Prevention of mental disorders, substance abuse, and problem behaviors

Many mental, emotional and behavioral disorders can be prevented before they begin and there is robust scientific base of evidence to support this conclusion, according to a report in the March issue of the American Psychiatric Association’s journal Psychiatric Services.

The article highlights and expands on the research identified in the 2009 Institute of Medicine report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Examples of evidence-based prevention interventions include parenting programs, particularly for parents of children preschool through middle school age, and prevention of depression, particularly with high risk groups, using cognitive-behavioral strategies and psychoeducational, family-based approaches. The report identifies three levels of prevention approaches:

• universal approaches addressing an entire population;
• selective approaches for people at elevated risk; and
• indicated approaches for people showing early signs of illness.

Prevention is developmental in perspective and often interdisciplinary in practice, according to the authors. Prevention focuses on young people because half of all mental, emotional, and behavioral disorders start by age 14 and three-fourths start by age 24. Also, there is typically a period of two to four years between the first symptoms and onset of a diagnosable disorder.

The article includes specific recommendations for psychiatrists and other mental health clinicians for individual practice and for advocating for broader system changes. “Our main recommendation for psychiatrists and practicing mental health clinicians is to think and act more preventively.” Among the specific recommendations for psychiatrists are:

• Understand evidence-based practices for mental health promotion and prevention. Look for
opportunities when these might apply.
• Encourage the developmental competencies of children. Use preventive strategies for children at risk,
such as children of parents with a mental illness or children with family stresses (such as divorce or
job loss).
• Support the mental health and parenting skills of parents.
• Promote widespread use of evidence-based prevention and health promotion in schools, in
communities, and in health care.
• Advocate for addressing the common risk factors for mental illness, such as poverty and exposure to
violence.

Implementing prevention would require “a paradigm shift to implementing strategies before the onset of illness and treating the population before waiting for people to come to our door,” the authors note.