Prevention of mental disorders are measures that try to decrease the chances of a
mental disorder
A mental disorder, also referred to as a mental illness or psychiatric disorder, is a behavioral or mental pattern that causes significant distress or impairment of personal functioning. Such features may be persistent, relapsing and remitti ...
occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
burden." The 2011
European Psychiatric Association
The European Psychiatric Association (EPA) is the main association representing psychiatry in Europe.
History
The EPA was founded in October 1983 as the Association of European Psychiatrists (AEP), at the University of Strasbourg, by twelve Frenc ...
(EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions." A 2011
UK Department of Health
The Department of Health and Social Care (DHSC) is a department of His Majesty's Government responsible for government policy on health and adult social care matters in England, along with a few elements of the same matters which are not otherwi ...
report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure". In 2016, the
National Institute of Mental Health
The National Institute of Mental Health (NIMH) is one of 27 institutes and centers that make up the National Institutes of Health (NIH). The NIH, in turn, is an agency of the United States Department of Health and Human Services and is the prima ...
re-affirmed prevention as a research priority area.
Methods
Parenting
Parenting
Parenting or child rearing promotes and supports the physical, emotional, social, spiritual and intellectual development of a child from infancy to adulthood. Parenting refers to the intricacies of raising a child and not exclusively for a ...
may affect the child's mental health,
and evidence suggests that helping parents to be more effective with their children can address mental health needs.
Assessing parenting capability has been raised in child protection and other contexts. Delaying of potential
very young pregnancies could lead to better mental health causal risk factors such as improved parenting skills and more stable homes,
and various approaches have been used to encourage such behaviour change.
Some countries run
conditional cash transfer welfare programs where payment is conditional on behaviour of the recipients.
Compulsory contraception has been used to prevent future mental illness.
Pre-emptive CBT
Use of
cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.
In 2014 the UK
National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis.
As of 2018, some health providers now advocate pre-emptive use of CBT to prevent worsening of mental illnesses.
Mental silence
meditation
Meditation is a practice in which an individual uses a technique – such as mindfulness, or focusing the mind on a particular object, thought, or activity – to train attention and awareness, and achieve a mentally clear and emotionally cal ...
Sahaja
Sahaja ( pra, সহজ sa, सहज ) means spontaneous enlightenment in Indian and Tibetan Buddhist spirituality. Sahaja practices first arose in Bengal during the 8th century among yogis called Sahajiya siddhas.
Ananda Coomaraswamy describe ...
meditators scored above control groups for emotional well-being and mental health measures on
SF-36
The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The SF-36 is a measure of health status and an abbreviated variant of it, the SF-6D, is commonly used in health economics as a variable in the quality-adjus ...
ratings, leading to proposed use for mental illness prevention, although this result could be due to meditators having other characteristics leading to good mental health, such as higher general self care.
Internet- and mobile-based interventions
A review found that a number of studies have shown that internet- and mobile-based interventions can be effective in preventing mental disorders.
Specific diseases
Depression
For
depressive disorders
A mood disorder, also known as an affective disorder, is any of a group of conditions of mental and behavioral disorder where a disturbance in the person's mood is the main underlying feature. The classification is in the ''Diagnostic and Stat ...
, when people participated in interventions, some studies show the number of new cases is reduced by 22% to 38%.
These interventions included CBT. Such interventions also save costs. Depression prevention continues to be called for.
Anxiety
For
anxiety disorder
Anxiety disorders are a cluster of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal function are significantly impaired. Anxiety may cause physi ...
s,
* use of
cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is a psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. CBT focuses on challenging and changing cognitive distortions (suc ...
(CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.
Other interventions (parental inhibition reduction, behaviourism, parental modelling, problem-solving and communication skills) have also produced significant benefits.
People with subthreshold panic disorder were found to benefit from use of CBT.
* for older people, a stepped-care intervention (watchful waiting,
CBT and medication if appropriate) achieved a 50% lower incidence rate of depression and anxiety disorders in a patient group aged 75 or older.
* for younger people, it has been found that teaching CBT in schools reduced anxiety in children, and a review found that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents.
* for university students
mindfulness
Mindfulness is the practice of purposely bringing one's attention to the present-moment experience without evaluation, a skill one develops through meditation or other training. Mindfulness derives from ''sati'', a significant element of Hind ...
has been shown to reduce subsequent anxiety.
