Neuropsychiatric disorders, their treatment and prevention. Mental disorders. Treatment of mental disorders

There is sufficient evidence indicating the effectiveness of interventions in reducing risk factors, enhancing protective factors, and preventing psychopathological symptoms and new cases of mental disorders. Macropolicy interventions aimed at improving nutrition, housing and education, or reducing economic instability have been shown to reduce the incidence of mental disorders. In addition, specific interventions aimed at building resilience in children and adolescents through parenting, early interventions and programs for children at risk of developing mental disorders, such as those with a mentally ill parent, the loss of a parent or family disruption, have been shown to improve mental health outcomes. weaken depressive symptoms and reduce the incidence of depressive disorders. Interventions for adults - from macro-policy policies such as alcohol taxation or workplace legislation to individual support for people with mental illness - can reduce psychiatric morbidity and its associated social and economic burden. Exercise, social support and community participation have also been shown to improve mental health in older adults. Public mental health systems will benefit from the continued development of evidence by combining different assessment methods in low-, middle- and high-income countries. Translating the findings into policy and practice requires efforts at the international, national and local levels, including the development of concepts of legal capacity, protection, channeling mental health into the health system, as well as other policies, safe infrastructure and stability. Mental health professionals have an important role to play in improving the quality of evidence on the prevention of mental disorders, promoting mental health in communities, engaging stakeholders in program development, and (as health care professionals) in their practice.

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

Universal, selective and specific preventive interventions belong to primary prevention. Universal preventive measures are aimed at the entire population that does not belong to a high-risk group, selective - at individuals or subgroups of the population in which the risk of developing mental disorders is significantly higher than average and is confirmed by biological, psychological or social risk factors. Specific preventive interventions are used for high-risk individuals who exhibit minimal but detectable signs or symptoms that predict the development of a mental disorder, or biological markers that indicate susceptibility to a mental disorder but do not meet the criteria for the 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 involves interventions aimed at reducing the severity of disability, improving the quality of rehabilitation and preventing relapses and exacerbations of the disease. This article is about primary prevention of mental disorders.

The difference between promoting mental health and preventing the development of a mental disorder lies in their target outcomes. Mental health promotion aims to positively stimulate it by improving psychological well-being, increasing competence and resilience, and creating supportive living conditions and environments. Prevention of mental disorders is aimed at eliminating symptoms and, of course, mental disorders. Strategies that promote mental health are used as one means of achieving these goals. Mental health support, which includes measures to strengthen it in the population, may also have the additional effect of reducing the incidence of mental disorders. Good mental health is a powerful protective factor against the development of mental illness. However, mental disorders and good mental health cannot be described as conditions located at opposite ends of a linear scale, but rather as two overlapping and interrelated components of one separate concept of “mental health”. Prevention of mental disorders and promotion of mental health often occur within the same programs and strategies, involving much the same types of activities and producing different but complementary results.

The need for evidence-based prevention of mental disorders has stimulated debate among researchers, practitioners, health promotion advocates and policymakers internationally. To paraphrase Sackett et al.'s definition of evidence-based medicine, evidence-based prevention and health promotion is defined as “the conscientious, accurate, and rational use of the best current evidence in selecting interventions for individuals, communities, and populations to minimize morbidity and create opportunities for people to gain greater control over and improve their health.” Evidence from systematic research will help avoid decision uncertainty due to lack of information or decisions based on biased assumptions, which would lead to unnecessary waste of time and resources or the funding of 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 implementation on a national scale). Given the high costs and lack of accountability in spending public money, it is imperative that such a decision be based on strong evidence showing that the program is effective and can pay for itself. Therefore, the use of evidence on the cost-effectiveness of these interventions is also important.

When assessing the value of scientific evidence, various factors must be taken into account. First, to avoid biased observations and unfounded conclusions, it is necessary to evaluate 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 larger in studies that use 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 must 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 important when discussing the spread or selection of prevention programs, such as the transferability of programs to other situations or cultures, their adaptability and feasibility.

