Primary prevention and health promotion in mental health.

Despite frequent pleas for mental health programs to devote more resources to primary prevention, mental health programs remain overwhelmingly oriented to treatment. Prevention is given low priority because many psychiatrists who are leaders in the mental health field are focused on a medical-pathological model of prevention that has limited usefulness in mental health and because the guidelines for a social-behavioral model are not always clear.A model for conceptualizing and programming of primary prevention and promotion in all of the human services is offered with special attention to mental health functioning. Strategies for both primary prevention and promotion may be directed to individuals or to the environment, but, in either case, the targets and the strategies must be clearly identified. Prevention strategies are directed toward persons under some specific stress or risk, while promotion activities are directed to persons in normal situations of growth and development. For either prevention or promotion, the most widely effective strategies are those that require the least personal cost and effort—usually the strategies that are directed toward the environment.Prevention and promotion both depend on clear assessment of the stresses and needs and must be evaluated. Programs are often too global or too diffuse to be effective or credible. Working in closed social systems and sharp evaluation will help correct these problems.