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Prevention of mental disorders

Topic: Medicine

 From HandWiki - Reading time: 16 min

Prevention of mental disorders are measures that try to decrease the chances of a mental disorder occurring. A 2004 WHO report stated that "prevention of these disorders is obviously one of the most effective ways to reduce the [disease] burden."[1] The 2011 European Psychiatric Association (EPA) guidance on prevention of mental disorders states "There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions."[2] A 2011 UK Department of Health report on the economic case for mental health promotion and mental illness prevention found that "many interventions are outstandingly good value for money, low in cost and often become self-financing over time, saving public expenditure".[3] In 2016, the National Institute of Mental Health re-affirmed prevention as a research priority area.[4]

Methods

Parenting

Parenting may affect the child's mental health,[5][6][7][8] and evidence suggests that helping parents to be more effective with their children can address mental health needs.[9][10][11]

Assessing parenting capability has been raised in child protection and other contexts.[12][13][14][15] Delaying of potential very young pregnancies could lead to better mental health causal risk factors such as improved parenting skills and more stable homes,[16] and various approaches have been used to encourage such behaviour change.[17][18] Some countries run conditional cash transfer welfare programs where payment is conditional on behaviour of the recipients. Compulsory contraception has been used to prevent future mental illness.[19]

Pre-emptive CBT

Use of cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.[20][21] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis.[22][23] As of 2018, some health providers now advocate pre-emptive use of CBT to prevent worsening of mental illnesses.[24]

Mental silence meditation

Sahaja meditators scored above control groups for emotional well-being and mental health measures on SF-36 ratings, leading to proposed use for mental illness prevention, although this result could be due to meditators having other characteristics leading to good mental health, such as higher general self care.[25][26][27]

Internet- and mobile-based interventions

A review found that a number of studies have shown that internet- and mobile-based interventions can be effective in preventing mental disorders.[28]

Other advice

Many sources advocate helping one's mental health by actions such as good exercise, diet, sleep, social contacts and gratitude.[29][30][31]

Specific diseases

Depression

For depressive disorders, when people participated in interventions, some studies show the number of new cases is reduced by 22% to 38%.[32][33] These interventions included CBT.[34][35] Such interventions also save costs.[36] Depression prevention continues to be called for.[37]

Anxiety

For anxiety disorders,

  • use of cognitive behavioral therapy (CBT) with people at risk has significantly reduced the number of episodes of generalized anxiety disorder and other anxiety symptoms, and also given significant improvements in explanatory style, hopelessness, and dysfunctional attitudes.[20][38] Other interventions (parental inhibition reduction, behaviourism, parental modelling, problem-solving and communication skills) have also produced significant benefits.[20] People with subthreshold panic disorder were found to benefit from use of CBT.[39]
  • for older people, a stepped-care intervention (watchful waiting, CBT and medication if appropriate) achieved a 50% lower incidence rate of depression and anxiety disorders in a patient group aged 75 or older.[40][non-primary source needed]
  • for younger people, it has been found that teaching CBT in schools reduced anxiety in children,[41] and a review found that most universal, selective and indicated prevention programs are effective in reducing symptoms of anxiety in children and adolescents.[42]
  • for university students mindfulness has been shown to reduce subsequent anxiety.[43]

Psychosis

In those at high risk there is tentative evidence that psychosis incidence may be reduced with the use of CBT or other types of therapy.[44][45] In 2014 the UK National Institute for Health and Care Excellence (NICE) recommended preventive CBT for people at risk of psychosis.[22][46]

There is also tentative evidence that treatment may help those with early symptoms.[47][48] Antipsychotic medications are not recommended for preventing psychosis.[22]

For schizophrenia, one study of preventative CBT showed a positive effect[44] and another showed neutral effect.[49]

Targeted vs universal

There has been an historical trend among public health professionals to consider targeted programmes. However identification of high risk groups can increase stigma, in turn meaning that the targeted people do not engage. Thus policy recommends universal programs, with resources within such programs weighted towards high risk groups.[50]

