What Would Prevention Look Like for Mental Health?

March 19, 2008

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Editor's note: This is the third in a series of articles that looks at the promise of taking a public health approach to mental health. The series starts with Creating an Ounce of Prevention.

At times, preventing mental illness may seem to be a lot like the weather. Everybody talks about it but nobody does anything about it.

But that's not entirely true. Last year's report from the Washington State Board of Health, Mental Health–A Public Health Approach: Developing a Prevention-Oriented Mental Health System in Washington State [ Portable Document Format 771KB], identifies a number of successful programs as well as several more fruitful avenues worth pursuing.

14 Cross-Cutting Themes

In our last article on prevention, "Can Mental Illness Be Prevented?," we discussed the example of the Nurse-Family Partnership as a program t hat successfully promotes mental health and prevents mental illness.

The Board of Health report identifies 14 overarching issues and common themes that each address mental health promotion in Washington State. Together, they apply to the entire range of the population, from infants to older adults. These themes are being used as the basis for the ongoing community and partner meetings, leading up to the policy discussions that will occur at the Prevention Summit in May of this year:

Institutionalize communications and coordination around shared outcomes.
Coordination of services across systems and agencies can increase effectiveness and efficiency, eliminate redundancy, reduce turf struggles, and prevent people, policies, and programs from falling through the cracks. Existing prevention services systems often address the same underlying risks, but because they are not coordinated around a shared set of outcomes, prevention loses economies of scale.
Market mental wellness and stigma reduction.
Marketing campaigns attempt to influence the attitudes and behaviors of a target audience. The public case made against tobacco use is a good example. The Mental Health Transformation Project Social Marketing Plan [ 190KB] provides some sense of what this might ultimately look like for mental health promotion.
Increase funding flexibility.
Flexible funding streams can support more efficient and effective program models than categorical funding streams, which are often created with overly narrow views of the needs of a population and quickly lead to multiple inefficiencies.
Leverage existing funding sources.
Existing funding streams – notably federal dollars – can be better used in the effort to promote mental health. A very good example is Medicaid's Early Periodic Screening, Diagnosis and Treatment (EPSDT) program, which provides primary care developmental and mental illness screenings for children on Medicaid.
Assess community risk and protective factors.
Robust and regular assessment would better inform local interventions. An example is the Healthy Youth Survey, which collects self-reported information from middle and high school students. Reducing risk factors and strengthening protective factors can result in addressing several disorders in one intervention.
Screen at multiple points of entry.
Conducting mental health screenings at multiple points of entry into multiple systems could identify problems more quickly and effectively. A key example would be integrating these screenings into medical care settings, particularly primary care, and for services to the elderly.
Provide care based on need.
This would reframe systems of care to provide help based on need, not solely on diagnoses. Even if individuals do not meet certain diagnostic criteria, they – and, ultimately, all of us – can benefit significantly from the delivery of services that interrupt the trajectory towards serious crisis.
Ensure age-appropriate services are available.
Availability of age-appropriate mental health services across an individual's lifespan is critical. These populations include infants and toddlers, school-age children, teens, adults, and older adults.
Provide culturally competent services.
Improving the availability of culturally competent services has an obvious potential to help in reducing the disparity in unmet needs for mental health services among communities of color.
Meet people where they are.
Adequate outreach and treatment programs should serve communities wherever they are found. Programs that reach people in their community settings, or their homes, reduce barriers to accessing services and also reduce the stigma of receiving services. School-based health centers, for example, can reach a great majority of children.
Support transitions across the lifespan.
Continuity of care support is critical at transition points in an individual's life. For example, ensuring continuity between child and adult Medicaid mental health systems can prevent disruptions in care, and lapses in recovery.
Provide mental health consultation.
Mental health consultation can be an effective way to address ongoing mental health needs, particularly across multiple systems. For example, mental health consultation with child-care providers can help keep children with behavioral and emotional problems in child care, which in turn helps them to be more successful in school and in relationships.
Increase and improve provider training.
Providers in multiple systems can work more effectively with diverse individuals if they have adequate training in mental health, especially training specific to the populations they primarily serve, along with a solid grounding in the principles of recovery.
Create trauma-sensitive or trauma-informed systems.
A system can be trauma-informed regardless of the specific services it offers. Trauma-informed systems have the advantage of making prevention of further trauma a priority even as they reduce its devastating impacts.

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