When assessing the quality of scientific evidence, perhaps one of the hottest debates is whether randomized controlled trials should be considered to best ensure the internal validity of results from 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 seriously objected to considering them as one single gold standard. Randomized controlled trials are designed to examine causal factors at the individual level using single-component interventions under strictly controlled conditions, and are therefore suitable primarily for evaluating clinical or preventive interventions at the individual or family level. Many prevention interventions are targeted at schools, companies, communities or the population at large. These trials examine multicomponent programs in a dynamic community setting where many contextual factors are unlikely to be controlled. A rigorous randomized controlled trial design is not entirely suitable in this context, so to maintain its benefits in a community intervention setting, randomization should be carried out at the level of larger components such as classrooms, schools or community populations. However, the feasibility of such community-based randomized trials is limited for practical, political, financial or ethical reasons. When the use of randomization is opposed on ethical grounds, quasi-experimental studies, which use matching techniques to achieve comparability between treatment and control groups, and time series studies are valuable alternatives.

Building a database requires a step-by-step and sequential approach using different methods depending on the information required for a given decision. Sharing information internationally through common databases is essential to building a strong evidence base as well as 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 resilience to risk factors and disorders: they are defined as factors that modify, improve, or change a person's response to certain environmental risk factors that predispose them to impaired adaptive capacity.

There is compelling evidence of 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 give a cumulative effect, which predisposes individuals to mental disorders, then to increased vulnerability, then a mental disorder and finally a full-blown clinical picture of severe mental illness.

The main socioeconomic and environmental determinants of mental health are related to macro-issues such as poverty, war and inequality. For example, poor people often live without basic political agency, choice, and the right to security, which do not require proof. They often lack adequate food, shelter, education and health opportunities; different types of deprivation prevent them from leading a lifestyle that everyone values. Population groups 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 displacement, racial discrimination, and economic instability, are associated with increased symptom frequency and high incidence of mental disorders.

Individual and familial risk and protective factors may be biological, emotional, cognitive, behavioral, interpersonal, or related to the family context. They can have the greatest 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 mental disorders.

Preventive interventions should target modifiable determinants, including disease-specific determinants, as well as more typical risk and protective factors common to several mental health and mental disorders. Interventions that effectively target such typical factors can produce a wide range of 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 may also be linked by common risk factors, for example poor housing can worsen both mental and physical health.

A thorough understanding of the links between different mental disorders and between mental and physical health, as well as the pathways through which common and disease-specific risk factors contribute to mental health conditions, is required. However, sufficient evidence has been generated to justify the investment of government and non-governmental organizations in the development, dissemination and implementation of evidence-based programs and policies. For policymakers and other stakeholders, the most cost-effective and attractive investments are those that address risk factors and protective factors that have a large impact on or are common to a range of related issues, including social and economic ones.

Changes in policy, legislation and the deployment of resources can significantly improve the mental health of populations 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 impact 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 socioeconomically disadvantaged environments promotes normal cognitive development, improves educational achievement and reduces the risk of poor mental health outcomes, especially for children at risk or living in impoverished areas. The most effective intervention models are those that include supplementary nutrition and monitoring and promotion of development. These models combine nutritional support (eg, nutritional supplements) with psychological counseling and psychosocial support (eg, compassion, listening). It is believed that the cost of maintaining developmental charts (in which a child's body weight is plotted against expected weight) is also effective. In addition, iodine plays an important role in preventing mental and physical development delays and learning disabilities. Programs that supplement foods 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 brought the use of iodized salt to 70% of households worldwide. This protects 91 million newborns from iodine deficiency and indirectly prevents the development of related mental and physical health problems.

Poor housing is considered an indicator of poverty and a target for improving public health and reducing health inequalities. Evidence from a recent systematic review of studies examining the health effects of housing improvements suggests favorable mental and physical health outcomes. These include improved mental and physical health and less self-reported mental stress, as well as wider positive social impact on factors such as perceptions of safety, involvement in crime, 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 prevalent among the female population. Lack of education sharply limits individuals' ability to access economic benefits. Most countries have made impressive strides in improving literacy rates through better education programs for children, but much less effort has been directed at the current illiteracy among adults. It is expected that programs aimed at eradicating illiteracy, especially among adults, can provide tangible benefits by relieving psychological stress and promoting mental health. For example, ethnographic studies in India have shown that literacy programs have been highly successful in addition to skills acquisition. By bringing women together in a new social format that allowed them to receive information and gain new ideas, the classes served as a catalyst for social change. By participating in teacher volunteer campaigns, impoverished literate women and girls gained a sense of pride, self-worth, and purpose in life. Positive effects on mental health were mediated in a variety of ways, including gaining quantitative reasoning ability to reduce the risk of being a victim of fraud, greater confidence in claiming rights, and overcoming barriers to opportunity. All of these gains are associated with preventing deterioration in mental health and reducing the risk of developing mental disorders.