Universal prevention (aimed at a population that has no increased risk for developing a mental disorder, such as school programs or mass media campaigns) need very high numbers of people to show effect (sometimes known as the "power" problem). Approaches to overcome this are (1) focus on high-incidence groups (e.g. by targeting groups with high risk factors), (2) use multiple interventions to achieve greater, and thus more statistically valid, effects, (3) use cumulative meta-analyses of many trials, and (4) run very large trials.[51][52]

History

History of mental illness prevention strategies

  • In 2020 a US paper identified the need for prevention, and led with focus on preventing traumatic events and adverse childhood experiences.[53] A European paper highlighted "addressing both poor parenting and children's maladaptive personality traits and insufficient life skills."[54]
  • In 2019 the leading UK mental health NGOs produced a combined manifesto which had prevention as its first point.[55] Mental Health Foundation produced a major strategy focus on prevention.[56] What Works Centre for Wellbeing produced a report on wellbeing which included a focus on "Parents ability to support the healthy development of their children’s social and emotional skills."[57]
  • In 2018 the University of Birmingham Mental Health Policy Commission focused on prevention, including the challenges of funding given the shortness of political cycles versus the longer paybacks of prevention.[58]
  • In 2018 11 European researchers published a review of mental illness prevention stating that "Increasing evidence suggests that preventive interventions in psychiatry that are feasible, safe, and cost-effective could translate into a broader focus on prevention in our field." and that "Gaps between knowledge, policy, and practice need to be bridged."[59]
  • In 2018 Massachusetts announced a mental health strategy including many prevention elements. The executive summary began "Behavioral health promotion and upstream prevention works."[60]
  • In 2017 the OECD published an overview of the development of approaches to promoting mental wellbeing and preventing mental ill-health in OECD countries, together with an assessment of what is known on their effectiveness and cost effectiveness.[61]
  • In 2017 the Australian Government funded a new Centre for Research Excellence in Prevention of Anxiety and Depression.[62]
  • The US Substance Abuse and Mental Health Services Administration (SAMHSA) advocates a 5-step prevention framework.[63]
  • In 2016:
    • the UK NHS Mental Health Taskforce included 'preventing mental health' in its 3 Priorities, focusing on children and young ages, and the importance of employment.[64]
    • the UK NGO Mental Health Foundation published a review of prevention approaches.[65]
    • the UK NGO Mind produced public mental health recommendations for more prevention.[66]
  • In 2015:
    • the Hunter Institute of mental health in Australia published its "Prevention First" strategic framework for prevention.[67]
    • the UK NGO Mental Health Foundation published a review of prevention research, paving the way for prevention strategies.[68][page needed]
    • the official journal of the World Psychiatric Association included a survey of public mental health which concluded "the evidence base for public mental health interventions is convincing, and the time is now ripe to move from knowledge to action".[69]
  • In 2014 the UK Chief Medical Officer, Professor Dame Sally Davies, chose mental health for her major annual report, and included prevention of mental illness heavily in this.[70]
  • In 2013 the Faculty of Public Health, the UK professional body for public health professionals, produced its "Better Mental Health for All" resource, which aims at "the promotion of mental wellbeing and the primary prevention of mental illness".[71]
  • In 2012, Mind, the UK mental health NGO, included "Staying well; Support people likely to develop mental health problems, to stay well." as its first goal for 2012–16.[72]
  • The 2011 mental health strategy of Manitoba (Canada) included intents to (i) reduce risk factors associated with mental ill-health and (ii) increase mental health promotion for both adults and children.[73]
  • The 2011 US National Prevention Strategy included mental and emotional well-being, with recommendations including (i) better parenting and (ii) early intervention.[74]
  • Australia's mental health plan for 2009–14 included "Prevention and Early Intervention" as priority 2.[75]
  • The 2008 EU "Pact for Mental Health" made recommendations for youth and education including (i) promotion of parenting skills, (ii) integration of socio-emotional learning into education curricular and extracurricular activities, and (iii) early intervention throughout the educational system.[76]
  • The 2006 Canadian "Out of the Shadows at last" included a section on prevention.[77]

History of mental illness prevention programmes and research

Historically prevention has been a very small part of the spend of mental health systems. For instance the 2009 UK Department of Health analysis of prevention expenditure did not include any apparent spend on mental health.[78] The situation is the same in research.[79]

