face of distress, adversity, and mental illness 

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Action Steps for Improving Women’s Mental Health
WHY ACTION STEPS FOR IMPROVING WOMEN’S MENTAL HEALTH?

The 1999 publication of Mental Health: A Report of the Surgeon General provided a comprehensive

review of advances in genetics, behavioral sciences, and neurosciences affecting the mental health of

Americans.1 The report highlighted the evidence base that has led to effective treatments for mental illnesses; encouraged individuals to seek treatment; and called for a societal resolve to address the fears,

misunderstandings, and stigma associated with mental illness through increased research and educational outreach.

Since the publication of that report, a growing body of evidence has underscored the important influence of gender differences in the prevalence, course, and burden of mental illnesses. A parallel body of

research has demonstrated the profound influence of mental health on physical health and survival.

Studies from the world of business and economic analysis have highlighted the enormous costs of

mental illnesses on American society, and research has shed new light on the long-term consequences

of intergenerational risks and effects associated with mental illnesses (e.g., depression) or family dysfunction (e.g., abuse or neglect). Additional findings have elucidated the impact of trauma, violence,

and abuse on the development of mental illnesses, particularly as they affect girls, women, and female

veterans. Research also has pointed to the effectiveness of a growing array of treatment options for

mental illnesses and of a new model of treatment that is recovery-oriented, focuses on building individual strengths and resilience, and includes the active participation of individuals in their treatment.

The evidence from recent research has carried implications for the

well-being of all Americans but has particular significance for the

health and well-being of women. Women not only suffer disproportionately from a number of mental illnesses but also they often

serve as caretakers for those suffering from mental illnesses, make

many of the health decisions in the family, and play a critical role 

in perpetuating or breaking the intergenerational effects of mental

illnesses.2

The HHS Women’s Mental Health Initiative has drawn from the

latest research; Surgeon General publications on related mental

health topics; 3,4,5,6 resources and publications from other HHS

agencies, and on the input of experts from the consumer, research,

advocacy, health care professional, and policymaking communities.

Building on the existing research base, the initiative has been

addressing the burden of mental illnesses on women across their

life spans through efforts to reduce stigma and discrimination,

bring mental health into mainstream health, promote treatment

and recovery, and support greater gender and cultural diversity in

mental health research and practice.

2

Action Steps for Improving Women’s Mental Health 

Glossary

Mental health is characterized by mental

functions that result in productive activities, fulfilling relationships with others, and

the ability to adapt to change or cope with

adversity.

Mental illness refers to all diagnosable

mental disorders, i.e., conditions characterized by alterations in thinking, mood,

and/or behavior. 

Recovery implies the reduction or complete

remission of symptoms and the ability to

live a fulfilling and productive life despite

a mental illness or addictive disorder.

Recovery-focused services go beyond the

treatment of symptoms to emphasize ways

to build resilience and facilitate recovery.

Patient and family-centered services are

those that are informed by the needs of

individuals affected by mental illnesses and

their families, who are integrated as active

participants in treatment and recovery.
Action Steps for Improving Women’s Mental Health

The HHS Women’s Mental Health Initiative has been sponsored by the HHS Office on Women’s

Health (OWH) and has been developed as a collaborative effort with women’s health and mental health

experts from the National Institute of Mental Health, the Substance Abuse and Mental Health Services

Administration, the Office of Minority Health, the National Institute on Drug Abuse, the Indian Health

Service, the Office of the Assistant Secretary for Planning and Evaluation, and the Office of the

Surgeon General. The purpose of the HHS Women’s Mental Health Initiative has been to explore questions related to the importance of gender-based differences in mental health; how the science and focus

of women’s mental health issues have evolved since the publication of the Surgeon General’s report on

mental health; and what gaps remain in our understanding of women’s mental health issues.

METHODOLOGY

In order to address its purpose and assess the current understanding of issues affecting the mental

health of women and girls, the HHS Women’s Mental Health Initiative included several background

research and information-gathering activities:*

A concept mapping activity to define and depict key women’s mental health issues. Issues 

were identified, ranked according to both their importance and potential for action, and 

organized according to common themes. The themes were arranged in a conceptual framework 

(presented in brief below and more fully in Appendix A), which offers a visual representation of

how women’s mental health issues are grouped and interrelated.

Leadership interviews with 25 high-level individuals representing governmental, provider, and

consumer organizations. Respondents identified current, critical women’s mental health issues 

and gave feedback to refine the conceptual framework developed through the concept mapping 

exercise.

Facilitated discussions in three cities with diverse groups composed of consumers, providers, 

and local government staff. Participants identified and examined key mental health issues 

concerning women and girls and added further suggestions and comments to help shape the 

conceptual framework of mental health issues affecting women and girls.

A literature review targeted to find the most recent and relevant articles on the mental health 

of women and girls and limited to U.S.-based studies and reviews published in prominent, peerreviewed journals or by Federal agencies since the 1999 release of Mental Health: A Report of 

the Surgeon General. 

An invitational workshop on women’s mental health with presentations and break out group 

discussions involving experts from the consumer, academic, advocacy, health insurance, health 

care delivery, program management, and public policy communities. 

The following conceptual framework reflects the concept mapping exercise and additional refinements

from the leadership interviews and facilitated discussions. It depicts the major issues associated with

3

* A more detailed description of each of these activities is included in Appendix A.
4

Action Steps for Improving Women’s Mental Health 

women’s mental health, capturing protective and resilience factors and the individual, environmental,

and system-based factors that affect the mental health risks, diagnosis, treatment, and challenges for

women and girls. A visual illustration of this conceptual framework is presented below. A more detailed

depiction of the conceptual framework is presented in Appendix A, which shows all of the issues that

were identified as being highly important and having the greatest potential for action.

Key themes and issues

The findings and recommendations of the HHS Women’s Mental Health Initiative underscore the continued importance of key cross-cutting themes from the 1999 Surgeon General’s report on mental

health, starting with the persistent need to combat stigma and the associated prejudice and discrimination

that affect individuals with mental illnesses and their families. The report also highlighted the need to

expand cultural competence across mental health research, training, and services; reduce disparities in

mental health access and treatment; and encourage treatment. In addition, a number of new issues have

emerged regarding the burden of mental illnesses: the importance of gender-based differences; effects

of trauma, violence, and abuse; the mental health of female veterans; lifespan and intergenerational

issues; and the need to include patients as active participants in their own treatment and recovery plans.

These themes and issues constitute the rationale for action described below.

Conceptual Framework of Issues Affecting the Mental Health of Women and Girls
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Action Steps for Improving Women’s Mental Health

RATIONALE FOR ACTION

Burden of mental illnesses

Recent findings from the World Health Organization and the National Comorbidity Survey suggest that

the burden and prevalence of mental illnesses in both men and women are enormous and far ranging.

On a global scale, four of the six leading causes of Years Lived with a Disability (YLD) are associated

with mental illnesses, including major depression, alcohol use disorders, schizophrenia, and bipolar

disorder. In developed countries, mental illness is second only to cardiovascular disease as a cause of

lost years of healthy life.7 In addition, mental and substance use disorders represent the top five causes

of disability among people ages 15-44 in the U.S. and Canada.8 In the United States, mental illnesses

are estimated to affect 46.4 percent of Americans at some point during their lifetimes9 and to cost the

Nation billions of dollars each year in direct health costs, lost wages, decreased productivity, relapse, and

suicide. For example, estimates indicate that depression alone costs our Nation $83 billion a year, and

another $63 billion is associated with the costs of anxiety disorders.10,11 Direct treatment costs for mental health and addictive disorders have been calculated to be $104 billion, and an estimated 217 million

days of work are lost each year due to these disorders.8

Persistence of stigma 

The stigma surrounding mental health and mental illnesses is strong and persistent.1,12 It perpetuates

prejudice against individuals living with mental illnesses and those close to them. Stigma and fear of

discrimination prevent people from recognizing the signs of mental illnesses, understanding the prevalence of mental illnesses, and comprehending the importance of mental health to overall health. They

also isolate individuals with mental illness, discouraging them from speaking up about mental health

concerns and from seeking treatment. Stigma remains particularly pronounced among racial and ethnic

minorities, older adults, and individuals living in rural areas.1 Stigma seems to have its roots in fear—

fear of the unpredictable or strange nature of mental illness or of an association between mental illness

and violence—and in a widespread misperception that mental illnesses are a sign of personal weakness

or poor choices.1,8

The 1999 Surgeon General’s report underscored the importance of combating stigma and its negative

influences by spreading the understanding that mental illnesses are indeed real illnesses, and that like

many other diseases they can be treated effectively. The report also highlighted the need for continued

social science research to develop and evaluate new approaches for disseminating information about

advances in mental health treatments to help combat stigma and potential discrimination.1 Evidence suggests that promoting a better understanding of the pervasiveness and importance of mental illnesses and

putting a personal face on the stories of mental illness are both effective strategies for reducing stigma.13

Thus, there is a continued need to advance treatment options for mental illnesses, ensure that findings are

rapidly transferred to practice, and promote effective strategies to combat stigma and discrimination.
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Action Steps for Improving Women’s Mental Health 

Rates of mental illnesses: gender differences

Although overall, men and women experience mental illness at 

similar rates, some mental disorders occur more frequently in

women than men (see figure 1).9 For example, women are nearly

twice as likely as men to suffer from major depression, which is

associated with problems such as lost productivity, higher morbidity from medical illness, greater risk of poor self-care or poor

adherence to medical regimens, and increased risk of suicide.14,15

Perinatal depression affects an estimated 8-11 percent of women

during pregnancy and 6-13 percent of mothers in the first postpartum year.16 Women are three times more likely than men to engage

in non-fatal suicidal behavior (e.g., taking an excessive dose of

sleeping pills), though less likely to use a lethal method (e.g.,

firearm) and die by suicide.17,18

Rates of anxiety disorders are two to three times higher in women

than men; this includes post-traumatic stress disorder (PTSD), which affects women more than twice as

often as men.9 Women represent 90 percent of all cases of eating disorders, which carry the highest

mortality rate of all mental illnesses.19 Eating disorders frequently are associated with other psychiatric

disorders, such as depression, substance abuse, obsessive-compulsive disorder, and social phobia.20,21,22

In contrast, men are more likely than women to suffer from impulse control disorders and from substance use disorders. 

In some cases prevalence rates are similar between men and women, but there are notable differences

in the treatment or course of particular mental illnesses. For example, the rates of schizophrenia and

schizophreniform disorders in men and women are similar (1.0 and 1.26 percent, respectively), but the

disorder has a later average age at onset and appears to be less severe in women compared with men.23

Similarly, although the rates of bipolar disorder are nearly equal for women and men (1.4 and 1.3 percent,

respectively) the onset tends to occur later in women, and they are more likely than men to experience

a seasonal pattern of the mood disturbance, depressive episodes, mixed mania, or rapid cycling.24

Women with bipolar disorders also are more likely than men to experience comorbidity, particularly

thyroid disease, migraine, obesity, and anxiety disorders, whereas men are more likely to experience a

co-occurrence of substance use disorders.24

The disproportionate prevalence of particular mental illnesses in women is all the more important in

light of the fundamental links between mental health, overall health, and social well-being. For

instance, in the case of major depression, the disorder can precipitate chronic disease or be exacerbated

by the presence of chronic disease.25 Individuals with depression are at greater risk of developing diseases such as cancer or cardiovascular disease.26,7 Mortality rates from disease increase significantly in

Perinatal depression encompasses major

and minor depressive episodes that occur

either during pregnancy or within the first

12 months following delivery. 

Anxiety disorders are characterized by a

disabling, excessive, or irrational dread of

everyday situations. They include generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and social phobia. 

Eating disorders may take the form of

excessive reduction of food intake or

overeating, possibly combined with excessive exercise and extreme concern about

body shape or weight.

Substance use disorder refers to the

abuse of or dependence on alcohol, illegal drugs, or prescription medications.
7

Action Steps for Improving Women’s Mental Health

people with depression, and there is evidence that treating the depression can improve survival rates for

conditions such as heart disease.27,28 Having depression is associated with risk-taking behaviors such as

smoking, abuse, unsafe sex, and not following a prescribed medical regimen.7 In turn, rates of depression are higher in people with chronic disease (e.g., diabetes, arthritis, asthma, cardiovascular disorders, cancer, neurological disorders, infectious disease) as are rates of suicide.29 Moreover, there are

important cost factors associated with the relationships between chronic health problems and mental

illnesses. For example, healthcare costs and use appear to be up to two times higher among diabetes

and heart disease patients with co-morbid depression compared to those who do not have depression,

and depressed patients are three times more likely to be non-compliant with their medical treatment

regimen.30,31,32 These connections need to be recognized and treated in an integrated manner if treatment

is to be fully effective.

