Moving Toward a Preventative Approach to Youth Mental Health

Responsive intervention is currently prioritized over prevention in mental health care. How can the field move toward prevention?

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A variety of mental health disorders are increasing in prevalence despite parallel growth in behavioral and pharmacological intervention initiatives. In a recent piece published in Child and Adolescent Mental Health, psychiatric epidemiologists Jonathan Ormel and Michael VonKorff outline a case supporting prevention as an alternative to the current orientation to mental health support. They outline multiple barriers and opportunities in the movement towards widespread adoption of preventative programming to reduce the occurrence of mental distress.

“Although expenditures on mental health care and drug therapy have increased dramatically in recent decades, expanding treatment rates for [Common Mental Disorder]s, the point-prevalence of [Common Mental Disorder]s has not decreased,” they write. “It has been rather stable since the 1980s and even on the rise in youth since roughly 2010.”

Ormel and VonKorff use Common Mental Disorders (CMDs) in reference to depression and anxiety disorders – also sometimes categorized as mood disorders or internalizing disorders. Often CMDs have roots in youth and extend well into adulthood with potential diverse, detrimental effects on wellbeing (e.g., compromised productivity, family instability, and substance abuse).

Specific findings vary across studies and frameworks of inquiry, but according to one recent study, depression, serious psychological distress, and suicide attempts have risen substantially since the turn of the century.

The authors emphasize that many intervention techniques currently available to relieve CMDs miss the mark. Tension exists between some orientations to intervention harbored by mental health professionals, and issues of access and effectiveness continue to compromise the impact of existing supports. An increasing appreciation for social determinants of distress combined with a lack of evidence for some individualized interventions has created momentum towards a broad shift in perspective favoring prevention over intervention. But we’re not there yet.

According to Ormel and VonKorff, the effects of prevention-aimed CMD initiatives documented to-date are limited by the populations with whom they’ve been sampled (not necessarily those at highest risk nor in greatest need of access to supports), and an absence of evidence for long-term effects. It may not be possible to demonstrate substantial and long-term effects without changes to major social institutions. Limited existing evidence does not minimize the potential preventative programming to propel substantive outcomes, however. According to the authors:

“[…] giving prevention a chance to prove its promise will require: (a) full embedment in social institutions; (b) long-term structural funding; (c) targeting major CMD determinants early in life combining population-level and individual-level strategies; and, (d) integrated evaluation of short-term and long-term effects to guide implementation.”

A major obstruction to quality implementation and preventative programming assessment is that considerable resources may be required to support high-quality programming. Organizations capable of large investments may not be compelled to contribute in the absence of high-quality evidence. The authors suggest that major changes would thus have to be prompted by major philosophical changes in political and social-psychological systems.

“There is growing societal consensus that increased investments in child development are needed to ensure the success of future generations in adolescence and adulthood and to reduce the growing burden of common mental disorders over the life span. But the costs of such investments and the uncertainties of where and how to make these investments in children, families, schools, and communities holds back concerted action. While promising, the challenge to achieve institutional change is formidable.”

The sheer upscaling of program development and evaluation procedures needed to provide impactful CMD preventative supports may be daunting and challenging to initiate without a boost in policymaker buy-in. Ormel and VonKorff note that although there seems to be a growing consensus that there are measurable, lifelong benefits to early education and attention to child development, the case for embracing preventative efforts for youth and families may be more complex.

Faith in the potential for prevention and adjustment in philosophy will be critical to change before robust data can fully support such change. Although unknowns remain concerning the possible influence of widespread prevention initiatives, change is indicated based on the reality that “[w]e currently invest 10%–18% of the gross domestic product in health care services that are not achieving hoped-for benefits.”

 

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Ormel, J., & Vonkorff, M. (2021). Debate: Giving prevention a chance to prove its worth in lowering common mental disorder prevalence: how long will it take? Child and Adolescent Mental Health. https://doi.org/10.1111/camh.12445 (Link)

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Sadie Cathcart
MIA Research News Team: Sadie Cathcart is a doctoral student and researcher within the Counseling and School Psychology program at the University of Massachusetts, Boston. Sadie belongs to the school psychology track, and her research interests include the psychosocial implications of chronic illness in childhood, relationships between health and educational opportunities, and creative approaches to boosting student and family engagement in learning.

13 COMMENTS

  1. Advertising “mental health” has had many benefits for therapists, school counselors and psychiatry. When unbelievable stressors overwhelm kids and young adults which causes them to look inward since the feelings are coming from themselves, makes them question themselves. Not for a minute does a young brain think that the “anxiety” actually just found itself a host. Not for a minute does the person experiencing the bewilderment realize that many people or systems are part of the expression. So it works perfectly for the “mental health” industry which includes teachers, classmates, family and friends.
    And always, to focus on someone, keeps the focus away from ourselves.

    the word “empowerment” which the industry throws around like plastic water bottles, is the last thing that is actually taught to those who seek out “mental health care”. Because a responsible therapist or shrink will look at the whole landscape and encourage the youngster to not think of themselves as being “mentally unwell”, despite the “feelings”.

