Preventing mental disorders: the time is right

Two recent events have highlighted the need for greater action to prevent mental disorders in Australia. The first was a national symposium on the prevention of mental disorders to guide the future funding priorities of Australian Rotary Health (ARH), the largest non-government funder of mental health research in Australia.1 The second was the establishment of the Alliance for the Prevention of Mental Disorders (http://apmd.org.au) by a group of researchers working in mental disorder prevention. The Alliance aims to: advocate for funding for prevention research and for the translation of evidence into policy and practice; facilitate research and encourage new researchers; facilitate knowledge translation; and build partnerships with other disciplines and organisations with common aims.

Mental disorders are the main source of disability burden in Australia and their impact begins early in life.2 In an effort to reduce this burden, the Australian Government has supported increases in clinical services for mental disorders, including the Better Access initiative, the Access to Allied Psychological Services scheme and youth-friendly headspace mental health services. While these initiatives have improved access to treatment, there is no evidence that they have produced detectable improvements in population mental health.3 The prevalence of mental disorders in Australia appears unchanged.4

Why might this be? The prevalence of a disorder is a function of both incidence and duration. We argue that, alongside the current clinical approaches to reduce the duration of mental disorders, it is time to focus on a complementary approach to reduce incidence. This proposed shift in focus is supported by a recent survey that highlighted the gap between mental health-related research funding and the priorities of stakeholders such as researchers, policymakers, health care consumers and carers.5 The divergence was most pronounced in the area of prevention and promotion, which, despite being the top-ranked priority for stakeholders, received low and diminishing amounts of funding over the past 10 years.

Despite these low levels of funding, we have reason to be optimistic about our ability to prevent mental disorders. Evidence presented at the ARH symposium suggests that prevention of mental disorders is possible, and is particularly promising for common mental disorders such as depression and anxiety.6 There are opportunities for prevention across the lifespan and across settings, with evidence that: parenting interventions can prevent mental health problems in children; school-based programs can prevent anxiety and depression in adolescents; cognitive behaviour therapy-based programs can prevent depression and anxiety in tertiary students; interventions targeting job stress can prevent depression in adults; and psychosocial interventions may prevent depression in older people.6 With the increasing popularity of digital media, the internet also offers a promising mode of delivery for mental disorder prevention programs.7 However, in all these cases, more research is needed to establish the most effective approaches and to assess the long-term impacts of preventive interventions.

A further promising area for investigation arises from the growing evidence that mental disorders and major physical disorders such as cardiovascular disease and cancer have common risk factors. This evidence suggests the need for greater integration of physical and mental health promotion and prevention, and for inclusion of mental health outcome measures in evaluations of physical health promotion interventions. The overlap of risk factors also offers those working to prevent mental disorders opportunities to learn from the successes and failures of decades of research in physical disorder prevention, as exemplified by the role of tobacco control in preventing cardiovascular disease and cancer.6

It is clear that dealing with the complex and interrelated risk factors for mental disorders will require interventions that are themselves complex and multifaceted. One of the key lessons from tobacco control is that policy change is crucial and can be more cost-effective than individual behavioural interventions.8 Achieving policy change to help prevent mental disorders is likely to be even more challenging, given the immediate demands of care for severe mental illness and the deferred benefits of prevention.

ARH’s new research focus on prevention and the formation of the Alliance for the Prevention of Mental Disorders, with its focus on prioritising research and policy change, offer significant opportunities to make progress in this area.