history of mental health essay

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The Realization of an Idea

by Dr. Wallace Mandell

The term mental hygiene has a long history in the United States, having first been used by William Sweetzer in 1843. After the Civil War, which increased concern about the effects of unsanitary conditions, Dr. J. B. Gray, an eminent psychiatrist, envisioned a community-based mental hygiene that would operate through education, social culture, religion and involvement in national life. In 1893, Isaac Ray, a founder of the American Psychiatric Association, provided a definition of the term mental hygiene as "the art of preserving the mind against all incidents and influences calculated to deteriorate its qualities, impair its energies, or derange its movements. The management of the bodily powers in regard to exercise, rest, food, clothing and climate, the laws of breeding, the government of the passions, the sympathy with current emotions and opinions, the discipline of the intellect—all these come within the province of mental hygiene." (Rossi, A., Some Pre-World War II Antecedents of Community Mental Health Theory and Practice. Mental Hygiene, 1962, 46, 78-98).

At the turn of the nineteenth century, Darwinian thinking dominated the biological and social sciences. Within the scientific community, mental deviations, i.e., extreme variations, were conceived as having a biological basis, primarily genetic, representing mutations that were unsuccessful adaptations for survival in the environments in which they appeared. This view provided little hope for recovery of the mentally deviant. Around 1900, some physicians and psychologists became convinced that deviant behavior was an expression of illnesses that lay at the other end of a continuum from mental health. Among leading thinkers of this period, G. Stanley Hall was convinced that early treatment might reduce both the severity and reoccurrence of mental illness. Adolph Meyerwas probably the single greatest proponent of this view. In 1906 he wrote on "The Problem of Aftercare and the Organization of Societies for the Prophylaxis of Mental Disorders" (Winters, E.E., The Collected Papers of Adolph Meyer, Vol. IV, Mental Hygiene. Baltimore, The Johns Hopkins Press, 1952).

By the 1890s, Meyer had become convinced by his experience with mental hospital patients that industrialization and urbanization were undermining human potential for continuous adaptability and constructive activity (Meyer 1921, quoted in Dreyer 1976). Meyer, combining the social reform ideology of the nineteenth century with his training as a physician, held that what man needed was a biologically sound idealism (Dreyer 1976). His concept of mental hygiene sprang from experience with the child study movement of the period. He proposed to apply those techniques to psychiatric hospital patients through study of their life histories, also including family and community factors. By 1908, these studies expanded Meyer's conception of mental hygiene to include reaching out into the community to prevent mental illness and preserve good mental health. Adolph Meyer, one of the founders of the mental hygiene movement in the United States, recalled that this new enterprise arose from "a mixture of humanitarian, fiscal and medical factors" (Meyer 1952).

Clifford Beers, after his release from an insane asylum, drafted the manuscript of his book A Mind That Found Itself, which included an agenda for mental hygiene societies. Under the sponsorship of William James and Adolph Meyer, the book was published in 1908. Beers called for the formation of a permanent voluntary health agency whose prime function would be to prevent the disease of insanity by providing information about it to the public. In the 1908 prospectus of the Connecticut Society for Mental Hygiene, the first in the nation, an article was included that committed it to "war against the prevailing ignorance regarding conditions and modes of living which tend to produce mental disorders." For this purpose the society set about to secure state legislation and appropriations, develop coordinated local programs to impregnate the schools and courts with the preventive view, and disseminate sound attitudes toward mental and emotional problems. Meyers wanted to move the mental hygiene movement, then focused on programs of intervention in social problems, to accept the necessity of basing its proposals on scientific research. He proposed a program of research based on the belief that the causes of mental illnesses were rooted in the interaction between biology and life history events. Meyers began a biographical or "life story" approach to studying mentally ill patients to provide a scientific knowledge base for mental hygiene efforts (Dreyer 1976).

In 1908, William Welch, dean of the Johns Hopkins Medical School, was present at the founding meeting of the National Committee for Mental Hygiene. He became its vice president in that year and later, in 1923, its president. In 1912 Thomas W. Salmon became the medical director of the National Committee. Under these auspices, he compiled statistics about mental illness for the United States. The Surgeon General of the United States Army became interested in the problem of psychiatric casualties in response to data on this problem in the peacetime army compiled by Pearce Bailey Sr., chief of neurology, psychiatry and psychology in the Office of the Surgeon General. Salmon worked with Welch on the problem of psychiatric casualties during World War I. During World War I, the National Committee for Mental Hygiene turned its attention to mental health problems in the armed services. American psychiatrists were able to detect and treat "shell-shock" casualties with success rates believed to be superior to those of other countries (Strecker, E.A., Military Psychiatry: World War I, in One Hundred Years of American Psychiatry. New York, Columbia U. Press, 1944, 385-418). Based on these experiences, William H. Welch and Witcliffe Rose included mental hygiene as part of the course of studies in their prospectus proposing the founding of the Johns Hopkins School of Hygiene and Public Health to the General Education Board of the Rockefeller Foundation in 1915.

