causality and the moderating genetic or environmental factors associated with mental, emotional, and behavioral outcomes.

The public health perspective endorsed by the committee also mandates that prevention not be limited only to those at imminent risk. Indeed, the mandate of agencies such as the National Institute of Mental Health (NIMH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) calls for a broader approach. For example, the ADAMHA Reorganization Act, which created both, states that the research program at NIMH “shall be designed to further the treatment and prevention of mental illness, the promotion of mental health, and the study of the psychological, social, and legal factors that influence behavior.” Similarly, the Center for Mental Health Services at SAMHSA is directed to establish national priorities for the prevention of mental illness and the promotion of mental health.

These mandates suggest a broad-based prevention approach that includes a balance between approaches aimed at those at imminent risk, those at elevated risk, and those who currently appear risk free but for whom specific interventions have been demonstrated to reduce future risk. As Chapter 2 emphasized, the prevalence of MEB disorders among young people suggests that few are entirely risk free. Furthermore, as outlined in this report, a substantial body of research established over the past several decades supports the efficacy or effectiveness of universal and selective interventions, particularly for behavioral disorders. A balance of universal, selective, and indicated prevention research and implementation is needed to address the mental, emotional, and behavioral needs of young people. Consistent with the agencies’ legislative mandates, targeted attention is also needed to approaches that can promote mental health, regardless of whether a specific disorder is being prevented.


The classification system used to define the boundaries of prevention and prevention research is critical for assessing the degree to which prevention research and services are being used along with treatment strategies as part of a public health approach to reduce the burden of MEB disorders in the population. And indeed, a variety of approaches have been proposed. The committee recognizes that it may be difficult in some cases to distinguish different prevention approaches from each other or even to identify clear boundaries between prevention and treatment. We also appreciate the importance of treatment, including its preventive aspects in terms of reducing the likelihood and severity of future problems. Interventions to prevent disability, comorbidity, or relapse are clearly important.

However, the committee thinks that these are aspects of quality treatment and are distinct from, though complementary to, prevention, concur-

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