gies to implement relevant policies on prevention, to widely and effectively adopt preventive interventions, to develop culturally relevant interventions, or to build the infrastructure for prevention, so that effective practices are available to every family and young person who could benefit from them.


Several core concepts underlie the ability to adopt prevention and promotion as national priorities. The committee views these concepts as essential elements that must be embraced by families, policy makers, service systems, and scientists in order to continue to make progress in this area. They also shed light on why not enough attention has been directed to prevention or promotion to date.

Prevention requires a paradigm shift. Prevention of MEB disorders inherently involves a way of thinking that goes beyond the traditional disease model, in which one waits for an illness to occur and then provides evidence-based treatment. Prevention focuses on the question, “What will be good for the child 5, 10, or more years from now?” and tries to mobilize resources to put these things in place. A growing body of prevention research points to the need for the national dialogue on mental health and substance abuse issues to embrace the healthy development of young people and at the same time to respond early and effectively to the needs of those with MEB disorders.

Mental health and physical health are inseparable. The prevention of MEB disorders and physical disorders and the promotion of mental health and physical health are inseparable. Young people who grow up in good physical health are more likely to also have good mental health. Similarly, good mental health often contributes to maintenance of good physical health. In their calculations of the burden of disease and injury in the United States in 1996 (the latest data available), Michaud, McKenna, and colleagues (2006) show that in children ages 5-14, 15 percent of disability-adjusted life years (DALYs) lost to illness are caused by mental illness. In youth ages 15-24, almost two-thirds of DALYs lost are due to mental illness, to substance abuse, or to homicide, suicide, or motor vehicle accidents, all of which have a strong association with mental illness and substance abuse. Furthermore, MEB disorders increase the risk for communicable and noncommunicable diseases and contribute to both intentional and unintentional injuries, so the percentage may be even higher (Prince, Patel, et al., 2007). Almost one-quarter (24 percent) of pediatric primary care office visits involve behavioral and mental health problems (Cooper, Valleley, et al., 2006).

Conversely, young people with special health care needs or chronic

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