Mental illnesses of children and measures for their prevention. Neuropsychic disorders and their prevention. Causes of mental illness

There is ample evidence that interventions are effective in reducing risk factors, in enhancing protective factors, and in preventing psychopathological symptoms and new cases of psychiatric disorders. Macropolicy measures that improve nutrition, housing, and education, or reduce economic instability, have been shown to reduce the incidence of mental disorders. In addition, it has been clearly demonstrated that specific interventions aimed at building the resilience of children and adolescents through education, early interventions and programs for children at risk of developing mental disorders, such as those with mental sick parent survivors of loss or family disruption improve mental health, reduce depressive symptoms, and reduce the incidence of depressive disorders. Interventions for the adult population, ranging from macro-policy strategies such as alcohol taxation or workplace legislation, to individual support for individuals with signs of mental illness, can reduce psychiatric morbidity and the associated social and economic burden. Exercise, social support, and social participation have also been shown to improve mental health in older people. The national mental health system will benefit from the continuous development of the database by combining different assessment methods in low, middle and high level income. Using the data obtained for political and practical purposes requires efforts at the international, state and local levels, including the formation of the concepts of legal capacity, protection, channeling mental health care into the health system, as well as other policies, safe infrastructure and stability. Mental health professionals have an important role to play in improving data on the prevention of mental disorders, promoting community mental health, engaging stakeholders in program design and (as health care professionals) in their practice.

In recent years, opportunities have emerged and significantly expanded for the prevention of mental and behavioral disorders. This article provides short review on the place of prevention of mental and behavioral disorders within the overall health strategy, briefly describes current evidence on typical prevention interventions, and makes suggestions on how they can become part of policy and practice. Readers wishing to obtain additional information may refer to two publications published by the World Health Organization.

Universal, selective and specific preventive interventions are referred to as primary prevention. Universal preventive measures target the entire population that does not belong to the high-risk group, selective ones target individuals or subgroups of the population in which the risk of developing mental disorders is significantly higher than the average and is confirmed by biological, psychological or social risk factors. Specific preventive interventions are used for high-risk individuals who have minimal but detectable signs or symptoms that predict the development of a psychiatric disorder, or biological markers that indicate a predisposition to a psychiatric disorder, but do not meet the criteria for a disorder at that time.

Secondary prevention involves reducing the frequency of well-known cases of a disorder or disease in a population (prevalence) by early detection and treatment of diagnosable diseases. Tertiary prevention includes interventions aimed at reducing the severity of disability, improving the quality of rehabilitation, and preventing relapses and exacerbations of the disease. This article focuses on the primary prevention of mental disorders.

The difference between promoting mental health and preventing the development of a mental disorder lies in their intended outcomes. Mental health promotion aims to positively stimulate it by improving psychological state, increasing competence and resilience, and by creating supportive living conditions and environments. Prevention of mental disorders is aimed at eliminating the symptoms and, of course, mental disorders. Strategies that promote mental health are used as one of the means to achieve these goals. Mental health care that promotes mental health in a population can also have the added benefit of reducing the incidence of mental disorders. Good condition mental health serves as a powerful protective factor against the development of mental illness. However, mental disorders and good mental health cannot be described as being at opposite ends of a linear scale, but rather as two overlapping and interrelated components of one distinct concept of mental health. Prevention of mental disorders and promotion of mental health are often found in the same programs and strategies, involving almost the same activities and producing different but complementary results.

The need for evidence-based prevention of mental disorders has sparked discussions among researchers, practitioners, health promotion advocates and policy makers at the international level. To rephrase the definition evidence-based medicine formulated by Sackett et al., evidence-based prevention and health promotion is defined as “the conscientious, accurate and rational use of the best available evidence in selecting interventions for individuals, communities and populations in order to minimize disease rates and empower people to increase control over your health and strengthen it.” Evidence from systematic studies will avoid decision uncertainty due to lack of information or decisions based on biased assumptions, which in turn would waste time and resources or fund interventions with poor outcomes.

