Report Says Family Focus Key to Mental Illness Prevention

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 health.

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 Practices.

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 noted.

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 substantial.

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>.▪