When the Substance Abuse and Mental Health Services Administration (SAMHSA) commissioned this report in 2007, a major aim was to consider how far prevention science has come since the publication of the National Academy of Sciences/Institute of Medicine’s original report on preventing mental illness, published in 1994.

The earlier publication was an NAS best-seller for many years. It introduced many people to some basic public health principles, such as the differences between universal, targeted, and indicated prevention. This was particularly valuable in the United States, where public health medicine is under-developed and there are few medical education programs. 

The new report confines itself to young people aged up to 25 years, which makes a lot of sense, given the committee’s interest in mental, emotional, and behavioral disorders. There is growing evidence that MEBDs, to use the report’s shorthand, have their onset before adulthood. 

In other ways, the 2009 publication has expanded the scope of its predecessor. A serious attempt has been made to estimate both the scale of the problem of mental, emotional, and behavioral disorders in young people and the financial cost to society.

The new report includes chapters on the neuroscience of prevention, about which far less was known in 1994. We know more about the genetic origins of MEBDs, and about how the brain works. This is throwing up new preventative potential. 

The committee concluded that wellness promotion cannot be separated from illness prevention, which widens the kinds of interventions covered in the report.

From my perspective, the most important change is the detailed attention paid to the quality prevention programs, meaning their effectiveness as well as their efficacy. Since 1994 a whole world of prevention science has come into being, and our grasp of the technology of prevention has strengthened considerably. So compared with the earlier report, we have been able to be more confident and far-reaching in our recommendations.

What was it like being a member of the committee? To begin with, it was a bit like first day in high school: lots of old friends, and some new ones; nervousness about the size of the task, and how we could make it manageable; increasing confidence as the group got to know one-another better and we could see how we could divide up the job into manageable chunks.

Our respect for and confidence in the wonderful National Academy of Sciences staff grew day by day. They looked after us like den mothers, though were not above turning into strict teachers when we needed a bit of discipline. Their vast experience of turning out this kind of report enabled them to reassure us, when we began to panic.

They reassured us that the task was indeed doable and that the report would come out on time; so long as we were all diligent and did our homework…

The timing of the report’s publication is extraordinarily fortunate, coinciding with a new administration that is committed to the reform of health care in the United States. Now the work in in the public domain our next task is to ensure, by all means, professional and political, that proper attention is paid to prevention and that the proposed reforms are implemented.

E Jane Costello

• Jane Costello was one of 13 members of the committee who prepared the National Academies report under the chair of Kenneth Warner from the University of Michigan. The committee met five times between May 2007 and March 2008, supported by four members of staff from the National Academy of Sciences.

See: National Research Council and Institute of Medicine of the National Academies, Preventing Mental, Emotional and Behavioral Disorders Among Young People, The National Academies Press, Washington, DC, 2009 and Institute of Medicine, Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research, The National Academies Press, Washington, DC, 1994.