Stronger effort needed to prevent mental, emotional, and behavioral disorders in young people

The federal government should make preventing mental, emotional, and behavioral disorders and promoting mental health in young people a national priority, says a new report from the National Research Council and Institute of Medicine. These disorders - which include depression, anxiety, conduct disorder, and substance abuse - are about as common as fractured limbs in children and adolescents. Collectively, they take a tremendous toll on the well-being of young people and their families, costing the U.S. an estimated $247 billion annually, the report says.

Research has shown that a number of programs are effective at preventing these problems and promoting mental health, the report says. Such programs could be implemented more broadly, but currently there is no clear federal presence to lead these efforts. The White House should create an entity that can coordinate agency initiatives in this area, set public goals for prevention, and provide needed research and funding to achieve them, said the committee that wrote the report.

"There is a substantial gap between what is known about preventing mental, emotional, and behavioral disorders and what is actually being done," said Kenneth E. Warner, committee chair and dean of the University of Michigan School of Public Health. "It is no longer accurate to argue that these disorders can never be prevented. Many can. The nation is well-positioned to equip young people with the skills and habits needed to live healthy, happy, and productive lives in caring relationships. But we need to develop the systems to deliver effective prevention programs to a far wider group of children and adolescents."

Most mental, emotional, and behavioral disorders have their roots in childhood and adolescence, the report notes. Among adults who have experienced these disorders, more than half report the onset as occurring in childhood or early adolescence. In any given year, an estimated 14 percent to 20 percent of young people have one of these disorders.

First symptoms typically occur two to four years before the onset of a full-blown disorder – creating a window of opportunity when preventive programs might make a difference, the report says. And some programs have shown effectiveness at preventing specific disorders in at-risk groups. For example, the Clarke Cognitive-Behavioral Prevention Intervention, which focuses on helping adolescents at risk for depression learn to cope with stress, has prevented episodes of major depression in several controlled experiments.

Other programs have demonstrated broader preventive effects in general populations of young people, the report says. Programs that can be offered in family or educational settings show particular promise in promoting mental health and addressing major risk factors.

One example of an effective school-based program is the Good Behavior Game, which divides elementary school classes into teams and reinforces desirable behaviors with rewards such as extra free time and other privileges. Studies have shown that the program significantly reduces aggressive and disruptive behavior during first grade. The one-year intervention also has benefits over the long term, lowering the students' risk of alcohol and drug abuse, as well as rates of suicidal thoughts and attempts. And it significantly reduces the likelihood that highly aggressive boys will be diagnosed with antisocial personality disorder as adults. Research has shown that programs that focus on enhancing social and emotional skills can also improve students' academic performance, the report notes.