PREVENTION Over the years, most mental health efforts have been largely restorative, geared towardhelping people only after they have already developed serious problems. Unfortunately, thecauses of many mental disorders are either not sufficiently understood or specific enough toenable practitioners to initiate targeted preventive programs. As a result, prevention in the mentalhealth field is still based largely on hypotheses about what works rather than on substantialempirical research. Nonetheless, many professionals believe that preventive mental health effortsare worthwhile. In the past the concepts of primary, secondary, and tertiary prevention were widely usedin public health efforts to describe general strategies of disease prevention. These terms werederived from public health strategies employed for understanding and controlling infectiousphysical diseases, and were thought to provide a useful perspective in the mental health field aswell.Primary prevention Primary prevention is directed at reducing the incidence (rate of occurrence of new cases)in the community. Primary prevention efforts are directed at people who are essentially normal,but believed to be at risk from the development of a particular disorder. In primary preventionwe are concerned with two key tasks: seeking out and eradicating conditions that can cause orcontribute to mental disorders, and establishing conditions that foster positive mental health.Thus it includes biological, psychosocial, and sociocultural measures. As Kessler and Albee(1975) have noted, “everything aimed at improving the human condition, at making life morefulfilling and meaningful, may be considered to be part of primary prevention of mental oremotional disturbance” (p. 557). Primary prevention may be subdivided into universal, selective and indicated prevention(Gordon, 1983). Universal prevention measures are those regarded as desirable for everyone, and thedecision to implement them is taken if their benefits clearly outweigh the costs and risks ofimplementing them (e.g. seatbelts, encouragement of safe drinking, reduction of cigarettesmoking, healthy eating and exercise). Selective prevention measures are agreed to be appropriate when an individual is amember of a subgroup of the population (e.g. age, gender or occupation) whose risk of becomingill is above average. Examples are good antenatal and perinatal care in pregnant women; healthinterventions in young unsupported teenage mothers; and social support for socially-isolatedelderly people.
Indicated prevention measures are undertaken for groups at high risk, such as forschizophrenia when a genetic susceptibility is strongly suspected, or for groups that haveexperienced severe, clearly defined, emotional stress, such as children exposed to disasters orviolence. Physical measures. Here primary prevention begins with help in family planning andincludes both prenatal and postnatal care. A good deal of current emphasis is being placed onguidance in family planning-how many children to have, when to have them in relation to maritaland other family conditions, and even whether to have children at all. Psychosocial measures. In regarding normality as “optimal development andfunctioning” rather than as mere absence of pathology, we imply that the individual will requireopportunities for learning needed competencies - physical, intellectual, emotional and social. Asecond crucial requirement for psychosocial health is that the individual acquire an accurateframe of reference-in terms of reality, possibility, and value assumptions. We have seenrepeatedly that when people’s assumptions about themselves or their world are inaccurate, theirbehaviour is likely to be maladaptive. General sociocultural measures. The relationship between the individual and thecommunity is a reciprocal one, a fact we sometimes forget in our prizing of individualism. Weneed autonomy and “space of free movement” to be ourselves, but we also need to belong andcontribute to a community. Without a nourishing community, the development of individuals isblighted.Secondary prevention Secondary prevention involves efforts to reduce the prevalence of a disorder by reducingits severity and duration. Thus, secondary prevention programmes are directed at people whoshow early signs of disorder, and the goal is to shorten the duration of the disorder by early andprompt treatment. It emphasizes the early detection of maladaptive behaviour in the individual’sfamily and community setting. Thus it requires knowledge of the incidence and scope ofmaladaptive behaviour in specific populations, facilities for the early detection of suchbehaviour, and available treatment facilities in the community. Epidemiological studies. Science has found that most contagious physical diseases canbe brought under control once their distribution and modes of communication are discovered byway of epidemiological studies. Epidemiological studies are also helping investigators obtaininformation concerning the incidence and distribution of various maladaptive behaviours in oursociety. Comprehensive community mental health centers. These are of particular significancebecause they mark a distinct trend away from the traditional state mental hospital approach.These centres offer at least five types of services: (a) inpatient care for persons requiring short-term hospitalization; (b) partial hospitalization, with day hospitalization for patients able to