In many developing countries, economic insecurity is a persistent source of stress and anxiety, which can contribute to symptoms of depression, mental illness and suicide. Non-governmental organizations, such as the Bangladesh Rural Development Committee, have developed poverty reduction programs targeting credit sources, gender equality, basic health care, education and human rights. Lending from such sources may reduce the risk of developing mental illness by eliminating a major cause of stress—the threat of informal borrowing. An evaluation of the Bangladesh Rural Development Committee's poverty alleviation programs targeting millions of the poorest people in Bangladesh finds that the psychological well-being of women members of the Committee is better than that of non-members.

Many community-based interventions focus on developing processes of empowerment and building a sense of belonging and social responsibility among community members. An example is the Communities Supporting Program initiative, which has been successful in several hundred communities in the United States and is currently being adopted and replicated in the Netherlands, England, Scotland, Wales and Australia. This initiative encourages communities to implement a violence and aggression prevention system by using local data to identify risk factors and develop appropriate interventions. This involves interventions at multiple levels simultaneously: at the community level (mass media, policy changes), at the school level (changes in management or teaching methods), at the family level (parenting classes) and at the individual level (e.g. improving social competence ).

Regarding addictive substances, effective regulatory measures are taken at the international, national, regional and local levels: levying a tax, limiting the availability of these substances and a complete ban on direct and indirect advertising.

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

Laws increasing the minimum legal drinking age are helping to reduce sales and problems among young drinkers. Reductions in hours and days of sale and fewer stores specializing in the sale of alcoholic beverages, as well as restrictions on access to alcohol, have been accompanied by a reduction in both alcohol use and alcohol-related disorders.

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

Data from home visits to pregnant women and young children, including maternal smoking, poor social support, poor parenting skills and early parent-child interactions, show that the health, social and economic consequences are of great public health importance . These included improvements in mental health for both mothers and newborns, reductions in health service utilization, and long-term reductions in behavioral problems after 15 years. When long-term outcomes are considered, these interventions may also be cost-effective.

The Pregnancy and Infant Home Visiting Program, a two-year program of home visits for poor first-time pregnant teenagers, 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 the number of preterm births, a more than half reduction in the number of emergency visits, and a significantly lower incidence 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, the number of arrests decreased by the same amount, the number of convictions decreased by 81%, and the number of sexual partners decreased by 63%. The families were financially well off, and the government's spending on such families more than offset the cost of the program. However, it has been found that not all nursing and social worker programs are effective, and therefore there is a need to identify factors that predict the effectiveness of interventions.

Interventions for poor children to improve cognitive functioning and language skills resulted in better cognitive development, better school performance, and less behavioral problems. For example, Project Perry, which spanned participants from preschool through adulthood, demonstrated favorable outcomes before ages 19 and 27 in lifetime arrest rates (40% reduction) and a sevenfold return on the government's economic investment in the program.

Parent coping training programs have also demonstrated significant preventative effects, such as the Incredible Years program, which provides behavioral interventions that enhance positive child-parent interactions, improve problem solving and social functioning, and reduce disruptive behavior at home and at school. . The program uses video-based 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: home visiting programs for high-risk mothers and self-defense programs for school-age children to prevent sexual abuse. Home visiting programs (such as the Pregnancy and Infant Home Visiting Program mentioned above) have shown that the number of verified cases of child abuse or neglect decreased by 80% within the first two years. Self-defense programs enable children to acquire the knowledge and skills needed to prevent their own victimization. These school-based programs are widely implemented in the United States in elementary schools. Well-controlled trials have shown that children feel better about their knowledge and skills. However, there is no evidence yet that these programs reduce the incidence of child maltreatment.