However more recently some prevention programmes have been proposed or implemented. Prevention programmes can include public health policies to raise general health, creating supportive environments, strengthening communities, developing personal skills, and reorienting services.[66]

  • In 2021 a meta review highlighted that "Targeted cognitive behavioural therapy interventions delivered to young people with minimal but detectable signs of depressive symptoms appear to be effective in reducing symptoms of depression in both the short and medium term."[80]
  • In 2017 the UK PHE and LSE produced research showing short payback periods for a number of prevention interventions.[81]
  • In 2017 the Scotland Mental Health Strategy included prevention, including a focus on improving parenting skills.[82]
  • In 2016, the UK Education Policy Institute advocated prevention through increased mental health literacy, better parenting and improving children's resilience and digital world skills.[83]
  • In 2013 the UK NGO Mental Health Foundation and partners began to use Video Interaction Guidance (VIG) in an early years intervention to reduce later life mental illness.[84][85]
  • In 2013 in Australia the National Health and Medical Research Council supported a set of parenting strategies to prevent teenagers becoming anxious or depressed.[86][87]
  • In 2012 the UK Schizophrenia Commission recommended "a preventative strategy for psychosis including promoting protective factors for mental wellbeing and reducing risks such as cannabis use in early adolescence."[79]
  • In 2010 the European Union DataPrev database was launched. It states "A healthy start is crucial for mental health and wellbeing throughout life, with parenting being the single most important factor," and recommends a range of interventions.[88]
  • In 2009 the US National Academies publication on preventing mental, emotional, and behavioral disorders among young people focused on recent research and program experience and stated that "A number of promotion and prevention programs are now available that should be considered for broad implementation."[89][90] A 2011 review of this by the authors said "A scientific base of evidence shows that we can prevent many mental, emotional, and behavioral disorders before they begin" and made recommendations including
    • supporting the mental health and parenting skills of parents,
    • encouraging the developmental competencies of children and
    • using preventive strategies particularly for children at risk (such as children of parents with mental illness, or with family stresses such as divorce or job loss).[91]

In India the 1982 National Mental health Programme included prevention,[92] but implementation has been slow, particularly of prevention elements.[93][94][95]

It is already known that home visiting programs for pregnant women and parents of young children can produce replicable effects on children's general health and development in a variety of community settings.[96] Similarly positive benefits from social and emotional education are well proven.[97] Research has shown that risk assessment and behavioral interventions in pediatric clinics reduced abuse and neglect outcomes for young children.[98] Early childhood home visitation also reduced abuse and neglect, but results were inconsistent.[99]

Issues in implementation

Prevention programs can face issues in (i) ownership, because health systems are typically targeted at current suffering, and (ii) funding, because program benefits come on longer timescales than the normal political and management cycle.[100][101] Assembling collaborations of interested bodies appears to be an effective model for achieving sustained commitment and funding.[102][103]

Commentary

In 2016 Mark Williamson, CEO of Action for Happiness said, regarding the increasing number of people being in treatment with mental illnesses, "What we believe is that you can help people develop better habits before that happens. We’ve got the beginnings now of a culture in preventative approaches to physical health problems, with anti-smoking and obesity drives. I think the next 20 years is going to be about massively proactive ways to look after your mental health and your social and emotional well-being, and to really think about what happiness means and how it can be achieved."[104]