Some of the sex-based variation in rates of selected mental illnesses and in the risk, course, or treatment of these disorders may be associated with biological differences between men and women.33 For

example, research has demonstrated that the female hormones, estrogen and progesterone, influence

brain function and stress response. Studies of reproductive events such as menstruation, pregnancy,

postpartum, perimenopause, and other changes in female hormone levels find that these changes lead

to an increase of the occurrence and intensity of symptoms of depression and other mood disorders,

such as bipolar disorder and dysthymia.34,35,36,37,38

Investigations of the neural mechanisms underlying the processing of emotionally arousing information

also suggest that there may be distinct differences between women and men in the activation of the

amygdala, the part of the brain involved in the processing of emotional information.39 Studies that

investigate male and female differences in brain volume or structure or those that look at differences in

Figure 1: Rates of Mental Disorders for Women and Men
the brains of individuals with and without mental illnesses appear to be inconclusive, suggesting that

further research is needed to establish a fuller understanding of how biologically-based brain differences may help inform future pharmacologic and medical treatments for women.40,41,42 

Environmental factors also play a significant role in the risk and prevalence of certain mental illnesses.

Some environmental factors may be the result of bias in reporting or diagnosis; for example women

may be more likely than men to seek treatment or there may be gender differences in rates of diagnosis

for particular disorders. In addition, there are important psychosocial factors from women’s environments that may influence the risk, diagnosis, course, and treatment of mental illnesses in women.

Examples of these may include such factors as differences in the ways girls and boys are raised; expectations about male and female roles in the family, workplace, or larger society; the higher rates of

abuse experienced by girls and women; the higher rates of poverty or single parenthood experienced by

women compared to men; or differences in the positive or negative ways men and women cope with

stress and adversity.43,44 

Cultural effects and disparities

Individual attitudes and responses to mental illness are highly affected both positively and negatively

by one’s family and cultural environment. These environments influence the meaning individuals

assign to illness, how they make sense of it, what the causes may be, and how much stigma surrounds

mental illness.6 In addition, they affect whether individuals will seek help (and from whom), how supportive their families may be, the pathways they take to obtain mental health services, and how well

they may respond to different types of treatments.6 

Use of “cultural disparities” can place women at greater risk for mental illnesses. Factors such as

racism, discrimination, violence, and poverty have measurable effects on rates of mental illness.45

These effects are coupled with the finding that racial and ethnic minorities are less likely to receive

needed services, including mental health services, and more likely to receive low-quality care.6 In addition, women who are recent immigrants or refugees may face extra stresses and traumas associated

with their immigration experiences. Migration itself is a stressful life event, requiring the need to adapt

to a new culture. Women and girls who are refugees may face additional stresses or trauma associated

with factors such as turmoil in their home country, long stays in insecure refugee camps or processing

centers, or experiences of trauma or violence.6 At highest risk are the estimated 50,000 women and

children who are victims of human trafficking each year into the United States.46 Research suggests

that nearly 90 percent of internationally trafficked women rely on drugs or alcohol to cope with their

situation, 50 percent report feeling hopeless, 85 percent experience depression, and 31 percent say they

have had suicidal thoughts.46

8

Action Steps for Improving Women’s Mental Health 
9

Surveillance systems for identifying mental health service needs and 

disparities

National, State, and community-based surveillance systems for measuring mental health and distress

can provide valuable data to measure the burden of mental illness on men and women, indicate potential mental health needs and disparities (e.g., racial, ethnic, age, and gender disparities), and track

progress over time.47 The State-based Behavioral Risk Factor Surveillance System (BRFSS) provides

continuous population data on the mental health perceptions of adult women in every State, the District

of Columbia, Puerto Rico, the Virgin Islands, and Guam48,49 This complements State-level records-based

data on mental health status. The value of these data for decision-making and population research in

women’s mental health is poised to increase now that a set of depression, mental illness, and stigma

measures has been added to this surveillance system. Data resources could be even further enhanced

with the addition of brief, validated measures of mental health and well-being to ongoing national surveillance systems such as the National Health and Nutrition Examination Survey (NHANES) and the

National Health Interview Survey. 

Trauma, violence, and abuse

The research literature has increasingly focused on the relatively high prevalence of trauma, violence,

and abuse in women’s lives and their effect on women’s mental health and overall well-being. Findings

from the National Violence Against Women Survey indicate that 17.6 percent of women compared to

3.0 percent of men report having experienced a completed or attempted rape in their lifetime, and 24.8

percent of women compared to 7.6 percent of men report being raped or physically assaulted by an

intimate partner.50 Thus, women are six times more likely than men to report being a victim of rape or

attempted rape, and they are three times more likely than men to suffer from sexual or physical intimate partner violence. Data also show that violence and abuse in women’s lives begin early in the

lifespan. For example, women are five times more likely than men to report being a victim of sexual

abuse in childhood.50

Effects on female veterans

One of the newly emerging areas of research regarding women’s experience of trauma, violence, and

abuse concerns the effects of military service and combat on female veterans. A number of factors are

combining to generate greater interest in this area including the growing numbers of women in active

duty; increasing rates of male and female soldiers returning from the conflicts in Iraq and Afghanistan

who are being diagnosed with mental disorders such as PTSD, generalized anxiety, or depression; and

findings suggesting that female veterans are at higher risk of PTSD and sexual abuse than either their

non-combatant counterparts or male veterans.51,52 

Recent figures suggest that the proportion of returning soldiers and Marines who have had a positive

screening for mental disorders is 17 percent, nearly twice the rate observed before deployment.53

Action Steps for Improving Women’s Mental Health
10

Action Steps for Improving Women’s Mental Health 

Additional research investigating differences in PTSD rates between men and women in the military

suggests that female veterans may face a higher risk of PTSD than their male counterparts, with rape

being the most common cause of onset.54 National surveys suggest that from 13 to 30 percent of

women veterans experience rape during their military service, increasing their risk of PTSD and associated problems such as poorer overall health functioning, depression, and substance abuse.54,55

Researchers conclude that these findings point to a need for regular screening of women veterans for

sexual trauma and PTSD to promote early detection and intervention. They also recommend increased

efforts to ensure that female veterans obtain needed treatment services in a timely fashion along with

greater research to better understand the specific nature of violence against women in the military and

identify effective prevention and treatment measures.

Association with other health risks and problems

Having a history of violence, trauma, or abuse is associated with increased risk of depression, PTSD,

panic disorder, and a tendency toward risky behaviors, such as smoking, binge drinking, cocaine use,

self-injury, unhealthy weight control, risky sexual behavior, and serious consideration of suicide.56,57,58,59

In addition, evidence from the neurobiological and other sciences shows that chronic or recurrent exposure to the stress associated with maltreatment can lead to potentially irreversible changes in the interrelated brain circuits and hormonal systems that regulate stress.60 Strong and prolonged activation of

these stresses, in the absence of any buffering relationships, leaves children who experience them vulnerable to a range of physical and other health problems throughout life, including mental health problems.61,62 Preventing abuse and trauma before it occurs—by creating safe, stable, and nurturing environments—is essential for buffering these stresses. 

Recent research is increasingly investigating the correlation between the co-occurring mental health

and substance use disorders in women with a history of sexual or physical trauma. Studies on this issue

find that from 55 to 99 percent of women in substance use treatment report a history of trauma, as do 85

to 95 percent of women in the public mental health system, with the abuse most commonly having

occurred in childhood.63,64,65,66 However, these associations are not always recognized, and thus they are

not successfully treated through trauma-integrated approaches that address the mental and substance

use disorders and the underlying histories of victimization. The research literature reflects the promise

of new trauma-based psychosocial educational empowerment group interventions for women that, in

addition to individual and drug therapies, help to promote recovery and restore social trust and involvement. When the connection between trauma and substance use is missed, however, the risks of treatment

failures, suicide, incarceration, revictimization, and repeated use of social and health services are

increased.67 

Disaster planning and response

Another issue that has been the basis of recent research and concern among mental health experts is

that of the traumatic effects of catastrophic events on women’s mental health. Lessons from Hurricane
11

Katrina and other large-scale disasters suggest that women may be more vulnerable than men in the

face of these events.68,69,70,71 In the United States, as in the rest of the world, women and children constitute 75 percent of people displaced by catastrophies of natural or human origin; women also are more

vulnerable than men to reproductive health problems (e.g., premature delivery, unmet needs for sanitary

hygiene supplies) resulting from disasters and post-disaster conditions, at higher risk of being abused,

and face greater family responsibilities.72,73 In addition, women face higher rates of depression and

report higher rates of post-disaster stress symptoms.72,74 Lessons from disaster experiences reveal that

response planning and interventions are made more timely and efficient when they integrate an understanding of gender differences in needs, vulnerabilities, responsibilities, capacities, and coping strategies.75,76 These findings suggest a need to incorporate gender considerations into emergency preparedness planning, training, and response. 

Life span and intergenerational issues

Mental illnesses, including those that disproportionately affect women such as depression and anxiety

disorders, are often chronic or recurrent. They may influence women’s lives across the life span and

those of their families across generations. Findings from the National Comorbidity Survey indicate that

mental illnesses in both men and women often begin at a young age, with half occurring before age 14

and three-fourths by the age of 24.9 If left unrecognized or untreated, mental illnesses that occur in

childhood frequently persist into adulthood. In addition, they may lead to conditions such as more risk

taking behaviors, low self-esteem, and school failure that can set forth a downward spiral of poor outcomes that reduce an individual’s quality of life and ability to meet his or her full potential.5 Indeed,

research on child and adolescent mental health indicates that no other illness has such damaging effects

on children as does mental illness.78 

These findings are important for young and adolescent girls, who appear to be at increased risk compared to their male peers and to adult women of being a victim of abuse, developing an eating disorder,

experiencing depression or anxiety, or engaging in suicidal behavior.79 They also underscore the importance of prevention and early intervention in stemming the risks of mental illness and the associated

health and social problems later in life. Thus, one strategy is to try to prevent abuse and trauma before

they occur by creating safe, stable, and nurturing environments for children, youth, and families. 

In addition, early intervention for children with mental illnesses has been shown to effectively address

health and behavioral concerns; shorten and lessen the disabling course of illness; reduce unnecessary

pain and suffering; and help promote greater resilience, self-esteem, and school achievement.12 Early

intervention and appropriate treatment also reduce the risk in children of developing co-occurring mental or addictive disorders. 

Research on the prevalence and effects of co-occurring disorders among children and adolescents indicates that the problem affects a substantial number of youth, and that if one of the disorders is not treated,

Action Steps for Improving Women’s Mental Health
12

Action Steps for Improving Women’s Mental Health 

both generally tend to become worse. As a result there is an increased risk of further problems (e.g.,

unemployment, poverty, incarceration, suicide, medical problems, social separation) later in life.80

However, there is evidence to suggest that girls may be less likely than boys to be identified as having a

mental disorder. Thus they may be more likely than their male peers to miss the opportunity for early

intervention and treatment.5

In addition to the effects of mental and behavioral disorders in children, there is considerable evidence

to suggest that mental illnesses can persist in an intergenerational cycle.81,82 For example, maternal

depression increases the risk of depressive symptoms in children, particularly those who are very

young, and it may lead to poorer health and developmental outcomes for children.83 Having a family

member with mental illness also carries the risk for both children and adults of increased stress, greater

financial burden, social isolation, and exposure to stigma and discrimination.7 

The long-term effects of exposure to trauma or abuse in childhood also correlate closely with increased

lifetime risks of mental illness and serious health problems in adulthood.84,85 This may be of particular

concern for girls and young women due to their higher vulnerability to physical and sexual abuse;

indeed, data from the National Violence Against Women Survey indicate that nearly 55 percent of

women report having been raped or physically assaulted, often during childhood.86 

Conversely, evidence suggests that environmental enrichments (e.g., positive parenting, social supports,

early recognition and treatment of mental health concerns) can help break the intergenerational cycle of

mental disorder or abuse and lead to changes in brain activity, with potential, positive, long-term intergenerational effects.87,88,89,90 Thus, researchers note that appropriate treatment along with the promotion

of healthy psychological states and resilience before, during, and after exposure to adverse childhood

events can help promote lifelong mental health for girls, women, and their children.88

Resilience and protective factors

Resilience means the personal and community qualities that allow individuals to rebound from adversity, trauma, tragedy, threats, or other stresses, which may be caused by psychological distress, specific

mental illnesses, or adverse environmental events. It also includes the ability to bounce back from difficult experiences and to go forward in life with a sense of mastery, competence, and hope.

The family and other interpersonal connections in women’s lives may play an important role in building resilience and offering protection from mental illness. Early evidence suggests that social support

systems, a stable family life, an abuse-free upbringing, optimism, positive role models, and self-identity build resilience and serve as protective factors for girls and women against mental illnesses.91,92

Similarly, interventions such as peer support and self-empowerment groups may hold the promise of

boosting resilience to help prevent mental illnesses or serve as an adjunctive therapy to help treat mental illnesses, and thus merit further research.93,94 
13

Recovery-oriented treatment

One of the key messages of the Surgeon General’s report on mental health regarded the well-documented variety and efficacy of mental health treatments, even for the most severe mental illnesses.1 In addition, treatment is very cost-effective in terms of workforce participation and productivity.95 Yet national

surveys indicate that most individuals with mental illnesses do not receive treatment.96,97 For many, this

is in part associated with a lack of understanding that a variety of effective treatments exist and that

recovery is possible. Other factors also contribute to lower rates of treatment use including stigma and

the fear of discrimination, lack of access to treatment services, cost and payment issues, and lack of

treatment options that are gender appropriate or culturally competent.

