This document outlines models of preventive psychiatry, including Caplan's model of primary, secondary, and tertiary prevention. Primary prevention aims to reduce incidence of mental illness through programs targeting at-risk groups. Secondary prevention focuses on early identification and treatment of symptoms to reduce duration and prevalence of illness. Tertiary prevention aims to reduce impairments through rehabilitation services and promotion of maximum functioning. The levels of prevention target individuals and environments to promote mental health.

1. MODELS OF PREVENTIVE
PSYCHIATRY
R. Ruppamercy
M.Sc. Nursing II year

2. INTRODUCTION
Preventive psychiatry is a branch of psychiatry that aims at health promotion,
protection from specific mental illnesses, early diagnosis, effective treatment,
disability limitation and rehabilitation. Mental disorder prevention aims at
“reducing incidence, prevalence, reoccurrence of mental disorders, the time
spent with symptoms, or the risk condition for a mental illness, preventing or
delaying recurrences and also decreasing the impact of illness in the affected
person, their families and the society”

3. REASONS FOR ILLNESS

4. DEFINITION
Preventive psychiatry is the application of knowledge of
psychiatric nursing in preventing, promoting and maintaining
health of the people, to help in early diagnosis and care to
rehabilitate the client after mental illness.

5. PREVENTION
• The main aim of prevention is to keep people healthy or become even
healthier and enhancing individual's ability to achieve psychosocial well –
being.
• Prevention focuses on cause or etiology of psychiatric illness to avoid
illness.
• Promotion and prevention are interrelated and overlapped.
• Eg. Psychological support
• Parenting skills training
• Clinical mental health counselors support
• Health education

6. CAPLAN’S MODEL
In the 1960s, Psychiatrist Gerald Caplan described levels of prevention specific to
psychiatry. He described Primary prevention as an effort directed towards
reducing the incidence of mental l disorders in a community. Secondary
prevention refers to decreasing the duration of disorder while tertiary prevention
refers to reducing the level of impairments. It was termed as Caplan’s Model

7. LEVELS OF PREVENTION

8. SPECTRUM

9. PRIMARY PREVENTION
Primary Prevention Services aimed at reducing the incidence of mental
disorders within the population.
Primary prevention targets both individuals and the environment.
Emphasis is twofold:
1. Assisting individuals to increase their ability to cope effectively with stress.
2. Targeting and diminishing harmful forces (stressors) within the
environment.

10. Nursing in primary prevention
focused on the targeting of groups at risk and the provision of educational programs.
Examples include:
• Teaching parenting skills and child development to prospective new parents.
• Teaching physical and psychosocial effects of alcohol/drugs to elementary school
students.
• Teaching techniques of stress management to virtually anyone who desires to
learn.
• Teaching groups of individuals ways to cope with the changes associated with
various maturational stages.
• Teaching concepts of mental health to various groups within the community
• Providing education and support to unemployed or homeless individuals.
• Providing education and support to other individuals in various transitional periods
(e.g., widows and widowers, new retirees, and women entering the work force in
middle life).

11. SECONDARY
• Secondary Prevention Interventions aimed at minimizing early symptoms
of psychiatric illness and directed toward reducing the prevalence and
duration of the illness.
• Secondary prevention is accomplished through
• early identification of problems and prompt initiation of effective
treatment.
• focuses on recognition of symptoms and provision of, or referral for,
treatment.

12. Nursing in secondary prevention
• Ongoing assessment of individuals at high risk for illness exacerbation (e.g.,
during home visits, at day care, in community health centers, or in any setting
where screening of high-risk individuals might occur).
• Provision of care for individuals in whom illness symptoms have been assessed
(e.g., individual or group counseling, medication administration, education and
support during period of increased stress [crisis intervention], staffing rape crisis
centers, suicide hotlines, homeless shelters, shelters for abused women, or
mobile mental health units).
• Referral for treatment of individuals in whom illness symptoms have been
assessed. Referrals may come from support groups, community mental health
centers, emergency services, psychiatrists or psychologists, and day or partial
hospitalization. Inpatient therapy on a psychiatric unit of a general hospital or in
a private psychiatric hospital may be necessary. Chemotherapy and various
adjunct therapies may be initiated as part of the treatment.

