Promotion of Mental Health

In December, I attended the Inaugural World Conference on the Promotion of Mental Health and Prevention of Mental and Behavioral Disorders at The Carter Center in Atlanta. In addition to the Carter Center, the other sponsors were the Centers for Disease Control and Prevention, the Center for Mental Health Services, the Clifford Beers Foundation, the Health Resources Services Administration/Bureau of Primary Health Care, the National Institute on Drug Abuse, the National Institute of Mental Health, the World Federation for Mental Health, and the World Health Organization. The conference had more than 220 attendees, including 75 from outside of the United States.

APA was invited to attend, but we were not asked to participate in the planning or presentations. Initially, I wondered why. But the answer is obvious. We have been preoccupied largely with our top two strategic priorities, advocating for our patients and our profession. Our other three priorities—supporting education, training, and career development; defining and supporting professional values; and enhancing the scientific basis of psychiatric care—do not focus on prevention of psychiatric illness or promotion of mental health specifically. Prevention was considered to be part of our strategic planning, but our priorities start with patients, that is, people who are ill and need treatment, not with individuals or families before a psychiatric disorder manifests itself.

The psychiatric profession and our academic institutions have largely ceded promotion of health and prevention efforts to others in the pediatric, mental health, and social sciences fields. We have concentrated on the development of an accurate and reliable diagnostic nomenclature, the recognition and treatment of psychiatric illnesses, patient access to high-quality care, and training psychiatrists to diagnose and treat. Psychiatric research and advocacy activities, including legislation and litigation, support these domains. Findings derived from the genome project with the possibility of altering pathogenic genetic patterns are beginning to pique our interest and may lead to the prevention of some mental illnesses.

The conference covered a wide range of topics with presentations from multiple fields and topics ranging from broad social global policies to specific prevention programs. One interesting presenter who talked about social justice described the relationship between freedom and equality. Total freedom would result in 20 percent of the population taking over or dominating. Total equality would require restrictions on individual freedom.

According to a presenter from England, more people die from suicide than from auto accidents, five of the 10 leading causes of disability are psychiatric illnesses, unipolar depression is responsible for 10 percent of the total years of disability, and psychiatric illness is the fastest growing burden of disease rising from 10.5 percent in 1996 to an estimated 15 percent by 2020. The World Health Organization has predicted that by 2020 major depression will be the second leading cause of disability worldwide.

State and national governments have shown little interest in the prevention of mental illness and promotion of mental health. The only time these considerations rise to the top of political agendas is after a tragic incident. Unfortunately, such incidents draw negative attention to psychiatric illnesses and increase stigma. We must emphasize worthwhile preventative efforts with families during pregnancy and in children’s formative years. Many studies have demonstrated the long-standing benefits of relatively simple and limited interventions with families and preschool children. Early studies by Chris Heinicke, Ph.D., at UCLA and more recent ones by David Olds, Ph.D., at the University of Colorado Health Sciences Center and their associates are excellent examples. Heinicke’s studies documented improved IQs in children. Olds’ 15-year follow ups on monthly family visits by a nurse revealed significant decreases in serious antisocial behavior and substance abuse in adolescents and reductions in the number of pregnancies, in the use of welfare, in child abuse and neglect, and in criminal behavior in low-income, unmarried mothers.

In talking to legislators, to get their attention, we must underscore the cost-benefit of prevention and demonstrate the multiple costs of not investing in the health of families at risk. It is time we showed some leadership in these efforts. ▪