Psychosis
In those at high risk there is tentative evidence that
psychosis
Psychosis is a condition of the mind that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are incoherent speech and behavior ...
incidence may be reduced with the use of CBT or other types of therapy.
In 2014 the UK
National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis.
There is also tentative evidence that treatment may help those with early symptoms.
Antipsychotic medication
Antipsychotics, also known as neuroleptics, are a class of psychotropic medication primarily used to manage psychosis (including delusions, hallucinations, paranoia or disordered thought), principally in schizophrenia but also in a range of oth ...
s are not recommended for preventing psychosis.
For
schizophrenia
Schizophrenia is a mental disorder characterized by continuous or relapsing episodes of psychosis. Major symptoms include hallucinations (typically hearing voices), delusions, and disorganized thinking. Other symptoms include social withdra ...
, one study of preventative CBT showed a positive effect
[ and another showed neutral effect.]
Targeted vs universal
There has been an historical trend among public health professionals to consider targeted programmes. However identification of high risk groups can increase stigma, in turn meaning that the targeted people do not engage. Thus policy recommends universal programs, with resources within such programs weighted towards high risk groups.
Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials.
History
History of mental illness prevention strategies
* In 2020 a US paper identified the need for prevention, and led with focus on preventing traumatic events and adverse childhood experiences Adverse childhood experiences (ACEs) encompass various forms of physical and emotional abuse, neglect, and household dysfunction experienced in childhood. The harms of ACEs can be long-lasting, affecting people even in their adulthood. ACEs have ...
. A European paper highlighted "addressing both poor parenting and children's maladaptive personality traits and insufficient life skills."
* In 2018 the University of Birmingham
, mottoeng = Through efforts to heights
, established = 1825 – Birmingham School of Medicine and Surgery1836 – Birmingham Royal School of Medicine and Surgery1843 – Queen's College1875 – Mason Science College1898 – Mason Univers ...
Mental Health Policy Commission focused on prevention, including the challenges of funding given the shortness of political cycles versus the longer paybacks of prevention.
* In 2018 11 European researchers published a review of mental illness prevention stating that "''Increasing evidence suggests that preventive interventions in psychiatry that are feasible, safe, and cost-effective could translate into a broader focus on prevention in our field.''" and that "''Gaps between knowledge, policy, and practice need to be bridged.''"
* The US Substance Abuse and Mental Health Services Administration
The Substance Abuse and Mental Health Services Administration (SAMHSA; pronounced ) is a branch of the U.S. Department of Health and Human Services. It is charged with improving the quality and availability of treatment and rehabilitative services ...
(SAMHSA) advocates a 5-step prevention framework.
* In 2016:
**the UK NGO Mental Health Foundation
The Mental Health Foundation is a UK charity, whose mission is "to help people to thrive through understanding, protecting, and sustaining their mental health."
History
The Mental Health Foundation was founded in 1940 as the Mental Health Res ...
published a review of prevention approaches.
**the UK NGO Mind
The mind is the set of faculties responsible for all mental phenomena. Often the term is also identified with the phenomena themselves. These faculties include thought, imagination, memory, will, and sensation. They are responsible for various m ...
produced public mental health recommendations for more prevention.[https://www.mind.org.uk/media/2976113/mind_public-mental-health-guide_web-version.pdf]
* In 2015:
** the Hunter Institute of mental health in Australia published its "Prevention First" strategic framework for prevention.
** the UK NGO Mental Health Foundation
The Mental Health Foundation is a UK charity, whose mission is "to help people to thrive through understanding, protecting, and sustaining their mental health."
History
The Mental Health Foundation was founded in 1940 as the Mental Health Res ...
published a review of prevention research, paving the way for prevention strategies.
** the official journal of the World Psychiatric Association
The World Psychiatric Association is an international umbrella organisation of psychiatric societies.
Objectives and goals
Originally created to produce world psychiatric congresses, it has evolved to hold regional meetings, to promote profess ...
included a survey of public mental health which concluded ''"the evidence base for public mental health interventions is convincing, and the time is now ripe to move from knowledge to action"''.
* In 2014 the UK Chief Medical Officer, Professor Dame Sally Davies, chose mental health for her major annual report, and included prevention of mental illness heavily in this.
* In 2013 the Faculty of Public Health
The Faculty of Public Health (FPH) is a public health association in the United Kingdom established as a registered charity. It is the standard setting body for public health specialists within the United Kingdom, setting standards for training ...
, the UK professional body for public health professionals, produced its "Better Mental Health for All" resource, which aims at ''"the promotion of mental wellbeing and the primary prevention of mental illness"''.
