Psych · Foundations — prevention and early intervention
Prevention and early intervention in mental health
Also known as Preventive psychiatry · Early intervention mental health · Universal selective indicated prevention · Clinical staging psychiatry · Duration of untreated psychosis · Youth mental health prevention · Indicated prevention depression psychosis
Exam-exhaustive fellowship reference on prevention and early intervention in mental health: Gordon and Caplan frameworks, Rose population strategy, life-course and ACE-informed selective programmes, school-based and perinatal prevention, indicated prevention of depression and clinical high-risk for psychosis, DUP reduction, multi-element early intervention services (OPUS/RAISE), clinical staging, ethics and implementation. FRANZCP-primary, globally tagged.
Practise this topic
On this page
Study tools
Your progress
Saved on this device.
Target exams
Red flags
- Designing only high-risk clinics while ignoring population strategies (Rose prevention paradox)
- Starting long-term antipsychotics by default for clinical high-risk / UHR youth without specialist rationale
- Equating school wellbeing programmes with proven elimination of depression incidence
- Leaving imminent suicide risk or frank psychosis in a 'prevention-only' track
- Labelling asymptomatic genetic risk as disease without current distress or functional need
- Claiming primary prevention of schizophrenia is solved as a population outcome
Meet the patient — and the planner's spreadsheet
A health-district planner asks you to justify a youth mental health budget. She has two columns on her spreadsheet: more tertiary beds, and a school wellbeing talk once a year. Both are the common reflex, and both are wrong for the same reason — they confuse activity with prevention.[2][16]
The prevention station tests whether you can hold four things at once: Gordon's three levels, Rose's paradox, the staging heuristic, and the evidence behind each layer. Candidates who reach for "start an antipsychotic fast" fail; candidates who design a layered service pass.[1][3][4]
Etymology for viva gold: prevention comes from the Latin praevenire, "to come before". The whole discipline is in the word — acting upstream of the disorder, not faster inside it.[1]
References16ShowHide
- [1]Gordon RS Jr An operational classification of disease prevention Public Health Rep, 1983.PMID 6856733
- [2]Rose G Sick individuals and sick populations Int J Epidemiol, 2001.PMID 11416056
- [3]Arango C, Díaz-Caneja CM, McGorry PD, et al. Preventive strategies for mental health Lancet Psychiatry, 2018.PMID 29773478
- [4]McGorry PD, Hickie IB, Yung AR, et al. Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions Aust N Z J Psychiatry, 2006.PMID 16866756
- [5]Cuijpers P, van Straten A, Smit F, et al. Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions Am J Psychiatry, 2008.PMID 18765483
- [6]van Zoonen K, Buntrock C, Ebert DD, et al. Preventing the onset of major depressive disorder: a meta-analytic review of psychological interventions Int J Epidemiol, 2014.PMID 24760873
- [7]Werner-Seidler A, Perry Y, Calear AL, et al. School-based depression and anxiety prevention programs for young people: A systematic review and meta-analysis Clin Psychol Rev, 2017.PMID 27821267
- [8]Olds DL, Eckenrode J, Henderson CR Jr, et al. Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial JAMA, 1997.PMID 9272895
- [9]Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients: a systematic review Arch Gen Psychiatry, 2005.PMID 16143729
- [10]Correll CU, Galling B, Pawar A, et al. Comparison of Early Intervention Services vs Treatment as Usual for Early-Phase Psychosis: A Systematic Review, Meta-analysis, and Meta-regression JAMA Psychiatry, 2018.PMID 29800949
- [11]Kane JM, Robinson DG, Schooler NR, et al. Comprehensive Versus Usual Community Care for First-Episode Psychosis: 2-Year Outcomes From the NIMH RAISE Early Treatment Program Am J Psychiatry, 2016.PMID 26481174
- [12]Fusar-Poli P, Bonoldi I, Yung AR, et al. Predicting psychosis: meta-analysis of transition outcomes in individuals at high clinical risk Arch Gen Psychiatry, 2012.PMID 22393215
- [13]van der Gaag M, Smit F, Bechdolf A, et al. Preventing a first episode of psychosis: meta-analysis of randomized controlled prevention trials of 12 month and longer-term follow-ups Schizophr Res, 2013.PMID 23870806
- [14]Davies C, Cipriani A, Ioannidis JPA, et al. Lack of evidence to favor specific preventive interventions in psychosis: a network meta-analysis World Psychiatry, 2018.PMID 29856551
- [15]Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication Arch Gen Psychiatry, 2005.PMID 15939837
- [16]Campion J, Javed A, Lund C, et al. Public mental health: required actions to address implementation failure in the context of COVID-19 Lancet Psychiatry, 2022.PMID 35065723