Recent advances in mental health treatment, supported by the recommendations of the President’s New

Freedom Commission on Mental Health, have broadened the definition of treatment to include patient

involvement, a focus on healthy self-development, and access to a range of quality mental health services.12 They also have called for a transformation from a model focused primarily on acute care to one

that incorporates long-term recovery, with an emphasis on building resilience, facilitating recovery, and

including active participation on the part of individuals with mental illnesses and their families.98 The

aim of this new model is to promote the patient’s ability to live a fulfilling and productive life despite a

mental illness and to have a reduction or complete remission of symptoms. For women with a history

of trauma, violence, or abuse, there is promising evidence that the most effective treatments are those

that are gender-specific, coordinated, multitargeted, and multimodal.99 The research evidence suggests

that there is clearly a need for more research on optimal treatment strategies, including combination

therapies, holistic and integrated approaches, and combining preventive interventions with treatment

for periods of risk (e.g., perinatal period) or for women at potential risk for co-occurring disorders.100 

Integration of mental health and primary care

Evidence indicates that primary care providers are critical in helping to recognize mental 

illnesses among women.101 Indeed, many individuals with mental illnesses are diagnosed through primary care physicians and other general medical providers, both within the public and private health

care systems.102 For example, 42 percent of those with clinical depression and 47 percent with generalized anxiety disorder are diagnosed by a general medical provider, and more than half of those treated

for depression (52 percent) are treated by a primary care or other general health provider.103,104 This is

particularly important for women, who are at higher risk for both of these disorders.9 Women also are

more likely than men to visit a primary care physician, representing nearly 60 percent of all visits to

primary care providers and averaging more than 363 visits per 100 persons per year compared to 266 

visits for men.105,106

Data also show that a majority of Americans receive behavioral health services from primary care

providers and that primary care providers prescribe the majority of psychotherapeutic drugs for both

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Action Steps for Improving Women’s Mental Health 

adults and children.8,107 The ability to receive mental health services in a primary care setting can help

reduce the fear and stigma associated with mental illnesses. The concern has been raised, however, that

the impetus for this trend may be more frequently associated with financial and health insurance factors rather than treatment considerations, and that the primary care setting may not necessarily be the

optimal one for treatment due to such constraints as time available, provider expertise, and reimbursement issues.8,108 This suggests a need to more effectively integrate mental health treatment across primary and specialty care services, potentially with simple screening tools that can be easily adopted in

the primary care setting, the ability to refer patients to appropriate services, and the expansion of evidence-based models for delivering mental health services in primary care. For example, early results

from demonstration programs funded by the Health Resources and Services Administration’s Bureau of

Primary Health Care and other State and private entities show promising results for treating depression

or anxiety with short visits in primary or community care clinics in a way that improves access and

helps to reduce stigma.109 

SUMMARY

Since the publication of the 1999 Surgeon General’s report on mental health there has been greater

recognition of the role of mental health in the overall health of individuals and of our Nation. Many

advances have been made in our understanding of mental illnesses, effective treatments, and promising

approaches for promoting mental health, resilience, and fulfilling lives for those living with mental illnesses. A key component of this progress has been the increased understanding of the critical role of

gender in the risks, course, and treatment of mental illnesses. However, for this knowledge to be effective, it must be translated into tangible actions that can promote change and support progress to

improve the mental and overall health of our Nation’s women and girls.
15

ACTIONS

Advances in the science and practice of women’s mental health in recent years provide an unprecedented

opportunity to address the burden of mental illnesses on women’s lives and increase the capacity for

recovery. They suggest multiple areas for action.

Action 

Promote the widespread understanding that women’s mental 

health is an essential part of their overall health.

The importance of mental health issues on women’s health and in women’s lives has remained largely

unrecognized, both within the medical community and among the general public.1 In addition, there are

important connections between mental illnesses and other diseases, such as heart disease and diabetes,

that are easily missed when mental and overall health are not considered together. By not approaching

these conditions in an integrated fashion, the efficacy of disease management programs for individuals

with co-morbid medical and mental illnesses may be compromised.

To increase the understanding of mental health issues, address stigma, and help reduce health disparities, there is a need to develop and disseminate information on gender-specific mental health issues

across the life span in both rural and urban settings and in ways that are culturally competent.

To address potential discrimination against individuals with mental illness, there is a need to disseminate information about relevant civil rights laws and the agencies that enforce these laws, including the

HHS Office for Civil Rights, the Equal Employment Opportunity Commission, the Civil Rights

Division of the Department of Justice, and the Office of Fair Housing and Equal Opportunity in the

Department of Housing and Urban Development.

Action 

Improve the interface of primary care and mental health services 

for women.

The gap between mental health and other health services exacerbates issues of stigma and decreases

the likelihood that women will obtain diagnostic and treatment services for mental illnesses.1 Primary

care providers and others who regularly interact with women are well-placed to help bridge this gap

and to incorporate mental health issues into their health screenings and discussions. This is particularly

important for conditions that disproportionately affect women (e.g., depression, history of trauma, anxiety

Action Steps for Improving Women’s Mental Health
16

Action Steps for Improving Women’s Mental Health 

disorders) or periods in women’s lives when they may be at higher risk (e.g., early adolescence, perinatal/postpartum period, menopause, aging, or with diagnosis of a major medical condition requiring

extended care).

To achieve this goal, however, there needs to be increased focus on the training and continuing education

of primary and general health care practitioners to recognize mental health risks, including genderbased differences. Further strategies include the implementation of systematic screening procedures to

identify mental health and substance use disorders and expansion of systems that can link those in need

with appropriate mental health services, supports, or diversion programs. The expansion of collaborative care models (combining care from primary care providers and behavioral health specialists) in primary health care settings and greater reimbursement rates for these services by both public and private

health insurers also have been cited as critical to promoting the integration of primary and mental health

services.12 Educating consumers to look for and ask for more integrated systems of care can also be an

important factor.

Action 

Accelerate research to increase the knowledge base of the role 

of gender in mental health and to reduce the burden of mental 

illnesses in both women and men.

The last decade of research has highlighted the importance of biological factors (e.g., hormonal fluctuations, psychotropic drug response, brain structure), psychosocial factors (e.g., gender roles, socialization, social status), and artifact (e.g., diagnostic bias, gender differences in seeking treatment) on

women’s mental health. In addition, a growing body of research is beginning to shed light on issues of

race, ethnicity, and culture as they relate to mental health.

The Federal action agenda for mental health care titled, Transforming Mental Health Care in America

Federal Action Agenda: First Steps,98 underscores the continued need to further develop the knowledge

base in understudied areas, including quality and access gaps facing racial and ethnic minorities, the

impact of trauma and violence on the mental health of women and children, and long-term and other

effects of psychotropic medications. In addition, a targeted review of recent literature on women’s

mental heath issues undertaken as part of the HHS Women’s Mental Health Initiative suggests the need

for randomized, controlled clinical studies in order to compare different treatment modalities, to

explore the efficacy of individual treatment components, and to determine best practice treatments for

women with differences in risk factors or presentation of symptoms.34 Specifically, the literature review

reveals that researchers point to the need for more studies to investigate:
17

Basic biological and behavioral male/female differences, including animal models, neuroimaging, and genetic studies to increase understanding of the neurobiological underpinnings 

of mental illnesses and addictive disorders

Effective pharmacotherapy for women and girls (using female study subjects)

Specific psychotherapeutic approaches that are effective in women

Successful treatment approaches for pregnant and postpartum women that minimize impacts on 

fetuses and infants

Biological differences between men and women with mental illnesses

Biological differences between women who develop disorders and those who demonstrate 

resilience

Gender-based risk factors and treatments for specific disorders (anxiety disorders, mood 

disorders, eating disorders, schizophrenia, addictive disorders, etc.)

Gender-based preventive interventions for specific disorders (eating disorders, depression, 

substance abuse, etc.)

Potential gender effects or differences in the effectiveness of programs and interventions to 

reduce the stigma or discrimination associated with mental illnesses

Gender differences in the etiology, course, and high-risk periods for mental illness

Potential gender differences in the risks, prevalence, and effective treatments for mental 

disorders among male and female veterans, including the effects of rape and sexual trauma on 

women in the military.

Action 

Increase gender and cultural diversity in academic research 

and medicine.

The growth of women in academic medicine has been slow; women represent just one-third of medical

faculty members in the U.S. and are still highly underrepresented among associate and full professors in

academic medical institutions.110 The greater participation of women, including women of color, in academic research is important to ensure that the research base reflects gender, racial, ethnic, and cultural

diversity not only in the types of topics that are being researched but also in the interpretation of the

findings.111 Advances in our understanding of gender and cultural diversity must be integrated into the

training of health care professionals and staffing of academic research institutions. Several national

efforts to promote greater gender and cultural diversity in academic health institutions and among

Action Steps for Improving Women’s Mental Health
18

Action Steps for Improving Women’s Mental Health 

health professionals currently are being sponsored by the HHS Office of Minority Health, HHS

Office on Women’s Health, the NIH Office of Research on Women’s Health, and the Substance

Abuse and Mental Health Services Administration. Areas of focus in these programs include promoting and investigating cultural competence and the representation of women in behavioral health care

education, training, and research; issues such as recruitment and retention of women, including

minority women; availability of bilingual trainees; integration of gender into research, training, and

practice; and the development of cultural and linguistic competence in clinical practice. However,

further efforts need to be undertaken to ensure that the voice of gender and cultural diversity is

clearly present in academic research.

Action 

Support efforts to track the mental health, distress, and well-being

of women and girls in national, State, and large community-based

surveillance systems.

The ability to track the mental health status of our Nation’s women and girls is vitally important for

identifying current mental health service needs and disparities, including those related to gender, age,

race, and ethnicity.112,113,114 It is also critical for guiding the allocation of resources and assessing the

effectiveness of interventions and policies. The improved surveillance of girls’ and women’s mental

health will require the development of brief, validated measures of mental health and well-being that

can be included in ongoing surveillance systems that currently emphasize physical health and injury.

Examples of these include the National Health and Nutrition Examination Survey (NHANES), the

National Health Interview Survey, the State-based Behavioral Risk Factor Surveillance System

(BRFSS), and the Youth Risk Behavior Surveys (YRBS). Population level data, particularly those gathered at the community level, can provide needed information for prevention research that complements

clinically-based research.

Action 

Decrease the amount of time required to translate research findings

in women’s mental health into practice.

Research suggests that it can take from 15 to 20 years for evidence-based practices to be translated into

the everyday delivery of mental health services and activities.115 Moreover, there is a shortage of

research on what works to actually change practice. Thus, many individuals are not benefiting from

new evidence-based treatments, preventive interventions, or practices—including those that may be

more suitable for women and girls. This points to the continued and urgent need to harness research
19

and transfer it effectively into usable methods and modalities that can be implemented in real-world

settings to improve care. Examples of areas in which practice may lag behind research include the

development of new medications and potential gender-based differences in their effectiveness, behavioral therapies that may be more appropriate and effective for girls or women, multi-systemic therapy,

parent-child interaction therapy, family psycho-education, assertive community treatment, and collaborative treatment in primary care.12

Action

Recognize the unique prevalence of trauma, abuse, and violence 

on the lives and mental health of girls, women, and female veterans. Address their effects, increase prevention efforts, and support

promising new approaches that enhance recovery.

The National Violence Against Women Survey indicates that there is a high prevalence of abuse in

women’s lives, both in absolute terms and relative to the rates experienced by men. The unique prevalence of trauma, violence, and abuse in women’s lives is important in and of itself and because of the

close correlation between being a victim of abuse, having a mental illness, and having a substance use

disorder. Thus, researchers recommend screening girls and women, including female veterans, more

widely for histories of trauma, abuse, and violence—particularly if they present with depression, substance use, or eating disorders. The results of recent research on rates of rape and associated PTSD

among women in the military also suggest a need for increased screening and treatment for trauma and

abuse in that population.117,54 Evidence indicates that integrated treatment approaches that address both

trauma histories and co-occurring mental or substance use disorders are more effective, especially if

they give the patient a voice in her own treatment.118

The research literature related to trauma, violence, and abuse focuses heavily on the prevalence and

characteristics of these experiences in the lives of girls and women. Less attention is paid, however, to

potential interventions for women and girls who have been or may be at risk for being abused or to

possible differences in the effects of different forms of abuse on their mental health. Researchers recommend that future studies include more measures of the effects that traumatic experiences have on

women in particular; collect longitudinal data to infer temporal and causal relationships; and develop

evidence based interventions to stem the effects that abuse, trauma, and violence have on mental and

other health outcomes.119,120 

Action Steps for Improving Women’s Mental Health
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Action Steps for Improving Women’s Mental Health 

Action 

Address the cultural and social disparities that place women at

greater risk for certain mental illnesses by including considerations of these disparities in diagnosis and intervention and by

investigating ways to increase cultural competence in treatment

approaches.