When making a positive decision, the use of scientific data becomes especially important if the consequences of the decision are large (for example, the choice of a new prevention program for national implementation). Given the high costs and lack of accountability in spending public money, it is essential that such a decision be based on solid evidence showing that the program is effective and can pay off. Therefore, it is also important to use evidence of cost-effectiveness for these interventions.

When evaluating the value of scientific evidence, various factors should be taken into account. First, in order to avoid biased observations and unfounded conclusions, it is necessary to evaluate the evidence in terms of its quality, determined by the adequacy of the research methods used. Evidence from several meta-analyses suggests that effect sizes are higher in studies using established, high-quality methods. Second, the significance of the results themselves, including the strength and type of effects, should also be assessed. Third, the value of scientific evidence needs to be assessed in terms of its actual use and impact on decision making. Finally, data values ​​should be combined with other indicators that are also very important when discussing the expansion of prevention programs or their choice, for example, the transferability of programs to other situations or cultures, their adaptability to them and their feasibility.

When assessing the quality of scientific evidence, perhaps one of the “hottest” discussions during the discussion is whether randomized controlled trials should be considered the best guarantee of the internal validity of the results of complex interventions. Although the power of such trials is widely recognized and used in research into the effectiveness of preventive interventions, many scientists in the field have strongly objected to considering them as the one and only gold standard. Randomized controlled trials are designed to investigate causative factors at the individual level using single-component interventions under highly controlled conditions, so they are primarily suitable for evaluating clinical or preventive interventions at the individual or family level. Many preventive interventions are directed at schools, companies, communities, or the general population. These trials examine multicomponent programs in a dynamic community setting where many contextual factors are unlikely to be controlled. The rigorous design of a randomized controlled trial is not entirely appropriate in this context, so randomization should be done at the level of larger components, such as classrooms, schools, or community populations, to retain its benefits in the setting of a community-based intervention. However, the feasibility of such randomized community trials is limited for practical, political, financial, or ethical reasons. Where randomization is opposed on ethical grounds, quasi-experimental studies that use matching techniques to achieve comparability between experimental and control groups, and studies using time series are valuable alternatives.

Building a database requires a step-by-step and sequential approach, using different methods depending on the information needed for a given solution. The exchange of information at the international level through common databases is of great importance for the formation of a strong evidence base, as well as for a deep understanding of cultural factors.

Risk factors are associated with an increased likelihood of developing, greater severity, or longer duration of severe health disorders. Protective factors are conditions that increase people's resistance to risk factors and disorders: they are defined as factors that modify, improve, or alter an individual's response to certain environmental risk factors that predispose to impaired adaptive capacity.

There is compelling evidence on risk and protective factors and their association with the development of mental disorders. By their nature, both factors can be individual, family, social, economic or environmental. The presence of multiple risk factors, the absence of protective factors, and the interaction of dangerous and protective situations generally have a cumulative effect, which predisposes individuals to mental disorders, then to increased vulnerability, then there is a mental disorder, and finally an extended clinical picture of severe mental illness.

The main socioeconomic and environmental determinants of mental health are linked to macro-problems such as poverty, war and inequality. For example, poor people often live without basic political freedom of action, choice and the right to security, which do not require proof. They often lack adequate food, housing, education and health opportunities; different types deprivation prevents them from leading a lifestyle that everyone appreciates. Populations living in poor socioeconomic conditions are at increased risk of poor mental health, depression, and lower levels of subjective well-being. Other macro factors, such as urbanization, war and population displacement, racial discrimination and economic instability, are associated with an increased frequency of symptoms and a high incidence of mental disorders.

Individual and familial risk and protective factors may be biological, emotional, cognitive, behavioural, interpersonal or related to the family context. They can have the strongest impact on mental health during particularly sensitive periods of life, and their influence can be passed on from one generation to the next. In table. Table 1 lists the main factors that have been found to correlate with the development of psychiatric disorders.

