Often we think of “prevention” in all-or-nothing terms – either you succeed in preventing a problem or you don’t. But there are different levels of prevention, and usually something can be done to at least keep things from getting worse…. This is an important concept in mental health care, as certain conditions that cannot be entirely prevented from occurring in some people or situations.
Primary prevention refers to efforts that might keep a mental health problem from developing in the first place. Examples of primary prevention include education focused on emotional/behavioral concerns like child neglect (e.g., leaving young children unattended in cars). Raising awareness about the risks of drinking alcohol during pregnancy, or good sleep hygiene, or safety precautions that decrease one’s vulnerability to crime can help prevent fetal alcohol syndrome, sleep deprivation, and post-traumatic stress disorder, respectively. Ensuring that people have access to basic medical care can help prevent mental health problems caused by untreated physical conditions, e.g., anxiety or depression related to hyper- or hypothyroidism. Public policy requiring employers to provide parental leave for a new baby might help prevent postpartum depression in the mother or attachment problems in the child, who could otherwise be deprived of adequate bonding during this crucial phase of development.
Some mental health conditions cannot be entirely prevented because:
- certain bad or stressful things that happen are outside of anyone’s control; and
- there are biological and/or hereditary components to many psychological disorders. Both depression and anxiety can be triggered or worsened by traumatic experiences, upsetting situations, or plain accumulations of stress from having too many demands and responsibilities. Some people have dispositional or biological tendencies toward depression or anxiety, but do okay until their symptoms are escalated by a serious stressor or multiple stressors within a short time frame. And there are psychological disorders like schizophrenia that have a strong hereditary component, and so will inevitably afflict some people (about 1% of the population).
Generally, there are many variables that determine how likely it is that emotional/ psychological problems will result from a stressful or traumatic experience. Some of these include: a person’s characteristic style of coping; level of social support; presence of other problems like substance abuse; suddenness or predictability of the stressor; and the nature of any traumatic experience (deliberately perpetrated by another person vs. accidental or due to natural forces). Off-time events such as the death of a child are particularly distressing since we are not mentally prepared for them. And certain losses and transitions which are “under ritualized” or not sufficiently acknowledged can leave people feeling isolated and stuck with their grief and associated feelings. Some such examples might include fertility problems, geographic dislocation, or the ending of a long-term, committed relationship between same-sex partners that has essentially the same impact as a divorce.
Secondary Prevention interventions are targeted at a specific at-risk population, attempting to decrease their likelihood of developing specific mental or behavioral health conditions. Often, such efforts are focused on economically disadvantaged groups, such as Head Start classes that help prevent learning problems and mentoring programs for teen parents that facilitate development of good parenting skills which can prevent child abuse. People with inherently traumatic jobs, such as military personnel and fire/rescue workers, might receive structured “de-briefing” sessions after a major incident to help minimize or prevent symptoms of post-traumatic stress disorder. In the medical domain, there are support groups for people with conditions like heart disease that help prevent depression, and respite services for caregivers of sick/disabled family members, who are vulnerable to their own stress-related symptoms and burnout. Other examples of secondary prevention include eating disorders awareness programs for student athletes, and domestic violence referrals posted in hospital emergency rooms.
Finally, the purpose of tertiary prevention is to decrease the severity or duration of existing mental health problems, or the negative fallout associated with them. Case management services which help ensure that mentally ill people get comprehensive treatment and motivate better compliance with doctors’ orders, are a type of tertiary prevention. Self-help groups for people with various addictions and compulsions (e.g., spending, gambling, sex, overeating, cluttering) help members get their problems under control with an integrated cognitive-behavioral, emotional and spiritual approach. Domestic violence shelters provide “safety planning” for victims who remain at risk of additional, possibly life- threatening attacks by their abusive partners. Likewise, sexual assault crisis centers provide counseling to address trauma-based symptoms, along with support for victims pressing criminal charges lest they end up feeling “re- victimized” by an insensitive legal system.
Some mental health programs encompass primary, secondary and tertiary prevention. Suicide prevention hotlines are a good example:
- publicizing warning signs so that friends/family will know when and how to seek help for someone at risk;
- provide support for people in distress who, without additional counseling, might become seriously depressed or suicidal; and
- provide crisis intervention services for anyone who calls to report they are contemplating suicide.
Employee assistance programs also provide different levels of preventative help, for example: education about various psychological and adjustment issues; assistance for employees experiencing personal or job-related stress; and referrals for those already struggling with problems like anxiety, depression or substance abuse.
Prevention is a hopeful term, and in fact it’s never too late to address problems with stress, adjustment or even more serious psychological symptoms. Getting professional consultation can actually help the affected person and their loved ones re-gain a sense of control. There is power in knowledge, whether it means recognizing the price of continued denial, learning ways to take better care of oneself to improve your mental state, or even finding that there is some type of psychological or psychiatric treatment that can stop certain problems from running you. Your employee assistance program or local community mental health center is often the best place to start.