Prevention of mental illness in primary care

Abstract

As a public health concern, mental illness is as serious and common as physical ill health. Mental disorders increase mortality, cause disability and suffering, bring about economic losses, lead to ex- clusion, and inuence the development of sub- sequent generations, possibly even more than physical ill health. This chapter explores and evalu- ates the possibilities for the promotion of mental health and the prevention of mental illness in pri- mary care settings. It draws out the implications for continuing education and deployment of the pri- mary care team. De® nitions Mental health is inuenced by such factors as early childhood experiences, genetic components, physi- cal health, stressful life events and chronic social dif® culties. These inuences may be moderated by intervening factors such as social supports and indi- vidual coping skills. Effective promotion depends upon the identi® cation of factors and processes that protect mental health and the reduction of harmful factors. The result for the individual is higher qual- ity of life, improved social functioning and inte- gration. Successful promotional activities are also reected in a lower prevalence and incidence of mental disorders and better use of services. Pro- motion of mental health puts special emphasis on participation and can involve whole societies, com- munities, social groups, high-risk groups or individ- uals. While there is necessarily overlap with promotion, prevention focuses explicitly on the causes of dis- ease. The aims are to reduce mental illness at popu- lation level (universal prevention), in speci® ed groups (selective prevention) and in groups at speci® c high risk (indicated prevention) by applying evidence-based and cost-effective interventions. Pri- mary prevention is directed at reducing the inci- dence (rate of occurrence of new cases) of a particular disorder in the population by targeting people who are essentially normal or believed to be `at risk'. It seeks to eliminate or mitigate risk factors, often by enhancing individual coping, relationship or parenting skills and social competence in general. Secondary prevention is concerned with early de- tection and treatment of mental disorders, thereby reducing duration and severity and preventing re- currence. The opportunities for primary and sec- ondary prevention in primary care are great since it is here that recognition of patient risk factors and detection of illness usually occurs. Up to 40% of patients attending will be suffering from the com- mon mental disorders. Given existing demands upon team members to provide screening for a variety of conditions, this paper will concentrate upon selective and indicated interventions with groups at high risk for mental illness. The interven- tions are based upon a strategy of reducing risk and strengthening protective factors. Life events and social support