The observation that “the health care workforce [is] … not equipped uniformly and sufficiently in terms of knowledge and skills, cultural diversity and understanding, geographic distribution, and numbers to provide the access to and quality of services needed by consumers” (Institute of Medicine, 2006b, pp. 286-324) was made with reference to mental health and certainly holds true for prevention, which has historically taken a back seat to diagnosis and treatment. Compounding this shortcoming is the broad range of health professionals who are engaged in mental health and substance use efforts, trained apart using curricula that are not built on core competencies or interdisciplinary considerations. The potential for clinicians to contribute systematically to prevention of MEB disorders is substantial, but realizing this potential will require transformational changes on the part of training institutions, professional societies, regulatory bodies, and funders.
Physicians: Medical School. Although health promotion and disease prevention are addressed formally or informally in many medical schools, mental health promotion and prevention of MEB disorders are often neglected. Less than half of all U.S. medical schools specifically address prevention and health maintenance. For those schools, it is taught primarily in the first 2 years for an average of only 22 hours (Institute of Medicine, 2004). Prevention of mental disorders would occupy at most a small percentage of that time. Similarly, dedicated training in substance use is rarely offered. According to 1998-1999 data from the Liaison Committee on Medical Education, only 8 percent of medical schools had a required course on substance use (Haack and Adger, 2002). The current level of exposure of medical students to substance use issues does not give graduates the confidence to screen, assess, or provide needed interventions (Miller, Sheppard, et al., 2001).
The knowledge base, skills, and attitudes for graduates regarding prevention of MEB disorders are not systemically assessed. The IOM report Improving Medical Education: Enhancing the Behavioral and Social Science Content of Medical School Curricula (2004, p. 98) recommended “that the National Board of Medical Examiners increase behavioral and social science content on the US Medical Licensing Examination.” Response to this recommendation would be a step in the right direction, but more specific attention to prevention and mental health promotion education is needed to prepare medical students for prevention activities related to MEB disorders.
Physicians: Residency. Postgraduate residency training in psychiatry; primary care specialties, such as pediatrics, internal medicine, and family medicine; preventive medicine; and in subspecialty training in such areas