References

  1. ↑ World Health Organization, Department of Mental Health and Substance Abuse; Prevention Research Centre of the Universities of Nijmegen and Maastricht (2004). Prevention of mental disorders: effective interventions and policy options: summary report. Geneva: World Health Organization. ISBN 978-92-4-159215-4. https://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf. 
  2. ↑ Campion, J.; Bhui, K.; Bhugra, D.; European Psychiatric, Association (2012). "European Psychiatric Association (EPA) guidance on prevention of mental disorders". European Psychiatry 27 (2): 68–80. doi:10.1016/j.eurpsy.2011.10.004. PMID 22285092. 
  3. ↑ "Mental health promotion and mental illness prevention: The economic case". London School of Economics and Political Science. 2 February 2011. http://www2.lse.ac.uk/businessAndConsultancy/LSEEnterprise/news/2011/healthstrategy.aspx. 
  4. ↑ "NIMH » Research Priorities for Strategic Objective 3". https://www.nimh.nih.gov/about/strategic-planning-reports/strategic-research-priorities/srp-objective-3/index.shtml. 
  5. ↑ Yap, Marie Bee Hui; Pilkington, Pamela Doreen; Ryan, Siobhan Mary; Jorm, Anthony Francis (2014). "Parental factors associated with depression and anxiety in young people: A systematic review and meta-analysis". Journal of Affective Disorders 156: 8–23. doi:10.1016/j.jad.2013.11.007. PMID 24308895. 
  6. ↑ Yap, Marie B.H; Pilkington, Pamela D; Ryan, Siobhan M; Kelly, Claire M; Jorm, Anthony F (2014). "Parenting strategies for reducing the risk of adolescent depression and anxiety disorders: A Delphi consensus study". Journal of Affective Disorders 156: 67–75. doi:10.1016/j.jad.2013.11.017. PMID 24359862. 
  7. ↑ "Systematic review identifies key parenting factors associated with adolescent depression and anxiety". 2014-02-04. https://www.nationalelfservice.net/mental-health/anxiety/systematic-review-identifies-key-parenting-factors-associated-with-adolescent-depression-and-anxiety/. 
  8. ↑ "Center on the Developing Child at Harvard University". https://developingchild.harvard.edu/. 
  9. ↑ Richard p. Barth (2009). "Preventing Child Abuse and Neglect with Parent Training: Evidence and Opportunities". The Future of Children 19 (2): 95–118. doi:10.1353/foc.0.0031. PMID 19719024. 
  10. ↑ Stewart-Brown, S. L; Schrader-Mcmillan, A (2011). "Parenting for mental health: What does the evidence say we need to do? Report of Workpackage 2 of the Data Prev project". Health Promotion International 26: i10–28. doi:10.1093/heapro/dar056. PMID 22079931. 
  11. ↑ "Parent training works for child and adolescent mental health". 2017-01-19. https://www.nationalelfservice.net/populations-and-settings/parenting/parent-training-works-for-child-and-adolescent-mental-health/. 
  12. ↑ Effective parenting capacity assessment: Key issues. Centre for Parenting & Research. May 2006. ISBN 978-0-7310-4387-3. http://www.community.nsw.gov.au/docswr/_assets/main/documents/researchnotes_parenting_keyissues.pdf. 
  13. ↑ "Assessing Parenting Skills and Competencies". Childwelfare.gov. http://www.childwelfare.gov/systemwide/assessment/family_assess/parentalneeds/skills.cfm. 
  14. ↑ White, Angela (December 2005). Assessment of parenting capacity Literature review. Centre for Parenting & Research. ISBN 978-0-7310-4385-9. http://www.community.nsw.gov.au/docswr/_assets/main/documents/research_parenting_capacity.pdf. [page needed]
  15. ↑ "Assessing parenting capacity". Practice Centre. http://www.practicecentre.cyf.govt.nz/policy/caring-for-children-and-young-people/key-information/assessing-parenting-capacity.html. 