One of the gaps in the research literature is the lack of information on how risk factors and treatment

approaches for mental illnesses among women and girls may differ according to race, ethnicity, and

culture. The National Institute of Mental Health’s Five-Year Plan for Reducing Health Disparities calls

for the inclusion of populations of women who have not been well represented previously in clinical

trials and investigation of diseases and conditions within particular female populations.121 Recent literature on women’s mental health issues suggests that there is only minimal focus in the scientific literature on considerations of cultural competency, racial and ethnic differences, and disparities affecting

the mental health of diverse women and girls. Specifically lacking are studies addressing issues of race,

ethnicity, and culture with sufficient sample sizes, rigor, or statistical power to provide generalizable

findings.

Action 

Promote a recovery-oriented, strengths-based approach to treatment for women promulgated by the recommendations of the

President’s New Freedom Commission

Most individuals with mental illnesses do not receive treatment due to a widespread lack of understanding that, in most cases, effective treatment options exist, recovery is possible, and treatment is

cost-effective.122 The message of hope for most women with mental illnesses that is advanced by

researchers, planners, and the recommendations of the President’s New Freedom Commission on

Mental Health is that they can be active partners in their recovery and build resilience.12,123 It is a message that needs to be conveyed more broadly to providers, planners, and members of the public and

translated into practice. Thus, there is a continued need to promote services and treatments that are

geared to give individuals with mental illnesses and their families meaningful choices about treatment

options and providers. In addition, care should be focused on coping with challenges, facilitating

recovery, and building resilience, not merely on managing symptoms of the disorder.12
21

Action 

Build resilience and protective factors to promote the mental 

health of girls and women and aid recovery

Effective prevention and mental health promotion may reduce the risk or recurrence of all but the most

severe mental illnesses. There is a call from researchers and program planners to increase the amount

of research, including gender-based research, to further the understanding of internal (e.g., optimism,

positive self identity) and external (e.g., societal roles, cultural supports) protective factors, interventions that build self-esteem and improve well-being, and other wellness enhancing programs as well as

preventive interventions for specific disorders.124,125,126 In addition, according to the World Health

Organization, there exists a wide range of evidence-based preventive programs and policies that can

help reduce risk factors, strengthen protective factors, decrease psychiatric symptoms and disability,

and potentially prevent the onset of some mental illnesses.127 Activities to build resilience and protective factors also have been shown to improve mental health, contribute to better overall health, and

generate long-term social and economic benefits, yet much remains to be learned about the gender-specific effects of preventive and promotive interventions.91,93 There also are challenges related to disseminating and translating evidence-based prevention activities into practice in a timely manner and to

making effective programs and policies widely available.

Action 

Meet the mental health needs of girls and young women as 

part of overall health care.

Most mental illnesses and addictive disorders begin in childhood

and, if left untreated, will put children at risk for further health

problems, school failure, poor self-esteem, and the adoption of

risk-taking behaviors. In addition, childhood and the teenage years

are the time when girls may be at higher risk of physical, emotional, or sexual abuse, as well as depression, eating disorders, anxiety, substance use (especially the nonmedical use of prescription psychotherapeutics), or even suicide. Thus, early detection and treatment of

girls’ mental health needs and disorders are critical for bringing them the supports and treatments they

need and help ensure that problems do not worsen or have negative long-term consequences on their

personal development and life potential.

In addition, childhood and adolescence are a prime time for laying a healthy foundation for social, cognitive, and emotional development. It is a key period in which to help build resilience and positive

Action Steps for Improving Women’s Mental Health

A recovery-oriented and strengths-based

approach is one that focuses on increasing

the ability of individuals with mental illnesses to successfully cope with life’s challenges,

facilitate recovery, and build resilience.
22

Action Steps for Improving Women’s Mental Health 

mental health habits through activities and individuals that develop self-esteem, promote positive connections and role models, and help girls resist bad influences and trust their own judgment.

Action 

Incorporate gender issues and considerations in emergency preparedness and disaster planning, including mental health issues.

The increased vulnerability faced by women in times of catastrophe is not well integrated into community-based disaster mitigation, planning, and exercises. Thus, it is important to ensure that women and

issues of gender are included in emergency preparedness planning to address the unique health and

mental health needs of women, including their increased risk of depression, anxiety disorders, being

abused, and having to face additional family and practical difficulties.53 Women also should be included in discussions among primary distributors of emergency and medical supplies. Considerations of

gender differences and needs in emergency preparedness apply not only to local, regional, and national

planners but also could involve national associations, university researchers, advocacy groups, the public media, and other stakeholders.

CONCLUSION

Today, we face an unprecedented opportunity for action regarding women’s mental health. Following

the recommendations of the President’s New Freedom Commission and of the Federal action agenda

for mental health, our Nation is in the process of transforming mental health care in America. Indeed,

mental health services are in the process of becoming more focused on resilience, recovery, and the

active participation of individuals in their own mental health promotion and treatment. The importance

of gender-based differences in the risk, etiology, and treatment of mental illnesses is more clearly

understood than ever before. These advances set the course for continued progress in our understanding

of the unique issues confronting the mental health of women and girls, and they lend urgency to our

ability to translate increased knowledge and evidence-based methods into daily practices that can

improve health outcomes. The purpose of these Action Steps for Improving Women’s Mental Health is

to spur positive changes. The hope is that policy planners, healthcare providers, researchers, and others

will take up its charges and help translate action into reality. In this way, we can promote improved

mental health and a healthier future for the women and girls of America.
23

APPENDIX A:

Detailed Conceptual Framework and Methodology 

Action Steps for Improving Women’s Mental Health

25

Action Steps for Improving Women’s Mental Health

The conceptual framework depicted above was developed and refined based on a multi-step process,

which included the following activities:

A concept mapping activity to define and depict key women’s mental health issues. This 

activity was based on input from 245 mental health experts, including individuals who had 

taken part in the development of the Surgeon General’s report on mental health, experts 

identified by those authors, and members of the Surgeon General’s Expert Working Group on 

Women’s Mental Health. They included representatives from the voluntary sector, academics, 

government planners, policymakers, and health care providers. Each participant was asked to 

complete the following statement: “A specific issue that is relevant to the mental health of 

women and girls is...” This activity generated 107 issues, which were then rated by the 

respondents according to the issue’s level of importance and potential for action. Those issues 

that were rated highly both in terms of importance and action potential were then plotted and 

grouped according to common themes. These themes were in turn organized into a conceptual 

framework, which offers a visual representation of how the themes and issues of women’s 

mental health are grouped and interrelated.

Leadership interviews with 25 high-level individuals representing governmental, provider, and

consumer organizations. Interviewees were selected from a database of experts developed by 

OWH and included individuals who had expert-level knowledge of women’s mental health; 

were members of an underrepresented group based on race, ethnicity, or age; and could offer a 

fresh perspective on the topic of women’s mental health. Interviewees shared what they saw as 

current, critical women’s mental health issues and offered feedback on ways to refine the 

conceptual framework developed through the concept mapping exercise.

Facilitated discussions in three cities with diverse groups composed of consumers, providers, 

and local government staff. Participants identified and examined key mental health issues 

concerning women and girls and added further suggestions and comments to help shape the 

conceptual framework of mental health issues affecting women and girls.

A literature review focused on the most recent and relevant articles on the mental health of 

women and girls and limited to studies and reviews published in prominent, peer-reviewed 

journals that occurred inside the United States and were published since the 1999 release of 

Mental Health: A Report of the Surgeon General. Prominent publications also were gathered 

from Federal Agency Web sites and the sites of other major mental health organizations. The 

literature search gathered information in areas that received limited coverage in the 1999 

report, including gender differences in mental health and the ways in which women and girls 

experience mental health issues. Topics included specific mental illnesses; protective, 

resilience, and risk factors; biological and developmental factors; environmental factors; 

trauma, violence, and abuse; and intervention and treatment systems issues. Studies were 

particularly abundant in areas such as depression, substance use disorders, perinatal mental 

health, trauma and abuse, and gender-specific risk factors for mental illnesses. One hundred 

eighty documents were included in the review and analysis.
26

Action Steps for Improving Women’s Mental Health 

An invitational workshop on women’s mental health with presentations and breakout group

discussions involving experts from the consumer, academic, advocacy, health insurance,

health care delivery, program management, and public policy communities. Breakout groups

addressed specific mental health topics that had been identified in the conceptual framework of

issues affecting the mental health of women and girls. Participants made suggestions regarding

the development of products and materials that could help advance knowledge, understanding,

and action around these issues.
27

APPENDIX B: 

Women’s Mental Health Resources, Products, and Tools

Action Steps for Improving Women’s Mental Health
28

Action Steps for Improving Women’s Mental Health 

This section provides an annotated listing of useful products and tools currently available as resources from

the Federal Government and the private sector related to the mental health of women and girls. Links to

non-Federal organizations do not constitute an endorsement of any organization or product by the Federal

Government, and none should be inferred. All links and Web sites were verified in April 2008.

FEDERAL GOVERNMENT RESOURCES

Administration on Aging

Healthy IDEAS: Evidence-Based Disease Self-Management for Depression. The

Administration on Aging Evidence-Based Disease Prevention Grant Program includes

Healthy IDEAS (Identifying Depression, Empowering Activities for Seniors). This

program incorporates four evidence-based components into the ongoing service delivery of care management or social service programs for older individuals in the home

environment. The components include screening and assessment, education for

clients and family caregivers, referral and linkages to appropriate health professionals,

and behavioral activation. The project targets a diverse older population at risk for

unrecognized or under-treated depression. A description of this grant program is available at: http://www.aoa.gov/prof/evidence/sheltarm.pdf

Additional information and a toolkit for local organizations wishing to implement

this program can be found at:

http://www.healthyagingprograms.org/content.asp?sectionid=32&elementid=40

Agency for Healthcare Research and Quality

Programs and Tools to Improve the Quality of Mental Health Services. The

Agency for Healthcare Research and Quality (AHRQ) has a broad portfolio of mental

health research. This report focuses specifically on AHRQ-funded research that has

led to the development of programs, methods, and tools for evaluating and improving

the of mental health services and improving the education of mental health professionals. Topics covered include depression, schizophrenia, adolescents at risk for

suicide, quality assessment, and professional education.

http://www.ahrq.gov/qual/menttoolria/menttoolria.htm

Centers for Disease Control and Prevention 

Live Well, Live Long Module on Mental Wellness for Older Adults. These materials provide health promotion strategies and materials developed by the American

Society on Aging through a cooperative agreement with the Centers for Disease
29

Action Steps for Improving Women’s Mental Health

Control and Prevention. The module offers a proactive approach, seeking out and

encouraging behaviors that contribute to mental wellness among older adults. They

also help individuals identify and address depressive symptoms and anxiety early.

The modules contain background information on depression and anxiety; information about who in a given community can help create mental-wellness programs; and

how, when, and where it can be done. Specific class and presentation outlines and tips

for preparing programs are also included. The module is available at:

http://www.asaging.org/cdc/module5/home.cfm

CDC Health Related Quality of Life Web site Prevalence Data Page. This Web

site now provides annual State-based prevalence and trend data for women’s perceived mental health and distress from 1993-2005. Available at

http://www.cdc.gov/hrqol

Rape Prevention and Education (RPE) Program. CDC’s Injury Center 

offers technical assistance to help State health departments and sexual assault coalitions more effectively use funds received through the Violence Against Women Act.

The funds — designed to enable States to educate communities about sexual violence and develop prevention programs — support educational seminars, hotlines,

training programs for professionals, the development of informational materials, and

special programs for underserved communities. With CDC’s support, States and

Territories have strengthened their infrastructures to address sexual violence and

implemented prevention and education programs. Further information is available at:

http://www.cdc.gov/ncipc/profiles/rpe/default.htm 

National Sexual Violence Resource Center (NSVRC). This Resource Center identifies

and disseminates information, resources, and research on all aspects of sexual violence

prevention and intervention. The NSVRC Web site features links to related resources and

information about confererences, funding, job announcements, and special events.

Additional activities include coordinating national sexual assault awareness activities;

identifying emerging policy issues and research needs; issuing a biannual newsletter; and

recommending speakers and trainers. Contact NSVRC toll free at 877-739-3895, access

the Web site: www.nsvrc.org, or email them at: resources@nsvrc.org 

The National Youth Violence Prevention Resource Center. This is a “one-stop shop”

for information on youth violence prevention, sponsored by the Centers for Disease

Control and Prevention. It offers resources and tools (e.g., checklists, fact sheets, curricula, statistics, hotlines) to youths, parents, members of the media, and different types

of professionals who interact with youth on preventing all forms of violence ranging

from bullying to suicide, substance abuse, and gang violence. Resources are available

at http://www.safeyouth.org/ scripts/about/index.asp A toll-free hotline is available

9AM-6PM EST at: 1-866-SAFEYOUTH (1-866-723-3968).

