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Monday, May 17, 2010

Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities (2009)

Several decades of research have shown that the promise and potential lifetime benefits of preventing mental, emotional, and behavioral (MEB) disorders are greatest by focusing on young people and that early interventions can be effective in delaying or preventing the onset of such disorders. National priorities that build on this evidence base should include (1) assurance that individuals who are at risk receive the best available evidence-based interventions prior to the onset of a disorder and (2) the promotion of positive MEB development for all children, youth, and young adults.

A number of promotion and prevention programs are now available that should be considered for broad implementation. Although individuals who are already affected by a MEB disorder should receive the best evidence-based treatment available, interventions before the disorder occurs offer the greatest opportunity to avoid the substantial costs to individuals, families, and society that these disorders entail.

Most MEB disorders have their roots in childhood and youth. Among adults reporting a MEB disorder during their lifetime, more than half report the onset as occurring in childhood or adolescence. In any given year, the percentage of young people with these disorders is estimated to be between 14 and 20 percent. MEB issues among young people—including both diagnosable disorders and other problem behaviors, such as early drug or alcohol use, antisocial or aggressive behavior, and violence—have enormous personal, family, and societal costs. The annual quantifiable cost of such disorders among young people was estimated in 2007 to be $247 billion. In addition, MEB disorders among young people interfere with their ability to accomplish normal developmental tasks, such as establishing healthy interpersonal relationships, succeeding in school, and transitioning to the workforce. These disorders also affect the lives of their family members.

A 1994 report by the Institute of Medicine (IOM), Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research, highlighted the promise of prevention. In response to a subsequently burgeoning research base and an increasing understanding of the developmental pathways that lead to MEB problems, the Substance Abuse and Mental Health Services Administration, the National Institute of Mental Health, the National Institute on Drug Abuse, and the National Institute on Alcohol Abuse and Alcoholism requested a study from the National Academies to review the research base and program experience since that time, focusing on young people. The Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth, and Young Adults was formed under the auspices of the Board on Children, Youth, and Families to conduct this review (see Box S-1 for the complete charge).

The 1994 IOM report reaffirmed a clear distinction between prevention and treatment. The current committee supports this distinction. The prevention of disability, relapse, or comorbidity among those with currently existing disorders are characteristics and expectations of good treatment. Although treatment has preventive aspects, it is still treatment, not prevention. The strength of prevention research using this concept of prevention, coupled with the need for focused research on risks prior to the onset of illness, warrants the field’s continued use of a typology focused on interventions for those who do not have an existing disorder. Interventions classified as universal (population-based), selective (directed to at-risk groups or individuals), or indicated (targeting individuals with biological markers, early symptoms, or problematic behaviors predicting a high level of risk) are important complementary elements of prevention. Going beyond the 1994 IOM report, we strongly recommend the inclusion of mental health promotion in the spectrum of mental health interventions. . . . . .