|Year : 2017 | Volume
| Issue : 2 | Page : 76-78
Preventive psychiatry: Overview
National Academy of Medical Sciences; NAMS House, Ansari Nagar, Mahatama Gandhi Marg, New Delhi, India
|Date of Web Publication||30-Jun-2017|
D-127, Preet Vihar, Vikas Marg, New Delhi - 110 092
Source of Support: None, Conflict of Interest: None
Preventive psychiatry aims at the reduction of mental disorders and behavioural problems by identifying risk and protective factors and applying evidence-based interventions in the framework of primary, secondary and tertiary prevention. Preventive psychiatry located within a public mental health framework provides an opportunity to recognise important preventive elements in the existing psychiatric practice. Mental health professionals have several important roles to play in the prevention field. These include role of mental health advocates, technical advisers, program leaders, researchers and preventive care providers.
Keywords: Preventive psychiatry, primary, secondary, tertiary prevention
|How to cite this article:|
Sharma S. Preventive psychiatry: Overview. Indian J Soc Psychiatry 2017;33:76-8
The concept of prevention in psychiatry has evolved over the last few decades and covers a wide range of strategies and objectives for primary, secondary, and tertiary prevention. Prevention psychiatry aims at the reduction of mental disorders and behavioral problems by identifying risk and protective factors and applying evidence-based interventions for their modifications. Promotion of mental health and wellness is a related concept. The distinction between mental health promotion and mental disorder prevention lies in their targeted outcomes. Mental health promotion aims to promote positive mental health by increasing psychological well-being, competence and resilience, and by creating supporting living conditions and environments. The target of mental health prevention strategies is the reduction of symptoms and mental disorders. However, differences between prevention, treatment, and care are not always clear, and its boundaries are less defined.
The mental health historically has been overlooked as a determinant of health. Only very recently, the disability and cost to society of mental and behavior disorders have been studied. Understanding has also emerged about the interwoven connections and interactions between physical and mental health within a social content. These recent developments offer a special opportunity to build collaborative efforts, but a caution is needed so that limited available resources are not diverted to the other noncommunicable diseases, such as diabetes mellitus, cardiovascular disorders, and cancer. There is an urgent need to identify the action required to accomplish overall goals in mental health prevention. It is necessary to develop a few linked and interactive themes/components that make up the matrix of prevention and promotion in population-based mental health. We need to connect the dots and develop an evidence-based systemic approach if progress is to be realized in this direction.
At present, our knowledge about evidence-based prevention in mental illness is limited, and efforts to prevent mental illness or to promote mental health are unstructured, unfocused, and uncoordinated. Although there have been many studies on various prevention strategies, very few clear-cut model of prevention exist. For example, if we look at the association of trauma and developmental disorder, it is well known that only a small percentage of people who have had a highly traumatic experience will develop posttraumatic stress disorder.
Primary prevention aims at reducing the incidence of disease. One of the example of primary prevention is the reduction of exposure to environmental toxins, such as lead in preventing childhood encephalopathies and associated mental retardation. The reduction of risky behaviors such as substance use and unsafe sex can contribute to the reduction of negative outcomes such as suicide, teen pregnancy, school dropout, and delinquency. Primary prevention has been further divided into universal, selective, and indicated prevention. Universal prevention strategies are targeted at the general public and whole population group that has not been identified on the basis of increased risk. Selective prevention targets individuals or subgroups of the population whose risk of developing a mental disorder is significantly higher than average, as evidenced by biological, psychological, or social risk factors. Indicated prevention targets high-risk persons who are identified as having minimal but detectable signs or symptoms foreshadowing mental disorder or biological markers indicating predisposition for mental disorder but who do not meet diagnostic criteria for disorder at that time.
The protective factors refer to conditions that improve people's resistance to risk factors and have been defined as those factors that modify, ameliorate, or alter a person's response to some environmental hazard that predisposes to a maladaptive outcome. Some of the examples of protective factors are support from caring adults like parents, relatives, mentors, good school performance, conflict resolution skills, positive role models and peers, and family support. There are a few general principles for effective prevention programs by addressing the factors that play causal roles, reverse or reduce risk factors, enhance protective factors to increase competency in multiple domains, and have to be age specific, developmentally appropriate, and culturally sensitive.
The evidence-based risk and protective factors for prevention in mental health are social, environmental, economic, individual and family-related, and genetic factors. Macro strategies to reduce risk and improve the quality of life are improving nutrition, housing, access to education, reducing economic security, and ensuring employment. Some of the strategies for reducing stressors and enhancing resilience are reducing child abuse and neglect, coping with parental mental illness, reducing risk behavior in schools and family disruption, and intervention in workplace. Some of the specific mental disorders for which preventive strategies have been used are conduct disorders in children, depression, anxiety, eating disorder and suicide, old age problems, alcohol and drug abuse.
