1.2.1 Preventative Strategies in Psychiatric Disorders

1.2.1 Preventative Strategies in Psychiatric Disorders

Preventative Strategies in Psychiatric Disorders and Where They Exist

Psychiatric disorders are a leading cause of disability worldwide, with an estimated one in four people experiencing mental health problems at some point in their lives (WHO, 2019). The UK government has recognized the importance of preventative strategies in mental health and has implemented several initiatives aimed at reducing the incidence of psychiatric disorders. In this article, we will discuss some of the preventative strategies for psychiatric disorders and where they exist in the UK.

The origin of most psychiatric disorders is commonly attributed to a biological or sociological cause that triggers the eventual development of the disorder. Following this trigger, patients may experience early symptoms or disturbances that often go unnoticed by clinicians. These prodromal symptoms can eventually progress into a fully diagnosable disorder, which can lead to a range of outcomes, including disability, death, or recovery. Understanding this natural progression of the disease allows for multiple opportunities for intervention:

  1. Primary intervention at the insult to prodrome to prevent the onset of the disorder
  2. Secondary intervention at the prodrome to diagnosis to facilitate early diagnosis
  3. Tertiary intervention at the diagnosis to outcome to prevent disability and improve outcomes.

Primary prevention:

Primary prevention aims to prevent the onset of mental illness in people who are currently well. One approach to primary prevention is to identify individuals who are at high risk of developing psychiatric disorders and provide them with targeted interventions. This approach is known as selective prevention. Another approach is to provide interventions to the general population to reduce the overall incidence of psychiatric disorders. This approach is known as universal prevention.

One example of a selective prevention approach is the use of cognitive-behavioural therapy (CBT) in individuals at high risk of developing depression. A study by Cuijpers et al. (2008) found that CBT reduced the incidence of depression in people with subthreshold symptoms of depression. Another example is the use of pharmacological interventions, such as atypical antipsychotics, in individuals at high risk of developing schizophrenia. A study by Woods et al. (2018) found that treatment with the atypical antipsychotic risperidone reduced the risk of developing psychosis in individuals at high risk of developing schizophrenia.

An example of a universal prevention approach is the implementation of mental health awareness programs in schools. A study by Kutcher et al. (2016) found that a school-based mental health literacy program reduced stigma and increased help-seeking behaviour among students.

Secondary prevention:

Secondary prevention aims to identify and treat mental health problems in their early stages to prevent them from becoming more severe. One approach to secondary prevention is to screen individuals for mental health problems and provide early interventions. Another approach is to provide interventions to individuals who have already developed mental health problems to prevent them from becoming more severe.

The UK government has implemented several initiatives aimed at improving early intervention for people with mental health problems. One example is the Improving Access to Psychological Therapies (IAPT) program, which provides evidence-based psychological therapies to people with common mental health problems, such as anxiety and depression (NHS, n.d.). Another example is the Early Intervention in Psychosis (EIP) program, which provides early intervention for people experiencing the first episode of psychosis (NHS, n.d.).

Tertiary prevention:

Tertiary prevention aims to reduce the impact of mental health problems on individuals and society by providing treatment and support to individuals who have already developed mental health problems. Examples of tertiary prevention include medication, psychological therapies, and social support.

The UK government provides funding for mental health services to provide tertiary prevention interventions. The National Institute for Health and Care Excellence (NICE) provides guidelines for the treatment and management of mental health problems, which are used by mental health services to provide evidence-based interventions (NICE, n.d.). The UK government has also implemented several initiatives aimed at improving social support for people with mental health problems, such as the Community Mental Health Framework (NHS, n.d.).

Preventative strategies in psychiatric disorders are essential for reducing the incidence of mental health problems and their impact on individuals and society. The UK government has implemented several initiatives aimed at primary, secondary, and tertiary prevention, including targeted interventions for high-risk individuals, early intervention for people with mental health problems, and evidence-based treatments and social support for people with mental health problems.

