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Prevention of mental disorders are measures that try to decrease the chances of a mental disorder occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the disease burden." [1] The 2011 European Psychiatric Association (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." [2] A 2011 UK Department of Health 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". [3] In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area. [4]
Parenting may affect the child's mental health, [5] [6] [7] [8] and evidence suggests that helping parents to be more effective with their children can address mental health needs. [9] [10] [11]
Assessing parenting capability has been raised in child protection and other contexts. [12] [13] [14] [15] Delaying of potential very young pregnancies could lead to better mental health causal risk factors such as improved parenting skills and more stable homes, [16] and various approaches have been used to encourage such behaviour change. [17] [18] 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. [19]
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. [20] [21] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. [22] [23] As of 2018, some health providers now advocate pre-emptive use of CBT to prevent worsening of mental illnesses. [24]
Sahaja meditators scored above control groups for emotional well-being and mental health measures on SF-36 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. [25] [26] [27]
A review found that a number of studies have shown that internet- and mobile-based interventions can be effective in preventing mental disorders. [28]
For depressive disorders, when people participated in interventions, some studies show the number of new cases is reduced by 22% to 38%. [29] [30] These interventions included CBT. [31] [32] Such interventions also save costs. [33] Depression prevention continues to be called for. [34]
For anxiety disorders,
In those at high risk there is tentative evidence that psychosis incidence may be reduced with the use of CBT or other types of therapy. [40] [41] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis. [22] [23]
There is also tentative evidence that treatment may help those with early symptoms. [42] [43] Antipsychotic medications are not recommended for preventing psychosis. [22]
For schizophrenia, one study of preventative CBT showed a positive effect [40] and another showed neutral effect. [44]
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. [45]
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. [46] [47]
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. [66] The situation is the same in research. [67]
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. [54]
In India the 1982 National Mental health Programme included prevention, [79] but implementation has been slow, particularly of prevention elements. [80] [81] [82]
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. [83] Similarly positive benefits from social and emotional education are well proven. [84] Research has shown that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children. [85] Early childhood home visitation also reduced abuse and neglect, but results were inconsistent. [86]
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. [87] [88] Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding. [89]