Simple Gifts

In March of 2009, the Institute of Medicine issued a new report on the Prevention of Mental, Emotional and Behavioral Disorders Among Young People.¹ Fundamentally, the report calls for ending the ration of prevention of mental, emotional and behavioral disorders among America’s youth and young adults. Continued rationing of access to scientifically proven prevention causes a serious threat to the country’s national security² and to our economic competitiveness compared to 22 other rich countries.³ Such mental, emotional and behavioral disorders are also the leading preventable cost center for local, state and the federal government.^{1 4} These are the disorders that cause our health-care costs to continue to spiral up and up.

The IOM Report calls for a public-health approach to mental, emotional and behavioral disorders—basically like how America dealt with the polio epidemic, measles, mumps, car passenger injuries to children, and accidental poisoning from medications and toxic chemicals.  Why is this necessary? America’s rates of some of these mental, emotional and behavioral problems are worse than other developed countries,^{5 6} and rates of some of these problems have objectively increased over the past 50 years in America.⁷ A public-health approach begins with key facts:

1) Potential harm to the population is high;

2) Individual risk is widespread;

3) Everyone deserves protection;

4) Stigmatizing people or groups reduces engagement in prevention; and

5) Universal approaches are cost-effective.

There are now multiple examples of how a public health approaches can and have reduced or prevented mental, emotional and behavioral disorders for less per child than being spent for medical vaccines for childhood diseases.  Many of these prevention strategies in the IOM report are being used by America’s economic competitors, an ironic event since the approaches were largely developed and tested in America. I propose some major policy actions can be adopted to advance the findings of the IOM Report, specifically:

1)     Unleashing consumer access to behavioral prevention strategies like car seats,

2)     Creating third-party reimbursements that would reduce health-care costs,

3)     Initiating public/private prevention mobilizations,

4)     Using proven, powerful marketing campaign strategies, and

5)     Creating cost-saving estimators like business software to calculate profit/loses from prevention strategies.

If you want to read more about these ideas, download a pdf at: http://bit.ly/aaeRBf

References Cited

1. O'Connell ME, Boat T, Warner KE, editors. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. . Washington, DC: Institute of Medicine; National Research Council, 2009.

2. McMichael WH. Most U.S. youths unfit to serve, data show. Army Times 2009 Nov. 5, 2009.

3. Schmitt J, Lane N. Small-business employment in 22 rich economies. Int J Health Serv 2010;40(1):151-63.

4. Biglan A, Brennan PA, Foster SL, Holder HD, Derzon JH, Embry DD, et al. Helping Adolescents at Risk: Prevention of Multiple Problem Behaviors. New York: Guilford Press, 2004.

5. Heiervang E, Goodman A, Goodman R. The Nordic advantage in child mental health: separating health differences from reporting style in a cross-cultural comparison of psychopathology. J Child Psychol Psychiatry 2008;49(6):678-85.

6. Heiervang E, Stormark KM, Lundervold AJ, Heimann M, Goodman R, Posserud MB, et al. Psychiatric disorders in Norwegian 8- to 10-year-olds: an epidemiological survey of prevalence, risk factors, and service use. J Am Acad Child Adolesc Psychiatry 2007;46(4):438-47.

7. Collishaw S, Maughan B, Goodman R, Pickles A. Time trends in adolescent mental health. J Child Psychol Psychiatry 2004;45(8):1350-62.