Prevention and Mental Health Promotion

Prevention and Mental Health Promotion

Gail W. Stuart

Mental and emotional well-being is essential to overall health. In Healthy People 2020 (Healthy People Gov, 2011), mental health is defined in a positive way:

Mental health is a state of successful performance of mental function, resulting in productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with challenges. Mental health is essential to personal well-being, family and interpersonal relationships, and the ability to contribute to community or society.

For too long the major emphasis in the United States has been on the treatment rather than on the prevention of mental disorders and promotion of mental health. Only recently is prevention emerging as a major force in health care. One of the reasons it is gaining momentum is because the health care system is beginning to provide some economic incentive for preventing illness rather than treating it. Another reason is that it has been found that good mental health improves the quality of life for people with physical illnesses and may contribute to longer life in general (New Freedom Commission on Mental Health [NFCMH], 2003; Centers for Disease Control and Prevention, 2011).

Promotion and Prevention

Mental health promotion and mental illness prevention are distinct but interrelated concepts. The distinction between health promotion and illness prevention is in their targeted outcomes.

Mental health promotion, when aiming to enhance positive mental health in the community, may also have the secondary outcome of decreasing the incidence of mental disorders. Thus, prevention and promotion strategies often involve similar activities and produce different but complementary outcomes.

Mental Health Promotion

The idea of promoting mental health in general is attractive. Promotion sounds optimistic and positive. It is consistent with the idea of self-help and being self-responsible for health. It implies changing human behavior and draws on a holistic approach to health.

The aims of mental health promotion are to enhance an individual’s ability to:

Mental health promotion considers mental health as a resource, as a value on its own, and as a basic human right essential to social and economic development. Mental health promotion aims to have an impact on the social determinants of health in order to increase positive mental health, reduce inequalities, build social capital, and narrow the gap in health expectancy between groups (World Health Organization [WHO], 2004). Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles.

Positive mental health allows people to realize their full potential, cope with the stresses of life, work productively, and make meaningful contributions to their communities. Early childhood experiences have lasting consequences later in life. Fostering emotional well-being from the earliest stages of life helps build a foundation for overall health and well-being.

There is solid research evidence indicating that anxiety, mood (e.g., depression), and impulse control disorders are associated with a higher probability of risk behaviors (e.g., tobacco, alcohol and other drug use, risky sexual behavior), intimate partner and family violence, many other chronic and acute conditions (e.g., obesity, diabetes, cardiovascular disease, HIV/sexually transmitted infections [STIs]), and premature death. Thus, the National Prevention Strategy (Healthy Care Gov, 2011) has identified the following four priorities for mental and emotional well-being:

Mental Illness Prevention

Prevention is often described with slogans such as “An ounce of prevention is worth a pound of cure” or “Curing is costly; prevention is priceless.” Preventive interventions work by focusing on reducing risk factors and enhancing protective factors associated with mental illness (Beardslee et al, 2011).

The aims of mental illness prevention are to reduce the:

A study by the National Research Council and the Institute of Medicine (2009) reviewed the research on the prevention of mental disorders and substance abuse among young people and recommended multiple strategies for enhancing the psychological and emotional well-being of young people. Research demonstrates the value of:

• Strengthening families by teaching effective parenting skills, improving communication, and helping families deal with potential problems (such as substance use), disruptions (such as divorce), and adversities (such as parental mental illness or poverty).

• Strengthening individuals by building resilience and skills and improving cognitive processes and behaviors.

• Promoting mental health in schools by offering support to children encountering serious stresses; modifying the school environment to promote socially adaptive behavior; developing students’ skills at decision making, self-awareness, and conducting relationships; and coping with potential violence, aggressive behavior, and substance use.

• Promoting mental health through health care and community programs by promoting and supporting socially adaptive behavior, teaching coping skills, and targeting modifiable lifestyle factors that can affect behavior and emotional health, such as sleep, diet, activity and physical fitness, sunshine and light, and television and computer use.

