(Note: Tony and I wrote this)
In March 2009, the U.S. Institute of Medicine (IOM) and the National Academy of Sciences announced that mental, emotional, and behavioral disorders (MEB’s) among young people were preventable because of powerful, replicated science largely funded by various National Institutes of Health . Not every case can be prevented, but enough can to have profound impact on American children, youth, families, communities, plus the nation’s health, wellbeing and economy. Most of the strategies the IOM committee reviewed have been shown by randomized-controlled trials and long term following up to prevent multiple problems for periods as long as 20 years. Most have proven cost-effective, saving far more money than it costs to implement them.
Presently other countries (e.g., Northern European or Lowland European Countries, Canada, Australia, Ireland) and their political sub-divisions are pursuing population-level protection of their future generations using science from the United States. A few U.S. states or counties are beginning to apply this science to scale: Ohio, Oregon, Oklahoma, and Washington. The Substance Abuse Mental Health Services Administration (SAMHSA) has demonstrated that many of these scientific prevention strategies can be used in communities with practical, measurable impact.
The large body of evidence on the impact of prevention is reminiscent of the discovery of the Salk vaccine to prevent polio . An initially favorable test of the vaccine triggered the massive population-level prevention study of 650,000 American children in 15,000 public schools in 44 of the 48 states That study proved that actual cases polio could be averted in the entire population [3, 4]. After that, public and private entities mobilized to assure that virtually every child was protected in the U.S., by either the Salk or Sabin vaccine. Polio cases were virtually non-existent by 1963. And the investment saved three dollars for every dollar spent on the vaccine.
There are twenty to forty times more cases of mental, emotional, and behavioral disorders (MEBs) now than there were of polio, and now MEBs contribute to as many as twelve to twenty times more deaths. Thus, now is the time for the United States to protect its future generations through a similar mobilization of society to implement tested and effective prevention strategies for mental, emotional, and behavioral disorders. We can significantly improve health and academic outcomes, at the same time that we prevent all manner of costly, interrelated problems such as delinquency, drug abuse, risky sexual behavior, depression, suicide, and obesity. Indeed the next generation of Americans can be the best educated, most productive, and most caring that we have ever seen.
Proposed Actions to Mobilize America
- Former Surgeon Generals hold National Press Club event featuring this U.S. prevention science, featuring some of the best strategies, respective scientists and the original NIH/CDC programs that can be scaled up for population-level protection. (See example members of the IOM panel on 2nd page).
- A social marketing campaign is launched. It targets private and public sector stakeholders who have a lot to gain from rapid prevention of mental, emotional, and behavioral disorders. It also informs the general public about the ways in which we can prevent most problems.
- Like the mobilization to test the Salk vaccine, public and private sector organizations announce a coalition to fund a population level study to, prevent MEB’s in 50 congressional districts in the U.S. The communities would agree to mobilize around and implement a small portfolio of scientifically proven preventive strategies for school, home, and community that have demonstrated ability to be scaled up for population-level prevention or protection and have solid evidence of a favorable return on investment.
- A scientific team is assembled to study the short-term and longer-term effects across these 50 sites, using a high-quality design with appropriate statistical controls (e.g., randomized waitlist control, hierarchical linear modeling, etc.).
- The 50 District sites (out of 435 Congressional Districts) are selected on the basis of competitive application, with relevant commitments from all stakeholders enunciated in the RFA. Using Congressional Districts provides reasonable population equivalence, and similar nested political structures.
- O’Connell ME, Boat T, Warner KE (eds.): Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: Institute of Medicine; National Research Council; 2009.
IOM Committee On The Prevention Of Mental Disorders And Substance Abuse Among Children, Youth, And Young Adults: Research Advances And Promising Interventions
- Kenneth E. Warner (Chair), School Of Public Health, University Of Michigan
- Thomas F. Boat (Vice Chair), Cincinnati Children’s Hospital Medical Center
- William R. Beardslee, Department Of Psychiatry, Children’s Hospital, Boston
- Carl C. Bell, University Of Illinois At Chicago And Community Mental Health Council
- Anthony Biglan, Center On Early Adolescence, Oregon Research Institute
- C. Hendricks Brown, College Of Public Health, University Of South Florida
- E. Jane Costello, Department Of Psychiatry And Behavioral Sciences, Duke University Medical Center
- Teresa D. Lafromboise, School Of Education, Stanford University Ricardo F. Muñoz, Department Of Psychiatry, University Of California, San Francisco
- Peter J. Pecora, Casey Family Programs And School Of Social Work, University Of Washington
- Bradley S. Peterson, Pediatric Neuropsychiatry, Columbia University
- Linda A. Randolph, Developing Families Center, Washington, Dc
- Irwin Sandler, Prevention Research Center, Arizona State University
- Salk JE, Bazeley PL, Bennett BL, Krech U, Lewis LJ, Ward EN, Youngner JS: Studies in human subjects on active immunization against poliomyelitis. II. A practical means for inducing and maintaining antibody formation.American journal of public health and the nation’s health 1954, 44(8):994-1009.
- Francis T, Jr., Korns RF, Voight RB, Boisen M, Hemphill FM, Napier JA, Tolchinsky E: An evaluation of the 1954 poliomyelitis vaccine trials. American journal of public health and the nation’s health 1955, 45(5 Pt 2):1-63.
- Monto AS: Francis Field Trial of Inactivated Poliomyelitis Vaccine: Background and Lessons for Today.Epidemiologic Reviews 1999, 21(1):7-23.
Note: essays at www.nurturingenvironments.org and other scientific papers expand on the 2009 IOM report, regarding the practicality and organizational issues of conducting a national campaign to implement the findings of that report. Specific papers include:
- Wilson, D. S., Hayes, S. C., Biglan, A., & Embry, D. D. (2014). Evolving the Future: Toward a Science of Intentional Change. Brain and Behavioral Sciences, in press.
- Biglan, A., Flay, B. R., Embry, D. D., & Sandler, I. N. (2012). The critical role of nurturing environments for promoting human well-being. American Psychologist, 67(4), 257-271. doi: 10.1037/a0026796
- Embry, D. D., Lipsey, M., Moore, K. A., & McCallum, D. F. (2013). Best Intentions are Not Enough: Techniques for Using Research and Data to Develop New Evidence-Informed Prevention Programs. Emphasizing Evidence-Based Programs for Children and Youth: An Examination of Policy Issues and Practice Dilemmas Across Federal Initiatives., 26. Retrieved from Research Brief website:http://aspe.hhs.gov/hsp/13/KeyIssuesforChildrenYouth/BestIntentions/rb_bestintentions.cfm
- Biglan, A., & Embry, D. D. (2013). A Framework for Intentional Cultural Change. Journal of Contextual Behavioral Science, 2(3-4).
- See entire issue of Psychiatric Clinics of North America, Prevention In Mental Health: Lifespan Perspective. Number 34 (March), 2012.