Mental illness appears in families of all social classes and backgrounds. "No one is immune."1

Mental health is much more than the absence of mental problems, mental disorders or mental illness. It is the state of mental and emotional well being characterized by flexibility, adaptability, resilience, and the capacity to balance and cope with strengths, weaknesses, opportunities, and adversity. People with strong mental health are able to juggle competing demands in life, prioritize needs and ways to fulfill them and nurture relationships in key areas of work, community, and family.

Mental illness is generally defined as a clinically diagnosable mental health disorder that persists over time. The stigma about mental illness contributes to the cruel and misguided view that mental illness is a disgrace, which compounds the problems that people with mental illness face.

The 1999 Surgeon General's report on mental health offers these definitions:

• Mental Health - the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity; from early childhood until late life, mental health is the springboard of thinking and communication skills, learning, emotional growth, resilience and self-esteem.
• Mental Illness - the term that refers collectively to all mental disorders. Mental disorders are health conditions that are characterized by alterations in thinking, mood, or behavior (or some combination thereof) associated with distress and/or impaired functioning.1

Mental illness and mental health flow along a continuum, and the forces that move us back and forth on that continuum are both internal and external. Internal factors may include biologi al or genetic factors that predispose a person to mental illness or personality characteristics such as optimism or negativism, ability to trust, and the ability to deal with stress, to name a few examples. External factors may include family connectedness, community support, educational and vocational opportunities, quality of care and education, and attachment and social networks that are encouraging, responsive, and supportive.

Approximately one in five Americans experiences a mental disorder in the course of a year.1

General understanding about mental health has moved from an "illness" perspective to a more holistic health perspective that encompasses the entire range of mental health and illness. Research and practical experience have confirmed that prevention and early intervention approaches are critical to improving and sustaining mental health. Waiting until a person has a serious mental health problem brings a high ost to individuals, families and society.

Approximately one in five Americans experiences a mental disorder in the course of a year.1 Often, people don't know where to turn for help or what treatment options are available. Where and how to access services varies tremendously depending on health are coverage, what type of servi es are needed and the treatment options available and accessible. In general, treatment can include counseling, psychotherapy, medication therapy, or rehabilitation--or any combination of these treatments. People have changing mental health needs as they grow from childhood to old age,and as their mental health issues flow along the continuum of need.

Many inequities exist across the spectrum of physical and mental health are in terms of insurance coverage. The deep and pervasive stigma in our society about mental health issues has contributed to mental health coverage lagging far behind physical health coverage. "Mental health parity" is a term used to refer to the need for equal coverage and access to both physical and mental health care.

The bottom line is that the mental health of a family is a composite of the mental health of all of its members.

Children are dependent on parents and other adults to provide love, support and discipline to assure that their mental, physical and spiritual needs are met. When a parent has mental health problems that are not being managed,it may affect the ability of the parent to provide for the needs of the children. When hildren have mental health problems that are not being managed, it an strain parents in many ways. This might in lude the parents' marriage, work and other relationships. The bottom line is that the mental health of a family is a omposite of the mental health of all of its members.

Older adults face unique mental health hallenges, which may be complicated by the misperceptions of many people, including their own family members and health are providers. An example of these misperceptions is that depression and anxiety are a "normal" part of aging. Consequently, mental health issues are under diagnosed and treated. Separation, loss, declining physical health and activity, isolation and dementia are common stressors faced by aging people, which may contribute to the development of mental disorders. Much can be done to alleviate the symptoms and avoid development of more serious disorders if effective support and treatment are available. With increasing frequency, older Americans receive care from adult children, spouses or other family members, which can create additional stress within families.