In one of the most important document on prevention and promotion in mental health, by World Health Organization, following key messages have been emphasized:
- Prevention of mental disorders is a public health priority
- Mental disorders have multiple determinants. Prevention must be multi-prolonged and multidisciplinary effort
- Effective prevention can reduce the risk of mental disorders
- Implementation should be guided by available evidence
- Successful programs and policies should be made widely available
- Knowledge of evidence for effectiveness needs further expansion.
Prevention must be sensitive to culture and to resources available across countries:
- Population-based outcomes require human and financial investment
- Effective prevention requires intersectoral linkages
- Protecting human rights is a major strategy to prevent mental disorder.
Our imagination has failed to cope up with the changing realities of not so brave world. This is obvious that the most fundamental of these is the belief, both individually and collectively, that the current models of development and lifestyle cannot be changed. In fact, our notion of freedom is tied up irrevocably with this concept. This resistance to change leads to an interesting conundrum that we are likely to spend more money on cure than on prevention. Billions are spent on cancer treatment but little on changing lifestyles that would prevent it. This drives both industrial and technological growth that keeps governments in power in the alcohol industry.
Preventive psychiatry can mitigate negative stereotypes about professionals that undermine public confidence in modern specialist psychiatric expertise and evidence-based interventions. Not all in historical practice was bad. Freud advocated understanding the influence of childhood adversity on adult psychopathology; he also attended to problems of society and group relations. Researchers and policy makers are still interested in a similar interplay of factors. Public mental health models of risk and protective factors exist at the individual, family, and community levels and can potentially explain the processes associated with mental health problems. These categories of risk and protection exist on and interact at multiple levels.
Preventive psychiatry has a role in managing work stress, returning people to work as soon as possible following illness, and preventing work-related health problems, especially among the most vulnerable. Thus, preventive psychiatry, located within a public mental health framework, provides an opportunity to recognize more explicitly important preventive elements of the existing psychiatric practice. Prevention of violence and hostility between adults and young people has been long recognized as a core task of preventive psychiatry.
Major socioeconomic and environmental determinants for mental health are related to macroissues such as poverty, war, and inequity. Other macrofactors such as urbanization, war and displacement, racial discrimination, and economic instability have been linked to increased levels of psychiatric morbidity. Family is the basic sociocultural unit through which values and culture are transmitted from one generation to another. It is the nest for the growth of an individual, the resource for social support. Values are learnt consequently, that is to say, values are transmitted and inculcated through an intricate web of societal agents and interactions in the family. Family members and social peers, mythological stories, and religious activities are primary to this web. However, values are relatively enduring and are grounded in the cultural heritage of a society and pervasively housed within the institutions of the society.
In short, values are well rooted in our everyday behavior. It is an established fact that values guide human conduct, providing a road map for action and establish disposition to act. Accordingly, values influence our behavior by preparing us to act in certain morally oriented ways. It may be useful to conclude with an ancient Indian thought, as reflected in the Vedas “Man can live individually but can survive only collectively.” Intercountry and intracountry migration has been increasing all over the world. People are moving in large numbers faster and further than any other time in the history. More than one million persons cross borders everyday. They carry with them, their values and culture and lifestyle. Migration leads to uprooting and displacement, increased refugee population, ethnic and civil conflict and may cause social displacement syndrome and increased mental distress. Migration affects the individual and family and may result in increase of physical, emotional, and social problems. There may be dilution of the values, and it also leads to both “brain drain” and “care drain” in the countries of origin.
Hence, a fundamental shift is needed in the way we view health services. Prevention should be guided by available evidence, and mental disorders have multiple determinants. Accordingly, preventive strategy should address these multiple causes and their interactions. Various epidemiological studies suggest that considerable comorbidity exists between mental disorders, physical diseases, and social problems. Hence, we should focus on common risk factors. Effective programs can reduce risk of mental disorders. Prevention of mental disorders is a public health priority. Mental health professionals have several important roles to play in the prevention field. These include role of mental health advocates, technical advisers, program leaders, researchers, and preventive care providers. We should strive to develop our own model for mental health prevention.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Prevention and Promotion in Mental Health. Geneva: World Health Organization; 2002.
World Health Organization. Prevention of Mental Disorders: Effective Interventions and Policy Options: Summary Report. Geneva: World Health Organization; 2004.