INTERVENTION RATIONALE

The past decade and a half has witnessed an explosion in knowledge regarding how to help young people experience healthy development. The evidence that these efforts can have a positive impact on the trajectory of their lives makes a compelling case for them. However, there have been strong pressures by some public interest groups against many types of preventive interventions. Objections have been particularly strong related to mandatory screening of children to identify those at high risk and therefore presumably in need of prevention or treatment, as well as to screening done with passive consent. Concerns have also been raised about the reliability of screenings conducted to identify suicide risk, as well as the effectiveness of preventive interventions designed to reduce suicide (Institute of Medicine, 2002).

Public views about mental health treatment and prevention often differ; this is certainly true in the United States. Insurance and government-funded programs typically support treatment but do so less for many kinds of prevention. A fundamental difference between some forms of prevention and treatment is that treatment is typically based on a one-on-one relationship between a person seeking care and a provider of care, whereas prevention can be on an individual (e.g., early child health screenings), group (e.g., a classroom behavior management program), or population (e.g., antidrug advertising campaigns or citywide antibullying programs) basis. In the case of prevention, the public sector, in the shape of a legislative body or a school system, sometimes takes it on itself to intervene in the lives of individuals in the interest of the common good. Public resistance may result when this public intervention infringes on individual rights. For example, the predominant view in the United States is that parenting—unless it results in abuse or neglect—is a private matter not subject to government intervention.

Both the practical public health context and various philosophical contexts provide strong justification for taking a preventive approach to the emotional and behavioral problems of youth. First, public health’s core focus is preventing rather than treating disease. The primary concern is the health of the population, rather than the treatment of individual diseases. Public health recognizes the importance of identifying and then intervening with known risk factors. In a public health context, population health is understood to result from the interaction of a range of factors beyond the individual. In the case of children, youth, and young adults, a public health model would call for the involvement of families, schools, health and other child service systems, neighborhoods, and communities to address the interwoven factors that affect mental health. Behavioral health could learn from public health in endorsing a population health perspective.



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