Screening Inventory for Intimate Partner Violence and Sexual Violence in

Healthcare Settings. This inventory provides information on screening tools for intimate partner violence and sexual violence victimization for use in healthcare settings. Psychometric information (e.g., validity, reliability) is provided for each measure when available. Further information is available from the National Center for

Injury Prevention and Control Web site: http://www.cdc.gov/ncipc/dvp/IPV/ipvSViolence.htm 
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Action Steps for Improving Women’s Mental Health 

Choose Respect. This initiative is designed to help adolescents form healthy relationships and to prevent dating abuse before it starts. It is a national effort designed

to motivate adolescents to challenge harmful beliefs about dating abuse and take

steps to form respectful relationships. According to recent research from CDC, one

in 11 adolescents reports being a victim of physical dating violence. Even more startling, adolescents who report experiencing dating violence are also more likely to

report binge drinking, suicidal behavior, physical fighting, and current sexual activity. Choose Respect reaches out to adolescents, ages 11 to 14, to reach them when

they are still forming attitudes and beliefs that will affect how they are treated and

how they treat others. The initiative also connects with parents, teachers, youth leaders, and other caregivers who influence the lives of young teens. The Choose

Respect Web site is available at: www.chooserespect.org

Sexual Violence Prevention: Beginning the Dialogue. Sexual Violence is a serious

public health problem with extensive short- and long-term health consequences.

Sexual Violence Prevention: Beginning the Dialogue identifies concepts and strategies

that may be used as a foundation for planning, implementing, and evaluating sexual

violence prevention activities. Further information is available at:

http://www.cdc.gov/ncipc/dvp/svprevention.htm

Measuring Intimate Partner Violence Victimization and Perpetration: A

Compendium of Assessment Tools. This compendium provides researchers and prevention specialists with a set of assessment tools with demonstrated reliability and

validity for measuring the self-reported incidence and prevalence of intimate partner

violence victimization and perpetration. Although the compendium includes more

than 20 scales, it is not intended to be an exhaustive listing of available measures.

The information is presented to help researchers and practitioners make informed

decisions when choosing scales to use in their work. Further information is available

at: http://www.cdc.gov/ncipc/dvp/compendium/measuring_ipv_victimization_

and_perpetration.htm

Food and Drug Administration’s Office of Women’s Health

Depression Medicines to Help You. This fact sheet is designed as a user-friendly

guide for consumers to help them talk to their doctor or pharmacist about antidepressant medications. http://www.fda.gov/womens/medicinecharts/depression.html 

Free Health Information: Depression. This fact sheet provides a short description

of the causes and signs of depression.

http://www.fda.gov/womens/getthefacts/depression.html 

Antidepressant Use in Children, Adolescents, and Adults. This informational Web

site from the FDA Center for Drug Evaluation and Research provides links to information on the use of antidepressant medications. http://www.fda.gov/cder/drug/antidepressants/default.htm 

Potentially Life-threatening Serotonin Syndrome with combined use of SSRIs or

SNRIs and Triptan Medications. This Web page presents a public health advisory
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Action Steps for Improving Women’s Mental Health

related to the potential dangerous effects of combining antidepressant medications

with medications used to treat migraines.

http://www.fda.gov/cder/drug/advisory/ssri_SS200607.htm

Treatment Challenges of Depression in Pregnancy. This public health advisory

presents information from a study illustrating the potential risk of relapsed depression after stopping antidepressant medication during pregnancy. In addition, it

reports new findings regarding the increased risk of persistent pulmonary hypertension in newborns of mothers who used a SSRI antidepressant in the second half of

pregnancy. http://www.fda.gov/cder/drug/advisory/ssri_pphn200607.htm

Health Resources and Services Administration

Knowledge Path: Postpartum Depression. This knowledge path offers a selection

of current, high-quality resources about the prevalence and incidence of postpartum

depression, identification and treatment, impact on the health and well-being of a

new mother and her infant, and implications for service delivery. Produced by the

Maternal and Child Health Library, the knowledge path includes information on (and

links to) Web sites, electronic and print publications, databases, and online discussion

groups. It is intended for use by health professionals, program administrators, policymakers, researchers, and women experiencing postpartum depression and their families. http://www.mchlibrary.info/knowledgepaths/kp_postpartum.html

Bright Futures for Womens Health and Wellness Initiative - Mental Health

Tools. The aim of this initiative is to help adolescent girls and adult women achieve

better physical, mental, social, and spiritual health by encouraging healthy practices

through active partnering with their health providers and communities. Based on the

latest research and the input of Federal experts and non-Federal mental health

experts, tools and materials for consumers, clinicians, and communities have been

developed to promote mental health and wellness among adult women and adolescent girls. Three concepts are threaded through these materials to promote mental

wellness. These include appreciating yourself, finding balance and purpose in life,

and connecting with others. The tools will be available on www.hrsa.gov/womenshealth and in limited supply through the HRSA Information Center at 1-888-ASKHRSA.

National Institute of Mental Health

Accessing Services

Getting Help: Locate Services. This section, located on the NIMH Website, provides information on where to find help with mental health issues.

http://www.nimh.nih.gov/health/topics/getting-help-locate services/index.shtml
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Action Steps for Improving Women’s Mental Health 

Anxiety

Anxiety Disorders. A detailed booklet that describes the symptoms, causes, and

treatments of the major anxiety disorders, with information on getting help and coping. http://www.nimh.nih.gov/health/publications/anxiety-disorders/complete-publication.shtml

When Worry Gets Out of Control: Generalized Anxiety Disorder. An easy-toread booklet on generalized anxiety disorder that explains what it is, when it starts,

how long it lasts, and how to get help.

http://www.nimh.nih.gov/health/publications/generalized-anxiety-disorder.shtml

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/trastornodeansiedad-generalizada-una-enfermedad-real.shtml

When Fear Overwhelms: Panic Disorder Easy to Read. An easy-to-read booklet

on panic disorder that explains what it is, when it starts, how long it lasts, and how

to get help. (in press as of January 2008).http://www.nimh.nih.gov/health/publications/panic-disorder-a-real-illness/summary.shtml

Post-Traumatic Stress Disorder. An easy-to-read pamphlet on post-traumatic stress

disorder that explains what it is, when it starts, how long it lasts, and how to get

help. (in press as of January 2008).

http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-a-real-illness/summary.shtml

Always Embarrassed: Social Phobia (Social Anxiety Disorder). An easy-to-read

booklet on social phobia that explains what it is, when it starts, how long it lasts, and

how to get help. http://www.nimh.nih.gov/health/publications/social-phobia-socialanxiety-disorder.shtml 

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/fobia-social-unaenfermedad-real/summary.shtml

When Unwanted Thoughts Take Over: Obsessive-Compulsive Disorder. An

easy-to-read booklet on Obsessive-Compulsive Disorder (OCD) that explains what it

is, when it starts, how long it lasts, and how to get help.

http://www.nimh.nih.gov/health/publications/when-unwanted-thoughts-take-overobsessive-compulsive-disorder/summary.shtml 

ADHD

A Look at Attention Deficit Hyperactivity Disorder. An easy-to- read booklet

with personal stories of attention deficit hyperactivity disorder (ADHD) - includes a

checklist of symptoms and tips on getting help. http://www.nimh.nih.gov/health/publications/a-look-at-attention-deficit-hyperactivity-disorder/summary.shtml

Attention Deficit Hyperactivity Disorder. A detailed booklet that describes the

symptoms, causes, and treatments, with information on getting help and coping.

http://www.nimh.nih.gov/health/ publications/adhd/complete-publication.shtml
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Action Steps for Improving Women’s Mental Health

Autism

Autism Spectrum Disorders (Pervasive Developmental Disorders). A detailed

booklet that describes symptoms, causes, and treatments, with information on getting help and coping. http://www.nimh.nih.gov/health/topics/autism-spectrum-disorders-pervasive-developmental-disorders/index.shtml 

Bipolar Disorder

A Story of Bipolar Disorder (Manic-Depressive Illness). Does This Sound Like

You? An easy-to-read booklet with a personal story of bipolar disorder — includes a

checklist of symptoms and tips on getting help. http://www.nimh.nih.gov/health/publications/a-story-of-bipolar-disorder-manic-depressive-illness-does-this-sound-likeyou.shtml

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/una-historia-personalsobre-el-trastorno-bipolar-enfermedad-maniaco-depresiva.shtml

Bipolar Disorder. A detailed booklet that describes symptoms, causes, and treatments, with information on getting help and coping.

http://www.nimh.nih.gov/health/publications/bipolar-disorder/completepublication.shtml

Child and Adolescent Bipolar Disorder: An Update from the National Institute

of Mental Health. A fact sheet that describes the symptoms and treatments of bipolar disorder in children and adolescents. http://www.nimh.nih.gov/health/publications/child-and-adolescent-bipolar-disorder/summary.shtml

Borderline Personality Disorder

Borderline Personality Disorder: Raising Questions, Finding Answers. A brief

overview that focuses on the symptoms, treatments, and research findings.

http://www.nimh.nih.gov/health/ publications/borderline-personality-disorder.shtml

Children and Adolescents

Helping Children and Adolescents Cope with Violence and Disasters: What

Parents Can Do. A booklet that describes what parents can do to help children and

adolescents cope with violence and disasters. http://www.nimh.nih.gov/health/publications/helping-children-and-adolescents-cope-with-violence-and-disasters-what-parents-can-do.shtml

Teenage Brain: A Work in Progress. A brief fact sheet about the developing teenage

brain. http://www.nimh.nih.gov/health/publications/teenage-brain-a-work-inprogress.shtml

Antidepressant Medications for Children and Adolescents: Information for

Parents and Caregivers. (online only). http://www.nimh.nih.gov/health/topics/childand-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml
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Action Steps for Improving Women’s Mental Health 

Depression

Depression. A detailed booklet that describes symptoms, causes, and treatments,

with information on getting help and coping. http://www.nimh.nih.gov/health/publications/depression/complete-publication.shtml

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/depresion/summary.shtml

Women and Depression: Discovering Hope. A detailed booklet that describes the

symptoms, treatment, unique factors related to women, and getting help for depression. (in press as of January 2008).

http://www.nimh.nih.gov/health/publications/depression-what-every-woman-shouldknow/summary.shtml

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/depresin-lo-quetoda-mujer-debe-saber/summary.shtml

Depression: When the Blues Won’t Go Away. An easy-to-read book let on

Depression that explains what it is, when it starts, how long it lasts, and how to get

help. http://www.nimh.nih.gov/health/publications/depression-easy-to-read.shtml

Eating Disorders

Eating Disorders. A detailed booklet that describes symptoms, causes, and

treatments, with information on getting help and coping.

http://www.nimh.nih.gov/health/publications/eating-disorders/ summary.shtml

Schizophrenia

Schizophrenia. A detailed booklet that describes symptoms, causes, and treatments, with information on getting help and coping.

http://www.nimh.nih.gov/health/publications/schizophrenia/complete-publication.shtml

In Spanish: http://www.nimh.nih.gov/health/publications/spanish/esquizofrenia/

summary.shtml

National Institute on Alcohol Abuse and Alcoholism

Alcohol Alert. No. 62: Alcohol–An Important Women’s Health Issue (2004).

Considering that about one-third of American women report regular alcohol consumption and 2.3 percent, or 2.5 million women, meet the criteria for alcohol

dependence, it is clear that research to better understand the effects of alcohol in

women is critical. This issue of Alcohol Alert summarizes some of the most practical implications for women across the lifespan to come from that research.

