Prevention and early identification of adolescent mental illness: Opportunities in health care reform

According to the U.S. Surgeon General, an estimated 20 percent of youth suffer from a diagnosable mental disorder, but research cited by the National Institute of Mental Health shows that more than two-thirds of youth with mental illness are not identified and do not receive mental health services. Increasingly, primary care providers are being asked to help ease this treatment gap by screening for, diagnosing and, in some cases, treating mental health disorders. Momentum around the need to improve access to screening for mental disorders as a preventive service increased in 2009, when the U.S. Preventive Services Task Force recommended annual depression screening for youth beginning at age 12 and the Institute of Medicine issued a report urging better screening and prevention practices for mental, emotional and behavioral disorders. This momentum continued to build in 2010, when the American Academy of Pediatrics' Task Force on Mental Health released new guidelines and tools to improve the incorporation of mental health screening into pediatric practice. The expert consensus now clearly endorses routine mental health screening. However, incorporating mental health into primary care poses the need for a significant change in clinical practice for many primary care providers, the majority of whom do not regularly screen patients for mental illness. The Patient Protection and Affordable Care Act included several provisions that will promote access to mental health screening in the primary care setting and create new opportunities to expand access to mental health services. These provisions will be identified and discussed.