While the value of prevention has won a seat at the table in the ongoing debate over health reform, the method of "scoring" potential savings has elbowed out a broader discussion of the advances made in identifying cost-effective interventions that lower the incidence of disease and produce healthier lives.
This is particularly true with mental health conditions among young people. While a number of reform proposals focus on preventing and managing chronic illness as a key principle, greater attention must be paid to mental and substance use conditions. We know that many behavioral conditions take a high toll in terms of treatment services and lost productivity-estimated at $247 billion annually. Mental and substance use conditions are the most chronic illnesses with an early age of onset and disabling course if left untreated. They are also the most likely co-occurring conditions with other chronic illnesses. In addition, they interfere with educational achievement and family cohesiveness.
As a major report issued this year by the Institute of Medicine and National Research Council demonstrates, there are evidence-based approaches that prevent the occurrence of these conditions and remove obstacles that impede young people's growth and potential. The report (a summary can be accessed here) documents effective interventions that could reduce problem behaviors, increase academic achievement and reduce the rate at which individuals develop diagnosable disorders.
Significantly, the report says prevention is one of the soundest investments a society can make producing monetary and societal benefits, including higher productivity, lower treatment costs, less premature mortality, stronger families, and more successful young people.
Early intervention and identification programs are breaking new ground and gradually gaining wider attention. But we have to do more to put these advances at the center of the debate. As the report states emphatically, we need to make the prevention of mental, emotional and behavioral disorders and the promotion of mental health among young people a national priority. Congress is starting to take notice. Last year, a bipartisan resolution also called attention to the need to put prevention at the top of the public health agenda.
As in other areas of medicine, our challenge is to ensure that every child, family and community have access to these evidence-based practices so young people can reach their full potential. Unfortunately, we lack a national initiative to advance the use of prevention and promotion approaches to benefit the mental health of the nation's young people. There is no national program, like the physical fitness initiative of the 60's, to ensure that every child maximizes his or her capacity.
Whatever place prevention takes in a health overhaul, there will be additional opportunities to realize the promise of science. We also have to take steps to expand screenings for youth, families and seniors.
