Behavioral Health Conference
The Contributions of the IOM
September 29, 2011
Camp LeJeune, NC
Anne Mathews-Younes, Ed.D.
Overview
Infrastructure
Other IOM Reports
What is the IOM?
• Part of the National Academies.
• Private, non-profit organization to provide
policy advice under a congressional charter.
• Charter was signed by Abraham Lincoln in
1863 to advise the US Government on science
and technology matters.
The Importance of Mental Health
From the World Health Organization:
Mental health is an integral component of
one’s overall well-being, playing a role in
whether “the individual realizes his or her
own abilities, can cope with the normal
stresses of life, can work productively and
fruitfully, and is able to make a contribution to
his or her community.”
Why Prevention?
The scientific foundation has been created for
the nation to begin to create a society in
which young people arrive at adulthood with
the skills, interests, assets, and health habits
needed to live healthy, happy, and productive
lives in caring relationships with others.
Where does the U.S. rate?
• Of 17 nations, the U.S. had the highest
lifetime rates of mental illness and the
second highest lifetime prevalence of
substance use disorders.
• Among 29 high-income countries, the U.S.
ranked 24th in the number of disability-free
life years despite having the most expensive
health care system in the world.
Behavioral Health and Academic
Achievement
Mental and emotional health are strongly
Correlated with academic achievement. Among
30 industrializes nations, U.S. ranks:
• 21st in science literacy;
• 25th in mathematics;
• 24th in problem solving.
Behavioral Health and Poverty
Poverty and inequality = risk factors for
behavioral health problems. Among
21 wealthy countries, the U.S. has:
• The second highest poverty rate (surpassed
only by Mexico);
• The most significant level of income and
wealth inequality in the industrialized world.
DAILY DISASTER OF UNPREVENTED AND
UNTREATED M/SUDs
10
Any MI:
45.1 million
SUD:
22.5 million
Diabetes:
25.8 million
Heart Disease:
81.1 million
Hypertension:
74.5 million
37.9 %
receiving
treatment
18.3 %
receiving
treatment
84 %
receiving
treatment
74.6 %
receiving
screenings
70.4%
receiving
treatment
Disorders are Common & Costly
• Around 1 in 5 young people (14-20%) have a
current disorder
• Estimated $247 billion in annual treatment
and productivity costs
• Significant other costs
– education, justice, health care, social welfare
– costs to the individual and family
Cost-effectiveness of Evidence-based
Practices
In 2003 dollars, the average net benefit per child
was:
• $6,000 for home-based interventions for very
young children;
• $10,000 for center-based pre-school
initiatives; and
• Over $10,000 for certain programs for youth
with justice system involvement.
Preventive Opportunities Early in Life
• Early onset:
– 50% of adult disorders had onset by age 14
– 75% by age 24
• First symptoms occur 2-4 years prior to
diagnosable disorder
• There are common risk factors for multiple
problems and disorders
Prevention Window
Source: Costello, Angold, et al., (1996)
Core Concepts of Prevention
•
Prevention requires a paradigm shift
•
Mental health and physical health are inseparable
•
Successful prevention is inherently interdisciplinary
•
Mental, emotional, and behavioral disorders are
developmental
•
Coordinated community level systems are needed
to support young people
•
Developmental perspective is key
Medical vs. Public Health Model
Medical Model
Public Health Model
• Primary - healthy
• Universal – everyone
• Secondary - patient has • Selective – individuals
the disease, by not
or subgroups that are at
symptomatic
risk
• Tertiary – symptoms
• Indicated – treating
have appeared
high-risk individuals
exhibiting signs and
symptoms
Preventive Intervention Opportunities
SOURCE: NRC and IOM, 2009, p. 155. Reprinted with permission from Preventing Mental, Emotional,
and Behavioral Disorders Among Young People: Progress and Possibilities, 2009 by the National
Academy of Sciences, Courtesy of the National Academies Press, Washington, D.C.
