ring with the perspective in the 1994 IOM report. We also conclude that the progress made since 1994, as outlined in this report, supports continued focus of prevention resources prior to the onset of disorders. We share the concerns, raised by the 1994 IOM committee and commentators on the NAMHC approach, that an overly inclusive definition of prevention research could dilute resources for interventions designed to prevent the onset of disorder and “often underlies a neglect of interventions to reduce risks” (Institute of Medicine, 1994, p. 28).

Therefore, in this report, the committee has adopted the definitions of prevention developed in the 1994 IOM report, along with the distinctions between prevention and treatment. This report focuses on preventive interventions that target multiple populations whose levels of risk vary, but that are not identified on the basis of having a disorder. As discussed below, however, the committee broadened the conceptualization of mental health to include both the prevention of disorders and the promotion of mental health (see Box 3-1).

RECONSIDERING MENTAL HEALTH PROMOTION

Mental health promotion is characterized by a focus on well-being rather than prevention of illness and disorder, although it may also decrease the likelihood of disorder. The 1994 IOM report included a general call for assessment of outcomes of mental health promotion activities. It also acknowledged that health is more than just the absence of disease and that the goals and methods of prevention and promotion overlap, but it concluded that the evidence of effectiveness of mental health promotion was sparse, particularly in comparison to that for prevention.

At this point in time, this committee views the situation differently. There is agreement that mental health promotion can be distinguished from prevention of mental disorders by its focus on healthy outcomes, such as competence and well-being, and that many of these outcomes are intrinsically valued in their own right (e.g., prosocial involvement, spirituality: Catalano, Berglund, et al., 2004; social justice: Sandler, 2007). As stated in the Report of the Surgeon General’s Conference on Children’s Mental Health (U.S. Public Health Service, 2000), “Mental health is a critical component of children’s learning and general health. Fostering social and emotional health in children as part of healthy child development must therefore be a national priority” (p. 3). There is also increasing evidence that promotion of positive aspects of mental health is an important approach to reducing MEB disorders and related problems as well (National Research Council and Institute of Medicine, 2002; Catalano, Berglund, et al., 2002, 2004; Commission on Positive Youth Development, 2005). These developments have led the committee to conclude that mental health promotion should



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