Figure 12-1 shows the developmental phases and the related opportunities for preventive intervention strategies. Box 12-1 lists mental health prevention recommendations made by Healthy People 2020 and the U.S. Preventive Services Task Force 2010-2011.

The time has come for health care in general and psychiatric care in particular to focus on promoting mental health and preventing mental illness whenever possible. The ability to prevent the development of a psychiatric illness would benefit individuals, families, communities, and society.

Thus, prevention activities in psychiatric nursing care have five basic aims:

Public Health Prevention Model

In the public health prevention model, the “patient” is the community rather than the individual, and the focus is on the amount of mental health or illness in the community as a whole, including factors that promote or inhibit mental health (Power, 2009). The emphasis in the public health model is on reducing the risk of mental illness for an entire population by providing services to high-risk groups. Use of the public health model requires that mental health professionals be familiar with skills such as community needs assessment, identifying and prioritizing target or high-risk groups, and intervening with treatments such as consultation, education, and crisis intervention.

Community Needs Assessment

In the public health model, services are developed and delivered based on a culturally sensitive assessment of community needs. Because it is not possible to interview each person in the community to identify mental health needs, four techniques are used to estimate service needs:

Epidemiological studies examine the incidence and prevalence of mental disorders in a defined population. Incidence is the number of new cases of a disease or disorder in a population over a specified period. Prevalence is the number of existing cases of a disease or disorder in the total population at a specified time.

Identifying and Prioritizing High-Risk Groups

When the data from the various community needs assessments are analyzed, specific high-risk groups begin to emerge. For example, socioeconomic data might show that a large number of elderly widows live in the community. Community forums and surveys of key informants may find that there are few services and programs for the elderly, and epidemiological studies might suggest that elderly widows living alone are at high risk for depression. Therefore elderly widows might become a target group for program development and intervention.

Demographic data might show that a community has many preadolescent females, and socioeconomic indicators may suggest that many of these young women live in single-parent households and in poverty. Community forums and surveys of key informants may reveal few recreational and social services for children and adolescents. Epidemiological studies may report high correlations among poverty, single-parent households, and adolescent pregnancy. Therefore, community mental health providers might consider adolescents in this community to be at risk for mental health problems and target them for intervention.


The public health model applies three levels of preventive intervention to mental illness and emotional disturbance (Caplan, 1964):

Each of these levels of intervention has implications for psychiatric nursing practice.

Medical Prevention Model

The medical prevention model focuses on biological and brain research to discover the specific causes of mental illness, with primary prevention activities focused on the prevention of illness in the individual patient. This model consists of the following steps:

This model has been effective for controlling many communicable diseases, such as smallpox, typhus, malaria, diphtheria, tuberculosis, rubella, and polio, and nutritional diseases, such as scurvy, pellagra, rickets, kwashiorkor, and endemic goiter.

It also has proved useful for preventing a variety of mental disorders caused by poisons, chemicals, licit or illicit drugs, electrolyte imbalances, and nutritional deficiencies. All these diseases have one thing in common: a known necessary, but not always sufficient, causative factor.

Nursing Prevention Model

The nursing prevention model stresses the importance of promoting mental health and preventing mental illness by focusing on resilience, risk factors, protective factors, vulnerability, and human responses. In the nursing prevention model, the “patient” may be an individual, family, or community. It is based on the understanding that mental disorders are the result of many causes, requiring that mental illness prevention be thought of as the promotion of resilience and adaptive coping responses and the prevention of maladaptive responses to life stressors.

Stressors can include one-time events, such as a divorce, or long-standing conditions, such as marital conflict. They can reflect either an acute health problem or a chronic health problem. For example, the following categories of maladaptive responses can arise from alcohol abuse:

The nursing prevention model assumes that problems are multicausal, that everyone is vulnerable to stressful life events, and that any disability or problem may arise as a consequence. For example, four vulnerable people can face a stressful life event, such as the ending of a marriage or the loss of a job. One person may become severely depressed, the second may be involved in an automobile accident, the third may begin to drink heavily, and the fourth may develop coronary artery disease.

