The Institute of Medicine’s 2009 report, Preventing Mental, Emotional, and Behavioral Disorders among Young People: Progress and Possibilities, documents that an increasing number of mental, emotional, and behavioral problems in young people are in fact preventable. The report calls for the establishment of new national priorities that emphasize the prevention of mental, emotional, and behavioral disorders and promotion of behavioral health as a national priority; the infusion of evidence-based interventions in a range of family, school and community settings; and the expansion of the existing research base. The report’s conclusions are very well aligned with the goals and strategies called for in the Affordable Care Act, highlighting the critical need for a more proactive, preventive focus on mental, emotional, and behavioral health. Unfortunately, neither the general public nor even the State, Community, and Tribal leaders charged with behavioral health promotion, prevention, and service delivery seem to be aware of the key messages the report outlines or the appropriate steps to take to implement its recommendations. There is an urgent need to broaden awareness of this report and support state and local leaders in developing well considered strategies to implement its recommendations. My presentation addressed many issues raised at the SAMSHA meeting

1. Taking behavioral health
promotion to national scale
SAMSHA, December 9, 2010
Dennis D. Embry, Ph.D.
senior scientist/president
PAXIS Institute
Thursday, December 9, 2010 1

2. Key messages…
Break-even for MEB MEB
MEB’s are MEB prevention prevention
preventable. prevention is balances gov’t improves US
one year. budgets. business.
Effective MEB MEB MEB prevention MEB
prevention prevention saves Social prevention
helps national helps US global Security & heals past
security. success. Medicare. inequities.
Thursday, December 9, 2010 2

3. Key message by showing dollar benefits
Use
personalized
business
models to
communicate to
cost-efficiency
and benefits.
Show short-
term benefits
Allow decision
makers and
advocates to
adjust cost
savings to their
location.
Thursday, December 9, 2010 3

4. Key message by showing dollar benefits
Show long-term
benefits, too
Thursday, December 9, 2010 4

5. Key message by showing dollar benefits
Allow people to see benefits
of universal access versus
rationing of prevention
Show multiple
outcomes to unite
stakeholders
Show costs of
doing nothing
Show break-even point
and ROI over short,
medium and long term
Thursday, December 9, 2010 5

6. Key message by showing clear visual results
30%
Why not help
Percentage with Psychosis at 12 months
27.5%
our serious 24%
at-risk 18%
This cost
$12 to
children with 12%
achieve
omega-3 to
prevent 6%
4.9%
psychosis? 0%
Amminger, G. P., M. R. Schafer, et al. (2010).
Omega-3 Placeo "Long-Chain {omega}-3 Fatty Acids for
See p.214, IOM Report Psychosis Indicated Prevention of Psychotic Disorders: A
Randomized, Placebo-Controlled Trial." Arch
Gen Psychiatry 67(2): 146-154.
Thursday, December 9, 2010 6

7. Reaching the faithful
๏ Tell stories of how faith-based groups can use
IOM cited prevention strategies
๏ Pastor Smith uses Triple P to counsel his
parishioners having common problems with their
children. “It’s very easy for me to relate Triple P
strategies to Scripture.”
๏ St. John’s uses the Good Behavior Game. “The
Game helps us not only with behavior and
academics, but also helping students understand
how early Christians had to cooperate.”
Thursday, December 9, 2010 7

8. Reaching businesses
๏ Give examples of immediate benefits to
productivity. “Having workplace Triple P has
reduced our employees having to take time off
for dealing with problems of their children.”
๏ Link business competition. “Other rich
democracies have extensive universal
prevention, and those countries have more
viable small business sector than the US.”
๏ Link to major cost of business, such as
depression is now major cause of disability.
Thursday, December 9, 2010 8

9. Reaching the
First Peoples
๏ Link key cultural wisdom to proven
science of prevention, such as:
๏ the use of omega-3 sources by virtually First
Peoples—and discovered by the Arctic
peoples
๏ the Good Behavior Game mimics common
traditional practices of assuring cooperation
among children
Thursday, December 9, 2010 9

10. Reaching the right
๏ Universal access enables individual
responsibility; rationing limits it.
๏ Link to accepted prevention practices like
universal inoculations of childhood diseases or
access to car safety seats.
๏ Link to balancing budgets, national security
and global competition.
Thursday, December 9, 2010 10

