Prevention of mental disorders : effective interventions and policy options : summary report / a report of the World Health Organization Dept. of Mental Health and Substance Abuse ; in collaboration with the Prevention Research Centre of the Universities of Nijmegen and Maastricht .

1.Mental disorders – prevention and control. 2.Evidence-based medicine. 3.Policy making I.World Health Organization II.Universities of Nijmegen and Maastricht. Prevention Research Centre.

ISBN 92 4 159215 X (NLM classification: WM 140)

© World Health Organization 2004

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One of the primary goals of the World Health Organization (WHO) Department of Mental Health and Substance Abuse is to reduce the burden associated with mental, neurological and substance abuse disorders. Prevention of these disorders is obviously one of the most effective ways to reduce the burden. A number of World Health Assembly and Regional Committee Resolutions have further emphasised the need for prevention. WHO published a document on primary pre- vention of mental, neurological and psychosocial disorders in 1998 (WHO, 1998). However, this scientific field has seen rapid development of ideas and research evidence, necessitating a fresh review. This Summary Report (along with the forthcoming Full Report) attempts to provide a com- prehensive overview of this field, especially from the perspective of evidence for effective inter- ventions and associated policy options. This is in accordance with the WHO mandate to provide information and evidence to Member States in order to assist them in choosing and implement- ing suitable policies and programmes to improve population health. In an area like prevention of mental disorders this task is even more critical since much evidence is recent and untested in varied settings.

Mental disorders are inextricably linked to human rights issues. The stigma, discrimination and human rights violations that individuals and families affected by mental disorders suffer are intense and pervasive. At least in part, these phenomena are consequences of a general percep- tion that no effective preventive or treatment modalities exist against these disorders. Effective prevention can do a lot to alter these perceptions and hence change the way mental disorders are looked upon by society. Human rights issues go beyond the specific violations that people with mental disorders are exposed to, however. In fact, limitations on the basic human rights of vulner- able individuals and communities may act as powerful determinants of mental disorders. Hence it is not surprising that many of the effective preventive measures are harmonious with principles of social equity, equal opportunity and care of the most vulnerable groups in society. Examples of these interventions include improving nutrition, ensuring primary education and access to the labour market, removing discrimination based on race and gender and ensuring basic economic security. Many of these interventions are worth implementing on their own merit, even if the evidence for their effectiveness for preventing specific mental disorders is sometimes weak. The search for further scientific evidence on effectiveness and cost-effectiveness, however, should not be allowed to become an excuse for non-implementation of urgently needed social and health policies. Indeed, innovative methods need to be found to assess the evidence while these pro- grammes are designed and implemented. These methods should include qualitative techniques derived from social, anthropological and other humanistic sciences as well as stakeholder analysis to capture the complexity and diversity of the outcomes.

A particularly potent and unfortunately common threat to mental health is conflict and vio- lence, both between individuals and between communities and countries. The resulting mental distress and disorders are substantial. Preventing violence requires larger societal efforts but mental health professionals may be able to ameliorate the negative impact of these phenomena by implementing some specific preventive efforts and by making humanitarian assistance more mental health friendly.

One of the crucial issues in the implementation of evidence-based prevention is the real-life appli- cability of laboratory-proven programmes, especially in widely varying cultural and resource set- tings. Rigorously controlled effectiveness trials seem to provide more definite evidence but in turn are less amenable to wider application across the world. Cultural and context variables should