Mental Disorders Prevention
Introduction to Mental Disorders Prevention
The prevention of mental disorders is grounded in a science that examines the incidence, prevalence, causes, and consequences of public health problems. It focuses on developing, evaluating, refining, and disseminating interventions aimed at preventing the occurrence or recurrence of these problems (Coie et al., 1993; Institute of Medicine [IOM], 1994). A core tenet of this science is that many mental disorders result from environmental stressors that place individuals and communities at risk. Furthermore, dysfunctional intra- and interpersonal patterns, often stemming from social and health disparities, can contribute to mental health problems (Albee, 1996). Preventive behavioral strategies can be powerful tools for blocking the onset or recurrence of mental disorders.
Goal and Risk Factors in Mental Disorders Prevention
The primary goal of preventive interventions is to reduce risk factors that increase vulnerability to mental disorders and to enhance protective factors that promote resilience. Risk factors are attributes or circumstances that increase an individual’s susceptibility to mental disorders (National Institute of Mental Health [NIMH], 1998a). For adults, the likelihood of developing a mental disorder increases with each additional risk factor. For children, each added risk exponentially increases their susceptibility to mental disorders (Reiss & Price, 1996).
Protective factors are compensatory resources that moderate or reduce the negative effects of adversity (IOM, 1994). These include individual attributes such as an easy temperament, above-average intelligence, and strong competency skills, as well as external factors like a supportive family environment. For children, effective parenting and involvement from caring adults can enhance resilience. For adults, a supportive marital relationship can be a protective factor.
Classification of Mental Health Preventive Interventions
There are two major classifications of mental health preventive interventions:
- Public Health Perspective (IOM, 1994):
- Primary Prevention: Targets individuals who do not have mental health problems but who seek to enhance their competence and well-being.
- Secondary Prevention: Aimed at individuals and families at risk for developing mental disorders due to multiple environmental stressors in their communities. It includes those with mild or moderate psychological symptoms but who are not in crisis.
- Tertiary Prevention: Directed at individuals in crisis, with the goal of preventing psychiatric hospitalization or incarceration. After the crisis, individuals should be directed to primary or secondary intervention programs to maintain or improve adaptive outcomes.
- Mental Health Field Perspective (IOM, 1994):
- Universal Preventive Interventions: Aimed at entire populations, such as the general public, to promote mental health and prevent disorders.
- Selective Prevention: Targets individuals, families, and communities at elevated risk for developing mental disorders due to specific risk factors. For example, programs may engage inner-city women in physical activity to reduce stress (Nies, Chrusical, & Hepworth, in press).
- Indicated Interventions: Designed for high-risk individuals who show early signs of mental disorders but do not yet meet the criteria for a formal diagnosis. For example, interventions may be directed at adolescents with early symptoms of schizophrenia (Haul et al., 1999).
Preventive Science as Multidisciplinary
Preventive science is a broad, multidisciplinary field involving researchers and clinicians from various disciplines who work in teams to leverage their diverse expertise. These scientists use a range of qualitative and quantitative strategies to investigate the multiple and interacting causes of mental health problems. Epidemiological and descriptive studies identify how risk factors and protective processes relate to mental disorders, which informs the development of targeted interventions.
To ensure cultural appropriateness, interventionists must partner with relevant stakeholders to assess whether a program meets the cultural needs of the target population (McClowry et al., 2004).
Timing of Preventive Programs
The timing of prevention programs is critical for maximizing their effectiveness. The most optimal time for these programs is before dysfunctional behaviors are established (Coie et al., 1993). Transitional periods in life, such as the birth of a child or the death of a family member, are particularly vulnerable times that lend themselves to preventive interventions.
Preventive Measures and Associative Interventions
Prevention science aligns well with the nursing profession, as nurses have a long history of engaging in prevention activities under terms like “anticipatory guidance” or “health promotion” (McClowry et al., 2004). Examples of clinical preventive services include suicide prevention, domestic violence prevention, drug abuse prevention, HIV education, pregnancy prevention, and bereavement support. Other programs aim to reduce child neglect or abuse or support caregivers of chronically ill or elderly family members.
Nursing Role in Preventive Services
Nurses play a vital role in preventive services, but they face similar challenges as other disciplines in the field. Time constraints imposed by the current healthcare system often limit the amount of time providers can spend with clients. Moreover, many types of preventive services are not covered by third-party payers, threatening the sustainability of these services in a cost-driven healthcare environment. As patient advocates, nurses must work to ensure that preventive services remain accessible to all healthcare consumers.
Future in Mental Disorders Prevention
A recent report by the NIMH (1998a) recommended several future initiatives to advance the field of mental disorders prevention. Key recommendations include:
- Increased Funding: More funding is needed for preventive interventions and related basic prevention science topics.
- Strengthening Epidemiologic Foundations: There is a need to expand the number of interventions evaluated empirically and to standardize prevention programs.
- Demonstrating Efficacy: Demonstrating the effectiveness of prevention programs is critical to justifying additional funding and establishing the value of this type of research.
Challenges in Mental Disorders Preventive Care
Expanding the field of mental disorders prevention presents several challenges:
- Coordination Across Agencies: Effective collaboration among federal, state, and private agencies is necessary to avoid duplication of services and ensure the highest quality programs are developed and tested.
- Dissemination of Findings: Research findings must be effectively disseminated to stakeholders, funding agencies, and policymakers to keep them informed of the field’s developments.
Nursing Contribution to Prevention of Mental Disorders
Despite rapid expansion in the prevention field over the last decade, there is still a need for highly qualified researchers and interventionists. Nurses are particularly well-prepared to contribute to recent emphases on the comorbidities between mental and physical disorders. To prepare nurses for such research and intervention roles, interdisciplinary courses, mentoring, and opportunities for collaboration are essential.
Nurses bring unique perspectives and skills to prevention efforts, particularly in managing holistic care that addresses both mental and physical health needs. Their involvement is crucial for advancing preventive strategies, promoting mental health, and reducing the burden of mental disorders in various populations.
Conclusion
The prevention of mental disorders is a critical component of public health, focusing on reducing risk factors, enhancing protective factors, and intervening before disorders develop. Nurses have a central role to play in this field, from developing and delivering preventive interventions to advocating for accessible mental health services. Future progress in mental disorders prevention will require increased funding, better coordination among agencies, and continued research to evaluate and refine preventive programs. By contributing their expertise and collaborating across disciplines, nurses can help advance the goal of preventing mental disorders and promoting mental health for all.