  16. ↑ Morris, N M (1981). "The biological advantages and social disadvantages of teenage pregnancy". American Journal of Public Health 71 (8): 796. doi:10.2105/AJPH.71.8.796. PMID 7258440. 
  17. ↑ "Adolescent Pregnancy Prevention Interventions – Family Home Visiting". Health.state.mn.us. http://www.health.state.mn.us/divs/fh/mch/fhv/strategies/tppinterventions.html. 
  18. ↑ Harden, A; Brunton, G; Fletcher, A; Oakley, A (2009). "Teenage pregnancy and social disadvantage: Systematic review integrating controlled trials and qualitative studies". BMJ 339: b4254. doi:10.1136/bmj.b4254. PMID 19910400. 
  19. ↑ Reilly, Philip (1991). The surgical solution: a history of involuntary sterilization in the United States. Baltimore: Johns Hopkins University Press. ISBN 978-0-8018-4096-8. [page needed]
  20. ↑ 20.0 20.1 20.2 Bienvenu, O. Joseph; Ginsburg, Golda S. (2007). "Prevention of anxiety disorders". International Review of Psychiatry 19 (6): 647–54. doi:10.1080/09540260701797837. PMID 18092242. 
  21. ↑ Seligman, Martin E. P.; Schulman, Peter; Derubeis, Robert J.; Hollon, Steven D. (1999). "The prevention of depression and anxiety". Prevention & Treatment 2 (1). doi:10.1037/1522-3736.2.1.28a. 
  22. ↑ 22.0 22.1 22.2 "Psychosis and schizophrenia in adults: updated NICE guidance for 2014". National Elf Service. 2014-02-19. http://www.thementalelf.net/treatment-and-prevention/medicines/antipsychotics/psychosis-and-schizophrenia-in-adults-updated-nice-guidance-for-2014/. 
  23. ↑ "Psychosis and schizophrenia". nice.org.uk. http://pathways.nice.org.uk/pathways/psychosis-and-schizophrenia#path=view%3A/pathways/psychosis-and-schizophrenia/prevention-in-adults-at-risk-of-developing-psychosis.xml&content=view-node%3Anodes-interventions-to-prevent-psychosis. 
  24. ↑ "Cognitive Behavioural Therapy (CBT)". http://www.hpft.nhs.uk/services/community-services/wellbeing-service/our-treatments/cognitive-behavioural-therapy-cbt/. 
  25. ↑ Manocha, Ramesh; Black, Deborah; Wilson, Leigh (2012). "Quality of Life and Functional Health Status of Long-Term Meditators". Evidence-Based Complementary and Alternative Medicine 2012: 1–9. doi:10.1155/2012/350674. PMID 22611427. 
  26. ↑ Manocha, Ramesh (2014). "Meditation, mindfulness and mind-emptiness". Acta Neuropsychiatrica 23 (1): 46–7. doi:10.1111/j.1601-5215.2010.00519.x. 
  27. ↑ Morgan, Adam (1999). Sahaja Yoga: an ancient path to modern mental health? (PhD Thesis). [page needed]
  28. ↑ Ebert, David Daniel; Cuijpers, Pim; Muñoz, Ricardo F; Baumeister, Harald (2017). "Prevention of Mental Health Disorders Using Internet- and Mobile-Based Interventions: A Narrative Review and Recommendations for Future Research". Frontiers in Psychiatry 8: 116. doi:10.3389/fpsyt.2017.00116. PMID 28848454. 
  29. ↑ https://www.actionforhappiness.org/10-keys-to-happier-living
  30. ↑ https://www.jeremyhunt.org/sites/www.jeremyhunt.org/files/2020-10/HUNT%20Mental%20Health%20Guide%20Sep20.pdf
  31. ↑ https://www.youtube.com/watch?v=p-KXvvkSXRk&feature=emb_logo at 27 mins
  32. ↑ Cuijpers, Pim; Van Straten, A; Smit, F; Mihalopoulos, C; Beekman, A (2008). "Preventing the Onset of Depressive Disorders: A Meta-Analytic Review of Psychological Interventions". American Journal of Psychiatry 165 (10): 1272–80. doi:10.1176/appi.ajp.2008.07091422. PMID 18765483. http://ajp.psychiatryonline.org/cgi/content/abstract/165/10/1272?maxtoshow=&hits=10&RESULTFORMAT=1&title=Preventing+the+onset+of+depressive+disorders%3A+A+meta&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT. 
  33. ↑ Muñoz, Ricardo F.; Beardslee, William R.; Leykin, Yan (2012). "Major depression can be prevented". American Psychologist 67 (4): 285–95. doi:10.1037/a0027666. PMID 22583342. 
