Toward Enough of the Best for All: Research to Transform the Efficacy, Quality, and Reach of Mental Health Care for Youth

Abstract

The articles in this special journal issue observe the same paradox about mental health services for children and adolescents expressed in this old joke about food. Taken together, they make the case that current mental health care for children and adolescents is of poor quality and questionable effectiveness, and, moreover, is delivered in inadequate doses to a only a fraction of the nation’s youth who need it. In order to address these shortcomings in quality, quantity, and effectiveness, the authors mainly agree to eschew traditional individual-level approaches to addressing mental health problems in favor of a public health approach. A public health approach would target the population, in contrast to individuals, with a range of consistently high-quality services to meet diverse needs and, thus, provide maximum mental health benefit for the greatest number of youth. A public health approach, and the requisite system alterations recommended in this journal, imply that change must occur at all levels, from Federal and State policies to mental health care agencies, treatment providers, and individual interventions. Foster and McCombs-Thornton (2010), for example, would target the economics of mental health care, given that financing and cost help to determine care quality and intensity by informing and influencing decisions about providing and using mental health services. Horwitz et al. (2010) propose policy levers be used to compel child welfare agencies to deliver evidence-based parent training programs. Stelk and Slaton (2010) assert that States must radically strengthen their mental health infrastructures if they are to support and withstand the process of transformational improvement. Kelleher and Atkins (2010) posit that transition from a clinician-patient model to a public health approach will require changes in organizational culture and capacity, including assimilation of new information technologies and accountability systems. Atkins et al. (2010) cite the emerging consensus to incorporate mental health services into schools as renewed motivation to find best models for integrating academic learning with emotional, mental, and behavioral health. Garland et al. (2010) focus on improving usual care and assert that to do so, providers and agencies need readily available feedback on treatment process, outcomes, and implementation of evidence-based strategies. Schoenwald et al. (2010) recommend rethinking of the child mental health workforce and distribution of labor. Taking aim at clinical practice, Alegria et al. (2010) argue that traditional clinical approaches to child mental health too often fail youth from diverse backgrounds by ignoring culture and context. Heflinger and Hinshaw (2010) exhort providers to The views expressed in this commentary do not necessarily represent the views of the NIMH, NIH, HHS, or the United States Government.