* In 2012, Mind
The mind is the set of faculties responsible for all mental phenomena. Often the term is also identified with the phenomena themselves. These faculties include thought, imagination, memory, will, and sensation. They are responsible for various m ...
, the UK mental health NGO, included ''"Staying well; Support people likely to develop mental health problems, to stay well."'' as its first goal for 2012–16.
* The 2011 mental health strategy of Manitoba (Canada) included intents to (i) reduce risk factors associated with mental ill-health and (ii) increase mental health promotion for both adults and children.
* The 2011 US National Prevention Strategy included mental and emotional well-being, with recommendations including (i) better parenting and (ii) early intervention.
* Australia's mental health plan for 2009–14 included "Prevention and Early Intervention" as priority 2.
* The 2008 EU "Pact for Mental Health" made recommendations for youth and education including (i) promotion of parenting skills, (ii) integration of socio-emotional learning into education curricular and extracurricular activities, and (iii) early intervention throughout the educational system.
* The 2006 Canadian "Out of the Shadows at last" included a section on prevention.
History of mental illness prevention programmes and research
Historically prevention has been a very small part of the spend of mental health systems. For instance the 2009 UK Department of Health analysis of prevention expenditure did not include any apparent spend on mental health. The situation is the same in research.
However more recently some prevention programmes have been proposed or implemented. Prevention programmes can include public health policies to raise general health, creating supportive environments, strengthening communities, developing personal skills, and reorienting services.
* In 2022 research showed the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of h ...
Self-Help Plus programme, at six-month follow-up, saw 22% incidence of mental disorder vs 41% in a control group, in Syrian refugees in Turkey.
* In 2016, the UK Education Policy Institute
The Education Policy Institute (EPI) is an education policy think tank that aims to promote high-quality education outcomes through research and analysis. It is based at 150 Buckingham Palace Road, in central London.
History
It was formed in 20 ...
advocated prevention through increased mental health literacy, better parenting and improving children's resilience and digital world skills.
* In 2013 the UK NGO Mental Health Foundation
The Mental Health Foundation is a UK charity, whose mission is "to help people to thrive through understanding, protecting, and sustaining their mental health."
History
The Mental Health Foundation was founded in 1940 as the Mental Health Res ...
and partners began to use Video Interaction Guidance (VIG) in an early years intervention to reduce later life mental illness.
* In 2013 in Australia the National Health and Medical Research Council
The National Health and Medical Research Council (NHMRC) is the main statutory authority of the Australian Government responsible for medical research. It was the eighth largest research funding body in the world in 2016, and NHMRC-funded rese ...
supported a set of parenting strategies to prevent teenagers becoming anxious or depressed.
* In 2012 the UK Schizophrenia Commission recommended ''"a preventative strategy for psychosis including promoting protective factors for mental wellbeing and reducing risks such as cannabis use in early adolescence."''
* In 2010 the European Union
The European Union (EU) is a supranational political and economic union of member states that are located primarily in Europe. The union has a total area of and an estimated total population of about 447million. The EU has often been des ...
DataPrev database was launched. It states ''"A healthy start is crucial for mental health and wellbeing throughout life, with parenting being the single most important factor,"'' and recommends a range of interventions.
* In 2009 the US National Academies publication on preventing mental, emotional, and behavioral disorders among young people focused on recent research and program experience and stated that ''"A number of promotion and prevention programs are now available that should be considered for broad implementation."'' A 2011 review of this by the authors said ''"A scientific base of evidence shows that we can prevent many mental, emotional, and behavioral disorders before they begin"'' and made recommendations including
** supporting the mental health and parenting skills of parents,
** encouraging the developmental competencies of children and
** using preventive strategies particularly for children at risk (such as children of parents with mental illness, or with family stresses such as divorce or job loss).
In India the 1982 National Mental health Programme included prevention, but implementation has been slow, particularly of prevention elements.
It is already known that home visiting programs for pregnant women and parents of young children can produce replicable effects on children's general health and development in a variety of community settings. Similarly positive benefits from social and emotional education are well proven. Research has shown that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. Early childhood home visitation also reduced abuse and neglect, but results were inconsistent.
Issues in implementation
Prevention programs can face issues in (i) ownership, because health systems are typically targeted at current cases, and (ii) funding, because program benefits come on longer timescales than the normal political and management cycle. Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding.
References
{{Reflist
Mental disorders
Medical prevention