Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders (2025) / Chapter Skim
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1 Introduction
1 Introduction
Pages 19-44
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From page 19... ...
Achieving this calls for concerted effort at all levels of government and in community-based multisector partnerships with the objective of creating and sustaining the conditions for infants, children, adolescents and emerging, working, and older adults to experience MEB health and well-being. Throughout this report, "MEB disorders" is used to describe disorders diagnosable using Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V)
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Variable risk factors include but are not limited to income level and adverse childhood experiences. This chapter describes the committee's charge and the committee's approach, explains the urgency for action, outlines the prevention ecosystem, and offers a timeline of the history of prevention for MEB disorders and other important milestones.
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. One recent bright spot has been the decline in 3 The following centers, institutes, and offices supported the study: CDC: National Center for Injury Prevention and Control, Office of the Director; NIH: Division of Program Coordination, Planning, and Strategic Initiatives Office of Disease Prevention, Office of Behavioral and Social Science Research, National Cancer Institute Office of the Director, National Institute for Dental and Craniofacial Research Office of the Director, National Institute of Mental Health Office of the Director, National Institute on Alcohol Abuse and Alcoholism Office of the Director, National Institute on Drug Abuse Office of the Director, National Institute of Nursing Research Division of Extramural Science Programs, National Institute on Minority Health and Health Disparities Office of the Director, National Center for Complementary and Integrative Health Office of the Director; and SAMHSA Center for Substance Abuse Prevention Office of the Director.
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From page 22... ...
Informed by this review, the com mittee will identify the optimal characteristics and components of a sustainable behavioral health prevention infrastructure. For this infrastructure, the committee should consider embedding pre vention services within existing systems and settings, establish ing an independent prevention delivery system to which existing systems and settings can refer individuals and families for the receipt of prevention services, and/or other possible approaches the rate of opioid overdose deaths beginning in the second half of 2022 and continuing into 2024 (NIDA, 2024)
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3. Identify specific research gaps germane to the widespread adop tion of evidence-based behavioral health prevention interventions.
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. Highlighting the Scope of the Problem in Populations that Experience Disproportionate Burdens • Between 2020 and 2021, the age-adjusted rate of drug overdose deaths rose more than 14 percent.
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. Before the need for treatment arises, many other wealthy nations have implemented strategies to promote well-being and prevent MEB disorders.
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Well-being is a more holistic way to consider the outcomes of an effective prevention infrastructure, and the report generally mentions MEB health and well-being as a broad label. In the context of health measurement, well-being is a broad construct (see the World Health Organization definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity of health")
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From page 27... ...
Primordial prevention = interventions that address social conditions and root causes of disorders; primary prevention = interventions to reduce risk factors and promote protective factors to prevent the onset of disease; secondary prevention = interventions that identify disease before it is symptomatic to treat early and reduce severity; tertiary prevention = interventions to prevent significant adverse consequences once a disease has been established. 6 In addition to MEB health investments, evidence-based prevention programs to increase physical activity, prevent smoking, and improve nutrition can yield $5.60 in savings on every $1 spent (TFA, 2008)
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. The Indian Health Service Division of Behavioral Health includes a focus on primary prevention of MEB disorders.
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; CDC; research entities in other federal government departments Academic institutions Other evidence-based intervention developers Practice-based research networks and partnerships Knowledge SAMHSA-funded Prevention Technology Transfer Centers translation, NIH Clinical and Translational Service Awards program and AHRQ technical Healthcare Extension Service assistance for service delivery CDC-funded Prevention Research Centers Bi-regional centers supported by SAMHSA Center for Mental Health: Dissemination, Implementation, and Sustainment Other training and technical assistance providers Community health centers Clearinghouses continued
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From page 30... ...
. The history of the field reflects broader tensions between the biomedical and population health paradigms and between pathologizing approaches focused on the individual compared with a broad focus on social and environmental factors that shape risk for and protection from MEB disorders (Acolin and Fishman, 2023)
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, and National Advisory Mental Health Council 1949 NIMH opens 1952 First Diagnostic and Statistical Manual of Mental Disorders (DSM-I) published 1963 Community Mental Health Act enacted 1965 First Neighborhood Health Centers launched Medicare and Medicaid Act enacted 1966 National Center for Prevention and Control of Alcoholism, and Center for Studies of Narcotic Addiction and Drug Abuse launched 1968 NIMH reorganized, with a focus on service delivery 1970 National Institute on Alcohol Abuse and Alcoholism (NIAAA)
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disorders" or "MEB health," the committee noted the use of the phrase "behavioral health disorders" in the statement of task, sponsors' remarks to the committee at the first meeting, and context provided by related National Academies reports that provide detailed reviews of the evidence base of interventions (NASEM, 2019; NRC and IOM, 2009)
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. The committee offers a blueprint to implement and sustain prevention of MEB disorders in the United States.
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IS offers frameworks and approaches that can be used to support sustaining delivery of the intervention as intended and adapting it intentionally and rigorously in response to community and population need. Second, achieving health equity -- "the state in which everyone has a fair opportunity to attain full health potential and well-being, and no one is disadvantaged from doing so because of social position or any other socially defined circumstance" -- is a key objective of the infrastructure to prevent MEB disorders and promote
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This report describes the components needed to successfully support the implementation of approaches to prevent MEB disorders and promote MEB health on a national scale. Boxes in each chapter highlight (1)
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36 PREVENTION INFRASTRUCTURE FOR MEB DISORDERS Early Health Care Education Public Health Childhood Behavioral Human Services Criminal Legal Other Systems Health EXISTING SYSTEMS Governance Funding Evidence Data GUIDING PRINCIPLES Health Equity (including attention to cultural context and communication) Implementation Prevention Science Workforce Strengthen protective factors Reduce risk factors MEB Health & Wellbeing FIGURE 1-1 A depiction of the prevention infrastructure for MEB disorders.
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From page 37... ...
the guiding principles that should permeate it. The interlocking gears represent how each element is complementary and critical to the others: governance and partnerships at federal, state, local, and tribal levels; sustained funding; supportive data systems; a constantly evolving evidence base; and a competent, supported workforce comprise a flexible and responsive infrastructure to prevent MEB disorders.
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From page 38... ...
The evidence base must reflect the communities to whom interventions are being delivered and must determine whose voices, perspectives, and contributions shape or lead these decisions. The charge to the committee underscores the lack of uptake of proven prevention interventions, and that, the committee shows, is fundamentally an implementation issue -- having to do with adequate, sustained funding; reliable dissemination of the evidence base with feedback loops to update it and fill gaps; data access, collection, and use to inform decision making and implementation; a well-trained and fairly compensated workforce with opportunities for growth; and a structure of oversight and leadership -- governance -- that is well coordinated, integrates MH and SUD functions and organizations, and engages community voice and lived expertise.
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From page 39... ...
As noted, this report emphasizes health equity ("the state in which everyone has a fair opportunity to attain their full potential for health and well-being and no one is disadvantaged from doing so because of social position or other socially defined circumstances" [NASEM, 2023]
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There are many tools to help support this assessment, such as a pragmatic context assessment tool (see pCAT12)
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Finally, Chapter 7 offers a brief overview of the social, economic, and environmental policies that create the conditions for primordial prevention of MEB health and population well-being. REFERENCES Abramson, B., J
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n.d. Mental and behavioral health– American Indians/Alaska Natives.
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2024. Expanding behavioral health care workforce participation in Medicare, Med icaid, and marketplace plans.
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2024. International Comparisons & International Health, presented to the Committee on Blueprint for a National Prevention Infrastructure for Behavioral Health Disorders, Meeting 3.
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