Available at: http://pubs.niaaa.nih.gov/publications/aa62/aa62.htm
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Action Steps for Improving Women’s Mental Health

Alcohol Alert. No. 50: Fetal Alcohol Exposure and the Brain (2000). This

bulletin presents new data on the prevalence and nature of the neurobehavioral

problems associated with alcohol use during pregnancy, explores potential

mechanisms underlying alcohol-induced damage to the developing brain, and

discusses prevention research. Available at: http://pubs.niaaa.nih.gov/publications/aa50.htm 

Alcohol Research & Health. Women and Alcohol: An Update (Volume 26,

Number 4, 2002). This issue focuses on the many aspects of alcohol use by and

its effects on women. Available at: http://pubs.niaaa.nih.gov/publications/arh26-

4/toc26-4.htm

Drinking and Your Pregnancy. This brochure answers commonly asked questions

about alcohol and drinking while a woman is pregnant. Available at:

http://pubs.niaaa.nih.gov/publications/drinkingpregnancy_html/pregnancy.htm. It is

also available in Spanish at: http://pubs.niaaa.nih.gov/publications/drinkingpregnancy_htmlspan/ pregnancy_spanish.htm

National Institute on Drug Abuse

A Collection of NIDA Notes Articles That Address Women and Gender

Differences Research. This collection covers a wide range of issues and

includes such topics as the relationship among victimization, violence, and drug

abuse in women; issues affecting drug treatment for women; drug use during

pregnancy; and gender differences in drug effects and patterns of drug use.

http://www.nida.nih.gov/nida_notes/nn0013.html

NIDA Women and Gender Differences Research Program. This program

promotes drug abuse research focusing on the study of women and gender differences. Data from laboratory, field, and clinical research are beginning to show

gender differences in biological factors in drug abuse, the progression and initiation to drug use and abuse, the antecedents and consequences of drug use and

abuse, and in drug abuse prevention and treatment. Further information on the

program is available at: http://www.drugabuse.gov/whgd/whgdhome.html

Broad-based NIDA-wide research program on women and sex/gender differences in drug abuse. For more information about this program, including

dozens of publications, visit http://www.nida.nih.gov/whgd/whgdhome.html

Office for Civil Rights (HHS)

Office for Civil Rights Web Site. This site offers access to information and fact

sheets on numerous issues related to patient privacy and civil rights, including

special protections for individuals with disabilities, such as mental illnesses. Fact

sheets on multiple topics are available in English, Spanish, Tagalog, Vietnamese,

Korean, Russian, Polish, and Chinese. http://www.hhs.gov/ocr 
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Action Steps for Improving Women’s Mental Health 

Office of Minority Health

Office of Minority Health Resource Center Web Site. This site presents

information on the latest news, treatment information, and publications regarding issues such as minority mental health, mental health and cultural competence, and the mental health of individuals in rural and isolated areas.

Information can be accessed at http://www.omhrc.gov/

A toll free information line is also available with English and Spanish-speaking

operators at: 1-800-444-6472.

Office of Research on Women’s Health

The Science of Sex and Gender in Human Health. This on-line course represents a collaborative effort between the National Institute of Health’s Office of

Research on Women’s Health and the Food and Drug Administration’s Office

of Women’s Health. This site was developed for researchers, clinicians, and

members of academia to gain a basic scientific understanding of the major physiological differences between the sexes, the influences these differences have on

illness and health outcomes, and the implications for policy, medical research,

and health care. Unless otherwise noted, the content on the site is in the public

domain and can be duplicated. The site currently offers one course titled, The

Basic Science and the Biological Basis for Sex-and Gender-Related Differences.

The course includes six lessons, each of which will take from 20 minutes to an

hour to complete. Taking the course is free and continuing education credit can

be awarded for successful completion of the course. Further details are available

at: http://sexandgendercourse.od.nih.gov/index.aspx 

Office on Women’s Health

GirlsHealth.gov. A Web site created to help girls (ages 10-16) learn about

health, growing up, and issues they may face. It focuses on health topics that

girls are concerned about and helps motivate them to choose healthy behaviors

by using positive, supportive, and non-threatening messages. The site gives girls

reliable, useful information on the health issues they will face as they become

young women and tips on handling relationships with family and friends, at

school and at home. http://www.girlshealth.gov

BodyWise. Fact sheets and other resources for adolescent girls regarding body

image, healthy eating, fitness, and illnesses and disabilities can be found on the

following site: http://www.womenshealth.gov/bodyimage/kids/bodywise/

WomensHealth.gov. This site provides information about a broad range of

issues that affect women’s health. The mental health pages discuss frequently

asked questions; offer information on specific mental health issues and target

audiences; feature mental health events; and present links to the best organizations, hotlines, and publications related to women’s mental health issues. They

can be accessed at: http://womenshealth.gov/mh/. Fact sheets on eating disorders and obesity can be accessed at www.womenshealth.gov/bodyimage/bodyworks/companionpiece.pdf
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A toll-free information line is available 9AM-6PM, Monday through Friday at:

1-800-994-9662 or 1-888-220-5446 (TDD)

Substance Abuse and Mental Health 

Services Administration (SAMHSA)

General

Helping Children Exposed to Substance Abuse, Mental Illness, and

Violence. The lead story in SAMHSA News (vol. 10, No. 2) reports on

SAMHSA’s Cooperative Agreement to Study Children of Women with Alcohol,

Drug Abuse, and Mental Health Disorders Who Have Histories of Violence. The

study seeks to identify models of care for the field that will prevent or reduce the

intergenerational perpetuation of violence, substance abuse, and mental illnesses

and reduce the effect of violence in the lives of children whose mothers have

co-occurring mental and addictive disorders and histories of trauma.

http://www.samhsa.gov/samhsa_news/volumex_2/index.htm

Starting Early Starting Smart (SESS) Training Package to Foster

Nurturing Parent-Child Relationships. This training package, available

through NCADI, is designed to prepare family service workers and their supervisors to nurture strong parent-child relationships through the use of video.

Developed through collaboration between SAMHSA and Casey Family

Programs, the SESS initiative supports the integration of substance abuse and

mental health services into primary health care and early childhood settings in

which children ages 0 to 6, their families, and their caregivers are served. The

complete four-module training package includes two VHS tapes, a CD with a

PowerPoint presentation, and a notebook-ready facilitator manual with a

detailed outline and materials for each of four training sessions.

http://ncadi.samhsa.gov/promos/sess/publications.asp 

Answers in the Aftermath: A Guide to Mental Health Concerns for Victims

of Violent Crime. This brochure describes the after affects of trauma, including

PTSD. It offers information on how to begin the healing process following a

traumatic event and has a list of resources for further help.

http://mentalhealth.samhsa.gov/publications/allpubs/SMA05-4027/lovedoneforprint.asp 

Center for Substance Abuse Treatment

Approaches in the Treatment of Adolescents with Emotional and Substance

Abuse Problems (TAP 1). Volume I in this series addresses the needs of adolescents with substance abuse problems and makes practical recommendations for

the implementation of effective treatment methods. http://www.eric.ed.gov/ericdocs/data/ericdocs2sql/content_storage_01/0000019b/80/23/fc/60.pdf 
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Action Steps for Improving Women’s Mental Health 

Assessment and Treatment of AOD Use/Abuse in Adolescents: A Two Day

Training Curriculum. This curriculum is designed for addiction counselors and

other helping professionals who come into contact with adolescents. The curriculum includes facilitative 

communication skills, adolescent diversity, legal issues in adolescent alcohol or

other drug assessment and treatment, the assessment process, and treatment recommendations. The purpose of this 2-day workshop is to consolidate the information presented in this self-paced training manual and present it through brief

lectures in tandem with experiential group exercises. Before implementing the 2-

day workshop, the facilitator should read and complete the exercises in the selfpaced training manual in order to gain a thorough understanding of the material

to be presented in the workshop. This curriculum package is based upon TIPs

manuals 31 and 32.

http://www.nattc.org/resPubs/pubCat/details.asp?topic=2&ID=1362

A Training Manual: TIPs on Assisting Service Providers to Appropriately

Respond to the Needs of the Pregnant and Substance-using Woman and Her

Alcohol/Drug-exposed Infant. It is essential that professionals and care providers

be adequately trained to detect a client’s substance abuse problem and the characteristics of a child exposed in utero to alcohol and/or drugs. It is equally important that

professionals and care providers be knowledgeable about what constitutes appropriate intervention and treatment for the needs of the addicted pregnant woman and her

alcohol or drug-exposed child. This training is orchestrated to provide a compendium of information addressing the special needs of these populations. A teaching outline is provided to serve as a guide through the information. This curriculum package is based-upon TIPs manuals 2 and 5.

http://nattc.org/resPubs/pubCat/details.asp?keyword=infant&Submit3=Go&ID=1363

Combining Alcohol and Other Drug Abuse Treatment with Diversion for

Juveniles in the Justice System (TIP 21). This TIP covers substance abuse

treatment-focused diversion program goals, diversion program collaboration,

and juvenile diversion to substance abuse treatment planning. http://ncadi.samhsa.gov/govpubs/bkd169/

Empowering Families, Helping Adolescents: Family Centered Treatment of

Adolescents with Alcohol, Drug Abuse and Mental Health Problems (TAP

6). This report describes issues, treatment models, and steps necessary to implement a family-centered approach to adolescent treatment.

http://www.eric.ed.gov/ericdocs/data/ericdocs2sql/content_storage_01/0000019b

/80/1a/26/7b.pdf

Identifying Substance Abuse among TANF-Eligible Families (TAP 26). As a

result of Welfare Reform in 1997, State and local governments have new requirements, such as time limits, for moving families from welfare to work. For some

families, the transition has been difficult, and one of the complicating factors is

chemical abuse and dependency. Temporary Assistance for Needy Families (TANF)

applicants and participants are reluctant to admit problems with substance use

because of the stigma associated with it, fear of sanctions, and referral to child welfare authorities. This publication addresses these and related issues and helps TANF
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Action Steps for Improving Women’s Mental Health

administrators to understand the issues involved in identification of substance abuse

among this population. http://humanservices.ucdavis.edu/resource/uploadfiles/identifying%20substance%20abuse%20among.pdf

Improving Treatment for Drug-Exposed Infants (TIP 5). Guidelines and

standards of care in monitoring and evaluating programs treating drug-exposed

infants are examined in this report. http://ncadi.samhsa.gov/govpubs/bkd110/

Integrating Substance Abuse Treatment and Vocational Services (TIP 38).

This publication introduces vocational services and resources and presents clinical issues related to integrating vocational services into a substance abuse treatment plan. It also discusses policy and funding, and a legal chapter explains the

recent regulation that affects employment and substance abuse disorder treatment. This TIP is intended for providers of substance abuse treatment services.

However, it also can be of use to vocational rehabilitation staff, social service

workers, and all who are involved in arranging for and providing vocational and

substance abuse treatment services. http://ncadi.samhsa.gov/govpubs/bkd381/

Navigating the Pathways - Lessons and Promising Practices in Linking

Alcohol and Drug Services with Child Welfare (TAP 27). This TAP offers a

unique perspective on ways to bridge the divide that too often prevents child

welfare and substance abuse agencies from effectively working together to help

children and families affected by substance abuse. Using a 10-element framework to measure the capacity of agencies to work as partners on the substance

abuse needs of child welfare services clients, this TAP describes seven sites

from around the Nation that have implemented programs for families in the

child welfare system with substance use disorders.

http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=16193

Pregnant, Substance-Using Women (TIP 2). This report defines guidelines

that reflect state-of-the-art scientific and clinical knowledge on effective treatment practices and care for pregnant addicts.

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.22442

Prevention Alert: 25% of U.S. Children Are Exposed to Household Alcohol

Abuse (April 18, 2003). Developed by CSAP, Prevention Alert is a twicemonthly feature on a topic of urgency in the substance abuse prevention field

that is distributed to prevention specialists.

http://ncadi.samhsa.gov/govpubs/prevalert/v6/5.aspx

Screening and Assessing Adolescents for Substance Use Disorders (TIP 31).

Substance use can disrupt a young person’s ability to meet developmental tasks

and impair identity development, a central theme of adolescence. This TIP presents information on identifying, screening, and assessing substance use in adolescents. Since adolescents differ from adults physiologically and emotionally, it is

important for professionals who come into regular contact with youth to recognize the signs of substance use. The TIP focuses on the most current procedures

and instruments for detecting substance abuse among adolescents, conducting

comprehensive assessments, and beginning treatment planning.

http://ncadi.samhsa.gov/govpubs/bkd306/
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Action Steps for Improving Women’s Mental Health 

Substance Abuse Treatment and Domestic Violence (TIP 25). Designed for

treatment providers, this TIP presents an introduction to domestic violence. It

offers providers information about the role of substance abuse in domestic violence - among both men who batter and women who are battered. Useful techniques for detecting and eliciting such information are supplied along with ways

to modify treatment to ensure victims’ safety and to stop the cycle of violence in

both parties’ lives. Legal issues are discussed and a blueprint is provided for an

integrated system of care. http://ncadi.samhsa.gov/govpubs/bkd239/

Substance Abuse Treatment and Family Therapy (TIP 39). This TIP addresses how substance abuse affects the entire family and how substance abuse treatment providers can use principles from family therapy to change the interactions

among family members. The TIP provides basic information about family therapy for substance abuse treatment professionals and basic information about substance abuse treatment for family therapists.The TIP presents the models, techniques, and principles of family therapy, with special attention to the stages of

motivation as well as to treatment and recovery. Discussion also focuses on clinical decisionmaking and training, supervision, cultural considerations, special

populations, funding, and research. The TIP identifies future directions for both

research and clinical practice.

http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=16892

Substance Abuse Treatment for Persons with Child Abuse and Neglect

Issues (TIP 36). Child abuse and neglect pose an increasingly recognized and

serious threat to the Nation’s children. Research suggests that adults with histories of child abuse and neglect are at high risk for developing substance abuse

disorders. Compounded with these problems is the increased likelihood of substance-abusing parents abusing their own children. By most accounts, substance

abuse contributes to almost three fourths of the incidents of child abuse or neglect for children in foster care.