13. TERTIARY PREVENTION
• Tertiary Prevention Services aimed at reducing the residual defects that are
associated with severe and persistent mental illness.
• Tertiary prevention is accomplished in two ways:
1. Preventing complications of the illness.
2. Promoting rehabilitation that is directed toward achievement of each
individual’s maximum level of functioning

14. Nursing in tertiary prevention
• Consideration of the rehabilitation process at the time of initial diagnosis
and treatment planning.
• Teaching the client daily living skills and encouraging independence to
his or her maximum ability.
• Referring clients for various aftercare services (e.g., support groups, day
treatment programs, partial hospitalization programs, psychosocial
rehabilitation programs, group home or other transitional housing).
• Monitoring effectiveness of aftercare services (e.g., through home health
visits or follow-up appointments in community mental health centers).
• Making referrals for support services when required

15. PSYCHIATRIC
REHABILITATION
• Rehabilitation is the process of enabling the individual to
return to his highest possible level of functioning.
• Rehabilitation is “an attempt to provide the best possible
community role which will enable the patient to achieve the
maximum range of activity, interest and of which he is capable
Maxwell jones

16. TEAM
• Psychiatrist
• Clinical psychologist
• Mental health nurse
• Occupational therapist
• Recreational therapist counselor
• Other supportive staff

17. DOMAINS OF PSYCHIATRIC
REHABILITATION SERVICES
• Skill training
• Peer support
• Vocational training
• Consumer – community resource development

18. REHABILITATIVE FACILITIES
• Hospital services
• Partial hospitals
• Quarter way homes
• Half way homes
• Self help groups
• Suicide prevention centres

19. HOSPITAL
• The psychiatric hospitals provides a part of continuum of
mental health services.
• They offer variety of treatment facilities.

20. PARTIAL HOSPITALS
An approach which helps in rehabilitating mentally ill patients
through several activities which tries to fix the shortcomings of
social withdrawals, cognition and physical impairments. Eg.
Neurotic conditions, MR and alcohol dependence
The partial hospitals are more suitable for chronic psychiatric
syndrome patients.
They include day care centres, day hospitals and Day treatment
programs

21. QUARTER WAY HOMES
Usually Located within the hospital campus, but not having the
regular services of a hospital. There may not be routine nursing
staff or routine rounds, most of the activities are taken care by the
patient themselves.

22. HALF WAY HOMES
• It is a transitory residential center for mentally ill patients who
no longer need the full services of hospital, but are not yet
ready for a completely independent living
• It helps to develop and strengthen individual capacities.
• A halfway home is a place that allows people with physical,
mental and emotional disabilities to learn the social and other
skills necessary to integrate or re – integrate into society.
• Aids to develop individual capacities

23. Contd..
• OBJECTIVES
• To ensure smooth transition from the hospital to the family.
• To integrate the individual into the mainstream of life
• ACTIVITIES
• Clinical assessment
• Social assessment
• Psychological assessment
• Vocational assessment
• Supportive interventions

24. SELF HELP GROUPS
• These are composed of people who are trying to cope with a
specific problem or life crisis and have improved the emotional
health and well being of many people
• Members have homogeneity and they work together using their
strengths to gain control over their lives
• They educate and support each other in solving the problems.
• They make others feel that they are not alone in having a
particular problems
• They emphasize cohesion, as they have similar problmes and
symptoms, they have a strong emotional bond
• Concepts used are psycho education, self disclosure and mutual
support.

26. CONCLUSION
To implement effective preventive mental health interventions, it
is imperative to develop adequate resources and infrastructures at
the local, national and international level that make efficient use
of existing opportunities. There is a need to devise and implement
ways to circumvent existing shortcomings and thus effective care
is provided.