    People might not think it’s possible in case of some “nasty” thoughts or feelings, and yes it is. Empowering people is the best thing one could possibly try first and with passionate belief in people, amazing things can happen.
    So far that word “empowerment” is mostly empowering for the “treatment teams”. And we have seen how damaging this has been to millions of youngsters.

  2. I am glad there are a few people still capable of reporting on such research without resorting to satire! I know I couldn’t!

    For some reason I get this image of someone chasing a horse to rescue the rider when the rider, long ago, already fell off.

    If they can’t treat distressing episodes successfully, why should we expect them to be able to prevent them? It goes without saying that “an ounce of prevention is worth a pound of cure.” But when you don’t have a clue, then it won’t matter how much “prevention” or “cure” you pile up, the problem will never go away.

    I wish these learned people would stop acting so helpless and start pushing the envelope a little harder. Better answers exist in this world. Who cares if you lose your job advocating for them? You’re probably better off without a job like that.

  3. Most mental illnesses are preventable but only if you know what to look for. Some kids have allergies because their histamine level is too high. They’re reacting to all kinds of things: food, chemicals in their food or in the air they breathe in, pollens, etc. How many parents are aware that their child’s histamine level can go even higher and that it will likely result in depression, even serious depression leading to suicide? I didn’t know that until my allergic-y son became seriously depressed. Are parents ever taught that if one’s histamine level goes even higher that it can cause psychosis? I didn’t know that either until it happened to my son. The idiot psychiatrists simply diagnosed him as “incurably mentally ill” with “bipolar with psychosis” and prescribed three daily antipsychotics for him. They told me I was “in denial” because I wouldn’t accept their stupid “diagnosis.” I had a lab test ordered which showed my son’s histamine level to be almost double the upper limit of normal. So I gave him the “nutraceuticals” to lower his histamine level and taper him off all three antipsychotic drugs. He’s been well for years AND STAYS WELL by keeping his histamine level in the right range. And that’s just ONE cause of mental illness. Scientists who aren’t employed by drug companies know most causes of mental illness and how to cure them. So do I. It’s easy to learn. I’m a retired high school teacher and if I can figure out how to cure people, you’d think a psychiatrist could. But they don’t because they’re all too stupid. They just want to prescribe synthetic drugs like the good little drug pushers they are. All students and their parents should be taught the basics of orthomolecular (“nutritional medicine”) treatment. –Linda from Facebook, “A Dose of Sanity”

  4. “The authors emphasize that many intervention techniques currently available to relieve CMDs miss the mark. Tension exists between some orientations to intervention harbored by mental health professionals, and issues of access and effectiveness continue to compromise the impact of existing supports.”

    This is impressive double-speak! To say that an intervention “misses the mark?” Doesn’t that mean that we are spending money and time and energy on things that DO NOT WORK? If an engineer “misses the mark,” his bridge falls down and he gets fired! And tension between “some orientations” and “effectiveness” seems another way of saying that practitioners continue to insist on using interventions that DO NOT WORK!

    Sounds like job protectionism for the incompetent to me!

  5. Since covering up child abuse, largely for the religions and wealthy, is the number one actual societal function of both the psychological and psychiatric professions. Which has turned the leaders of my former religion into child abuse cover uppers, too.

    https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
    https://www.madinamerica.com/2016/04/heal-for-life/
    https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

    I’m quite certain that getting the police to arrest the child molesters and traffickers, and getting the psychological, psychiatric, and other DSM “bible” thumping industries out of the business of aiding, abetting, and empowering wealthy pedophiles, would be a good way to help prevent harm to children.

    • In the U.S. there is no law that requires psychiatrists to actually cure patients. All psychiatrists who are members of the American Psychiatric Association have to treat their patients however the APA tells them to. Sadly, the leaders of the APA have been fighting an integrative, restorative approach for about 60 years called “orthomolecular medicine.” There are only puny little profits to be made from curing patients. The big profits are to be found by turning each and every patient into a lifelong customer of psychiatric goods (drugs) and services (talk therapy). It bears repeating that a psychiatrist could treat his patients with voodoo and he wouldn’t even be breaking the law because there is no law to break. We could talk to our lawmakers until we’re blue in the face but they’re never going to introduce a law requiring integrative, restorative treatment. They’d be giving up any campaign contributions from Big Pharma for sure. No lawmakers would take that chance and risk not being re-elected! So if you want to avoid politics and simply get well, I suggest you consider using orthomolecular care. Homeopathy also can work miracles. I’ve seen it happen in my own family when one relative’s psychosis disappeared in about 10 minutes with the right homeopathic remedy.

  6. Many years ago in the city where I lived some agency sponsored an event entitled “Run For Mental Health” — one of those deals where someone sponsors you and pledges x amount for each mile you run. Anyway we printed up our own leaflets with a similar look saying “Run FROM Mental Health,” with some sort of appropriate AP info inside. I found a copy recently. Anyway this reminded me of that, with the phrase “preventative approach to youth mental health,” as what is considered “mental health,” such as unquestioning adherence to prevailing social attitudes and assumptions, should definitely be prevented, if we can. 🙂

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