children, youth, and families, as they are for adults (Institute of Medicine, 2006b) and for physical health care (Institute of Medicine, 2001). In the long run, consideration needs to be given to an effective, broad-based, strong public health network that can provide adequate data to monitor progress and support the delivery of high-quality preventive services focused on mental and physical health in a variety of sectors. Linked services for the promotion of mental and physical health can respond to the growing recognition that mental health is dependent on good physical health and vice versa.

The committee was struck by the pervasive role played by poverty in development of a range of MEB disorders and related problems. Similarly, the health care system in the United States, which limits access to and quality of care for many of the most poor and disenfranchised, complicates effective prevention. National attention should be paid to narrowing income and health care disparities as a fundamental part of the promotion of mental health and prevention of MEB disorders.

DEVELOPING STATE AND LOCAL SYSTEMS

Prevention science has identified the major malleable risk factors for the development of most MEB disorders and related problems. The number of efficacy trials and the experimental and statistical methods needed to make reliable conclusions have exploded since 1994. Numerous interventions have been tested in two or more randomized controlled trials, and several have been tested in multiple U.S. communities or implemented nationwide in European countries.

The inability of the mental health care system to respond to the demands for treatment is well documented. Many young people receive treatment in systems outside the formal mental health care system, such as schools, primary medical care, child welfare, and criminal justice. Not all cases of MEB disorder can be prevented, but a concerted effort to determine the proportion of such disorders that can be prevented is now possible. Shifting the focus toward prevention may help alleviate pressures on treatment resources; this would need to be empirically tested through community- or statewide implementation of prevention.

The mental, emotional, and behavioral health of young people cannot, and should not, be the responsibility of the mental health care system alone. Improvements or potential savings from effective prevention inherently benefit systems other than, or in addition to, the system implementing an intervention. Similarly, the failure of one system involved in a young person’s life can have costs for another. For example, there is evidence that improving social and emotional functioning improves academic outcomes. Interventions involving both families and schools seem to have a high level



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement