Fifty years of endeavour, prevention and health in mental health policy

Abstract

In the mid-1960s Gerald Caplan offered a system of psychiatric care based on the prevailing public health models of the time; in short: stop it happening, catch it early and treat it effectively (Caplan, 1964). He suggested that it was time to turn models of psychiatry on their head, arguing that psychiatric treatment was a model of last resort and that there were several stages of observation and intervention that should precede treatment. These were presented as: primary prevention, strategies that aimed to reduce the chances of people becoming mentally ill; secondary prevention, early detection and minimising the effects of mental illness; and, finally, tertiary prevention, working positively to reduce the effects of mental illness. In the 50 years in between, UK mental health policy has often focussed on parts of the Caplan model but has seldom been able to exert enough influence to change and develop services that are sufficiently systemic and preventive. Current work in England to develop mental health policy has returned to basics and made a brave attempt to take an all embracing view. ‘New Horizons’ (Department of Health, 2009) a recent English mental health consultation is an iterative product of a large consultation process with the public, people who use services and the professions. At a time when investments in mental health service provision has seen unprecedented growth over a 10-year period there has been much to applaud but a greater task has been to locate mental health into a broader landscape through which it becomes the business of all parts of Government, health and social care services for children and adults as well as education and employment. The policy brief offers some hard reminders about mental health and mental illness.