Prevention and Early Intervention for Mental Illness - The Time is Right

Epic arguments are being waged regarding the pros and cons of disease prevention. However, few, if any, are offering serious insight as to how to address the host of mental health disorders estimated to affect 14 to 20 percent of America's young people in any given year. A perfect storm is brewing, exacerbated by a troubled economy, rising unemployment, increasing bankruptcies and home foreclosures, and dwindling funds for programs. Dismal realities affect families and threaten the mental health of our nation's youth.

Passionate exchanges tout the medical benefits and lives saved through the early detection of breast cancer, stroke, and heart disease, while the stigma surrounding mental illness persists. Workplace shootings, familicides, and the overdose deaths and suicides of notable celebrities prompt frequent news coverage, with discourse on prevention and early detection in an everyday setting taking a noticeable backseat. The public interprets the message: the mentally ill aren't safe to be around. As a result, would-be-patients fly below the radar to avoid detection. Without the increased use of prevention strategies that are scientifically proven to work, and a correspondingly swift uptick in early detection efforts and community awareness and education in national media, mental disorders continue to fester like an undetected cancer.

The discussions regarding preventative healthcare are more than politically fueled punditry about dollars and cents. Saving money is important, however, the bottom line should include safeguarding a quality of life. When it comes to mental healthcare, or lack thereof, individuals and their families are hoping for anyone to throw them a lifeline, to live a "normal" life. According to the March 2009 Institute of Medicine (IOM) report brief for policymakers: Preventing Mental, Emotional, and Behavioral Disorders Among Young People, Progress and Possibilities, evidence-based approaches are proving to prevent certain mental health disorders, and limit risk factors, and are likely to be far more cost-effective at addressing mental, emotional, and behavioral disorders (MEBs).

Most MEB disorders erupt during childhood and adolescence. The IOM report suggests that the "window of opportunity" when symptoms first appear, typically 2 to 4 years before the onset of the disorder, is the prime time when prevention strategies have the most impact. Persons with mental health disorders have usually been identified only after they dropped out of school, and shuffled through the criminal justice system, and multiple hospitals, leaving extraordinary healthcare bills in their wake. The Early Detection and Intervention for the Prevention of Psychosis Program, a national effort launched by the Robert Wood Johnson Foundation and spearheaded by program director, William R. McFarlane, MD, estimates the cost to society to be higher than $10 million over the lifespan of a person who has schizophrenia. Most community mental health organizations supports early intervention, before costs escalate and the prospects of a happy, healthy life disintegrate. The ensuing discussions beg the question - just how much is an improved quality of life worth these days?

Community mental health organizations also recognize that the issue reaches beyond the bread and butter aspects of healthcare, and becomes muddled when editorials sound the alarm of diagnosing millions with a disease that requires treatment. An op-ed piece by David Harsanyi in The Denver Post insists that expanding the definition of diseases such as diabetes, high cholesterol, and osteoporosis, has already placed millions more Americans at the swelling healthcare trough. The idea that patients shouldn't be identified for having a disease, or the potential to develop one, is a precarious one, especially for mental health. Sweeping mentally ill patients under the carpet has been going on for years and has hindered even the most ardent efforts of dedicated mental health professionals. Harsanyi is blunt - end of life care is costly, and free will overrides the patient's decision to follow the doctors' advice anyway. Part of the stigma plaguing mental illness is the notion that one can simply "snap out of" depression, or that persons "choose" to be mentally ill.

Chicago Tribune reporter Carla Johnson acknowledges in her article, Disease Prevention Often Costs More than it Saves, that disease prevention won't necessarily save money, but that some efforts to prevent illness are necessary. Johnson quotes Robert Gould, president of the nonprofit Partnership for Prevention, saying that "Many of the services that don't save money, improve people's lives at relatively low cost." A "pro-prevention" piece, More Attacks on Prevention and Its Role in Health Reform That Make No Sense, by Kenneth Thorpe in The Huffington Post, cautions against using "imprecise language" when it comes to policy-making, and strongly supports effective prevention programs that work simply "because they reach the right people at the right places with the right interventions" -  precisely steering back to that "window of opportunity" and the value of a healthy mind and a sound quality of life.

Several community mental health organizations have helped to bring the evidence-based public education program, Mental Health First Aid to the U.S. The program has trained more than 3,000 persons in its first year. Studies show that persons trained in what to do when someone is experiencing a mental health crisis have a greater likelihood of actually helping the person, and show a decrease in attitudes that encourage stigma and misperceptions.

The Early Detection and Intervention for the Prevention of Psychosis Program uses evidence-based interventions that help youths succeed, without stigma, before they experience the negative effects of a fully developed mental illness.

Geoffrey Canada's Harlem Children's Zone, launched in 1970 as a community-based truancy prevention program, has grown to include diverse programs and serve more than 10,000 youth. The proven results - in 2008, nearly all students in third and eighth grade in HCZ charter schools outperformed the average New York student in math.

College Dreams, an alcohol and drug prevention program in Oregon, has saved thousands of youth from school dropout, substance abuse, and delinquency. The program is based on scientific evidence regarding the risk factors for substance abuse and the protective factors that lead to long-term success for children who are beset by multiple and severe life adversities.

The following suggestions serve to increase public awareness and education efforts concerning mental illness, and to also fortify the case for evidence-based research and the use of proven practices regarding prevention and early detection:

Taking charge on a national level: The IOM report recommends that "the White House create an entity to lead toward a broad implementation of evidence-based prevention approaches and to direct research on interventions." Public goals must be set for preventing specific mental disorders and promoting mental health, and funding must be provided to launch and improve evidence-based programs.

Dovetail efforts: Many mental disorders have common developmental pathways. Resources must be aligned between the departments of Education, Justice, and Health and Human Services. The National Institutes of Health should develop a comprehensive 10-year plan to research ways to promote mental health and prevent mental disorders in young people. State and local agencies should coordinate efforts and foster a multi-agency approach to ensure a comprehensive developmental perspective.

Equality in research funding: At present, a great deal of research leans toward treatment. Research needs to move from laboratory settings to real world settings, and must be responsive to community socioeconomic needs, diversities, values, and goals. The IOM report also cautions that funding should not support mental health programs that lack empirical evidence, despite their popularity within communities.

Identifying children with risk factors: Mental health screenings can be a helpful tool if parents and communities are aware of the purposes and methods of screenings, and have the ability to decline if they do not want their children included. But all families can learn to be aware of warning signals for teen depression, for example, and to distinguish between signs of impending psychosis, and teenage angst that falls within the norm of behaviors prompted by the transition from children to teens to young adults.

Speak up: Programs that work need media attention to thrive. Seek out members of the media, distribute press releases, and invite the media and the public to "community education nights" that highlight prevention and early intervention efforts that build strong, healthy communities and improve the quality of life. Society can no longer afford to ignore the risk factors for and the onset of mental illnesses and substance use disorders. Ignoring prevention and early intervention is issuing a personal invitation to cut a young life drastically short.