Preventive interventions should address manageable determinants, including those specific to the disease, as well as more common risk and protective factors common to several mental disorders and mental disorders. Interventions that effectively address these typical factors can wide range preventive effects. There is also a relationship between mental and physical health: for example, cardiovascular disease can cause depression and vice versa. Mental and physical health can also be associated with common risk factors, for example, poor housing can exacerbate both mental and physical health.

A deep understanding of the links between different mental disorders and between mental and physical health is required, as well as the ways in which general and disease-specific risk factors develop that exacerbate mental health conditions. However, there is enough evidence to justify government and non-government investment in the development, dissemination and implementation of evidence-based programs and strategies. For policy makers and other stakeholders, the most cost-effective and attractive investments are those aimed at removing risk factors and creating protective factors that have a high impact or are typical of a number of related problems, including social and economic ones.

Changes in policy, legislation and resource allocation can significantly improve the mental health of the population in different countries and regions. It has been proven that such changes, in addition to reducing the risk of developing mental disorders and improving mental health, have a positive effect on overall health, social and economic development of society.

Table 1. Mental health and mental disorders: risk and protective factors

There is strong evidence that improving the nutrition and development of children living in disadvantaged socioeconomic environments promotes normal cognitive development, improves educational achievement, and reduces the risk of mental health deterioration, especially in children at risk or living in impoverished areas. Intervention models that include supplementary nutrition, developmental control and promotion are considered to be the most effective. These models combine nutritional support (eg, nutritional supplements) with psychological counseling and psychosocial support (eg, kindness, attentive listening). The cost of maintaining developmental charts (in which the child's body weight versus expected weight is plotted on a graph) is also thought to be cost effective. In addition, iodine plays an important role in preventing mental retardation and physical development and learning disabilities. Programs that supplement food with iodine along with iodized salt or water ensure that children receive an adequate dose of iodine. Global programs such as those supported by the United Nations Children's Fund (UNICEF) have made it possible to use iodized salt in 70% of households around the world. This protects 91 million newborns from iodine deficiency and indirectly prevents the development of related mental and physical health.

Poor housing is considered an indicator of poverty and a “target” for improving public health and reducing health inequalities. Evidence from the latest systematic review of studies on the health effects of housing improvement shows favorable mental and physical health outcomes. These include improved mental and physical health and less mental stress (self-reported), as well as broader positive social impacts on factors such as perceived safety, participation in criminal, social, and community activities.

Low levels of literacy and education are major social problems in many countries, especially in South Asia and sub-Saharan Africa, and are more common among women. Lack of education severely limits the ability of individuals to access economic benefits. Most countries have made impressive strides in improving literacy rates through better educational programs for children, but much less effort has been directed at current adult illiteracy. It is expected that programs aimed at eradicating illiteracy, especially among adults, can bring tangible benefits in reducing psychological stress and promoting mental health. For example, ethnographic studies in India have shown that literacy programs have been very successful in addition to acquiring specific skills. By bringing women together in a new social format that allowed them to receive information and be enriched with new ideas, the sessions served as a catalyst for social change. By participating in volunteer teacher campaigns, impoverished literate women and girls gained a sense of pride, dignity and purpose in life. Positive influence on mental health was mediated in a variety of ways, including gaining the ability to think quantitatively, which reduced the risk of becoming a victim of fraud, greater confidence in declaring one's rights, and overcoming barriers to favorable opportunities. All of these advances have been associated with preventing mental health deterioration and reducing the risk of developing mental disorders.

In many developing countries, economic insecurity is a persistent source of stress and anxiety, which can lead to symptoms of depression, mental illness, and suicide. Non-governmental organizations such as the Bangladesh Rural Development Committee have developed poverty alleviation programs targeting sources of credit, gender equality, basic health care, education and human rights. Loan provision from such sources may reduce the risk of developing mental illness by addressing the root cause of stress, the menace of informal borrowing. An evaluation of the poverty alleviation programs of the Bangladesh Committee for Rural Development, targeting millions of the poorest people in Bangladesh, indicates that the psychological well-being of women members of this committee is better than that of non-members.

