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Why Are We Making Such Slow Progress in Promoting Child Mental Health?

Illustration of maze over young girl's brain

The economic costs to society of ignoring child mental health are staggering. The Agency for Healthcare Research and Quality (2009) estimates that childhood mental disorders account for the largest category of spending of health dollars for children (ages 0-17).

Another recent estimate places the annual cost of childhood mental disorders at $247 billion (National Research Council and Institute of Medicine, 2009), with additional costs incurred outside the healthcare system (e.g., special education, child welfare, juvenile justice).

With these kinds of costs, why aren’t we making faster progress in promoting child mental health, especially when the science base is growing so quickly?

There are three critical obstacles to effective advocacy in child mental health.

1.      Lack of a shared definition of child mental health

Professionals working in different aspects of child mental health operate in silos. This has made it difficult to seize opportunities for promotion and prevention. Child mental health is best viewed as a public health issue and broadly defined to include mental, social and emotional, and behavioral health.  This definition is consistent with both the NRC/IOM report and the Surgeon General’s conference report (U.S. Public Health Service, 2000) on children’s mental health.

2.      Lack of understanding of the strong and growing body of science by the public and policymakers

Research has produced critical evidence on:

  1. The importance of mental health for healthy development,

  2. How many child mental health problems are preventable and treatable, and

  3. The benefit of early intervention.

Communication science can play a key role in bridging what the science says and what the public believes. 

3.      Lack of effective collaboration across stakeholders

Stakeholders across science and practice, advocacy groups, communities, policymakers, and communication science should collaborate with each other to improve public understanding of and investment in child mental health.

APA’s Interdivisional Task Force on Child and Adolescent Mental Health (IDTF) led two national summits to address these obstacles.

Our 2009 summit – Healthy Development: A Summit on Young Children’s Mental Health – aimed to enhance collaboration and partnership with communication scientists.

Our participants developed consensus about what the public should understand about research evidence in four domains outlined by Tolan and Dodge (2005):

  1. promoting healthy development

  2. everyday challenges for parents

  3. prevention opportunities

  4. evidence-based treatments for disorders

Recommendations from the first summit emphasized that child mental health should be addressed where children live, play, work and grow.  We know that investing in young children’s mental health can lead to savings downstream in areas such as special education, child welfare, juvenile justice, work productivity, and physical health.

Colleagues in communication science at FrameWorks Institute have produced a strategic frame™ that builds public understanding of the science on children’s mental health and willingness to support investment in this area.

Public policy currently “turns on” only when there are problems – which is not a good fit for promoting healthy development.  This policy landscape called for a second summit – focused on using what we KNOW to inform what to DO.

Our 2013 summit – Healthy Development: Changing Frames and Expanding Partnerships to Promote Children’s Mental Health and Social/Emotional Wellbeing aimed to:

  1. encourage shared framing about the importance of child mental health for healthy development and

  2. increase effective collaboration and advocacy.

Our participants identified realistic opportunities and priorities for promoting child mental health within the same four domains as the first summit.

They also outlined next steps for collaboration across different sectors – including practitioners and scholars, the public, policymakers, and organizations and agencies.

Recommendations from this recent summit are being compiled and a full report will be posted on APA’s website soon.

Effective and lasting collaboration is critical for progress, yet it is difficult to sustain. 

We want to hear from you. Tell us in the comments:

  1. How can we support new collaborations and champions to promote child mental health? 

  2. How can we overcome the challenges to collaboration (e.g., different funding streams and competing time demands)?


Agency for Healthcare Research and Quality. (2009). The five most costly children’s conditions, 2006: Estimates for the U.S. civilian noninstitutionalized children, ages 0-17. Retrieved from

National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press. Retrieved from

Tolan, P. H., & Dodge, K. A. (2005). Children’s mental health as a primary care and concern: A system for comprehensive support and service. American Psychologist, 60(6), 601-614. doi:10.1037/0003-066X.60.6.601

U.S. Public Health Service. (2000). Report of the Surgeon General’s conference on children’s mental health: A national action agenda. Washington, DC: Department of Health and Human Services, 2000. Stock No. 017-024-01659-4 ISBN No. 0-16-050637-9. Retrieved from:

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