- Summary of the book literature for Prevention in Mental Health at Radboud University
- Author of the book: Prof. Dr. Hosman
- Composed by the questions at the end of each chapter
Arguments for investing in prevention and mental health promotion stem from both ethical
and economic perspectives. Mental health care can be improved while costs can be reduced
when investing in prevention and mental health promotion. Following are the most important
arguments for investing in prevention and mental health promotion. Humans are by nature
preventive being, but the efficacy of their ‘naive prevention’ has its limits and regularly fails.
Professional prevention aims to restore and strengthen the preventive capacities of citizens,
families, organisations and communities. Serious psychiatric problems are prevalent in
society and have reached epidemic proportions. This number is expected to further increase
as well as the demand for treatment, unless the society invests more in mental health
promotion and prevention. An important number of people with serious psychiatric problems
is without help (untreated morbidity) notwithstanding expanding services (the treatment gap).
In the end, therapeutic help resembles at ‘’mopping up the floor while the water tap keeps
running’’ (Dutch expression). ‘’Therapy has never eliminated a disease from society’’. The
costs of curative mental health care and many other social and economic costs of mental
disorders are high and expected to increase significantly. Investments in prevention can
reduce these costs. Psychiatric disorders are a significant risk factor for chronic physical
disorders and preterm mortality. Preventing mental disorders is expected to contribute to
less physical illnesses and mortality. Mental health care often means individualising
problems of people, while many problems are the outcome of social factors (e.g. poverty,
domestic violence, discrimination). Therapy is not addressing such causes and does not
have the potential to change them; prevention and health promotion may also include efforts
to influence social risk factors. Historically, the focus of health care systems has evolved
from caring to curative and, during the last century, more and more to prevention. Society as
a whole develops steadily towards a more preventative orientated society, across multiple
social sectors investments in prevention are increasing. Preventive interventions are found
to be effective in controlled studies and show a wide range of health-, social-, and economic
effects. A mere treatment-focused health care system should be considered as unethical
when possibilities for effective prevention exist.
Chapter 1:
Humans show preventive behavior in nature. Preventive behavior can consist of habits.
Preventive behavior helps to prevent a certain (future) damage or negative outcome from
occurring. Preventive behaviors can have short term and/or long term preventive goals and
outcomes. Examples of preventive (habitual) behavior are brushing your teeth, stopping for
red traffic lights, eating healthy food and cleaning your home. Also traffic signs, warning
signs on products and rituals are preventive for human health. Even social laws like
anti-discrimination policies, labour policies and security acts are forms of social conflict
prevention.
Naive prevention means preventive functions and behaviours that show itself in nature and
culture, without being elicited by professional interventions. Scientific prevention without the
,drawbacks of professionalisation is only possible when it chooses this ‘natural prevention’ or
‘naive prevention’ as a starting point and understands its role. Knowledge on naive
prevention enables professional preventionists and health promoters to better attune to the
needs and strengths of the people they serve. This can avoid that professional prevention
has an alienating or even iatrogenic effect. More attention to naive prevention makes it
easier for prevention experts to adopt a respectful and democratic attitude towards their
target groups.
Preventive behavior is closely related to our daily battle for existence and survival, the
evolution of the species and adaptation to the constant changes around us. A distinction is
made between functional preventive behaviors (inborn behaviors with a preventive effect)
and intentional preventive behaviors in which people purposefully want to achieve a
preventive effect. Many preventive behavior features are innate and result from processes of
natural selection. Others are acquired and the result of learning processes, reflection,
parenting and education, sometimes concerning learning processes across multiple
generations. These ‘explicitly learned’ preventive behaviors are seen as characteristic
preventive behaviors of humans. Preventive behaviors derived from natural selection are
seen as characteristic for both animals and humans.
Proto-professionalisation is the dependency of people on professional care. Structural
iatrogenesis or clinical iatrogenesis means medicalisation. This refers to the detrimental
consequences of medical interventions such as drug reaction and hospital acquired
infections. Prevention experts and scientists need to be constantly aware of the danger of
proto-professionalisation and structural iatrogenesis and the need to respect, use and
reinforce the capacities already present in people and communities to prevent physical and
mental diseases. Proto-professionalisation and structural iatrogenesis lead to a lack of
self-preservation, self-defence, avoiding of danger and/or adaptation and this can be
dangerous for the continuation of health of human beings.
Reactive prevention is preventive behavior when a threatening situation is already present.
An example is self-defending behavior in a direct violent confrontation. Proactive prevention
is preventive behavior when a threatening situation is to be expected in the near future.
Examples are brushing your teeth, taking driving lessons and informing children about sex.
So, preventive capacities can be inborn or learned. Sources for the development of
preventive capacities are: biological influences and natural selection (heredity), socialisation
(e.g. parenting, model behavior, education, myths and legends), personal learning
experiences and self-reflection. Preventive reactions can be reflexes, intuitive or rational in
nature, more internal or external (behavioral). The perception and evaluation of impending
danger, understanding its causes and the execution of preventive behaviours are all basic
adaptive capacities of humans, which can be biological, psychological or social in nature. To
protect health and to prevent disease many types of preventive behaviors and mechanisms
can be used. They can refer to behavior or processes of individuals, organisations
neighbourhoods or societies. In response to danger or threats humans and animals make
use of signals to enable the perception of danger and to enhance timely preventive
behaviors. The time period between signal, preventive behavior and the moment that the
,preventive effect becomes visible can vary significantly. Preventive behaviors can focus
reactively on preventing damage in the present (e.g. pain), but also proactively on achieving
long term benefits (e.g. strengthening capacities for adulthood, preservation of health,
preventing future disease). The social environment can have different preventive roles: direct
protection against danger by influencing the danger source or prevent exposure to it,
sending signals, social support, implementing taboos or rituals, sitting behavioral norms, and
creating legal barriers to expose people to high risks and obligations to prevent danger. The
prevention of serious mental and physical problems can be studied as an individual
phenomenon (e.g. instinctive reactions, attitudes, individual preventive behavior), but also as
a behavior that is contingent on our social environment and culture (e.g. taboos, norms,
customs, parenting, education, legislation).