The nursing model of prevention is based on the application of the nursing process and incorporates the following aspects:


Risk Factors and Protective Factors

Risk factors are those predisposing characteristics that, when present, make it more likely that the person will develop a disorder. Some risk factors are fixed, such as one’s genetics and family history, whereas others can be changed, such as lack of social support and inability to read. Current research is focusing on the interplay among biological, psychosocial, and environmental risk factors and how they can be modified to eventually prevent a biological risk factor, such as the genes that may contribute to developing a mental illness, from being expressed.

Protective factors are the coping resources and coping mechanisms that can improve a person’s response to stress, resulting in adaptive behavior. These factors exist in the individual, family, and community. They can have a powerful buffering effect on the influence of risk factors.

Target Populations

Three types of preventive interventions based on target populations have been identified (Mrazek and Haggerty, 1994):

Knowledge of normal growth and development is essential for assessing a person’s functioning and for being able to intervene with preventive nursing interventions. The nurse should be familiar with normative stages, tasks, and parameters. This will help the nurse understand what issues the person has faced in the past and what challenges lie ahead. In addition to understanding the person’s development, the nurse must know about the family cycle because many nursing interventions are directed at the family, from mobilizing their support of a patient to modifying dysfunctional family patterns.

Assessment in primary prevention involves identifying individuals and groups of people who are vulnerable to developing mental disorders or who may display maladaptive coping responses to specific stressors or risk factors. In this process, it is important for the nurse to realize that not all people in these groups are at equal risk. What these groups share is the experience of a life event, stressor, or risk factor that represents a loss of some kind or places an excessive demand on one’s ability to cope. The more clearly the subgroup can be defined, the more specifically the prevention strategies can be researched, identified, and implemented.

Planning and Implementation

The Stuart Stress Adaptation Model presented in Chapter 3 is a useful tool for the nurse that can help in planning strategies for primary prevention. The overall nursing goal is to promote constructive coping mechanisms and maximize adaptive coping responses. Thus prevention strategies should be directed toward influencing predisposing factors, precipitating stressors, appraisal of stressors, coping resources, and coping mechanisms through the following interventions:

In each of these areas, the nurse can focus on decreasing risk factors or increasing protective factors. Further, a single intervention can affect many parts of a person’s life. For example, an environmental change, such as changing jobs, can affect an individual’s predisposition to stress, decrease the amount of stress, change the appraisal of the threat, and perhaps increase financial or social coping resources.

Health Education

The health education strategy of primary prevention in mental health involves the strengthening of individuals and groups through competence building or resilience. It is based on the knowledge that many maladaptive responses are the result of a lack of competence, that is, a lack of perceived control over one’s own life and the lowered self-esteem that results.

Competence building is also referred to as resilience. The report of the New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America (NFCMH, 2003), offers this definition of resilience:

Resilience means the personal and community qualities that enable us to rebound from adversity, trauma, tragedy, threats, or other stresses—and to go on with life with a sense of mastery, competence, and hope. We now understand from research that resilience is fostered by positive individual traits, such as optimism, good problem-solving skills, and treatments (Kobau et al, 2011). Closely knit communities and neighborhoods are also resilient, providing supports for their members.

Competence building or resilience may be the single most important preventive strategy. A competent individual or community is aware of resources and alternatives, can make informed decisions about issues, and can cope adaptively with problems. Coping in the face of adversity involves emotional intelligence and resilience, both of which can be developed through support and education (Luthar, 2008). Other clinical strategies include early intervention and promoting a social and familial climate, self-esteem, support building, and social/life and vocational skills. Four categories of resilience strengths are presented in Box 12-2.

Feb 25, 2017 | Posted by in NURSING | Comments Off on Prevention and Mental Health Promotion
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