CHAPTER 37
Prevention
The adage ‘prevention is better than cure’ encapsulates an attractive
idea. The pain and suffering of established disorders will be avoided, as
will the considerable expense of treating them. Medicine provides some
excellent examples: stopping smoking prevents needless lung cancer and
heart attacks, as well as asthma in children exposed to the smoke; folic
acid in pregnancy prevents babies’ risk of being born with spina bifida;
immunisation with polio vaccine prevents paralysis from poliomyelitis.
Since in all countries in the world the majority of children and adolescents
with psychiatric disorders are not treated by specialists at all, and even
the best resourced countries have insufficient services to do so, prevention
may be especially relevant. But can prevention be applied in practice to
child and adolescent psychiatric disorders? And will it be cost effective?
There are downsides to over-enthusiastic implementation of prevention
programmes. Given finite resources to spend on mental health, there is
a risk that treatment services for established conditions will be cut back.
This will be unwise for two reasons. Firstly, even cheap and effective
prevention programmes are never going to eliminate the development
of substantial numbers of cases (and indeed may increase the demand
for the treatment of established conditions by detecting more of them).
Secondly, more expensive, less effective prevention programmes may
not be better than effective, curative treatment. This chapter aims to
explore the conditions that are necessary for prevention to be effective
in improving child mental health, and give some examples of where it has
been attempted in practice.
Types of prevention
Primary preventionstops the occurrence of the disorder in the first place;
secondary preventionstops the development of complications of the disorder.
In child and adolescent mental health, we may want to aim for more
Child and Adolescent Psychiatry, Third Edition. Robert Goodman and Stephen Scott.
©c2012 Robert Goodman and Stephen Scott. Published 2012 by John Wiley & Sons, Ltd.
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