A community health system balances health promotion, disease prevention, early detection and universal access to care.5

The Minnesota Comprehensive Mental Health Act for adults and children became law in the late 1980's. It was created for the purpose of establishing a statewide system of programs, services, funding and support to address the mental health needs of Minnesotans. When the children's section of the legislation passed, full funding for implementation was not provided. The subsequent development of a wide range of implementation problems across the state has compromised the spirit, intent and effectiveness of the Children's Mental Health Act.3

Throughout Minnesota, the availability, accessibility and quality of mental health services for adults and children is inconsistent and often inadequate. All rural Minnesota counties are now federally-designated Mental Health Professional Shortage Areas, due to the lack of qualified providers. Key issues that also need clarification or resolution include: the roles of schools and other child-serving agences, access and funding of services under managed health care, the coordination of services and sharing of information across service delivery systems, and early identification, diagnosis and "labeling"of mental health needs.

A movement toward a more public health approach to mental health has shifted the focus on services for a severe and chronic population to a more inclusive array of services and needs. The advantages of being proactive about good mental health - providing prevention and early intervention services for people of all ages - are becoming increasingly evident.

At a national level, the U.S. Congress declared the 1990s as the Decade of the Brain. This declaration has accelerated the state of brain development research, resulting in an improved research base to contribute to the development of sound mental health public policy. Sadly, however, there are still many misconceptions and misunderstandings about mental health and mental illness that perpetuate misinformation and negative stereotypes.

Mental health is core to the person,the person is core to the family and the family is core to society.

Mental health, by its very nature, is the core of a person's "modus operandum." It is entral to how well or poorly a person or family is able to fun tion. It is perhaps easiest to think about families and mental health policy within several primary age groups,and identify a corresponding range of public policy issues. For all age groups,we an apply research findings about risk and resiliency factors and how they affect functionality and mental health:

• Children need a healthy birth, secure attachment, quality care and education, and freedom from family violence.
• Adolescents need parental love and guidance, freedom from violence, strong onnections with peers and adults, safe and healthy community space in which to socialize and go to school, and an opportunity to become productive citizens.
• Parents need jobs that pay living wages and allow them time with their children, quality day care, supervised programs for school-age children, effective schools, and opportunities to meet their own personal, social, spiritual and physical needs.4
• Aging people need access to good mental and physical health are to assist them with aging, and onnections with families, friends and society.

Across all ages and stages of life, the link between mental health needs and other public policy issues emerge. Mental health policy is intertwined with prenatal care, early care and education, freedom from neglect and violence, quality education, affordable housing, and employment policies, respite are and living options for seniors. Effective collaboration between government agencies, schools, employers, faith communities, and private agencies is essential to strengthening society's ability to care for its members.

"One of the foremost contributions of contemporary mental health research is the extent to which it has mended the destructive split between mental and physical health."2

The research on child development, mental health and public health offers clear recommendations. Several examples include:

• Mental health problems appear in families of all social lasses and backgrounds. Risk is increased by: physical problems, intellectual disabilities, low birth weight, family history of mental and addictive disorders, multigenerational poverty, caregiver separation and/or abuse and neglect.1 Programs and policies should aim to reduce or mitigate those risks.
• Early interventions an improve mental health and shift the odds toward more favorable outcomes. Prevention and early intervention services are a critical part of an effective set of treatment options.3,6,7
• Children need to get a healthy start in life, adolescents need support to grow into happy and productive adults, parents need community support in order to parent well and remain productive, and aging people need to remain connected to and supported by families and remain vital to society.1,3,5,6,7
• Rigorous mental health outcome evaluations are needed to improve services and the outcomes that are achieved.3,6
• Positive child development depends on the health and well-being of a child's parents and caregivers. Public policies must support positive early experiences, which clearly affect the development of the brain.6
• Parents and regular caregivers are the "active ingredients" of environmental influence during early childhood. Policies must be developed and supported that recognize the importance of stability and quality in relationships with parental and non- parental caregivers.6,7
• Coordinated, functionally effective infrastructures for service delivery are needed to reduce the long-standing fragmentation of programs and services for children and youth.3,5,6,7
• According to the National Research Council and the Institute of Medicine, substantial new investments are needed to build the nation's capacity to address the mental health needs of young children.6