Editorial: The Enigma of "Real World" Mental Health Care

Copeland et al.¹ have analyzed the Great Smoky Mountains Study (GSMS) database to address an important question in health services research: Does the use of mental health services in childhood prevent the later occurrence of mental health disorders in adulthood? Their answer is, somewhat surprisingly, no. As the authors note, the treatment as prevention hypothesis is not only unsupported in their analyses, but there is also evidence of iatrogenic effects on the later development of substance use disorders, particularly among children with behavioral disorders.