Children who have a parent with a mental illness, such as depression, have a 50% increased risk of developing a depressive disorder before age 20. The findings indicate that the intergenerational transmission of mental disorders is the result of an interaction of genetic, biological, psychological and social factors operating both during pregnancy and infancy. Interventions to prevent the intergenerational transmission of mental disorders target risk and protective factors, such as increasing family knowledge of the disorder, increasing psychosocial resilience in children, improving parent-child and family interactions, stigma, and the social network support. There are still very few controlled studies examining the effects of such programs, although they are promising, such as a randomized controlled trial of the effectiveness of a program targeting the cognitive functioning of group participants. This trial showed a reduction in new cases of depressive disorder and relapse from 25% in the control group to 8% in the intervention group during the first year after the intervention and from 31 to 21%, respectively, during the second year of follow-up.

School-based programs improve mental health through environmental interventions and teaching appropriate social-emotional behavior. Some interventions in a comprehensive approach are carried out across the whole school over a number of years, while others target only one part of the school (for example, children in one class) or a specific group of students at identified risk. The results were improved school performance, increased problem-solving skills and social competence, and decreased internalizing and externalizing problems such as depressive symptoms, anxiety, bullying, substance use, aggressive and delinquent behavior.

Ecologically focused interventions target contextual variables in the child's home and school. Programs that restructure the school environment (e.g., the School Transition Project) have been shown to influence the psychological climate of the classroom (e.g., the Good Behavior Game) or the entire school (e.g., the Norwegian Bullying Prevention Program*) improve emotional reactions and behavior and prevent or mitigate symptoms and associated negative outcomes.

Adolescents whose parents are divorced are more likely to drop out of school, have higher rates of pregnancy, internalizing and externalizing disorders, and are at higher risk of divorce and premature death. Effective school-based programs for children of divorced parents (e.g., child support group, intervention program for children of divorced parents) that provide coping skills training using CBT techniques and social support have been shown to reduce stigma and reduce depressive symptoms and conduct problems, which have been reported noted during a one-year follow-up study. Programs aimed at improving parenting skills and coping with divorce-related emotional reactions in parents improve the quality of the mother-child relationship and mitigate internalizing and externalizing 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 greater rates of anxiety and depressive symptoms, including clinical depression, behavioral problems, and lower academic performance. 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 surviving caregivers that promoted positive parent–child relationships, effective coping, good mental health among caregivers, improved discipline, and facilitated sharing of feelings and experiences. The effects were more pronounced in children who were at higher risk, meaning those who were already symptomatic at the start of the program.

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

To reduce work stress, interventions should be aimed at either increasing workers' ability to cope with stressors or eliminating them in the work environment. Three types of strategies can be used to organize work environments: business and technical interventions (eg, increasing job variety, improving work processes and working conditions, reducing noise, reducing workload), clearly defining job responsibilities, and improving social relationships (eg, communication , conflict resolution), as well as interventions aimed at multiple changes aimed at both work and employees. Although there is national and international legislation regarding the psychosocial work environment that emphasizes risk assessment and risk management, most programs focus on reducing the cognitive appraisal of stressors and their subsequent effects, rather than reducing or eliminating the stressors themselves.

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

A number of programs support the unemployed by helping them return to paid work, such as the Workers' Club and the Jobs Scheme. These simple, low-cost programs combine basic job search skills with increased motivation, social support, and coping skills. In the United States and Finland, the workplace program was tested and replicated in large randomized trials. They demonstrated increased rates of reemployment, better quality and higher pay for jobs obtained, increased self-efficacy in job search and skill, and reduced symptoms of depression and distress.

Caregivers of the chronically ill and older adults are at increased risk of experiencing excessive stress and an increased incidence of new cases of depression. Many controlled studies examining the effectiveness of psychoeducational programs for family caregivers of older relatives indicate a reduction in burden, depressive symptoms, subjective well-being, and perceived caregiver satisfaction. Psychoeducational programs provide information about the person's illness and available resources and services, as well as training in how to effectively respond to problems that arise with the relative's specific illness. Such programs include lectures, group classes and the use of printed materials.

