The Value of Model Programmes in Mental Health Promotion and Mental Disorder Prevention
| DOI | https://doi.org/10.1108/17465729199900013 |
| Pages | 20-21 |
| Published date | 01 February 1999 |
| Date | 01 February 1999 |
| Author | Beverley Raphael |
| Subject Matter | Health & social care |
20 International Journal of Mental Health Promotion VOLUME 1 ISSUE 2 • APRIL 1999 © Pavilion Publishing (Brighton) Limited.
hile prevention has become a focus for program
development in mental health in recent years, there is still considerable difficulty
in introducing such programs. This
difficulty has many sources:
■
afocus of mental health services on adults with
‘serious mental illness’
■
acommitment to traditional models of child and
adolescent mental health service provision
■
aperceived conceptual hiatus between prevention
initiatives and current practices or mental health
treatment paradigms which require the presence of
adisorder to justify resource untilisation
■
an increasing biomedical focus with lesser recognition
of development and disorder antecedents
■
afailure to view mental health in a population health model
■
abelief that there is little scientific basis for prevention
and that scarce resources must therefore be directed to the treatment of
people who are disabled or ill.
Recent excellent initiatives such as the report of the US Institute of Medicine
(Mrazek & Haggerty, 1994) and the UK report (Jenkins & Üstün,1998), as well as
numerous scientific papers and research studies, many of which have been
replicated, now provide a sound basis to establish such programs. Indeed, the
evidence is so strong that in many
fields it could be considered almost negligent not to provide prevention
programs, as these have greater demonstrated effectiveness than treatment for
the same condition (Offord
et al., 1998). Furthermore,the recognition and support of
the importance of this field provided by organisations like
the WHO give currencyfor the development of prevention programs in mental
health.
Afurther matter of value has been the concept of a spectrum of interven-
tions from prevention to treatment to maintenance, as conceptualised by Mrazek
&Haggerty (1994, p23).The gro wing requirement for evidence-based intervention
Win mental health is also important, for,in contradistinction to the earlier phase of
prevention in mental health (Caplan, 1964), there is now a strong and growing
evidence base for the effectiveness, both short- and long-term (Olds et al.,
1997), and for even cost-effectiveness, of a prevention approach in mental
health. In addition, the focus on ‘early intervention’,for instance in the prodromal
period of psychosis (McGorry et al., 1996), has allowed a bridge to be made for
consideration of development and for opportunities for a prevention approach.
Nevertheless, resistance by mental health services to commitment to
prevention as a required component of their portfolio of programs is still present.
Much of the science
has been carried out apart from these services, and is is not ‘owned’ or even
valued by them. While there has been a growing commitment to prevention
programs in mental health in the US and to a degree in Europe, these are often
not part of formal policy,nor widely taken up on a national mental health a genda.
This valuable paper from Hosman and Engels highlights
the use of the ‘model program’ as a mechanism for the implementation and
dissemination of prevention and promotion programs in mental health. They write
both from extensive experience in this area and from their research into the use
of the model program concept to disseminate and extend the implementation of
mental health promotion and prevention programs. This is particularly relevant to
the translation of prevention from a research base to a program, and from one
socioeconomic and cultural setting to another.Hosman and Engels exemplify this
dissemination process in a number of replication studies that are themselves
undergoing randomiseds controlled trials in new settings, such as parenting,
home visiting and anti-bullying programs.
They also write of Hosman’s comprehensive national study on the develop-
ment of transferable, evidence-based model programs and the identification of
predictors and moderators of effects, this in a ‘complex, multi-phased and long-
term process’. This helps,they suggest, to provide trajectories for program
implementation. More important, this research can identify effect predictors,
effect mediators and effect moderators for such program replication and
extension.
Furthermore, this model program concept and its evaluation allow the
marriage of the science of program effectiveness with the realities of adaptation
to different populations, and the empowerment of these groups to own and be
involved in local program implementation. Developing different versions of
The Value of Model Programmes
in Mental Health Promotion and
Mental Disorder Prevention
Beverley Raphael
Director, Center for Mental Health,
New South Wales Health Department
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