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Prevention and Early Intervention Policy

Not a lot of Prevention and Early Intervention

Prevention and early intervention (PEI) is effective, but it only exists in pockets throughout the country. Even when an area implements PEI and gets great results, it can be challenging to continue the program let alone spread it to other places. Because most PEI is paid for through grants, it often requires a motivated community with strong leadership to start and continue PEI.

When government, businesses, or foundations offer grant money for groups to implement PEI, the funding usually only lasts a few years before it becomes necessary to reapply or find different sources of funding. This means that most PEI struggles to stay funded, taking a toll on the work and those involved. This is clearly not the best system for encouraging long-term and widespread use of strategies that we already know can make a large impact.

Not Designed for Prevention and Early Intervention

With so much evidence to support PEI, why isn’t it easier to fund? Not only does PEI help and support individuals before they reach a crisis, it also benefits the community and country as a whole. We spend less than we do with later stage expenses like hospital stays and disability benefits, and we gain more with more people contributing to and working in the community.

Although PEI is the right choice for most communities, our current system makes it difficult to implement. In addition to challenges with grants, governments struggle to support PEI because of the initial costs, even if it is a responsible investment that would save us lives and money. Our health care system was not designed to support PEI, and most government programs only provide assistance when individuals reach a certain threshold, like poverty or disability. We only provide help when something has already gone wrong, treating when you are already sick or providing help when you have already lost a lot. When we made our system, we did not have as much research about prevention and early intervention, and we did not leave space for it.  Now that we have the research, we need to make that space.

Investing in PEI makes sense, but many people do not have incentives to work on prevention and early intervention due to something called the wrong pocket problem. In the wrong pocket problem, those who invest in the programs are not the people who get the money back in savings – it goes into the wrong pocket. For example, as a member of the community or a local business, I benefit from improved mental health outcomes for me and the people around me, but I may or may not see concrete savings. As a government agency, I may save money that would have been spent long-term but do not have an easy way to measure my outcomes. As an insurance company, I may have to pay fewer claims but do not see as many benefits because people switch insurance so frequently.

Making our system make sense

In order to create a system that helps people before they reach crisis, we need to get serious about prevention and early intervention. To begin, we suggest three approaches:

  1. Fix the Wrong Pocket Problem: We could fix the wrong pocket problem with regulations so everyone shares incentives to pay for prevention and early intervention.  There are many ways we can do this, but one way is with sharing savings.  Right now groups of providers called Accountable Care Organizations (ACOs) can share savings with the government when they spend less on health care while demonstrating good outcomes.  If ACOs and others could share savings in other areas where prevention and early intervention save money, then more people would be motivated to work together toward prevention and early intervention.
  2. Cover Prevention and Early Intervention: We could expand coverage of preventive care in health insurance.  Right now, health insurers mostly only cover prevention and early intervention inside a doctor’s office.  Think about what we know effective PEI looks like and what we would need to change. We need to pay for PEI because these are as important to mental health as services in a doctor’s office.  This includes paying for services out in the community, to individuals without a diagnosable condition, to groups, to family-members and teachers, and using texts, phone calls, and other technology.
  3. Engage Communities: We also need to get communities engaged in prevention and early intervention.  Community-based coalitions, made up of members of state and local government, hospitals, health insurers, provider groups, consumers, families, business owners, and other leaders, should coordinate funding.  Similar coalitions should exist in every state and each member should have a designated role in the coalition.  Community engagement will ensure not only that the money goes to the right places, but also that the community sees the wins they get.  Seeing wins is important to make sure the programs that work keep getting funded.

These three changes would have a tremendous impact on the 50% of Americans who will meet criteria for a diagnosable mental health condition at some point in their lives.[i] Whether it is you, someone in your family, or a friend, we all know someone who needs help. Reducing risk factors and promoting protective factors is something we all benefit from, especially those who are at the greatest risk. When we have a system that is consistent with what we know about prevention and early intervention in mental health, we can prevent suffering and use our money responsibly. By investing in early programs and providing access to appropriate services where needed, we can stop failing our children and begin supporting them in our communities.

Prevention and Early Intervention in Mental Health- Home

[i] Ronald C. Kessler et al., Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication, 62 Arch. Gen. Psychiatry 593, 595 (2005).