11. CEPR An International Comparison of Small Business Employment !"8
Key message by showing global competion
!"#$%&'!(%$)*#+)#,%-''#$)*$.&.+,$,#/0123#&$.4$)*5#-%!)6#*7$#18#4!9)*.+$,#"!.#:7+47#*7$#;<=>#7-,#
+)*$.)-*+!)-''(#4!%&-.-?'$#@-*-2##
#
FIGURE 3
Manufacturing, Employment in Enterprises with fewer than 500 Employees, 2001
LE7/BA4< )!#% All of these other rich
F/4<9 )'#%
democracies have nearly
3K4.- )$#(
J4K4- &+#)
universal access to prevention for
G0/I07<4-15 &%#" MEBs, compared to the rationing
6700=0 &!#" model in the US.
G0:2H04<4-1 &'#+
GE7:49 &$#$
Having “fitter” employees allows
F70<4-1 &"#'
CB5/7.4 &*#+
these countries to have higher
,-./012D.-A1E8 %&#( paying manufacturing jobs and
CB5/74<.4 %!#) compete globally.
@0<A.B8 %!#(
>0-847? %!
;74-=0 %'#&
;.-<4-1 !&#!
3:010- !%#&
60784-9 !%#%
,-./0123/4/05 !"#$
* $! !* &! "**
!"#$"%&'()'*+%,)+$&,#-%.'"*/0(1*"%&
Source: Authors’ analysis of OECD data.
Thursday, December 9, #
2010 11

12. Nearly 75 percent of the nation's 17- to 24-year-olds are
ineligible for service
• Medical/physical problems, 35
percent.
• Illegal drug use, 18 percent.
• Mental Category V (the lowest 10
percent of the population), 9
percent.
• Too many dependents under age
18, 6 percent.
• Criminal record, 5 percent.
Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd
Thursday, December 9, 2010 12

13. Reaching to the left
๏ Link prevention to remedying historic
disparities such as:
๏ Good Behavior Game increases high-school
graduation and college entry rates and reduces
lifetime incarceration rates of inner city kids.
๏ Will help with maintaining Social Security, Medicare
and Medicaid
Thursday, December 9, 2010 13

14. Key message by showing age dependencies
Requiring more wealth transfer
5-Year 65-Year
Olds But elders voting to stop funds to kids Olds
Who are living
Who are less
longer though get
and less able…
progressively sicker…
Thursday, December 9, 2010 14

15. Reaching to the center
๏ Emphasize that MEB’s affect every family,
every school, every neighborhood, and every
business.
๏ Example: “How many of you know a
reasonably OK middle class or upper class
family with a child or teen with a mental illness,
learning disability or addictions problem?”
Thursday, December 9, 2010 15

16. Reaching state legislators,
county & city leaders
๏ Show how prevention for everyone will help
balance the local budget and keep it balanced
over time.
๏ Show data how universal access to prevention
will help the jurisdiction specifically
๏ Share such data with advocates for local
emotional impact
Thursday, December 9, 2010 16

17. Promote existing prevention sustainability mechanisms
Existing laws and policies have
been and can be used prevent
MEB’s using featured IOM
strategies such as Triple P for
parents, Good Behavior Game for
teachers, and omega-3 for
children to adults.
Thursday, December 9, 2010 17

18. Key message for every sector
“Mental illness is preventable,
just like many childhood diseases,
tra c injuries or even addictions
are preventable.”
In every communication say…
๏ Mental, emotional and behavioral disorders are
preventable like most childhood diseases and
childhood injuries.
๏ MEB’s harm and kill more children, youth and
“Yes, it is preventable.
Read all about it,
in the ‘09 IOM Report
young adults than any childhood diseases, and on the Prevention of
Mental, Emotional, &
Behavioral Disorders.
the prevention of MEB’s is less expensive than We’ve been conditioned
to think these were
just manageable…”
childhood medical vaccines. O'Connell, M. E., T. Boat, et al., Eds. (2009). Preventing Mental,
Emotional, and Behavioral Disorders Among Young People:
Progress and Possibilities. . Committee on the Prevention of Mental
Disorders and Substance Abuse Among Children, Youth and Young
Adults: Research Advances and Promising Interventions.
Washington, DC, Institute of Medicine; National Research Council.
TO READ THE IOM REPORT, GO TO: http://bit.ly/IOMPREV
Thursday, December 9, 2010 18

19. My perspective
Full disclosure as a prevention scientist and advocate
Born premature, exposed Parents hospitalized for
Gay man in
to alcohol & tobacco and diagnosed mental illness and
20-year relationship
Descendent of a freed slave educably mentally retarded die of addictions
Thursday, December 9, 2010 19

20. thank you
If not not now, when…
If not us, who…
Thursday, December 9, 2010 20