Universal, selective and indicated preventive intervention:

In 1994, the Institute of Medicine (IOM) proposed a framework for classifying prevention strategies that have since become widely used in public health research and practice. The framework identifies three types of prevention strategies: Universal preventative intervention, Selective preventative intervention, and Indicated preventative intervention.

Universal preventative interventions are designed to prevent the onset of problems in entire populations, regardless of their individual risk factors. These interventions aim to improve the overall health and well-being of everyone in the population, regardless of their individual circumstances. Examples of universal preventive interventions include public health campaigns, such as anti-smoking or anti-drinking campaigns, and policies that promote healthy lifestyles.

Selective preventative interventions, on the other hand, target specific subgroups of the population that are at increased risk of developing a problem. These subgroups may be identified based on demographic, behavioural, or environmental risk factors. Examples of selective preventive interventions include school-based prevention programs for at-risk youth or targeted screening programs for certain health conditions.

Indicated preventative interventions are designed for individuals who are already showing signs of a problem, or who are at very high risk of developing a problem. These interventions aim to prevent the problem from getting worse or to prevent it from occurring altogether. Examples of indicated preventive interventions include early intervention programs for children with developmental delays, or targeted counselling for individuals with substance abuse problems.

Prevention StrategyDescriptionExample
Universal Preventative InterventionDesigned to prevent problems in entire populations, regardless of individual risk factorsPublic health campaigns, policies promoting healthy lifestyles
Selective Preventative InterventionTargets specific subgroups of the population at increased risk of developing a problemSchool-based prevention programs for at-risk youth targeted screening programs for certain health conditions
Indicated Preventative InterventionDesigned for individuals showing signs of a problem or at very high risk of developing a problemEarly intervention programs for children with developmental delays, targeted counselling for individuals with substance abuse problems

By classifying prevention strategies into these three categories, the IOM framework provides a useful way to think about how different prevention strategies can be tailored to different populations and individual needs. This framework has been used to guide the development of public health programs and policies and to evaluate the effectiveness of different prevention strategies.

References:

  1. Cuijpers, P., van Straten, A., & Warmerdam, L. (2008). Behavioural activation therapy for depression: An update of meta-analysis of effectiveness and sub-group analysis. Psychological Medicine, 38(3), 411- 418. https://doi.org/10.1017/S0033291707001663
  2. Kutcher, S., Wei, Y., & Morgan, C. (2016). Successful application of a Canadian mental health curriculum resource by usual classroom teachers in significantly and sustainably improving student mental health literacy. Canadian Journal of Psychiatry, 61(4), 222-226. https://doi.org/10.1177/0706743716635595
  3. National Health Service (NHS). (n.d.). Early intervention in psychosis (EIP). Retrieved February 23, 2023, from https://www.nhs.uk/conditions/early-intervention-psychosis/
  4. National Health Service (NHS). (n.d.). Improving Access to Psychological Therapies (IAPT). Retrieved February 23, 2023, from https://www.england.nhs.uk/mental-health/adults/iapt/
  5. National Health Service (NHS). (n.d.). Community mental health framework. Retrieved February 23, 2023, from https://www.england.nhs.uk/mental-health/adults/community-mental-health-framework/
  6. National Institute for Health and Care Excellence (NICE). (n.d.). Mental health. Retrieved February 23, 2023, from https://www.nice.org.uk/guidance/conditions-and-diseases/mental-health
  7. Woods, S. W., Walsh, B. C., Hawkins, K. A., Miller, T. J., Saksa, J. R., D’Souza, D. C., … & McGlashan, T. H. (2018). Glycine treatment of the risk syndrome for psychosis: Report of two pilot studies. European Neuropsychopharmacology, 28(7), 919-928. https://doi.org/10.1016/j.euroneuro.2018.04.011
  8. World Health Organization (WHO). (2019). Mental health. Retrieved February 23, 2023, from https://www.who.int/health-topics/mental-health#tab=tab_1