Many community-level interventions focus on developing empowerment processes and building a sense of belonging and social responsibility among community members. An example is the "Communities Supporting the Program" initiative, which has been successful in several hundred communities in the US and is being adopted and replicated in the Netherlands, England, Scotland, Wales and Australia. Such an initiative encourages the population to apply a system for the prevention of violence and aggression, using local data to identify risk factors and develop appropriate measures. This involves interventions that are carried out simultaneously at many levels: among the population (media, change in strategy), in the school (change in management or teaching methods), in the family (sessions for parents) and at the individual level (for example, increasing the level of social competence ).

With respect to addictive substances, regulatory measures taken at the international, national, regional and local levels are effective: levying a tax, limiting the availability of these substances, and completely banning direct and indirect advertising.

Price is one of the most significant determinants of alcohol and tobacco use. Increasing the tax, which raises the price of tobacco by 10%, reduces consumption tobacco products about 5% in high-income countries and 8% in low- and middle-income countries. The same pattern holds for alcohol: a 10% price increase can reduce long-term alcohol consumption by almost 7% in high-income countries and, although data is very limited, by almost 10% in low-income countries. In addition, higher taxes on alcohol reduce the incidence and prevalence of alcohol-related liver disease, traffic accidents, and other intentional and unintentional injuries, such as domestic violence and the adverse effects of alcohol-related mental illness.

Laws that raise the minimum legal drinking age reduce sales and reduce problems for young drinkers. The reduction in hours and days of sale and the reduction in the number of stores specializing in the sale of liquor, as well as restrictions on access to alcohol, are accompanied by a reduction in both alcohol consumption and related violations.

Working with vulnerable populations to mitigate stressors and build resilience effectively prevents the development of mental and behavioral disorders and promotes mental health. The following subsections provide some information relevant to different periods life.

Evidence from home visits to women during pregnancy and young infants, including maternal smoking, lack of social support, poor parenting skills, and early parent-child interactions, has shown that the health, social and economic consequences are of great public health importance. . These include improved mental health for both mothers and newborns, reduced utilization of health services, and a long-term reduction in behavioral disorders after 15 years. If long-term results are considered, these interventions can also be cost effective.

The Pregnancy and Infant Home Visit Program, a two-year home visiting program for poor first-time pregnant adolescents, is a prime example of a program with favorable outcomes for both mothers and newborns. Randomized controlled trials showed an increase in birth weight of almost 400 g, a 75% reduction in preterm births, a more than halving of emergency visits, and significantly less cases of child abuse by teenage mothers. . Employment among mothers increased by 82%, and the birth of a second child was delayed by more than 12 months. When children reached the age of 15, they were 56% less likely to have problems with alcohol and other psychoactive substances, there was a similar decrease in the number of arrests, an 81% decrease in the number of convictions and a 63% decrease in the number of sexual partners. The families were financially wealthy, and the government's cost to such families more than offset the cost of the program. However, not all nursing and social work outreach programs have been found to be effective and therefore factors that predict the effectiveness of interventions need to be identified.

Interventions for children from poor families aimed at improving the quality of cognitive functioning and language skills have contributed to better development cognition, better school performance, and less behavioral problems. For example, the Perry project, which spans participants from preschool to adulthood, has shown favorable results through age 19 and 27 in lifetime arrests (a 40% reduction) and a sevenfold return on the government's economic investment in the program.

Parental coping programs have also shown significant preventive effects, such as the Incredible Years program, which provides behavioral interventions that enhance positive parent-child interactions, improve problem-solving and social functioning, and mitigate behavioral disturbances at home and at school. . The program uses video-assisted modeling techniques that include modules for parents, school teachers and children.

