Prevention of mental disorders

Did You Know?

• Sahaja meditators scored above control groups for emotional well-being and mental health measures on SF-36 ratings.
• Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding.

Methods

Physical exercise and maintaining a predictable sleeping schedule are forms of self-care that can prevent mental disorders. Helping parents become more effective with their children can address mental health needs, and delaying very young pregnancies may improve parenting skills and home stability. Some countries use conditional cash transfer welfare programs to encourage such behaviour change, and compulsory contraception has been employed to prevent future mental illness. Cognitive behavioral therapy (CBT) given to at-risk individuals has significantly reduced episodes of generalized anxiety disorder and improved explanatory style and hopelessness. In 2014, NICE recommended preventive CBT for people at risk of psychosis, and some health providers now advocate pre-emptive CBT to prevent worsening of mental illnesses. Sahaja meditators scored higher on emotional well-being measures, though this may reflect other characteristics. Internet- and mobile-based interventions have also shown effectiveness in preventing mental disorders.

Targeted vs universal

Public health professionals have historically considered targeted programs, but identifying high-risk groups can increase stigma and reduce engagement. Policy therefore recommends universal programs, with resources weighted toward high-risk groups. Universal prevention requires very large numbers to show effect; this can be addressed by focusing on high-incidence groups, using multiple interventions, conducting cumulative meta-analyses, or running very large trials.

History

In 2020, a US paper identified the need for prevention and focused on preventing traumatic events and adverse childhood experiences, while a European paper highlighted addressing poor parenting and children's maladaptive personality traits. In 2018, the University of Birmingham Mental Health Policy Commission focused on prevention challenges related to short political cycles versus longer payback periods. Also in 2018, 11 European researchers published a review stating that preventive interventions in psychiatry are feasible, safe, and cost-effective, and that gaps between knowledge, policy, and practice need bridging. The US Substance Abuse and Mental Health Services Administration advocates a five-step prevention framework. In 2016, the UK Mental Health Foundation and Mind both published reviews or recommendations for prevention. In 2015, the Hunter Institute of Mental Health in Australia published its Prevention First framework, and the World Psychiatric Association journal concluded that the evidence base for public mental health interventions is convincing. In 2014, the UK Chief Medical Officer included prevention heavily in her annual report on mental health. In 2013, the Faculty of Public Health produced its Better Mental Health for All resource. In 2012, Mind set staying well as its first goal. The 2011 Manitoba mental health strategy included reducing risk factors and increasing promotion, and the 2011 US National Prevention Strategy included recommendations for better parenting and early intervention.