18
Prevention at Different Life Stages
•
•
•
•
•
•
•
Prenatal and infancy
Early Childhood
Childhood
Adolescence
Young Adults
Adulthood
Older Adults
Social Ecological Model
20
Risk and
protective
factors (not
“causes”) at
all levels
Individual Factors
RISK
PROTECTIVE
•
•
•
•
•
•
•
•
•
Age/sex
Mental illness
Substance abuse
Loss
Personality traits or
disorders
• Failure/academic
problems
Cultural/religious beliefs
Coping/problem-solving skills
Good peer relationships
Resiliency, self esteem,
direction, mission,
determination, perseverance,
optimism, empathy
• Intellectual competence
(youth)
21
Relationship (Family) Factors
RISK
PROTECTIVE
• Family
dysfunction/conflict
• Family substance
abuse
• Economic difficulties
• Poor parenting skills
• Family cohesion
• Sense of social
support
• Interconnectedness
• Married/parent
• Adequate socioeconomic supports
22
Community Factors
RISK
PROTECTIVE
• Urban setting
• Poverty
• Barriers to health
care and mental
health care
• Witnessing
community violence
• Access to healthcare
and mental health care
• Social support, close
relationships, caring
adults, participation
and bond with school
• School and community
policies that support
engagement and high
quality care
23
Implementation Needed at
Multiple Levels
• Public education
• Policies
• Programs
– Family-based
– School-based
– Community-based
• Principles
– Eliminate or reduce exposure to toxic events
– Reinforce prosocial behaviors and environments
Implementing Evidence-Based Prevention
Practices in Schools
Early aggressive
and disruptive
behavior
ODD, Conduct
Disorder
Adolescent
Substance
abuse
Good Behavior Game: prevention strategy outlined in the IOM.
Outcomes include:
• Less likely to use illicit drugs
• Less likely to have an anti-social personality disorder
• Less like to have suicidal ideation as a youth.
Marine Corps Suicide Prevention Program
• Never Leave a Marine Behind
– Suicide prevention training
– Improves coping skills and resilience
– Encourages help-seeking behavior
– Gives Marines tools to help struggling peers
• DSTRESS counseling phone line
– By-Marine-for-Marine
– 24/7 counseling
– Coping skills training
United States Air Force
Suicide Prevention Program
• Population-oriented approach to reducing the risk of
suicide.
• 11 initiatives aimed at strengthening social support,
promoting social skills, encouraging help-seeking
behaviors.
• Outcomes:
– 33% reduction of risk of committing suicide
– 54% reduction of risk for severe family violence
– 51% reduction of risk for homicide
Program Implementation:
Three General Approaches
• Implement specific evidence-based programs
• Adapt (and evaluate) evidence-based program
to community needs
• Develop and test community-driven models
The Stress Continuum
From Behavioral Health Information Network, USMC: Combat and
Operational Stress First Aid
Adapted from the Institute of Medicine (1994, p 23)
Military Families Strategic
Initiative
• Improve military families’ access to community-based behavioral
health care through coordination among SAMHSA, TRICARE, DoD, and
Veterans Health Administration services.
• Improve the quality of behavioral health prevention, treatment, and
recovery support services by helping providers respond to the needs
within the military family culture.
• Promote the behavioral health of military families with programs and
evidence-based practices that support their resilience and emotional
health and prevent suicide.
• Develop an effective and seamless behavioral health service system
for military families through coordination of policies and resources
across Federal, national, State, Territorial, Tribal, and local
organizations.
Select Other IOM Reports
• The Science of Adolescent Risk-Taking: Workshop
Report (2011)
• Early Childhood Obesity Prevention Policies (2011)
• Adolescent Health Services: Missing Opportunities
(2009)
• Reducing Underage Drinking: A Collective
Responsibility (2004)
• Community Programs to Promote Youth
Development (2002)
• Report available at: http://www.nap.edu
• Report now available as free download
• Four report briefs available: policymakers,
researchers, parents, cost-benefit
• Webcast of 3/25/10 event posted on web
“At first people
refuse to believe
that a strange new thing can be
done, then they begin to hope it
can be done, then they see it can
be done— then it is done and all
the world wonders why it was not
done centuries before.” (Children’s
author Frances Hodgson Burnett
(1849–1924), quoted in McGorry &
Jackson, 1999, p. 466)
Questions?
Anne Mathews-Younes, Ed.D.
Director, Division of Prevention, Traumatic Stress
and Special Programs
240-276-1860
[email protected]
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