  34. ↑ Cuijpers, Pim; Muñoz, Ricardo F.; Clarke, Gregory N.; Lewinsohn, Peter M. (2009). "Psychoeducational treatment and prevention of depression: The "coping with depression" course thirty years later". Clinical Psychology Review 29 (5): 449–58. doi:10.1016/j.cpr.2009.04.005. PMID 19450912. 
  35. ↑ Perry, Yael; Werner-Seidler, Aliza; Calear, Alison; MacKinnon, Andrew; King, Catherine; Scott, Jan; Merry, Sally; Fleming, Theresa et al. (2017). "Preventing Depression in Final Year Secondary Students: School-Based Randomized Controlled Trial". Journal of Medical Internet Research 19 (11): e369. doi:10.2196/jmir.8241. PMID 29097357. 
  36. ↑ Smit, Filip; Ederveen, A; Cuijpers, P; Deeg, D; Beekman, A (2006). "Opportunities for Cost-effective Prevention of Late-Life Depression: An Epidemiological Approach". Archives of General Psychiatry 63 (3): 290–6. doi:10.1001/archpsyc.63.3.290. PMID 16520434. 
  37. ↑ Muñoz, Ricardo F; Bunge, Eduardo L (2016). "Prevention of depression worldwide: A wake-up call". The Lancet Psychiatry 3 (4): 306–7. doi:10.1016/S2215-0366(15)00555-6. PMID 26827251. 
  38. ↑ Seligman, Martin E. P.; Schulman, Peter; Derubeis, Robert J.; Hollon, Steven D. (1999). "The prevention of depression and anxiety". Prevention & Treatment 2 (1). doi:10.1037/1522-3736.2.1.28a. 
  39. ↑ Gardenswartz, Cara Ann; Craske, Michelle G. (2001). "Prevention of panic disorder". Behavior Therapy 32 (4): 725–37. doi:10.1016/S0005-7894(01)80017-4. 
  40. ↑ Van't Veer-Tazelaar, Petronella J.; Van Marwijk, HW; Van Oppen, P; Van Hout, HP; Van Der Horst, HE; Cuijpers, P; Smit, F; Beekman, AT (2009). "Stepped-Care Prevention of Anxiety and Depression in Late Life: A Randomized Controlled Trial". Archives of General Psychiatry 66 (3): 297–304. doi:10.1001/archgenpsychiatry.2008.555. PMID 19255379. 
  41. ↑ "CBT lessons in school reduce anxiety in children". University of Bath. 16 July 2014. http://www.bath.ac.uk/research/news/2014/07/16/cbt-primary-schools/. 
  42. ↑ Neil, Alison L; Christensen, Helen (2009). "Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety". Clinical Psychology Review 29 (3): 208–15. doi:10.1016/j.cpr.2009.01.002. PMID 19232805. 
  43. ↑ Galante, Julieta; Dufour, Géraldine; Vainre, Maris; Wagner, Adam P; Stochl, Jan; Benton, Alice; Lathia, Neal; Howarth, Emma et al. (2018). "A mindfulness-based intervention to increase resilience to stress in university students (the Mindful Student Study): A pragmatic randomised controlled trial". The Lancet Public Health 3 (2): e72–e81. doi:10.1016/S2468-2667(17)30231-1. PMID 29422189. 
  44. ↑ 44.0 44.1 Stafford, M. R; Jackson, H; Mayo-Wilson, E; Morrison, A. P; Kendall, T (2013). "Early interventions to prevent psychosis: Systematic review and meta-analysis". BMJ 346: f185. doi:10.1136/bmj.f185. PMID 23335473. 
  45. ↑ Ising, Helga K; Lokkerbol, Joran; Rietdijk, Judith; Dragt, Sara; Klaassen, Rianne M. C; Kraan, Tamar; Boonstra, Nynke; Nieman, Dorien H et al. (2016). "Four-Year Cost-effectiveness of Cognitive Behavior Therapy for Preventing First-episode Psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial". Schizophrenia Bulletin 43 (2): 365–374. doi:10.1093/schbul/sbw084. PMID 27306315. 
  46. ↑ "Psychosis and schizophrenia". nice.org.uk. http://pathways.nice.org.uk/pathways/psychosis-and-schizophrenia#path=view%3A/pathways/psychosis-and-schizophrenia/prevention-in-adults-at-risk-of-developing-psychosis.xml&content=view-node%3Anodes-interventions-to-prevent-psychosis. 
  47. ↑ Marshall, Max; Rathbone, John (2011). "Early intervention for psychosis". Cochrane Database of Systematic Reviews (6): CD004718. doi:10.1002/14651858.CD004718.pub3. PMID 21678345. 
