S.Saxena : THE CHALLENGE OF PRIMARY PREVENTION

Mental and behavioural disorders cause an enormous burden on individuals, families and societies. According to the latest figures available from the World Health Organization (WHO), 12.9% of all disability adjusted life years (DALYs) lost are accounted for by these disorders. in addition, these disorders decrease quality of life and cause a massive economic burden. Existing methods for treatment, though effective, have serious limitations. If the burden caused by mental and behavioural disorders has to be decreased, it is essential that primary preventive strategies are utilised more effectively and more widely. Some of the main barriers to using preventive interventions are lack of conceptual clarity around the aims, boundaries and overlap between prevention, promotion and treatment interventions, lack of awareness of evidence for their effectiveness and lack of consensus on roles and responsibilities of mental health professionals for prevention. The WHO has recently completed an international review of effectiveness of preventive strategies. While this review has clarified conceptual issues and provided much needed evidence, it has also revealed the extreme paucity of research from low and middle income countries and almost a complete lack of cost-effectiveness information. Efforts to fill these lacunae need to be made urgently, but the available evidence clearly substantiates the effectiveness of a variety of interventions. These range from macro-level strategies, like improving nutrition , housing, education and economic stability, to more specific meso- and micro-level strategies like home-based or school-based programmes for children, work-place interventions and those targeted at vulnerable populations. While the effectiveness of these strategies is established (at least in some cultures), a major challenge is to find financial and professional resources to implement these widely. This nvolves convincing the policy makers and competing for resources against more immediate demands. Traditional medical thinking has placed more emphasis on treatment and the entire health care systems organized around care rather than prevention. There are also serious issues around financing of prevention activities. How can prevention succeed ? The key to implementing prevention programmes is to establish strong links across sectors and to utilize synergies of efforts. Prevention messages need to be delivered to colleagues from sectors as diverse as education, social security, employment, justice, housing, community development, poverty reduction, sports and many more. The role of mental health professionals is to inform, advise, guide, support and lead these sectors into adopting policies and implementing actions that facilitate prevention of mental disorders. Our success will depend on how effectively we fulfil these roles.