Family Physicians Can Help Prevent Mental, Emotional Disorders in Young People

Family physicians and other primary care physicians can play a role in preventing mental, emotional and behavioral disorders in young people. In fact, primary care physicians and U.S. schools should become partners in first-line prevention efforts, according to the authors of a recent report from the National Research Council, or NRC, and the Institute of Medicine, or IOM.

"Primary care and the schools are two places that touch all the children," said Thomas Boat, M.D., vice chair of the NRC/IOM Board on Children, Youth and Families' Committee on Mental Disorders and Substance Abuse Among Children, Youth and Young Adults, which produced the report.

Boat, who also is executive associate dean for clinical affairs at the University of Cincinnati College of Medicine, spoke during a March 25 public meeting in Washington to announce findings from the report, "Preventing Mental, Emotional and Behavioral Disorders Among Young People: Progress and Possibilities." The report calls on the federal government to make prevention of these disorders a national priority and to fund systems to promote mental health and deliver prevention programs in states, counties and local communities.

According to the report, 14 percent to 20 percent of young people -- defined as children, adolescents and adults 25 or younger -- have one or more mental, emotional or behavioral disorders at any one time. Such disorders include depression, anxiety and conduct disorder, as well as substance use disorders.

In fact, the report says, these disorders "should be considered as commonplace as a fractured limb" in children and adolescents. In conjunction with problems such as antisocial or aggressive behaviors and violence, they take an enormous toll on the well-being of young people and their families and cost the United States an estimated $247 billion a year in quantifiable costs.

A window of opportunity for targeting prevention efforts in these teens exists, the report says, because the onset of symptoms precedes development of full-blown disorders by several years. This window allows alert caregivers, school officials and family members to note these symptoms and get the affected teen help.

Prevention systems should involve individuals, families and, particularly, primary health care providers, said speakers at the public briefing. In addition, any prevention activities at the federal level also must be connected to those at state and community levels.

David Tayloe, M.D., president of the American Academy of Pediatrics, said that his association is troubled by statistics that show an increase in mental health conditions in children. It is incumbent on physicians, he said, to bring people to the table who together can address these problems. "The name of the game is coalition-building," said Tayloe.

According to AAFP member Beth Barnet, M.D., of Baltimore, family physicians are perfectly positioned to learn about prevention and intervention programs in their practice communities and refer young patients and their families to such programs.

One of the first family physicians to complete a fellowship in adolescent medicine at Johns Hopkins University, Barnet conducts research on adolescent health, including mental health, as well as on community-based interventions for pregnant and parenting teens.

There's no question that family physicians can help adolescents avoid both physical and mental ailments, Barnet told AAFP News Now. "We're in the forefront of prevention efforts and intervention efforts. The central tenet of family medicine is that you don't separate the two," she said.

Barnet said she has led some interventions in school and community settings that promote both mental and physical health. The best interventions that promote mental health acknowledge that life is stressful and teach appropriate social and coping skills, she said. Managing stress by taking long walks or engaging in other physical activities is one example, said Barnet.

Family physicians also can identify support networks and can link adolescents to community services that offer skills training and youth development programs that provide a feeling of belonging, she said.