Another approach to managing mental illness is attempting prevention. This requires finding and eliminating the conditions that cause or contribute to mental disorders and substituting conditions that foster well-being. Prevention takes three forms: primary, sec- ondary, and tertiary.
Primary prevention refers to efforts to improve the overall environment so that new cases of mental disorders do not develop. Family planning and genetic counseling are two
Beginning in the 1950s and 1960s, the policy of deinstitutionalization led to the release of many individuals, who, without proper follow- up care, ended up living on the streets. Although not all homeless people are men- tally ill, estimates suggest that nearly 40% of homeless persons suffer from some type of mental disorder.
primary prevention Techniques and programs to improve the social environment so that new cases of mental disorders do not develop.
Examples of primary prevention programs. Other primary prevention programs aim at increasing per- sonal and social competencies in a wide variety of groups. For example, there are programs designed to help mothers encourage problem-solving skills in their children and programs to enhance competence and adjustment among elderly persons. Current cam- paigns to educate young people about drugs, alcohol abuse, violence, and date rape are examples of pri- mary prevention (Foxcroft, Ireland, Lister, Lowe, & Breen, 2003; Schinke & Schwinn, 2005).
Secondary prevention involves identifying high risk groups—for example, abused children, people who have recently divorced, those who have been laid off from their jobs, veterans, and victims of terrorist incidents. Intervention is the main thrust of sec- ondary prevention—that is, detecting maladaptive
behavior early and treating it promptly. One form of intervention is crisis intervention, which includes such programs as suicide hotlines (R. K. James & Gilliland, 2001), or short- term crisis facilities where therapists can provide face-to-face counseling and support.
The main objective of tertiary prevention is to help people adjust to community life after release from a mental hospital. For example, hospitals often grant passes to encourage people to leave the institution for short periods of time before their release. Other tertiary prevention measures are halfway houses, where people find support and skills training during the period of transition between hospitalization and full integration into the community, and nighttime and outpatient programs that provide supportive therapy while people live at home and hold down full-time jobs. Tertiary prevention also includes community education.
Prevention has been the ideal of the mental health community since at least 1970, when the final report of the Joint Commission on Mental Health of Children called for a new focus on prevention in mental health work. Ironically, because preventive programs are usually long range and indirect, they are often the first to be eliminated in times of economic hardship.
Suicide hotlines and other crisis intervention programs are secondary prevention mea- sures designed to serve individuals and groups at high risk for mental disorders.
Access to Mental Health Care
A friend feels overwhelmed by sadness and is exhibiting depressive symp-toms. He comes to you for advice. How likely would you be to suggest thatyour friend seek psychotherapy or drug treatment? Think about the follow- ing questions:
• Would you seek therapy yourself in a similar situation? • What would you think of a friend who you knew was seeing a therapist? • Would your friend be able to obtain therapy services? Would he be able to
afford these kinds of services?
• Do you think that mental illness and physical illness are equivalent and should be treated the same by insurance companies?
secondary prevention Programs to identify groups that are at high risk for mental disorders and to detect maladaptive behavior in these groups and treat it promptly.
tertiary prevention Programs to help people adjust to community life after release from a mental hospital.