Creating the Conditions to Prioritize Prevention

What a new report can tell us about preventing mental, emotional, and behavioral disorders

When rising floodwaters threatened his riverfront restaurant, Andrew Masterson didn’t wait for disaster to strike. Instead, he did something counterintuitive but smart: he flooded it himself—with clean water. By filling Captain’s Quarters Riverside Grille with tap and well water, Masterson created a pressure barrier strong enough to keep dirty, destructive floodwater out. He and his team cleared out appliances, pumped in the water, and braced for the storm.

I have been fascinated by this story - not just the ingenuity of doing what needed to be done in a moment of crisis, but how I had never heard of something like this before. I can’t get over how this calculated move was done to prevent greater damage when it felt like it was pretty damaging to begin with. In a world where extreme weather is becoming more common, it was also a reminder: prevention isn’t passive. It’s a choice. And too often, prevention is a choice we skip—especially when it comes to mental health.

The U.S. has spent decades documenting the cost and scale of mental, emotional, and behavioral (MEB) disorders especially among children and youth. In 2009, a landmark National Academies report, Preventing Mental, Emotional, and Behavioral Disorders Among Young People, laid out the case for early prevention and presented a strong evidence base for what works. And while it made a compelling argument for why prevention matters, it left the how—the systems, structures, and sustained investment required—largely unaddressed. It was also another example of an important report that simply couldn’t get the traction it needed to be used in a meaningful way.

Now, in 2025 a follow-up report from the National Academies, Blueprint for a National Prevention Infrastructure for Mental, Emotional, and Behavioral Disorders, picks up where this previous report left off.

This new report is different in two key ways:

First, the 2025 report digs deeper on infrastructure. Rather than rehashing which programs work, it looks at the machinery behind delivery: how to get evidence-based interventions to every community that needs them. The report lays out the specific components needed—from governance, workforce, data systems, funding, and cross-sector partnerships to what it takes to build them at scale.

Second, almost 20 years later, the evidence is stronger, and the stakes are higher. Over the years the science has only gotten clearer as well as the gaps more glaring. We now know even more about what works to prevent MEB disorders, from parenting programs and school-based initiatives to upstream policy levers like tax credits or housing security. But without an infrastructure to support delivery, the impact of these interventions remains limited and uneven especially in under-resourced communities.

What this 2025 report makes clear is that we already have the tools to reduce suffering; what we lack is a functional, national delivery system for prevention. This 2025 report is a blueprint of sorts - a call to action to build one.

Some Highlights

In reading the report, there’s a lot to love. I realize that not all of us are going to read through or scan such a dense document, so here are some highlights (and please note, some of these will not be a surprise!):

Prevention is Underfunded and Undervalued: Our current infrastructure leans heavily on treatment over prevention. There’s a lack of consistent federal, state, and local support for preventative programs. Also, the sky is blue.

The Infrastructure is Fragmented: Prevention services are scattered across agencies and lack coordination. Substance use prevention is more developed than mental health prevention.

There’s a Solid Evidence Base, But It's Underused: Proven interventions exist (e.g., Nurse-Family Partnership, Good Behavior Game), but dissemination and implementation are inconsistent and limited in reach—especially among marginalized groups and older adults.

Workforce is Underdeveloped: Prevention workforces lack clear roles, training pathways, and sustainable support. And to add insult to injury, many of these positions are unpaid or underpaid.

Data Systems are Weak at the Community Level: Local groups lack timely, granular data to assess needs and track progress. Available tools that may be in the field often still need MEB-specific enhancements.

Funding is Inadequate and Misaligned: Prevention budgets haven’t kept pace with inflation. Most federal money goes to treatment. There's a call for a $14B investment to universally support prevention in youth, which in the current climate feels like an impossibility and also entirely doable.

Policies Matter Just as Much as Programs: Economic, social, and environmental policies (e.g., housing, education, tax credits) can serve as population-level preventatives—but aren’t currently integrated into MEB prevention strategy (PREACH!). This is a massive lift, and also one of the least discussed avenues for prevention in the mental health field.

We’ve long treated prevention like an afterthought; something nice if we have the time, the resources, or the will. But prevention is not a luxury. It’s not soft or abstract. It’s infrastructure. Just like roads or clean water, it’s what keeps our systems from collapsing under pressure. The 2025 NASEM report reminds us that we already know what works; what we need now is the commitment to build around it. Prevention, like flooding a restaurant to save it, might feel uncomfortable or costly upfront. But in a world bracing for storms—literal and mental—it feels like the only rational choice.