Different types of interventions, including exercise, improved social support through companionship, and education for older people with chronic illness and caregivers, have been shown to improve mental health in older adults with varying degrees of effectiveness.
their people, early screening, treatment by primary care providers, and programs that use techniques to discuss life events. Prevention of traumatic brain injury, normalization of high systolic blood pressure and high serum cholesterol also appear to be effective in reducing the risk of dementia.

For example, exercise such as aerobics and tai chi provide both physical and psychological benefits to older adults, including greater life satisfaction, good mood and mental well-being, reduced psychological distress and symptoms of depression, lower blood pressure, and lower incidence of depression. falls. Other programs, although showing promising effects, require replication studies, such as studies of the effectiveness of early mass screening of older people and case management, including various types of social assistance, as a means of reducing depression and increasing life satisfaction.

Although depression is quite common among older people, there have been few controlled studies examining the effectiveness of prevention of this disease and suicide in this population group. There is some evidence of improved social relationships and decreased depressive symptoms among participants in a widows' peer support program. Preliminary evidence also suggests that life-debriefing sessions and reminiscence therapy may reduce the risk of depression in older adults, particularly nursing home residents, although the beneficial effects appear to fade over time, suggesting 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 prognosis and coping skills for chronic conditions have produced short-term beneficial effects, such as reducing symptoms of depression. Providing hearing aids to older adults with hearing loss may also promote better social, emotional, and cognitive functioning and reduce symptoms of depression.

Evidence collected over the past few decades and summarized above clearly demonstrates that it is possible to reduce the risk of poor mental health and prevent the development of mental disorders. Next, an important task is to facilitate the use of the obtained data for developing strategy and for practical work. This section summarizes 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 of and confidence in mental health care about prevention work. The findings need to be widely disseminated among policymakers and the general population. Current knowledge and resources to prevent mental disorders and promote mental health are unevenly distributed around the world. International programs are needed to support countries that do not yet have the capabilities 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 expertise to do so.

To strengthen the knowledge base, research evaluating the effectiveness of prevention should be expanded, especially through international collaboration. To achieve this, a network of collaborating research centers should be formed that respond to the needs of low-, middle- and high-income countries. Researchers should pay particular attention to multisite and replication studies examining the ability of program and policy designers to respond responsively to the cultural background of subjects. In addition, longitudinal studies should be conducted to examine the long-term effects of preventive interventions; research into 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 services 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 must involve action horizontally across different government sectors, such as the environment, housing, social welfare, labor and employment, education, criminal justice and human rights. National governments and health insurers should allocate appropriate resources to implement evidence-based activities, including supporting the development of capabilities across multiple sectors with established responsibilities; funding training, education, implementation and evaluation research; promoting coordination between different sectors that are related to mental health.

Government services must develop national and local infrastructure to prevent mental disorders and promote mental health, and work in collaboration with other public health and public policy agencies. Government agencies and health insurance companies should allocate appropriate resources to implement evidence-based activities, including supporting the development of human resources across multiple sectors with established functional responsibilities; funding internships, education, program implementation, and evaluation research; promoting coordination between different sectors that are relevant to mental health.

Given the high comorbidity rates of mental disorders and poor physical health, comprehensive prevention strategies in primary care and skilled nursing are essential. Supportive prevention methods are needed along with increased resources and training for primary care and skilled nursing professionals.

To sustain beneficial public health outcomes over time, it is critical to build community accountability to support strategies to maintain stability within health authorities. Government authorities and implementers must choose programs and strategies that make use of existing infrastructures and resources. Mental health promotion and prevention components must be structurally integrated with existing effective health promotion programs and social policies in schools, workplaces and communities.

Preventive strategies should be based on systematic assessments of the needs of the public mental health system. To extend the impact of preventive interventions to the mental health of all populations, programs should be developed that are widely accessible to these groups. Program designers and implementers should consider evidence-based principles and conditions that can improve effectiveness and cost-effectiveness while improving mental and physical health, as well as social and economic benefits.

