Prevention of Mental Illness using the Public Health Model.

Disease evolves over time and the pathological changes become less reversible as the disease process continues. The main aim of health care services is to reduce or to reverse the changes as early as possible, thereby preventing further damage to the body tissues and organs.

A three level model for intervention, based on the stages of disease was developed in 1965 by H.R Leavell and E.G Clark.

The three levels of the model are:

• Primary prevention of disease
• Secondary prevention of disease
• Tertiary prevention of disease

Now move on to look at each of these levels individually.

Primary Prevention

This is the true prevention of disease. The actions of primary prevention are carried out before the disease or dysfunction has occurred in the body. Primary prevention actions are directed at depressing the risks of acquiring disease. The activities include health education, environment sanitation, supply of clean safe water, adequate nutrition, rest, sleep, recreation, personal hygiene, good working conditions, good housing, regular physical checkups, screening for disease, genetic screening and counselling.

Additional activities are immunisation against specific diseases, avoidance of home accidents, preventing road, rail, air, sea and industrial accidents.

Secondary Prevention

This focuses on preventing the development of complications in persons who are already suffering a health problem. Secondary preventive actions are aimed at diagnosing disease early and treating it promptly so that the condition of the diseased individual does not worsen.

The main goal is to cure the disease completely in its early stages or when a cure is possible. If a cure is impossible, secondary prevention slows the progression of disease as well as preventing complications and limiting disability. Some of the secondary prevention activities are: 

• Screening tests to detect early pre-symptomatic physiological and anatomical 
• indications of disease, for example, Pap smear, random blood sugar test, etc.
•  Case finding and case holding
•  Screening surveys and examinations
•  Mass treatment campaigns
• Adequate treatment of disease
•  Follow-up of treated clients of special clinics and home visits. 

Functional Disorders

These can occur in the form of manic-depressive psychosis, depressive or manic phase. Depression is the most common form, and may result in suicidal ideation, guilt and/or negative feelings towards the baby. For example, the mother may think that the child has a serious ailment and for that reason she should kill it to save it from suffering.

Schizophrenia

This tends to develop sooner and is more acute than depression.

Schizoaffective Disorders

Schizoaffective disorders incorporate features of schizophrenia and affective disorder, which appear in the same person at the same time.

The clinical presentation will depend on the presenting condition.

Tertiary Prevention

When a disease or a dysfunction causes permanent disability, tertiary prevention is used to limit the severity of the disability in the early stages of the disease. In those cases where residual damage is being experienced, disability is permanent and tertiary prevention takes the form of rehabilitation.

Tertiary prevention activities include restoration of functioning and
rehabilitation through:

• Retraining and education to maximise use of
  remaining capacities
• Selective placement
• Work therapy
• Modification of environment
• Home nursing and health visiting

Tertiary prevention care aims at helping the patient achieve as high a level of functioning as possible, despite the limitations caused by illness or impaired functioning.

Psychiatry has traditionally focused on secondary and tertiary prevention. Secondary prevention involves lowering the disability rate by shortening the average duration of nervous disturbances through early diagnosis and effective treatment. Tertiary prevention involves reduction of disability in individuals with long-standing and incurable psychiatric disorder.
By contrast, primary prevention is total prevention.

Alternatively one can use the modified public health model.

The Public Health Model

The public health model of 'primary, secondary and tertiary prevention' has been modified in order to provide distinction between prevention and treatment. Prevention efforts are classified into three sub-categories: universal, selective and indented intervention.

Universal Intervention

These are efforts aimed at influencing the general population, mainly concerned with two tasks:

• Altering the conditions that cause or contribute to mental disorders, also known as risk factors.
• Establishing conditions that foster positive mental health, also known as protective factors.

Universal intervention includes biological, psychological and socio-cultural efforts.

Biological Measures - This includes the development of adaptive life style, improvement of diet, having routine exercise, and overall good
health habits.

Psychosocial Measures - Here opportunities to learn physical, intellectual, emotional and social competencies are provided. For example an individual is assisted to develop skills needed for effective problem solving, for expressing emotions constructively and for satisfying relationships
with others.

The person may also be helped to acquire an accurate frame of reference on which to build their own personality. The patient should be prepared
for problems they are likely to encounter during certain stages of life, for example, problems associated with pregnancy and child rearing
must be discussed with women.

Socio-cultural Measures - These measures ensure a reciprocal relationship between an individual and their community. They also encourage social conditions that promote healthy development and functioning individuals, and incorporate services ranging from public education and social security to economic planning and social legislation directed at ensuring adequate health care for all citizens.

Selective Intervention

This model involves the establishment of programs that prevent the development of disorders, before people become so involved with certain behaviour patterns that future adjustments become difficult or impossible.

Examples of successful programs include:

• Education programs, which involve the provision of information to the groups at risk.
• Intervention programs involving the identification of high-risk groups and taking the necessary measures.
• Peer group influence programs, which help youngsters to overcome negative pressures from peers by being assertive.
• Programs to increase self-esteem, which enable the individual to overcome pressure from more dominant peers.

Indicated Intervention

This program emphasises the early detection and prompt treatment of maladaptive behaviours in a person's family and community setting. For example, in a crisis after a disaster, immediate and relatively brief intervention is carried out to prevent any long-term consequences