Reflexes are preventive capabilities that humans have acquired through biological selection
processes during their evolution. Furthermore, people learn signals (‘cues’) of potential
dangers through classical and instrumental conditioning and through tradition and education.
Examples are beginning toothache, ‘something sharp’, and a thermometer with a value
below zero, a red light signal, a siren, a label with a skull, and the smell of smoke.
Knowledge of the meaning of these signals helps us to prepare for risks and future damages
and to avoid or reduce them.
Rituals have preventive functions as well. These are both psychological and social. First,
they serve an adaptive and economical function. This refers to adaptation to internal and
environmental changes. The economic function of rituals refers to rituals as ready solutions
for problems that save us a lot of thinking, risky try-outs and disappointments and needless
loss of energy in difficult periods of our life. Another function is the perceptual function.
Rituals may structure perception, offering an interpretational framework that helps people
understand and calculate their situation. Rituals indicate what is important and what is not in
a situation. Besides, rituals offer an emotional function. They can play an important role in
emotional dealing with problems or transitional situations. Next, they have a behavioral
function. Rituals offer behavioral reactions in times of stress in situations where people feel
the need to act but don’t know how. Lastly, rituals have a religious or magical function which
means that persons who use such rituals think they can evoke supernatural forces to
support and protect them. Irrespective of the question whether supernatural forces actually
exist, the mere belief in the existence of such forces can already make a huge difference in
dealing with highly stressful situations. Besides above described functions, rituals may have
other functions such as sense making, contacting the past, strengthening identities of
persons and groups, reinforcing group cohesion and social control. Examples of rituals are
transition rituals (from one stage of life to another), mourning rituals, healing rituals, birth
rituals, initiation rites, marriage rituals, family rituals, meeting rituals, religious rituals,
conflict-related rituals and reconciliation rituals. Studies show that the disappearance of
traditional rituals and the lack of renewing rituals can have a strong impact on the mental
health of people.
Causes of prevention failure are: 1. Overdose of threat or damage: The danger is too grave
compared to the natural preventive capacities available to a person and his direct
environment, for instance in extreme circumstances as natural disaster, child abuse,
, hostage, war violence or combinations of threatening circumstances. 2. Unforeseen danger
or consequences: A danger was not perceived or too late because (a) there were no
alarming signals or they were not recognised as such and (b) lack of knowledge of the
dangers and the harmful consequences of certain circumstances. 3. Only short term
anticipation: A selective focus on the ‘here and now’ and the inability to anticipate long term
dangers and benefits. It is more difficult to recognise long term dangers and benefits than
those that we face directly. Eating unhealthy food and harsh parenting are good examples.
4. Insufficient knowledge of the causes: People might not be familiar with the causes of a
certain danger, or might have incorrect beliefs about the causes. For instance, parents might
not understand what causes aggressive behavior in their children, or might have wrong
ideas about what causes such behavior. As a consequence, they are poorly equipped to
prevent such behavior in their children. 5. Lack of preventive capacities: This lack can be, for
example, insufficient knowledge or skills to deal with a problem, or inability for long term
investment. This can be caused for example by a lack of coping skills or by exposure to
inadequate role models. 6. Lack of support and protection from the social environment: This
could be caused by a loss of rituals or by rituals being outdated, growing individualisation in
society, decline of traditional family ties and neighbourhood networks, more single parent
families and the increase of single elderly, designs of new neighbourhoods not attuned to
current needs for communication and support.
Prevention of health problems can follow different types of strategies: 1. Making people
aware of our preventive nature and advocating the importance of investing in prevention and
health promotion. 2. Stimulate awareness and reflection on the impact of one’s own behavior
and social risk factors. 3. Improve preventive capacities and health promotion competence
through education. 4. Health protection; prevent an overdose of threat of important stressors
by implementing social and environmental interventions. 5. Strengthen social support;
promote the possibilities of people to support each other in solving problems and protecting
each other’s health. Examples are parenting education, strengthening social networks and
supportive peer contact, and the creation of self-help organisations or supportive internet
communities.
Chapter 2: not needed for the exam
Chapter 3:
Mental health has a lot of different definitions. The functional model of mental health is
considered a cluster of psychological resources and abilities that people need for well-being,
to develop themselves mentally and physically across the life span, to have a satisfying and
productive life in domains as health, relationships, love, school, parenting and work, to be
able to cope with life stressors and challenges and to reduce the risk of negative life
outcomes such as mental disorders, physical diseases and serious social problems. This
functional model is in agreement with current definitions of mental health that differentiate
between an internal dimension of mental health (subjective well-being) and an external one
(capacity to relate positively and productively with one’s environment). It conceives mental
health as cluster of adaptive features. The functional model considers mental health and
mental disorders as different concepts but assumes a functional relationship between the
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