Providers have a responsibility to ensure that programs are culturally appropriate and appropriate, especially when they are evidence-based from other countries or cultures, or when they are used in communities and target populations that differ from those for whom they were originally developed. and tested. Adaptation of programs, even taking into account the cultural characteristics of its participants, must be subject to the principles of effective intervention and successful implementation. There is a need for greater understanding of the transferability of evidence-based programs and strategies, and the potential for adaptation and adaptation across different countries and cultures.

Practitioners and program implementers must ensure high quality implementation and the use of tools that improve quality and ensure accurate implementation of programs, such as software manuals, guidelines for effective implementation, training and expert advice.

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

Mental health professionals are committed to raising awareness and communication about prevention among policymakers, other professionals, and the general public, creating an environment conducive to prevention efforts. Currently, it is generally believed that mental disorders arise from an unknown cause and are almost impossible to prevent. To address these myths, correct information about the identified causes and possible methods to reduce the incidence and improve the course of mental disorders must be widely available.

With their knowledge base in place, mental health professionals should advise public health planners and program developers on opportunities to initiate preventive interventions or integrate mental health interventions with existing programs. The opportunity to fulfill this role is enormous, as most countries and communities have public health and social programs that can serve to prevent mental disorders. Even if no changes are required, the perception that the program is helping to prevent the development of mental disorders helps reinforce the need for continuation or expansion of the program.

In many cases, mental health professionals must play an active role in initiating prevention programs. This may be a leadership or active collaborator role, especially in an interdepartmental 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 preventing mental disorders. It is known that there is far less research on mental health as part of all health research than the proportional burden of mental disorders, and even less research in low- and middle-income countries. Even among the available mental health studies, the effectiveness of preventative measures has not been sufficiently studied. Mental health professionals and researchers must correct this imbalance and build a better evidence base, especially in low- and middle-income countries. The evidence base for real-life implementation of prevention programs is particularly compromised: this gap is being addressed by systematic evaluation within existing prevention programs. Innovative proposals, especially those that are interdepartmental in nature and target multiple outcomes, are likely to help overcome funding gaps, increasing interest from potential funding agencies.

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

Another way that mental health professionals can promote prevention efforts is by initiating preventive interventions with family members of individuals receiving mental health care. Preventive methods for children whose parents suffer from a mental disorder, who are at particular risk, can be highly effective, but, unfortunately, are rarely used. Mental health professionals must balance providing adequate care to patients receiving treatment with preventing future health care needs among their families.

Preventing mental disorders is a public health priority. Given the gradually increasing burden of mental and behavioral disorders and the known limitations in their treatment, the only feasible method of reducing 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 amenable to intervention and are potential targets for preventive and other appropriate measures. A wide range of evidence-based principles and strategies (in addition to those specific to specific mental disorders) are available for implementation to help prevent the development of mental and behavioral disorders. It has been established that preventive strategies mitigate risk factors, enhance 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.

Although sufficient evidence supports implementation of programs, additional efforts are needed to further expand the range of effective preventive interventions, improve their effectiveness and cost-effectiveness in changing environments, and enrich the evidence base. This requires regular evaluation of the effectiveness of programs and policies and their implementation, and a sufficient number of controlled scientific studies.

Mental health professionals must serve several important roles in the field of prevention, namely: prevention advocates, technical consultants, program managers, researchers, and prevention implementers. These roles are challenging but appear to be very rewarding responsibilities. However, the results of population-level prevention programs can only be expected after investing sufficient human and financial resources. Financial support should be directed toward the implementation of evidence-based prevention programs and strategies and the development of necessary infrastructure. In addition, investment in capacity building at the country level should be promoted through internships and an informed workforce. Much of the investment should come from the government, as it is ultimately responsible for the health of the population. Current resources for preventing mental disorders and promoting mental health are unevenly distributed around the world. International programs should aim to reduce this gap and support low-income countries to develop knowledge and experience in prevention, as well as strategies and interventions that take into account 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. Interventions to prevent mental disorders and promote mental health should be integrated into public policies that include different activities across different government sectors, such as the environment, housing, social welfare, labor and employment, education, criminal justice and defense human rights. This will create win-win situations across sectors, including a wide range of health, social and economic benefits.