Expanding the Toolkit or Changing the Paradigm

Abstract

Kazdin and Blase aptly describe the enormous mental health burden facing our nation and suggest several ways to reform the workforce, setting, and content of services to address this long-standing unmet need. We propose that current health care reform legislation and associated advances in service delivery provide a unique and timely opportunity for a paradigm shift in mental health research, practice, and training to support services that are comprehensive, readily accessible, and relevant to a broad range of mental health needs and capacities. Using the recent public health initiative to contain the H1N1 virus for comparison, and informed by a long-standing and extensive literature documenting the need for a public health model for mental health, we describe the rationale for a three-tiered public mental health model, illustrated with examples from ongoing research, to minimize universal risk for mental health difficulties via capacity building in natural settings; reduce onset and severity of symptoms by prioritizing high-risk groups via screening and services for targeted populations; and reduce psychiatric impairment among individuals with more intensive needs via individual, family, and group interventions. New priorities for clinical science to support a public health approach are proposed.