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.63145

Substance Abuse Treatment for Persons with Co-Occurring Disorders (TIP

42). This TIP provides information about new developments in the rapidly

growing field of co-occurring substance use and mental illnesses and describes

the state of the art in the treatment of people with co-occurring disorders. The

TIP contains chapters on terminology, assessment, treatment strategies and models, and an overview of specific mental illnesses and cross-cutting issues such as

suicidality and nicotine dependence. The TIP’s appendices provide additional

information on topics such as specific mental illnesses, emerging models of

treatment, common medications, screening and assessment instruments, dual

recovery mutual self-help programs, and other resources for consumers and

providers, as well as confidentiality issues.

http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat5.chapter.74073

Substance Abuse Treatment for Women Offenders, Guide to Promising

Practices (TAP 23). Services for women offenders are fragmented or absent all

across the country, and funds are scarce for developing the comprehensive networks of community services that women need. Many new programs to treat

women have been started or are planned in correctional systems across the

country. This guide describes many such promising and creative strategies.

http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=15498
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Action Steps for Improving Women’s Mental Health

Treatment for Alcohol and Other Drug Abuse: Opportunities for

Coordination (TAP 11). This publication contains an exhaustive review of the

need for and benefit of systemic coordination among State, legislative, public

health, criminal justice, and social service entities in order to provide a continuum of comprehensive treatment services. http://kap.samhsa.gov/products/manuals/taps/11.htm

Treatment of Adolescents with Substance Use Disorders (TIP 32). This TIP

presents information on substance use disorder treatment for adolescent clients.

Adolescents differ from adults physiologically and emotionally as they make the

transition from child to adult and require treatment adapted to their needs. In

order to treat this population effectively, treatment providers must address the

issues that play significant roles in an adolescent’s life, such as cognitive, emotional, physical, social, and moral development as well as family and peer environment. The TIP focuses on ways to specialize treatment for adolescents, as

well as on common and effective program components and approaches being

used today. http://ncadi.samhsa.gov/govpubs/bkd307/ 

Welfare Reform and Substance Abuse Treatment Confidentiality: General

Guidelines for Reconciling Need to Know and Privacy (TAP 24). This report

provides alcohol and drug agencies, substance abuse treatment providers, and

welfare officials with guidance in resolving issues related to the confidentiality

of patient/client information.

http://ncadistore.samhsa.gov/catalog/productDetails.aspx?ProductID=15537

Center for Substance Abuse Prevention

Alcohol Use Among Girls (2000). This SAMHSA fact sheet contains information on prevalence of alcohol use in girls, some risk factors for girls who use

alcohol, and why males and females respond differently to alcohol.

http://ncadi.samhsa.gov/govpubs/rpo993/ 

CSAP Substance Abuse Resource Guide: Children of Alcoholics (2000). 

This guide lists resources and organizations that can provide help to children of

alcoholics (both adults and children, along with their parents) and prevention,

treatment, and intervention professionals. http://ncadi.samhsa.gov/govpubs/ms417/

CSAP Substance Abuse Resource Guide: Violence Against Women (2000).

This resource guide presents recent research findings and information on the

relationship of alcohol and substance abuse to violence against women, include

battering, murder, stalking behaviors, rape, and sexual assault.

http://ncadi.samhsa.gov/govpubs/ms715
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US Department of Veterans Affairs

Mental Health Services at the Department of Veterans Affairs is where veterans, their families, and mental health clinicians and associations can go for

resources related to veterans’ mental health services. It shows where to access

the specialty inpatient and outpatient mental health services available to veterans and their families, and has up-to-date news and information on issues such

as suicide prevention awareness, help for veterans returning from Iraq, and

changes in healthcare eligibility laws that may affect veterans or their families.

http://www.mentalhealth.va.gov/ 

Collaborative Care for Depression in the Primary Care Setting: A Primer on

VA’s Translating Initiatives for Depression into Effective Solutions (TIDES)

Project. This is a primer, developed by VHA’s Office of Research and

Development, on approaches to depression management that have proven successful in the VA’s healthcare system. The focus is VA’s TIDES project, an evidence-based collaborative approach that involves collaboration between the

patient, a primary care physician, and a Depression Care Manager. The paper

describes the TIDES process, its effectiveness and cost-effectiveness, and its

implementation. It also contains a suggested reading list on mental health care

for depression and other resources. The document is intended primarily for

healthcare providers, policymakers, and researchers.

http://www.hsrd.research.va.gov/publications/internal/depression_primer.pdf 
43

Action Steps for Improving Women’s Mental Health

NONGOVERNMENT RESOURCES

American Foundation for Suicide Prevention

This organization sponsors multiple educational and suicide prevention

activities. The key theme of its youth suicide prevention campaign is: “Suicide

Shouldn’t Be a Secret.” The campaign includes public service announcements

featuring real teens who have lost a friend to suicide. The Foundation also has

an online registry of evidence-based programs and practices in suicide prevention aimed at providing objective and reliable information to decision-makers

seeking to select suicide prevention programs to implement in their schools or

communities. Information and resources are available at:

http://www.afsp.org/index.cfm?fuseaction=home.viewpage&page_id=1

Center for Addiction and Mental Health

Women: What Do These Signs Have in Common? Recognizing the Effect

of Abuse-Related Trauma. A brochure for self-assessment for the signs of

trauma from abuse. http://www.camh.net/about_

addiction_mental_health/mental_health_information/women_signs_ abusetrauma.pdf

Depression and Bipolar Support Alliance (DBSA)

Taking Care of Both of You: Understanding Mood Changes After the 

Birth of Your Baby. Topics include defining postpartum depression, 

treatment options, and how to stay healthy.

http://www.dbsalliance.org/site/PageNavigator/about_publications

Gender and Disaster Network

The Gender and Disaster Sourcebook. This sourcebook addresses the link

between gender and disaster risk. It presents lessons learned in the field of

disaster preparedness and response regarding gender differences and genderrelated factors and shows how this knowledge can be applied in practice to

reduce risk and improve response outcomes in disaster events.

http://www.gdnonline.org/sourcebook/index.htm
Geriatric Mental Health Foundation

A Guide to Mental Wellness in Older Age: Recognizing and Overcoming

Depression. This depression recovery toolkit aims to help consumers, in partnership with their health care providers, to identify and treat late-life depression. http://www.gmhfonline.org/gmhf/consumer/depression_toolkit.html

Hogg Foundation for Mental Health

Cultural Competency: A Practical Guide for Mental Health Service

Providers. A comprehensive guide to providing culturally competent mental

health services. Includes a definition of cultural competency and information

on building rapport, failures in the cross-cultural therapeutic process, conducting culturally sensitive assessments, evaluation of culturally related syndromes, and other challenges. http://www.hogg.utexas.edu/PDF/Saldana.pdf 

Men’s Health Network 

Your Head: An Owners Manual; Understanding and Overcoming

Depression, Anxiety and Stress. Produced by the Men's Health Network, this

manual is the latest addition to the Blueprint for Men's Health series. It provides men of all ages, and those who love them, with realistic perspectives

about mental health along with practical approaches that can make a difference

in their lives. Much like an owner’s manual for their car, this tool highlights

common signs and symptoms of depression, anxiety, and stress to help men

and those who love them recognize the need for intervention, and provide suggestions for dealing with everyday problems. Copies available on line at:

www.blueprintformenshealth.com or via phone at: 202-543-6461 x101. 

National Alliance on Mental Illness

What Families Should Know about Adolescent Depression and Treatment

Options: A Family Guide. This guide discusses the causes and symptoms of

adolescent depression. The brochure outlines current options for treatment and

the risks of not treating adolescent depression, and it offers resources for families to become effective advocates for their child in determining the appropriate treatment.

http://www.nami.org/content/contentgroups/caac/family_guide_final.pdf

There is a toll-free information line at: 1-800-950-NAMI (1-800-950-6264);

TTY: 1-888-829-0500. Spanish-speaking operators are available.

44

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National Center for Victims of Crime 

The National Center’s toll-free Helpline, 1-800-FYI-CALL, offers supportive counseling and practical information about crime, victimization, and

trauma in both English and Spanish. The center offers special resources for

adolescents, individuals affected by Hurricane Katrina, and those affected by

the attacks of 9/11. Also available are referrals to local community

resources, social service systems, and legal support and advocacy.

National Council on Aging

NCOA Model Health Programs Toolkits: Healthy IDEAS for a Better

Life. Healthy IDEAS (Identifying Depression, Empowering Activities for

Seniors) is a community depression program designed to detect and reduce

the severity of depressive symptoms in older adults with chronic health conditions and functional limitations. The program incorporates four evidencebased components into the ongoing service delivery of care management or

social service programs serving older individuals in the home environment

over several weeks. http://www.healthyagingprograms.org/content.asp?sectionid=30&elementid=12

National Mental Health Consumers’ Self Help Clearinghouse

This clearinghouse works to foster consumer empowerment through its web

site, up-to-date news and information announcements, a directory of consumerdriven services, electronic and printed publications, training packages, and

individual and onsite consultation. It maintains an extensive library of information on topics such as peer counseling, deinstitutionalization, fundraising,

involuntary treatment, patient rights, using the media, and many others.

Clearinghouse staff and resources are available to help consumers organize

coalitions, establish self-help groups and other consumer-driven services,

advocate for mental health reform, and fight the stigma and discrimination

associated with mental illnesses. The clearinghouse strives to support consumer involvement in planning and evaluating mental health services and to

encourage providers and others to accept people with psychiatric disabilities

as equals and full partners in treatment and in society. www.mhselfhelp.org

45

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46

Action Steps for Improving Women’s Mental Health 

National Mental Health Association

Depression in Women. This fact sheet about women and depression includes 

information on prevalence, contributing factors, and treatment. 

http://www.nmha.org/index.cfm?objectid=C7DF952E-1372-4D20-

C8A3DDCD5459D07B

Postpartum Disorders. This fact sheet about postpartum disorders includes

information on causes, symptoms, and treatment.

http://www.nmha.org/go/postpartum

Tips on Healthy Parenting for Mothers with Depression. This fact sheet 

on parenting for women with depression includes valuable parenting tips. 

http://www1.nmha.org/infoctr/factsheets/healthyparentingtips.pdf

What to Do When Depression Enters a Relationship. This fact sheet on 

dealing with depression in a relationship includes steps for overcoming 

depression and keeping a relationship healthy. http://www.nmha.org/index.

cfm?objectid=C7DF95BB-1372-4D20-C8EC4BBBEF879A20

Society for Women’s Health Research

Fact Sheet on Sex Differences in Mental Health. This sheet offers 

information on sex differences in the rates and etiology of several 

mental disorders, including depression, schizophrenia, Alzheimer’s 

disease, and stress disorders. Available at: http://www.womenshealth

research.org/site/PageServer?pagename=hs_facts_mental 

ADDITIONAL TOOLS TO PROMOTE THE PSYCHOLOGICAL, EMOTIONAL, 

AND SPIRITUAL WELLNESS OF WOMEN AND ADOLESCENT GIRLS

Assessment Tools

Beck Self-Concept Measure. Measures competency, potency, and selfworth of youth. Sample statements include “I like myself” and “I do things 

well.” http://www.beckinstitute.org/

HardiSurvey III. Measures hardiness. Sample statements include “By 

working hard, you can always achieve your goal.” This item is copyrighted 

and cannot be adapted. http://www.hardinessinstitute.com/

How Resilient Are You? Measures resiliency (how people react to 

difficulties). Sample statements include “I adapt quickly, I’m good at 
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Action Steps for Improving Women’s Mental Health

bouncing back from difficulties.” http://www.resiliencycenter.com/ 

resiliencyquiz.shtml 

Mindfulness Attention Awareness Scale. Measures mindfulness (how aware

people are of what they are doing). Sample statements include “I rush through

activities without really being attentive to them.”

http://www.psych.rochester.edu/SDT/measures/mindfulness.html

Oxford Happiness Questionnaire. A broad measure of personal happiness.

Sample statements include “Life is good” and “I find beauty in some things.”

http://www.coachingtohappiness.com/happiness-test.html

Satisfaction with Life Scale. Measures life satisfaction in general. Sample

statements include “In most ways, my life is close to ideal” and “I am satisfied

with my life.” http://www.psych.uiuc.edu/~ediener/hottopic/hottopic.html

Tools for Adults

Authentic Happiness. A Web site that contains a series of assessment tools

available for free to registered users. One of these tools is the Signature

Strengths Inventory. http://www.authentichappiness.sas.upenn.edu/default.aspx

Freeze Frame, One-Minute Stress Management (Institute for

HeartMath). This tool focuses on teaching a technique to control and more

effectively respond to stress. Researchers have found that this technique

reduces blood pressure and stabilizes heart rhythms, and users report a sense

of calm and guidance in their decisionmaking. This tool focuses more on

controlling and dealing effectively with day-to-day stressors to improve

overall quality of life as opposed to avoidance of negative outcomes like

depression. http://www.heartmath.org/index.html

Hardiness Institute for Performance Enhancement and Leadership

Training. This Web site primarily exists as a commercial site to encourage

target audience members to purchase tools offered by this organization.