Only two types of proactive strategies have been shown to be effective in preventing or mitigating child maltreatment: high-risk mother visitation programs and self-advocacy programs for school-aged children to prevent sexual abuse. Home visitation programs (such as the Pregnancy and Infant Home Visit Program mentioned above) have shown that the number of verified cases of child abuse or abandonment decreased by 80% within the first two years. Self-protection programs enable children to acquire the knowledge and skills they need to prevent their own victimization. These school programs are widely implemented in the US in elementary schools. Well-controlled trials have shown that children do better with knowledge and skills. However, there is as yet no evidence that these programs reduce child abuse.

Children whose parent has a mental illness, such as depression, have a 50% increased risk of developing a depressive disorder before the age of 20. The findings indicate that the transmission of mental disorders from one generation to another is the result of the interaction of genetic, biological, psychological and social factors acting both during pregnancy and in infancy. Intergenerational interventions that prevent the transmission of mental disorders from one generation to the next target risk and protective factors, such as increasing family members' knowledge of the disease, increasing psychosocial resilience in children, improving parent-child and family interactions, stigma, and the social network. support. So far, there have been very few controlled studies examining the results of such programs, although they are promising, for example, a randomized controlled trial of the effectiveness of a program focused on the cognitive functioning of group participants. This trial showed a decrease in the number of new cases of depressive disorder and relapses from 25% in the control group to 8% in the prevention program group during the first year after the intervention and from 31% to 21%, respectively, during the second year of follow-up.

School programs improve mental health through environmental interventions and teaching appropriate social-emotional behavior. Some integrated interventions are carried out over a number of years throughout the school, while others target only one part of the school (for example, children in the same grade) or a specific group of students at identified risk. As a result, school performance improved, problem-solving skills and social competence increased, and internalized and externalized impairments such as symptoms of depression, anxiety, bullying, substance use, aggressive and delinquent behavior decreased.

Environmental-focused interventions target contextual variables in a child's home and school. Programs that restructure the school environment (e.g. School Transition Project) have been shown to affect the psychological climate in the classroom (e.g. the good behavior game) or the entire school (e.g. the Norwegian Bullying Prevention Program*) . improve emotional responses and behavior and prevent or alleviate symptoms and associated adverse outcomes.

Adolescents whose parents are divorced are more likely to drop out of school, among them more high performance prevalence of pregnancies, internalized and externalized disorders, and a higher risk of divorce and premature death. Effective school programs for children of divorced parents (e.g., child support group, intervention program for children of divorced parents) that include coping skills training using cognitive behavioral therapy techniques and the provision of social support reduce stigma and reduce depressive symptoms and behavioral disorders, which has been noted during a one-year follow-up study. Programs focused on improving parenting skills and coping with divorce-related emotional reactions in parents improve the quality of the mother-child relationship and mitigate internalized and externalized disorders in children. One six-year randomized follow-up study found a difference in the prevalence of mental disorders: in the experimental group, the one-year prevalence of diagnosed mental disorders among adolescents was 11% compared with 23.5% in the control group.

The death of a parent is associated with a greater incidence of symptoms of anxiety and depression, including clinical depression, behavioral disturbances, and lower academic achievement. Although many interventions are available for bereaved children, few have been evaluated in controlled trials. A case in point is an intervention that simultaneously targeted children, adolescents, and survivors of caregivers, which promoted positive parent-child relationships, effective coping, good mental health in caregivers, improved discipline, and facilitated sharing of feelings and experiences. The effects were more noticeable in children who were at higher risk, i.e. those who already had symptoms at the beginning of the program.

Work stress and unemployment can exacerbate mental health and increase the incidence of depression, anxiety, burnout, alcohol use disorders, cardiovascular disease and suicidal behavior.

In order to reduce work stress, interventions should aim either to increase the ability of workers to cope with stressors or to eliminate them in the work environment. Three types of strategies can be used to organize the working environment: business and technical interventions (e.g., increasing work diversity, improving work processes and working conditions, reducing noise, reducing workload), clearly defining job responsibilities, and improving social relationships (e.g., communication , conflict resolution), as well as interventions aimed at multiple changes, both for work and workers. Despite the existence of national and international legislation on the psychosocial work environment that emphasizes risk assessment and risk management, most programs aim to reduce the cognitive assessment of stressors and their subsequent effects rather than to reduce or eliminate the stressors themselves.

