Primary Psychiatric Prevention : Problems and Prosepects1

X he interest in preventive psychiatry was given a great fillip with the advent of the Community Psychiatry movement in the U.S.A. in the early sixties. Caplan (1964) saw primary prevention as an essentially public health concept. It aims at reducing the incidence (occurrence of fresh or new cases) of psychiatric disorders of all types in a community and at promoting mental health among its members. He admitted that few of the principles enunciated in the pages of his book on Prentive Psychiatry (Caplan, 1964) were based on solid research findings or even on consensus among experts. He conceded that no organised programme for prevention of specific mental disorders existed and the necessarry knowledge for that purpose was lacking. He did hope however, that epidemiological and other types of aetiological research as well as evaluative study of the effects of differing methods on a variety of disorders will one day make this posible. Today 37th year later, Caplan's hope still remains largely unrealised. In fact, for a long time after Caplan's formulation of the principLes and practice of Primary Prevention in Psychiatry, there was considerable lack of activity in the field till 1978. The president's Commission of Mental Health in U.S.A. (1978) stated in its report to the president: "At present our effort to prevent mental illness or to promote mental health are unstructured, unfocused and un-coordinated. They command few dollars, limited personnel, and little interest at levels, where resources are sufficient to achieve results....". Though considerable progress in activity was evidenced in subsequent years, in the preventive field in U.S.A., it was felt 8 years later that "prevention has a long way to go to be accorded an equitable share, when the various mental health budgets are apportioned, and the concept of prevention is neither fully understood nor heartily endorsed by all decision makers" (Goldstone, 1986).