Psychiatry (1990) reported that growing numbers of children and adolescents are at exceptionally high risk for developing a mental disorder: for example, 1.5 million children are reported abused or neglected each year. Toward the other end of the life span are the 4 million older Americans who, according to a National Institute on Aging estimate, are likely to be suffering from Alzheimer's disease (Evans, Scherr, Cook, Albert, Funkenstein, Smith et al., 1990) and the 15 to 25 percent of the elderly in nursing homes who are clinically depressed (NIH Consensus Panel on Depression in Late Life, 1992).

In addition to the cost in human suffering and lost opportunity, mental illness of this magnitude places an extraordinary burden on the financial and social resources of this country. According to one estimate, the economic costs for 1990 were $98 billion for alcohol abuse, $66 billion for drug abuse, and $147 billion for other mental illness (D. Rice, personal communication, April 1993). Mental and physical health are closely linked, and beyond the costs just described, the contribution of mental health to physical well-being has to be considered. Despite these enormous expenditures, it is estimated that only 10 to 30 percent of those in need receive appropriate treatment (DHHS, 1991; IOM, 1989; NMHA, 1986).

Problems on this scale require attacks on many fronts. Major advances in the prevention of health-related problems in several areas of physical health have led the way to an increased awareness of the promise of prevention in enhancing mental health (DHHS, 1991). Childhood immunization programs have prevented numerous physical diseases and large-scale prevention programs have demonstrated notable success in reducing the risk of onset of cardiovascular disease (Flora, Maccoby, and Farquhar, 1989). Could advances of the same magnitude occur in mental health? Could similar successes be achieved in the prevention of disorders such as depression and schizophrenia?

Over the years, there have been many efforts to address mental health problems from a prevention perspective (see Table 1). At the same time, Americans have begun to recognize that their physical health and mental health are intertwined. Many people are striving to improve their physical and mental well-being, not just to avoid illness but to achieve what they consider greater personal rewards, including a more active life and a generally more positive disposition (Breslow, 1990). In the report summarized herein, the Institute of Medicine's Committee on Prevention of Mental Disorders examines what is currently known about the prevention of mental disorders and promotion of mental health and outlines the prospects for advances in that knowledge and its application over the next decade.



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