The most well-known universal interventions as responses to job risk and unemployment include legal provisions governing job loss insurance and unemployment benefits, or provisions to improve job security. Their availability varies widely in different parts of the world. A number of workplace regulations are aimed at reducing the risk of job loss and unemployment, including split wages, provisions guaranteeing employment with a given employer, reduced pay, and reduced working hours. There is no empirical evidence of their potential to protect the mental health of workers, although it is clear that they can reduce the stress associated with unemployment.

A number of programs support the unemployed by helping them return to paid work, such as a work club and jobs program. These simple, low-cost programs combine basic job search skills with increased motivation, social support, and coping skills. In the US and Finland, the jobs program has been tested and replicated in large randomized trials. They showed higher rates of re-employment, best quality and higher pay for the work received, increased self-efficacy in finding a job and greater skill, and reduced symptoms of depression and distress.

Among caregivers of the chronically ill and people old age, increased risk of excessive stress and increased incidence of new cases of depression. Many controlled studies examining the effectiveness of psychoeducational programs for family members caring for elderly relatives have shown reduced burden, reduced symptoms of depression, subjective improvement in well-being, and perceived satisfaction of caregivers. Psychoeducation programs provide information about the mentee's illness and the resources and services available, as well as training in how to respond effectively to problems that arise when a relative has a particular illness. Such programs include lectures, group sessions and the use of printed materials.

The mental health of the elderly is improved with varying degrees of effectiveness by various types of interventions, including exercise, improved social support through friendships, outreach to older people with chronic illnesses and caregivers
their people, early screening, treatment by primary care specialists medical care and programs that use techniques to discuss the events of their lives. Prevention of traumatic brain injury, normalization of high systolic pressure and high serum cholesterol also appear to be effective in reducing the risk of dementia.

For example, physical exercise, such as aerobics and tai chi, has both physical and psychological benefits for older adults, including greater life satisfaction, good mood and mental well-being, reduced psychological distress and symptoms of depression, reduced blood pressure, and fewer falls. Other programs, while showing promise, require repeated research, such as the effectiveness of early screening of older adults and case management, including various types of social assistance, as a means of reducing depression and increasing life satisfaction.

Although depression is common among the elderly, few controlled studies have been conducted on effectiveness of prevention of the disease and suicides in this population. There is some evidence of improved social relationships and reduced symptoms of depression among participants in a program that includes widows who provide mutual support. Preliminary evidence also suggests that life events meetings and reminiscence therapy may reduce the risk of depression in older adults, especially in care home care patients, although the beneficial effects appear to fade over time, suggesting the need for ongoing support.

Depression is often observed in people with chronic or stressful somatic diseases. However, there are very few examples of effective programs in this area. Patient education techniques aimed at teaching methods of prognosis and coping with chronic conditions have produced short-term beneficial effects, such as a reduction in depressive symptoms. Providing hearing aids to older people with hearing loss may also contribute to better social, emotional and cognitive functioning and to the reduction of depressive symptoms.

The data collected over the past few decades and summarized above clearly demonstrate that it is possible to reduce the risk of mental health deterioration and prevent the development of mental disorders. Further, an important task is to facilitate the use of the obtained data for the development of a strategy and for practical work. This section briefly outlines some of the steps and factors that can facilitate international, national and local efforts to prevent mental and behavioral disorders.

A global advocacy campaign is needed to raise awareness and confidence in preventive work in the mental health care system. The findings need to be widely disseminated among policy makers and the general population. Modern knowledge and resources in the field of prevention of mental disorders and the promotion of mental health are unevenly distributed around the world. International programs are needed to support countries that do not yet have the capacity and experience in this area. International curricula, especially in middle- and low-income countries, should be developed in collaboration with international organizations that already have the capacity and experience to do so.

