Moving Upstream to Improve Children's Mental Health Through Community and Policy Change

Using a social determinants of health framework, we argue that the majority of evidence-based interventions focused on child and adolescent mental health are limited by their focus on individual youth (and sometimes families). While necessary, these interventions are insufficient for addressing the midstream- and upstream/macro-level determinants of mental health in society. We illustrate our perspective through four examples from youth mental health and related services, in which midstream and upstream interventions-i.e., at the community and public policy levels-need to be prioritized along with downstream treatments to improve population mental health and reduce social inequalities in mental health outcomes.