  48. ↑ Hutton, P.; Taylor, P. J. (2013). "Cognitive behavioural therapy for psychosis prevention: A systematic review and meta-analysis". Psychological Medicine 44 (3): 1–20. doi:10.1017/S0033291713000354. PMID 23521867. https://www.research.ed.ac.uk/portal/en/publications/cognitive-behavioural-therapy-for-psychosis-prevention(9c20c533-a978-4ba7-a51a-7269db23751a).html. 
  49. ↑ McGorry, Patrick D; Nelson, Barnaby; Phillips, Lisa J; Yuen, Hok Pan; Francey, Shona M; Thampi, Annette; Berger, Gregor E; Amminger, G. Paul et al. (2013). "Randomized Controlled Trial of Interventions for Young People at Ultra-High Risk of Psychosis". The Journal of Clinical Psychiatry 74 (4): 349–56. doi:10.4088/JCP.12m07785. PMID 23218022. 
  50. ↑ "UK Faculty of Public Health :: Examples of interventions". Fph.org.uk. 2013-01-07. http://www.fph.org.uk/examples_of_interventions. 
  51. ↑ Muñoz, Ricardo F.; Cuijpers, Pim; Smit, Filip; Barrera, Alinne Z.; Leykin, Yan (2010). "Prevention of Major Depression". Annual Review of Clinical Psychology 6: 181–212. doi:10.1146/annurev-clinpsy-033109-132040. PMID 20192789. 
  52. ↑ Cuijpers, P. (2003). "Examining the Effects of Prevention Programs on the Incidence of New Cases of Mental Disorders: The Lack of Statistical Power". American Journal of Psychiatry 160 (8): 1385–91. doi:10.1176/appi.ajp.160.8.1385. PMID 12900296. 
  53. ↑ Purtle, J., Nelson, KL, Counts, NZ and Yudell, M. (2020). Population-based approaches to mental health: history, strategies and evidence. Annu. Rev. Public Health; 41: 21.1-21.21.
  54. ↑ What is needed to eradicate the depression epidemic, and why, Johan Ormela, Pim Cuijpers, Anthony Jorm, Robert A.Schoevers, Journal of Mental Health & Prevention, Volume 17, March 2020, 200177 https://doi.org/10.1016/j.mhp.2019.200177
  55. ↑ https://www.centreformentalhealth.org.uk/sites/default/files/mhpg_manifesto_november_2019_0.pdf
  56. ↑ https://www.mentalhealth.org.uk/sites/default/files/MHF_Prevention_Report_ONLINE-VERSION_0.pdf
  57. ↑ https://whatworkswellbeing.org/blog/wellbeing-across-the-lifecourse-the-big-picture/
  58. ↑ "Mental Health Policy Commission: Investing in a Resilient Generation - University of Birmingham". https://www.birmingham.ac.uk//research/impact/policy-commissions/mental-health. 
  59. ↑ Arango, Celso; Díaz-Caneja, Covadonga M; McGorry, Patrick D; Rapoport, Judith; Sommer, Iris E; Vorstman, Jacob A; McDaid, David; Marín, Oscar et al. (2018). "Preventive strategies for mental health". The Lancet Psychiatry 5 (7): 591–604. doi:10.1016/S2215-0366(18)30057-9. PMID 29773478. http://eprints.lse.ac.uk/88090/1/McDaid_Preventative%20Strategies_Accepted.pdf. 
  60. ↑ https://www.promoteprevent.com/[full citation needed][yes|permanent dead link|dead link}}]
  61. ↑ https://www.oecd-ilibrary.org/social-issues-migration-health/understanding-effective-approaches-to-promoting-mental-health-and-preventing-mental-illness_bc364fb2-en;jsessionid=o6KBV-7Ow1L3kBLUG0to_hGX.ip-10-240-5-167
  62. ↑ Cross, Brooke (10 May 2017). "World-class mental health research centre announced in Budget 2017". http://www.himh.org.au/home/news-and-media/news/2017/world-class-mental-health-research-centre-announced-in-budget-2017. 
  63. ↑ "SAMHSA's Efforts Related to Prevention and Early Intervention". U.S. Department of Health and Human Services. 20 January 2017. http://www.samhsa.gov/prevention/samhsas-efforts. 
  64. ↑ https://www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf[full citation needed][yes|permanent dead link|dead link}}]
  65. ↑ "Mental health and prevention: taking local action for better mental health". 2016-07-26. https://www.mentalhealth.org.uk/publications/mental-health-and-prevention-taking-local-action-better-mental-health. 
