Clinical Manual of Prevention in Mental Health

So goes a Chinese proverb: "The inferior doctor treats actual sickness. The mediocre doctor attends to impending sickness. The superior doctor prevents sickness." Although clinicians have the responsibility and mission to serve persons with "actual" mental illness, we also maintain the worthy vision of recovery and prevention. The Clinical Manual of Prevention in Mental Health provides the reader with a pragmatic, evidence-based resource for prevention in psychiatric settings. The seed for this work was planted in 2007, during discussions within the Prevention Committee of the Group for the Advancement of Psychiatry (GAP). Michael Compton of Emory University edited the manual, working with chapter authors, several of whom are from the GAP Prevention Committee.

The first two chapters introduce the reader to the various prevention classifications, present the GAP Prevention Committee's eight guiding principles in considering prevention in mental health, and provide an overview of risk and protective factors. The next several chapters focus on mood and anxiety disorders, which are followed by specific attention to schizophrenia, alcohol and substance abuse, cigarette smoking, suicide, family violence, and somatic illness. Also covered are health promotion and use of complementary and alternative medicine. Sensitivity to developmental perspectives is apparent throughout, with entire chapters devoted to prevention principles for adolescents and older adults. Each of the central chapters is uniformly organized into overviews, epidemiology, diagnostic criteria, and risk factors and protective factors, ending with advice for clinicians and key points.

The core prevention sections are often presented in the format of universal, selective, and indicated preventive interventions. Primary, secondary, and tertiary prevention strategies are also addressed. Universal interventions focus on the general population, selective prevention targets specific groups at elevated risk associated with certain risk factors, and indicated interventions focus on individuals with a high likelihood of developing the disorder.

Some authors provide in-depth reviews of the specific prevention studies, which help the reader make an informed decision as to the weight and quality of the literature. Issues not addressed by the authors, and which I would have read with interest, include the challenges and solutions associated with operationalizing prevention into mental health system settings in terms of resource allocation, politics, education, financing of prevention services, system structure support, and integration.

Dr. Compton and colleagues more than fulfilled their ambition to provide a manual "to encourage mental health professionals to adopt prevention-mindedness into their everyday practice with patients and in their collaborations with community organizations and agencies that may have a role to play in prevention efforts." They have created a valuable resource that would also be beneficial for mental health system architects and funders, including the Substance Abuse and Mental Health Services Administration, Centers for Medicare and Medicaid Services, National Institute of Mental Health, National Association of State Mental Health Program Directors, and state and regional mental health system leaders. The manual also serves advocates and consumers. For example, the National Alliance on Mental Illness assessment Grading the States ( 1 ) could incorporate the evidence-based prevention elements, which are summarized well in these chapters, into its analytic review of the states' investment in evidence-based prevention, a component of recovery. Dr. Compton and his colleagues have succeeded in providing a manual to help us realize the 13th century English jurist Henry de Bracton's adage: "An ounce of prevention is worth a pound of cure."

The reviewer reports no competing interests.