Reducing Risks for Mental Disorders Frontiers for Preventive Intervention Research (1994) / Chapter Skim
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2 NEW DIRECTIONS IN DEFINITIONS
2 NEW DIRECTIONS IN DEFINITIONS
Pages 19-30
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From page 19... ...
Because of its record of success, this model was extended for use with a broad range of prevention efforts for noninfectious diseases and other chronic physical illnesses. CLASSIFYING PREVENTIVE INTERVENTIONS POR PHYSICAL ILLNESS The original public health classification system of disease prevention was proposed by the Commission on Chronic IlIness (1957~.
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From page 20... ...
Although the goals of these three types of prevention appear to be clear-cut, in practice there is considerable disagreement about their usage. The classic example of primary prevention within a public health context was the history-making action in the nineteenth century of John Snow (Last, 1988)
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From page 21... ...
Gordon meant for the recipients of indicated preventive interventions to be asymptomatic regarding the disease but to have a "clinically demonstrable abnormality." Indicated preventive measures are usually not totally benign to the subject or minimal in cost. If they were, the balance in the benefit-cost analysis might favor their wider application, including segments of the population at lower risk of disease, and they would tend to move into the selective or universal classes.
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From page 22... ...
are often not diagnosable as "psychiatric caseness" but rather as impairments in cognition and psychosocial development. The Mental Health Intervention Spectrum for Mental Disorders Because of all the difficulties described above, the committee has chosen not to use the public health classification system of primary,
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\: \ /~//( care (\~NC\~\ FIGURE 2.1 The mental health intervention spectrum for mental disorders. secondary, and tertiary prevention.
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Preventive Interventions for Mental Disorders In the mental health intervention spectrum, universal preventive interventions are targeted to the general public or a whole population group that has not been identified on the basis of individual risk. The intervention is desirable for everyone in that group.
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From page 25... ...
Whereas he meant it to apply only to asymptomatic individuals, within this mental health classification system it can be applied to asymptomatic individuals with markers as well as to symptomatic individuals whose symptoms are still early and are not sufficiently severe to merit a diagnosis of a mental disorder. An example of an indicated preventive intervention from this report is a parent-child interaction training program delivering an intervention for children who have been identified by their parents as having behavioral problems (see Chapter 7~.
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From page 26... ...
Likewise, the delay of onset of Alzheimer's disease would result in a delay in the stress-induced problems experienced by family caregivers. MENTAL HEALTH PROMOTION The phrase promotion of mental health has definitional problems similar to those of prevention, meaning different things to different people.
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From page 27... ...
The U.S. Public Health Service's 1984 definition of prevention research includes "only that research designed to yield results directly applicable to interventions to prevent occurrences of disease or disability, or the progression of detectable but asymptomatic disease." The lack of description of "occurrence," "disease," and "disability," as well as a breakdown of activities into "intervention," "preintervention," and "prevention-related research" (see Table 2.1)
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From page 28... ...
Therefore the committee presents an alternative, using the term prevention research to refer only to preventive intervention research that can be further classified into universal, selective, and indicated types. In service, these three general preventive intervention strategies can be integrated within an overall public health plan and are likely to occur in primary health care settings, schools, work sites, churches, and other community settings.
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From page 29... ...
Also within the public health care plan, adequate treatment and after-care interventions need to be readily available for those who have not had access to preventive interventions or for whom the interventions were not effective in preventing the onset of a mental disorder. Although the focus in this report is on prevention, the other components of the classification system outlined here deserve equal emphasis in a comprehensive and coordinated new approach to our nation's mental health.
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