Putting the "community" back into "mental health": the challenge of a great crisis in the health and well-being of children and families.

For more than a generation, the levels of anxiety, depression, and misconduct among young people in the United States have been steadily increasing. So too have isolation, alienation, mistrust, and boredom, with the result that ongoing social support has been diminishing, particularly for young people. These trends constitute a national public health crisis affecting young people in general, those already defined as having mental health problems, and their families. To respond adequately, the child mental health system must change dramatically--away from the provision of units of service defined by protocols, time, and professionals' presence and toward the engagement of primary community institutions in the creation and maintenance of new norms of giving and receiving help. Initial evidence suggests that such a shift requires massive effort but that it is feasible and potentially effective.