Child- and family-based mental illness prevention efforts got a boost in
November from a congressionally mandated report that found such approaches to
be highly effective and good investments.
The Center for Mental Health Services of the Substance Abuse and Mental
Health Services Administration (SAMHSA) issued a report to Congress on
November 7 that detailed the many advantages of a wide range of mental illness
prevention and detection programs that have emerged in local communities.
The report was requested by the Senate Appropriations Labor, Health and
Human Services, and Education Subcommittee to address whether evidence-based"
prevention and wellness-promotion efforts that strengthen parenting and
enhance child resilience" would significantly impact children's mental
Research has identified factors that increase or decrease the risk that
children will develop mental health problems. The report authors noted that
although some risk factors—such as poverty and neighborhood
violence—cannot be addressed by mental health programs alone, other
approaches to mental illness prevention have registered some success.
"Many protective factors such as relationship skills, conflict
management, and positive problem-solving can be taught to children, family
members, teachers, and other caregivers," the report stated.
Family-focused, evidence-based programs that function over the long term
can have a profound, positive effect on the parenting and development of
children who face multiple risk factors, according to the report. Its authors
encouraged wider adoption of such programs, often begun through federal
initiatives such as SAMHSA's National Registry of Evidence-Based Programs and
The best mental health promotion programs integrate parents and other
caregivers as equal partners—along with school and community
leaders—in selecting, implementing, evaluating, and sustaining the
programs. The authors concluded that parental involvement was more likely if
services were provided in easily accessible settings and if they were"
culturally and linguistically appropriate."
Although federal, state, and local governments have provided very little
funding for primary prevention of mental illness, the authors identified a
growing body of data showing that such approaches are highly cost-effective. A
small number of long-term, follow-up studies show that some programs continue
to generate positive returns over multiple years as participants grow into
healthy, well-functioning adults.
The need for such preventive and early-intervention approaches is evident
in the large number of children suffering from mental illness. The 2005
National Survey on Drug Use and Health revealed that about 5.5 million U.S.
children (more than 20 percent of those aged 12 to 17), received treatment or
counseling for emotional or behavior problems in the prior year. Other
estimates indicate that 10 percent of this age group experiences a mental
health problem serious enough to cause a significant level of impairment in
functioning at home, at school, or in the community.
The collaborative prevention programs the report urges are particularly
crucial because the majority of lifelong mental illnesses begin in youth. Half
of all diagnosable lifelong cases of mental illness begin by age 14, according
to the National Comorbidity Survey Replication, and three-fourths of chronic
cases of mental illness start by age 24.
"If early intervention does not occur, childhood disorders may
intensify and persist, often leading to a downward spiral of school failure,
poor employment opportunities, and poverty in adulthood," the authors
The report urged a public-health approach to mental illness, which aims to
promote health and prevent illness before it begins. The same approach is
being used nationally to prevent obesity in children rather than intervening
later when the associated health risks and financial costs become
Among the examples of successful programs cited in the report is a school
program that uses teacher visits to the child's home to teach child-learning
and development lessons to the parents. Among the program's long-term results:
by age 27, program participants had many fewer arrests and were less likely to
use public services than nonparticipant peers.
The primary obstacle to implementing such prevention programs is the
difficulty in obtaining start-up funding—while initial expenses are
immediate and easily quantified, the benefits are long term and it's difficult
to assign a dollar value to them.
Among the report's recommendations is for stakeholders to seek alternative
funding methods beyond the standard reimbursement system for mental health
care, which pays for individualized treatment services following the diagnosis
of a disorder rather than interventions to prevent disorders.
Prevention-funding approaches cited in the report include the approach of some
localities that include mental illness prevention funding aimed at their
entire student population within their school budgets.
"Better coordination of programs across systems could maximize the
use of available resources," the report authors stated.
"Promotion and Prevention in Mental Health: Strengthening
Parenting and Enhancing Child Resilience" is posted at<http://download.ncadi.samhsa.gov/ken/pdf/SVP-0186.pdf>.▪