Prevention 313condition requires expensive services. Thus, prevention of depression
would lead to greater reduction of suffering and cost savings than
the prevention of spider phobia. Worldwide, depression is reckoned
to be the most expensive of all adult mental disorders due to its high
prevalence and impact.
4 Prevention is especially indicated if there is no effective, available
and relatively inexpensive treatment for the full-blown condition. For
example, autism prevention might reasonably be prioritised over the
prevention of specific phobias since there are cheap, rapid and effective
treatments for the latter.
Targeting risk and protective factors
Much is known about what predisposes children and adolescents to
psychiatric disorders, as described in Chapter 34 and much of the rest of
this book. Some risk factors are relatively specific, such as having a strong
genetic loading for schizophrenia. Other risk factors are more non-specific,
predisposing individuals to a range of disorders, and usually to poorer psy-
chosocial functioning too. Examples of relatively non-specific risk factors
include low IQ and academic attainments, neurodevelopmental problems,
poor parenting, lack of at least one trusting relationship, disrupted care,
lack of a source of self-esteem, antisocial friends and a badly organised
school. Poverty is associated with a plethora of difficulties, although the
fact that it indexes them well (and so can be used as a marker for a
targeted intervention) does not necessarily mean it is causal. Therefore,
abolishing poverty may not reduce the prevalence of disorders to a great
extent (which is not to say that it is not desirable for other reasons). Since
the impact of risk factors is usually cumulative (see Chapter 34), the best
prevention strategy may be to target several risk factors simultaneously.
Many of the risk factors for child psychiatric disorders fall outside the
clinical remit of child mental health professionals. This, of course, does
not stop them from joining with other professionals and members of
the general public in promoting measures that reduce these risk factors.
For example, although there are many good reasons for promoting im-
provements in education, child mental health professionals can provide
evidence from their clinical work and research that one of the knock-on
benefits will be improvements in emotional and behavioural adjustment
during the school years, and later in life too. Similarly, there are many
good reasons for controlling traffic and reducing accidents, but child men-
tal health professionals can add their evidence that this will reduce chronic
and incapacitating psychological consequences, such as childhood PTSD or
the neuropsychiatric consequences of severe childhood head injuries.
Even where symptoms or a disorder cannot be directly prevented, psy-
chosocial functioning and quality of life may be improved by boosting pro-
tective factors. These are especially important where there are a number of
risk factors operating. Box 37.2 illustrates this point with data from a study