In order to strengthen the knowledge base, the scope of research on the evaluation of the effectiveness of prevention should be expanded, especially through international cooperation. To this end, a network of collaborating research centers should be formed, responsive to the needs of low-, middle- and high-income countries. Researchers should pay attention Special attention to multicenter and replication studies to study the ability of program and strategy developers to quickly respond to the cultural characteristics of the subjects. In addition, longitudinal studies should be carried out to study the long-term results of preventive interventions; research on the relationship between mental, physical and social health disorders; cost-effectiveness studies to identify the most effective strategies and determine the value of prevention beyond its mental health benefits; research to identify predictors of effects to improve cost effectiveness.

Government agencies should develop national and regional strategies for the prevention of mental disorders and the promotion of mental health as part of a public health strategy and in accordance with the principles of treatment and rehabilitation. Public policy should provide for horizontal action across various public sectors, such as security agencies environment, housing, social security, labor and employment, education, criminal justice and human rights protection. National governments and health insurers should allocate appropriate resources to implement evidence-based activities, including by supporting capacity building in many sectors with defined responsibilities; funding training, education, implementation and evaluation studies; stimulating the coordination of the work of different sectors that are related to mental health.

Government services should develop national and local infrastructure for mental health prevention and promotion, and work in collaboration with other public health and policy authorities. Government agencies and health insurers should allocate appropriate resources to implement evidence-based activities, including supporting the development of human resources in many sectors with defined functional responsibilities; funding internships, education, program implementation and evaluation studies; stimulating the coordination of the work of different sectors that are relevant to mental health.

Given the high rates of comorbidity in psychiatric disorders and poor physical health, comprehensive prevention strategies within primary care and skilled care systems are of paramount importance. Supportive prevention methods are needed, along with increased resources and training for primary care professionals and skilled health care professionals.

In order to sustain favorable public health outcomes over the longer term, community accountability is essential to support strategies to maintain stability within health authorities. Governments and implementers must choose programs and strategies that make use of existing infrastructures and resources. The mental health promotion and prevention components need to be structurally integrated with existing effective health promotion programs and social strategies in schools, workplaces and communities.

Prevention strategies should be based on systematic assessments of the needs of the national mental health system. In order to extend the impact of preventive interventions to the mental health of all population groups, programs should be developed that are widely available to such groups. Program designers and implementers should take into account evidence-based principles and conditions that can improve performance and cost-effectiveness while improving mental and physical health, as well as achieving social and economic benefits (benefits).

Providers have a duty to ensure programs are culturally appropriate and appropriate, especially if they are based on evidence drawn from other countries or cultures, or when they are used in communities and target populations that differ from those for whom they were originally designed. and tested. The adaptation of programs, even taking into account the peculiarities of the culture of its participants, must be subject to the principles of effective intervention and successful implementation. A deeper understanding of the possibilities for transferring (to another place) evidence-based programs and strategies, the possibilities for adapting and reworking them in different countries and cultures is needed.

Practitioners and program implementers must ensure that the quality of their implementation is high and that tools are used to improve quality and ensure accurate program execution, such as guidelines for software, guidelines for effective implementation, trainings and consultations of specialists.

Mental health professionals, including psychiatrists, psychologists, psychiatric nurses, social workers and other professionals trained in mental health, can and must play several roles to make prevention of mental and behavioral disorders a reality. Next, we will briefly describe them.

Mental health professionals are on the job of raising awareness and communication about prevention among policy makers, other professionals and the general public, creating an environment conducive to prevention work. At present, it is generally believed that mental disorders arise from an unknown cause and are almost impossible to prevent. In order to eliminate these myths, correct information about the established causes and about possible methods to reduce the incidence and improve the course of mental disorders must be widely available.

