Samples and Systems: Finding the Fit to Improve Care for Adolescent Depression

Abstract

The papers in this special issue wrestle with two similar but separable questions—how can we best improve youth mental health, and how can we better the youth mental health system? Both questions are of high consequence. The mental health needs of the nation’s (and the world’s) youth are well-documented and dire. In the United States, we have developed an elaborate and expensive set of institutions devoted to providing mental health services to address these needs, although serious questions have been raised about the effectiveness of these services in reducing psychiatric disorder and improving youth functioning. Thus, it would be eminently rational to link these queries— improving youth mental health rightly ought to involve improving the youth mental health system. However, despite the logic of this prescription, we find ourselves sympathetic to the ‘‘separatist’’ view of these questions, as expressed across this special issue. This is due, in part, to the impact systems have on defining samples. Characteristics of systems influence who seeks and receives care in particular settings, and the characteristics of youth and families further shape the needs and missions of these