title: Expanding the Toolkit or Changing the Paradigm: Are We Ready for a Public Health Approach to Mental Health?
abstract: Kazdin and Blase aptly describe the enormous mental health burden facing our nation and suggest several ways to reform the workforce, setting, and content of services to address this long-standing unmet need. We propose that current health care reform legislation and associated advances in service delivery provide a unique and timely opportunity for a paradigm shift in mental health research, practice, and training to support services that are comprehensive, readily accessible, and relevant to a broad range of mental health needs and capacities. Using the recent public health initiative to contain the H1N1 virus for comparison, and informed by a long-standing and extensive literature documenting the need for a public health model for mental health, we describe the rationale for a three-tiered public mental health model, illustrated with examples from ongoing research, to minimize universal risk for mental health difficulties via capacity building in natural settings; reduce onset and severity of symptoms by prioritizing high-risk groups via screening and services for targeted populations; and reduce psychiatric impairment among individuals with more intensive needs via individual, family, and group interventions. New priorities for clinical science to support a public health approach are proposed.
authors.affiliation: University of Illinois at Chicago atkins@uic.edu.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Atkins
authors.affiliation: University of Illinois at Chicago.
authors.forename: Stacy L
authors.initials: SL
authors.lastname: Frazier
keywords: policy; public health; treatment