Landmark IOM Report Paves Road to Prevention

Prevention of mental illness and promotion of mental health are scientifically feasible, and the time is ripe to transfer the science into practice.

That is the conclusion of a landmark report by the Institute of Medicine (IOM) titled “Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities.”

Prevention practices have emerged in a variety of settings, including programs for selected at-risk populations—such as children and youth in the child-welfare system—school-based interventions, interventions in primary care settings, and community services designed to address a broad array of mental health needs and populations, according to the report.

The report updates a 1994 IOM book, Reducing Risks for Mental Disorders, and focuses attention on the research base and program experience with younger populations that have emerged since that time.

The book-length report includes chapters on (among other subjects) using a developmental framework to guide prevention and promotion; perspectives from developmental neuroscience; preventive intervention research—including family, school, and community interventions; prevention of specific disorders; screening; benefits and costs of prevention; and implementation and dissemination of prevention and promotion practices.

APA leaders are hailing the report saying it points to a paradigm shift in the way psychiatry approaches mental illness in the future.

“Both prevention and psychiatry have always been the stepchildren of medicine,” said APA President Nada Stotland, M.D. “It is not as glamorous as open-heart surgery or restoring a brilliant individual with bipolar disorder to her career and family. It is much easier to get credit for fixing something that is broken than for keeping it from breaking in the first place. However, most of the improvements in life span are the result of preventive, rather than treatment, measures—immunizations, pap smears, clean air and water, smoking cessation.

“Most health professionals are unaware of the crucial data in the IOM report,” Stotland said. “Now that it has been published, and we know that there are effective ways to prevent psychiatric disorders in children, there is no excuse for our country's continued failure to implement the policies that would protect our children from lifetimes of suffering and disability.”

Child psychiatrist William Beardslee, M.D., a member of the IOM committee and chair of APA's Corresponding Committee on Prevention of Mental Disorders and Promotion of Mental Health, echoed Stotland.

“This is a landmark report and deserves to be read with care by every psychiatrist,” Beardslee told Psychiatric News.“ Psychiatry has an opportunity to provide extraordinary leadership in the prevention of mental illness, and we strongly urge APA and individual psychiatrists to support the report's recommendations.”

Those recommendations include a call for a coordinated national strategy originating in the White House for implementing prevention and promotion practices.

The IOM report stated, “The White House should create an ongoing mechanism involving federal agencies, stakeholders (including professional associations), and key researchers to develop and implement a strategic approach to the promotion of mental, emotional, and behavioral health and the prevention of mental, emotional, and behavior disorders and related problem behaviors in young people.”

Psychiatrist Carl Bell, M.D., also a member of the IOM committee, said that recommendation was modeled on the success of a similar White House cabinet-level strategy during the Clinton administration concerning violence against women.

“What the IOM is saying is that it is possible to prevent psychiatric disorders, substance abuse, and problem behaviors,” Bell told Psychiatric News. “The challenge for psychiatry is to shift its paradigm and stop thinking of itself as a field that only treats the sick, but begins to think in terms of a public-health model.”

Beardslee and Bell both stressed that the IOM report underscores the importance—and scientific basis—not only of preventing or preempting the occurrence of major mental disorders among individuals who exhibit preclinical symptoms, but also broad population-based strategies aimed at promoting mental health.

Beardslee stressed as well that in the background of all behavioral disorders are the issues of poverty and health disparities.

“Prevention should be a part of regular psychiatric practice,” Beardslee said. “I see three levels at which psychiatrists can be putting prevention into practice. As social scientists, we should be embracing the public-health perspective and broad reforms to address health disparities and poverty. A second level where psychiatrists can have a very large impact is in working with adults with mental illness who have children, doing preventive work using psychoeducational models.

“And the third level is the use of preventive strategies that have been designed for people at very high risk.”

“Preventing Mental, Emotional, and Behavioral Disorders Among Children: Progress and Possibilities” is posted at<http://books.nap.edu/openbook.php?record_id=12480&page5>.▪