Such tools, including assessments, evaluation materials, and training materials are designed to strengthen performance effectiveness. http://www.hardinessinstitute.com/

Positive Psychological Interventions That Increase Happiness (Seligman,

Steen, and Peterson). The authors describe and test five potential interventions to increase happiness. Each intervention is theorized not only to cause a

temporary increase in happiness but also to be able to produce long-term

gains in happiness. The interventions themselves range in content.

http://www.psych.upenn.edu/seligman/articleseligman.pdf

Introducing Resilience (Natural Health Perspective). A Web site that contains a description of resiliency and why it is important. The site contains
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Action Steps for Improving Women’s Mental Health 

links to numerous articles on resiliency, including information on how to

develop resiliency and a short quiz to measure how resilient you are.

http://naturalhealthperspective.com/resilience/resilience.html

Self-Esteem Games (McGill University). This Web site contains 

computer games designed to improve players’ self-esteem. The games 

are based on research showing that those with low self-esteem have 

a tendency to focus on negative outcomes and are more sensitive to 

negative feedback. http://www.selfesteemgames.mcgill.ca/

The Science of Happiness (Time Magazine). This special issue of Time is 

exclusively devoted to the latest research on mental health and wellness. The 

issue includes an overview article on what makes people happy, as well as 

articles on the biology of joy, laughter, marriage and happiness, religion and 

happiness, resilience, and happiness at work. Included are eight tips 

for increasing happiness. http://www.time.com/time/2005/happiness/

The Tree of Contemplative Practices (The Center for Contemplative 

Mind in Society). This Web site is devoted to encouraging people to 

develop their contemplative minds (i.e., the ability simply to “be”). The 

wellness tool of particular interest on this site is the tree of contemplative 

practices, which visually depicts the development of one’s inner awareness

as well as a connection to spiritual things without focusing on any one 

religion or faith. http://www.contemplativemind.org/practices/tree.html

Wellness Guide (University of California, Berkeley). Provides information

on a variety of topics related to wellness and well-being. The section on 

emotional health talks about how emotional health is related to overall 

health, and it discusses relationship issues, mental illness, disaster, and 

violence. http://www.wellnessletter.com

Tools for Adolescents

Empower Me! 12 Sessions for Building Self-Esteem in Girls 

(Raica-Klotz). Empower Me! is designed as a guide for counselors/ 

involved parents to help girls aged 11-14 to build self-esteem. The 56-

page booklet contains comprehensive information to lead 12 sessions on 

self-esteem with a small group of girls. Each session includes activities and 

information to help girls identify stressful situations in their lives and how 

to overcome these situations. Sessions focus on issues such as discovering 

yourself, understanding relationships with other people, understanding your 

feelings, thinking about how the relationships you see in your family and 

images in the media impact your understanding of self, learning to say no, 

identifying stressful life situations, and understanding your own talents and 

skills. http://rpinet.com/products/eme.html

Hardy Girls Healthy Women. This Web site is run by a nonprofit organization

in Maine and is dedicated to promoting resources to help communities support
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Action Steps for Improving Women’s Mental Health

adolescent girls. The goal of the site is to serve as an organizing point for

resources (including lists of available articles and books) and for local programs

and activities to support girls. The site has a strong focus on promoting wellness,

creating safe places (e.g., places where girls can share and learn without being

judged), and overcoming negative stereotypes about girls. The site promotes hardiness and seeks to develop and promote ways for girls to overcome stressful

events and become more resilient. It advocates the creation of hardiness zones,

within which girls can thrive. This organization actively has created such zones in

the local community and has created regular programming opportunities for girls

to experience such zones. http://www.hardygirlshealthywomen.org/ index.php

Penn Resiliency Program (Adaptive Learning Systems and The University

of Pennsylvania). This project provides 10 sessions for youth to help them

develop skills to become more resilient. The program was originally designed

for at-risk youth but has been shown to benefit all youth. Benefits include positive influences on exploratory style, problem-solving ability, self-esteem, selfefficacy, hope, and general health. The 10 sessions focus on links between

thoughts and feelings, thinking styles, alternatives and evidence, evaluating

thoughts and de-catastrophizing, discussion of conflict, assertiveness and negotiation, coping strategies, social skills training, decisionmaking, and social

problem solving. http://www.ppc.sas.upenn.edu/prpsum.htm

Positive Psychology and the Cultivation of Character Among Youth

(Positive Psychology for Youth Project). This tool is designed as a positive

intervention for youth. It consists of twenty 80-minute lessons for 9th graders,

administered as part of the general language arts curriculum at intervals of

approximately every 2 weeks. The lessons are designed to nurture positive character development, positive emotion, and citizenship in high school students.

The tool is grounded in positive psychology research. The three main foci of the

lessons are positive emotions, identifying and using signature strength, and

meaning and purpose in life. http://www.positivepsychology.org/

Raising Confident and Competent Girls (Wellesley College Center

for Research on Women). This program focuses on bringing research

on girl’s self-esteem to teachers and parents to help them support 

adolescent girls better. A 36-page manual provides full details for trainers. 

The manual also includes an additional 50-pages of supporting materials, 

including handouts, overheads, research reports, and a detailed appendix. 

This training is provided to teachers and parents in a 3-hour training session.

The main points of the training are that teachers need to have high expectations

for all students, support girls’ aspirations, show girls how to reach their 

goals, tell girls if they must reveal confidential information (e.g., if girls tell 

them about an abusive situation, explain that they must report this information

before doing so), and support parents in their efforts to raise girls. 

http://www.wcwonline.org/

Uniquely Me! The Way to Be (Girls Scouts). The tools consist of a 

24-page booklet for girls aged 8-10, as well as two 28-page booklets for 

adolescent girls aged 12-14. The main points of these materials include 

appreciating yourself for who you are, thinking about and setting your own 

values, dealing with peer pressure, and setting appropriate life habits (e.g., 
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Action Steps for Improving Women’s Mental Health 

getting enough rest/exercise and eating a healthy diet). The materials also 

help girls to identify potential negative influences in their lives (e.g., media 

portrayals of girls as too thin) and learn how to counteract these forces. 

http://store.girlscoutshop.org/unmewaytobe.html

Tools for Communities

The Organization of Hope: A Workbook for Rural Asset-Based Community

Development (Asset-Based Community Development Institute). This tool is

designed for rural community leaders and encourages such leaders to take a

“glass half full” view on rural community development. The premises of the

workbook are that rural communities have many existing assets in the way of

people, places, and resources and that the key to community development is to

integrate these assets and build on their collective strengths. The 120-page booklet contains a simple model built around inventorying existing assets, getting others involved, and building enthusiasm to address community-level problems. The

introduction to the guide and ordering information are available at:

http://www.northwestern.edu/ipr/publications/community/buildingblurb.html

THRIVE: Community Tool for Health and Resilience in Vulnerable 

Environments (Prevention Institute). THRIVE is designed to help 

communities identify health disparities and work to improve community 

health. For example, the tool assists community leaders in identifying the 

building blocks of healthy communities; e.g., parks, community gathering 

places, quality schools, and available social services. In addition to this 

community assessment tool, THRIVE also includes training materials and 

guidelines to translate assessment results into local policies, programs, and 

priorities. THRIVE has a woman-focused section, but this section is 

somewhat narrow and focuses on health as opposed to mental wellness. 

http://www.prevention institute.org/thrive.html
51

ENDNOTES

1 U.S. Department of Health and Human Services, Substance

Abuse and Mental Health Services Administration, Center for

Mental Health Services, National Institutes of Health, National

Institute of Mental Health (1999). Mental health: a report of the

Surgeon General, Rockville, MD: U.S. Department of Health and

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2 U.S. Department of Health and Human Services, Office on

Women’s Health (April 2002). A century of women’s health: 1900-

2000. Rockville, MD: U.S. Department of Health and Human

Services. Available at: http://www.4woman.gov/timecapsule/century/index.htm. 

3 U.S. Department of Health and Human Services, Public Health

Service, Office of the Surgeon General (2001a). National strategy

for suicide prevention: goals and objectives for action. Rockville,

MD: U.S. Department of Health and Human Services.

4 U.S. Department of Health and Human Services, Public Health

Service, Office of the Surgeon General (2001b). Youth violence: a

report of the Surgeon General. Rockville, MD: U.S. Department of

Health and Human Services.

5 U.S. Department of Health and Human Services, Public Health

Service, Office of the Surgeon General (2000). Report of the

Surgeon General’s Conference on Children’s Mental Health: a

national action agenda. Washington: U.S. Department of Health

and Human Services. Stock no. 017-024-01659-4; ISBN no. 0-16-

050637-9.

6 U.S. Department of Health and Human Services, Public Health

Service, Office of the Surgeon General (2001c). Mental health:

culture, race, and ethnicity - a supplement to Mental Health: A

Report of the Surgeon General. Rockville, MD: U.S. Department

of Health and Human Services.

7 World Health Organization (2003). Investing in mental health.

Geneva: World Health Organization.

8 National Business Group on Health (2006). An employers’ guide

to behavioral health services. Washington, D.C. Center for

Prevention and Health Services.

9 Kessler RC, Berglund PA, Demler O, Jin R, Merikangas KR,

Walters EE. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey

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10 Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe

SW, Berglund PA, Corey-Lisle PK. (2003). The economic burden

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11 Langlieb A, Kahn J. (2005). How much does quality mental health

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12 President’s New Freedom Commission on Mental Health.

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19 Birmingham CL, et al., (2005 Sep). The mortality rate from

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20 American Psychiatric Association Work Group on Eating

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21 Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K.

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22 Lewinsohn PM, Striegel-Moore RH, Seeley JH. (2000).

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23 Kendler KS, Gallgher TJ, Abelson JM, Kessler RC (1996).

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24 Arnold LM. (Sep 2003). Gender differences in bipolar disorder.

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25 Chapman DP, Perry G, Strine TW. (2005). The vital link

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26 Eskandari F, Mistry S, Martinez PE, Torvik S, Kotila C,

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27 Rumsfeld RS, et al. (2005). Depression predicts mortality and

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28 Taylor CB, et al. (2005). Effects of antidepressant medication

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29 Chapman DP, Perry G, Strine TW. (2005).The vital link

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30 National Center on Quality Assurance. (2004). State of Healthcare

2004: Industry Ternds and Analysis. Washington, DC. NCQA. 

31 Lustman PJ, Clouse RE. (2005). Depression in diabetic

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32 Ziegelstein RC. (2001). Depression in patients recovering from

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33 Wizemann TM, Pardue ML, Committee on Understanding the

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34 Burt, V.K. (2004). Plotting the course to remission: The search

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35 Cohen, L.S. (2003). Gender-specific considerations in the treatment of mood disorders in women across the life cycle. Journal of

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36 Daly, R.C., Danaceau, M.A., Rubinow, D.R., & Schmidt, P.J.

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37 Schmidt, P.J., Haq, N., Rubinow, D.R. (Dec 2004). A longitudinal evaluation of the relationship between reproductive status and

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38 Freeman, M.P., Smith, K.W., Freeman, S.A., McElroy, S.L.,

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39 Cahill, L., Uncapher, M., Kilpatrick, L., Alkire, M.T., & Turner,

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41 Goldstein, J.M., Seidman, L.J., O’Brien, L.M., Horton, N.J.,

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42 Castellanos, X.F., Giedd, J.N., Berquin, P.C., Walter, J.M.,

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43 Bjorklund P. (Jan 2006). No man’s land: gender bias and social

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GLOSSARY

Anxiety disorders are characterized by a disabling, excessive, or irrational

dread of everyday situations. They include generalized anxiety disorder,

obsessive-compulsive disorder, panic disorder, post-traumatic stress disorder, and social phobia.

Eating disorders may take the form of excessive reduction of food intake

or overeating, possibly combined with excessive exercise and extreme concern about body shape or weight.

Mental health is characterized by mental functions that result in productive

activities, fulfilling relationships with others, and the ability to adapt to

change or cope with adversity.

Mental illness refers to all diagnosable mental disorders, i.e., conditions

characterized by alterations in thinking, mood, and/or behavior.

Patient and family-centered services are those that are informed by the

needs of individuals affected by mental illnesses and their families, who are

integrated as active participants in treatment and recovery.

Perinatal depression encompasses major and minor depressive episodes

that occur either during pregnancy or within the first 12 months following

delivery.

Recovery implies the reduction or complete remission of symptoms and the

ability to live a fulfilling and productive life despite a mental illness or

addictive disorder.

Recovery-focused services go beyond the treatment of symptoms to

emphasize ways to build resilience and facilitate recovery.

Substance use disorder refers to the abuse of or dependence on alcohol,

illegal drugs, or prescription medications.