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  67. ↑ "New Prevention Framework to support mental health of all Australians". 19 March 2015. http://himh.clients.squiz.net/home/news-and-media/news/2015/new-prevention-framework-to-support. 
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  70. ↑ "Chief Medical Officer (CMO) annual report: public mental health". 9 September 2014. https://www.gov.uk/government/publications/chief-medical-officer-cmo-annual-report-public-mental-health. 
  71. ↑ "Better Mental Health for All". http://www.fph.org.uk/better_mental_health_for_all. 
  72. ↑ "Our plans". Mind. http://www.mind.org.uk/about/what_we_do/our_plans. 
  73. ↑ Rising to the Challenge: A strategic plan for the mental health and well-being of Manitobans (Report). Winnipeg, Manitoba: Manitoba Health, Healthy Living and Seniors. June 2011. https://www.gov.mb.ca/healthyliving/mh/docs/challenge.pdf. 
  74. ↑ National Prevention Council (16 June 2011), National Prevention Strategy: America's Plan for Better Health and Wellness, Washington, DC: Office of the Surgeon General, http://www.healthcare.gov/prevention/nphpphc/strategy/report.pdf 
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  76. ↑ EU High-level Conference: Together for Mental Health and Well-being (13 June 2008), European Pact for Mental Health and Well-being, Brussels: European Union, http://ec.europa.eu/health/mental_health/docs/mhpact_en.pdf 
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  84. ↑ "Babies in Mind – Early Intervention in Sutton". Mentalhealth.org.uk. http://www.mentalhealth.org.uk/our-work/research/sutton-early-intervention-project/. 
  85. ↑ "Babies In Mind, a project by Home-Start Sutton | The Big Give". Secure.thebiggive.org.uk. https://secure.thebiggive.org.uk/projects/view/20729/babies-in-mind. 
  86. ↑ "Preventing Depression & Anxiety – Home Page". Parenting Strategies. http://www.parentingstrategies.net/depression/index.php. 
  87. ↑ "A new guide to help navigate the terrible teens". Beyondblue.org.au. http://www.beyondblue.org.au/about-us/news/news/2013/08/30/a-new-guide-to-help-navigate-the-terrible-teens. 
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  89. ↑ O'Connell, Mary Ellen; Boat, Thomas; Warner, Kenneth E., eds (2009). Prevention of Mental Disorders, Substance Abuse, and Problem Behaviors: A Developmental Perspective. National Academies Press. ISBN 978-0-309-12674-8. http://www.nap.edu/catalog.php?record_id=12480. [page needed]
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  96. ↑ Olds, David L.; Sadler, Lois; Kitzman, Harriet (2007). "Programs for parents of infants and toddlers: Recent evidence from randomized trials". Journal of Child Psychology and Psychiatry 48 (3–4): 355–91. doi:10.1111/j.1469-7610.2006.01702.x. PMID 17355402. 
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  101. ↑ Executive Office of the President: Office of Management and Budget (13 April 2011), "Statement of Administration Policy: H.R. 1217 – Repeal of the Affordable Care Act's Prevention and Public Health Fund (Rep. Pitts, R-PA, and 3 cosponsors)", Office of Management and Budget (Washington, DC), https://obamawhitehouse.archives.gov/sites/default/files/omb/legislative/sap/112/saphr1217h_20110413.pdf 
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  103. ↑ A related model ref. domestic abuse https://www.socialfinance.org.uk/resources/publications/changing-lives-changing-systems-lessons-reducing-and-preventing-domestic
  104. ↑ https://www.telegraph.co.uk/good-news/2016/06/11/can-you-teach-yourself-to-be-happy/




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