return home evenings, or night hospitalization for patients able to work but in need of furthercare; (c) outpatient therapy permitting patients to live at home and go about their daily activities;(d) emergency care, with psychiatric services around the clock; and (e) consultation andeducation for professionals who have contact with members of the community. Crisis intervention. Crisis intervention emerged as a response to a widespread need forimmediate help for individuals and families confronted with especially stressful situations(Golan, 1978; Rosenbaum & Beebe, 1975). Often such people are in a state of acute turmoil andfeel overwhelmed and incapable of dealing with the stress by themselves. They do not have timeto wait for the customary initial therapy appointment, nor are they usually in a position tocontinue therapy over a sustained period. They need immediate assistance. To meet this need,two modes of therapeutic intervention have been developed: (a) short-term crisis therapyinvolving face-to-face discussion, and (b) the telephone “hot line.” Consultation and education of intermediaries. Community mental healthprofessionals, such as psychologists and psychiatrists, are able to reach a larger group ofindividuals in need of psychological attention by working through primary care professionals,such as teachers, social workers, and police personnel. Here the mental health professionalsidentify a population at risk for the development of psychological disorder and then work withpersonnel in community institutions who have frequent contact with the members of thispopulation.Tertiary prevention Tertiary prevention is designed to reduce the disability and handicap associated with aparticular disorder. It is preventive in that by reducing disability and handicap, it prevents manyof the associated squeal of chronic illness. Tertiary prevention involves prompt and intensiveinpatient treatment for patients whose disorders require it. Its double aim is to prevent thedisorder from becoming chronic and to enable the individual to return home as soon as possible.It includes assessment, therapy, and provisions for aftercare following release. CHARACTERISTICS OF COUNSELLING Counselling denotes a professional relationship between a trained counsellor and a client.This relationship is usually person-to-person, although it may sometimes involve more than twopeople. It is designed to help clients to understand and clarify their views of their lifespace, andto learn to reach their self-determined goals through meaningful, well-informed choices andthrough resolution of problems of an emotional or interpersonal nature. (Burks and Stefflre 1979: 14)
Counselling as a professional occupation, therefore, derives not from the clinic but frommore social settings. It focuses on helping persons resolve problems or role issues related towork or school or family matters. In this setting, the counsellor is a “problem solver” whothrough direct advice or non-directive guidance helps the client make rational decisions. The following can be said as the characteristics of counselling:1. Counselling as a Relationship Counselling is sufficient for constructive changes to occur in clients (Rogers, 1957). Thecounselling relationship is characterized by core conditions namely empathy, unconditionedpositive regard, and genuineness.2. Counselling as a Repertoire of Interventions In counselling several questions (like which, when, and with what client) are answeredand while interventions are decided an attempt is made to have a match between the client andthe counsellor.3. Counselling as a Psychological Process i. Goals of counselling have a mind component. ii. Counselling Process is psychological. iii. Underlying theories are psychological: Some psychologists like Rogers, Albert Ellis and psychiatrists like Berne and Beck have contributed enormously to counselling theories. For example, information about human nature has been derived from psychological theories. iv. Some people argue that counselling is not a profession as it is used in so many disciplines in so many sphere of life, e.g., loan counsellors, business counsellor, etc., but the difference is that professional counsellors work according to some theoretical model. v. Psychological research contributes both to creating counselling theories and to evaluate counselling process.4. It is concerned with “normal” problems rather than mental health problems.5. It is concerned with role functioning, with choices to be made, and with actions to be taken.6. It is more concerned with present events than with past events.7. It is more concerned with conscious, rational thinking than with unconscious functioning.
References: James C. Coleman, James N. Butcher, Robert C. Carson (1980). Abnormal Psychologyand Modern Life, Sixth Edition. Illinois: Scott, Foresman and Company. Royal College of Psychiatrists (2002). Prevention in psychiatry. London. Richard Nelson-Jones (2005). Practical Counselling and Helping Skills, Fifth Edition.New Delhi: SAGE Publications India Pvt Ltd