The role of primary prevention in mental health services: A review and critique

Abstract

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.

Community psychology and politics

“…If sense is to be made of 'real' social power of this kind, it has to be analysed into its material components, and these are inevitably going to reflect coercive, economic and ideological factors (see, for example, Runciman, 1989) over which psychologists, individually and even collectively, have no more control than anyone else. Pretty well any competent review in the general area of community psychology does, I know, tend to indicate that 'real' power cannot be ignored (Blair, 1992, provides a good example) but the implications are rarely, if ever, taken fully into account. Foremost among such implications is likely to be the realization that the causes of individual distress, though mediated through the person's proximal relations with those encountered in the course of everyday life, have their origin in distal (usually economic and political) factors well out of reach of any individual.…”

Primary mental health prevention themes in published research and academic programs in Israel

“…However, mental health prevention at a public health level has received less attention than individualized treatment efforts. Thus, there is a need for the development of effective universal preventive approaches to the common mental disorders at a population level [ 44 , 45 ]. The majority of resources, available for mental health service provision in the West are allocated to the treatment or rehabilitation of those experiencing metal health disorders.…”

The Little Hulton Project: A Pilot Child Clinical Psychology Service for Pre‐School Children and their Families

“…Studies suggest that children with early externalising problems are more likely than comparison children without such early symptoms to have difficulties in behavioural control in early school years to middle childhood (Richman, Stevenson, & Graham, 1982; Fisher et al., 1984; Campbell & Ewing, 1990). In line with these studies, intervention in the pre‐school years can be seen as a primary preventative strategy (Goldstein, 1977; Blair, 1992). It is estimated that 80–90% of children with psychosocial difficulties never reach specialist child services (Cox, 1993).…”