With their knowledge base, mental health professionals should advise health planners and program developers about the possibilities of initiating preventive interventions or integrating mental health interventions with existing programs. The scope for this role is enormous, as most countries and communities have public health and social programs that can serve the cause of preventing mental disorders. Even if no changes are needed, knowing that a program helps prevent the development of mental disorders helps reinforce the need to continue or expand the program.

In many cases, mental health professionals must play an active role in initiating prevention programs. This may be a leadership role or an active collaborator, especially in an interagency program. Some of the most effective prevention programs have been initiated by mental health professionals working closely with other professionals.

Mental health professionals should begin further research to evaluate the effectiveness of prevention of mental disorders. It is known that there is far less research on mental health as part of all health research than the proportionate burden of mental disorders, and even less in low- and middle-income countries. Even among the available mental health studies, the effectiveness of preventive measures has not been studied enough. Mental health professionals and researchers need to correct this imbalance and build a better database, especially in low- and middle-income countries. The database on the implementation of prevention programs in real life is particularly affected: this gap is filled by systematic evaluation within the framework of existing prevention programs. Innovative proposals, especially those that are interagency in nature and aimed at multiple outcomes, are likely to help overcome the lack of funding, increasing interest from potential funding agencies.

Mental health professionals come into close contact with people with mental disorders and their families. The opportunities for primary prevention in these settings are enormous. People with one or more psychiatric disorders (active or in remission) are more likely to develop another psychiatric disorder. Preventive interventions among these people, even if they are in contact with mental health professionals, are ignored. An example would be the prevention of depression in people with a substance use disorder, or emotional distress in a child with a specific developmental disorder.

Another way in which mental health professionals can contribute to preventive work is by initiating preventive interventions in family members of people receiving mental health care. Preventive methods for children whose parents have a mental disorder at particular risk can be highly effective, but, unfortunately, are rarely used. Mental health professionals need to balance providing the right amount of care for patients on treatment with preventing their family members from needing future care.

Prevention of mental disorders is a public health priority. Given the progressively increasing burden of mental and behavioral disorders and the known limitations in their treatment, the only viable method to reduce this burden is prevention. Sociologists and biologists have brought significant clarity to the role of risk and protective factors in shaping the development of mental disorders and poor mental health. Many of these factors are modifiable and potential targets for preventive and other relevant measures. A wide range of evidence-based principles and strategies (in addition to those specific to specific mental disorders) are available for implementation to prevent the development of mental and behavioral disorders. It has been established that preventive strategies mitigate risk factors, increase protective factors, reduce psychopathological symptoms and more often prevent the development of certain mental disorders; they also improve mental and physical health and generate social and economic benefits.

While sufficient evidence justifies putting programs into practice, further efforts are needed to further expand the range of effective preventive measures, improve their effectiveness and cost-effectiveness under changing conditions, and enrich the database. This requires regular evaluation of the effectiveness of programs and strategies and their implementation, and a sufficient number of controlled scientific studies.

Mental health professionals have several important roles to play in prevention, namely prevention advocates, technical advisers, program managers, researchers and prevention implementers. These roles are difficult, but apparently very rewarding duties. However, the results of prevention programs at the population level can only be expected after sufficient human and financial resources have been invested. Financial support should be directed towards the implementation of evidence-based prevention programs and strategies and the development of the necessary infrastructure. In addition, investment in capacity building at the country level should be promoted through internships and a workforce of knowledgeable professionals. Much of the investment must come from the government, since it is the government that is ultimately responsible for the health of the population. Modern resources for the prevention of mental disorders and the promotion of mental health are unevenly distributed around the world. International programs should aim to bridge this gap and support low-income countries in building knowledge and experience in prevention, as well as strategies and interventions that are tailored to needs, cultures, contexts and opportunities.

Prevention of mental disorders and promotion of mental health should be an integral part of public health and related policies at local and national levels. Measures to prevent mental disorders and promote mental health should be integrated into public policies that include different horizontal activities across different public sectors, such as the environment, housing, social security, labor and employment, education, criminal justice and protection human rights. This will create win-win situations in various sectors, including a wide range of health, social and economic benefits.