Mental health problems often can be prevented if children get the help they need early on from parents and schools, according to a new report from the Institute of Medicine. "This was news to me," says Kenneth Warner, chairman of the group that wrote the report and dean of the University of Michigan School of Public Health. "There are many options for literally preventing episodes of mental illness and others for substantially reducing the adverse consequences."
With 14 to 20 percent of children suffering a mental illness, that's very good news. The IOM estimates that mental disorders, which include depression, anxiety, conduct disorder, and substance abuse, cost the United States about $247 billion annually. "We have consistent scientific evidence that parents, along with the other important people in their children's lives, can use to help shape the positive behaviors of children," says David Shern, president and CEO of Mental Health America, an advocacy group.
Quite a few programs work, the IOM group found, ranging from Early Head Start programs for 3-year-olds to long-term interventions, from kindergarten through 10th grade, designed to reduce aggression and conduct disorder in children and teens. One of the programs evaluated successfully reduced aggressive behavior by one quarter to one third; another raised academic performance of children by 10 percent.
A few of the programs singled out by the IOM for praise:
- The Good Behavior Game, in which elementary students compete for rewards such as extra free time by acting appropriately in class, significantly reduced aggressive behavior in first graders. Students who participated were less likely to smoke or be aggressive in middle school and less likely to abuse drugs or alcohol as young adults.
- Positive parenting programs, in which parents learn to use praise and rewards to encourage good behavior and rely less on harsh punishments. Children of parents in one such program, the Incredible Years, were less aggressive. Preschoolers and first-graders whose teachers used the method were rated more socially competent and had fewer behavior problems.
- The Clarke Cognitive-Behavioral Prevention Intervention, which focuses on helping teenagers at risk for depression learn to cope with stress, reduced episodes of major depression.
- The Promoting Alternative Thinking Strategies (PATHS) program, which teaches elementary and preschool children about emotion, self-control, and problem solving, significantly reduced conflict and depression.
But the good news is tempered by the fact that the vast majority of children who need help never get it. "Figuring out how to get scaled up is a real challenge," says Warner, who is an economist by training. "A lot of the problems exist in underprivileged settings, where parents don't have the basic resources. They're stressed out by economic issues, ethnic and racial discrimination, work problems—they just don't have the resources to do what needs to be done for all children."
It's no secret to any parent who has tried to find mental health services for a child that good help is often scarce to nonexistent. The new expanded version of SCHIP Medicaid coverage for children, which President Obama signed into law earlier this month, expands mental health coverage for poor kids. But even families with private insurance can find it hard to find care. (Here's advice from one clinical psychologist on strategies to find mental health care in your community.)
The report calls on Obama to create a new group that will push for adoption of these evidence-based prevention programs, with goals for preventing specific disorders.