In line with the thinking about the emerging role of local departments of public health, in 1915 Meyer envisioned community mental hygiene districts in which the services of schools, playgrounds, churches, law enforcement agencies and other social agencies would be coordinated by mental health personnel to prevent mental disorders and to foster sound mental health (Meyer, A., Organizing the Community for the Protection of its Mental Life. Survey, 1915, 34, 557-560).

Apparently Welch was looking for a leader for the mental hygiene activity and considered offering the position of professor of Mental Hygiene to Salmon in 1918. However, Salmon was not interested (Lemkau 1961). Despite the lack of a professor, social and mental hygiene were included in areas of study for candidates for the degree of Doctor of Public Health in 1920 (Preliminary Announcement, School of Hygiene and Public Health, Baltimore, Johns Hopkins Press, 1981.)

C.E.A. Winslow, professor of Public Health at Yale, was also concerned to include mental hygiene in public health education. He described mental hygiene in 1933 as "an organized community response to a recognized community need; and it lays its prime emphasis on the detection and the control of those incipient maladjustments with which the physician qua physician never comes into contact, unless specific community machinery and far-flung educational facilities are provided for the purpose." (Winslow, C. A. E., The mental hygiene movement and its founder, in National Committee on Mental Hygiene, The Mental Hygiene Movement, Garden City, NY, Country Life Press, 1938, pp. 303-17.)

The first International Congress on Mental Hygiene convened in 1933. Included in the purpose statement there was the idea that it was necessary to determine "how best to care for and treat the mentally sick, to prevent mental illness, and to conserve mental health" (in National Committee for Mental Hygiene, The Mental Hygiene Movement). By World War II, the mental hygiene movement had expanded to the ideas that 1) maladjustments that are not psychiatric but that bring the child into conflict with the law are of concern to mental health; 2) even slight deviations from harmony with the environment in the social world of the school and nursery are close to the roots of ultimate difficulties that produce mental disorder; 3) institutional programs should be encouraged that are favorable to the creation of a mentally healthy environment; 4) community forces should be coordinated to supply mentally health environments; and 5) mental health principles should be integrated into the practices of social work, nursing, public health administration, education, industry and government.

The mental hygiene movement, as it was called, was criticized in some medical circles for its lack of an objective scientific basis for its proposals and its "unscientific" focus on sociological factors as being the key to the prevention of mental illness and preservation of health. The mental hygiene movement was torn by differences between psychiatrists devoted to treating the mentally ill through biological means and mental hygienists attempting to promote mental health by changing societal institutions.

In an attempt to increase the scientific basis for mental hygiene activities, a mental hygiene study unit with full-time personnel was established at Johns Hopkins in 1934 (Dr. Ruth Fairbank, psychiatrist; Dr. Bernard Cohen, statistician; and Miss Elizabeth Green, social worker) (Lemkau 1961) to be the urban counterpart of a rural study carried out in Williamson County, Tennessee. In this first study, in the Eastern Health District of Baltimore City, all cases of mental disturbance, illness or retardation were identified from agency records and self reports of symptoms and were analyzed in terms of age, sex, geographic location and socioeconomic status.

Adolph Meyer proposed a young physician, Paul Lemkau, whom he had trained as a psychiatrist at Johns Hopkins, to continue the work on the precedent-setting Baltimore Study of Chronic Illness at the School of Hygiene and Public Health. In 1936, further data were gathered and analyzed by the Lemkau, Tietze and Cooper team (Cohen and Fairbank, American Journal of Psychiatry 1937-38; Lemkau, Tietze, Cooper, 1940-41). This study was pioneering in that it included data on the extent of mental illness in a defined population sample using both survey methods and institutional records. Working with Dr. A. W. Freeman, Lemkau became convinced that epidemiological study of the prevalence of mental disorders was possible. Clinical psychiatrists of that period rejected symptom inventories as an inadequate basis for determining the prevalence of disorder (Kleiman and Weisman). Lemkau believed, accordingly, that mental hygiene would have its foundation in research based on the treatment of individual patients. He held that theories could be formulated from this clinical research that would serve as a basis for preventive programs directed toward whole populations.

Working with Meyer, Lemkau had developed a deep commitment to the view that mental disorders had a biological basis, and a conviction that life events were the precipitants of illness. These events, identified by the life history method, would provide the database for a theory on which prevention programs could be based. Meyer had envisioned the nation divided into mental hygiene districts in which psychiatrists would catalyze friendships and cooperation among teachers, playground workers, charity organizations, ministers and physicians, to help individuals and families maintain their mental health by teaching people constructive tolerance for individual differences. In 1941, Lemkau presented the first course at the School of Public Health, relating the material arising from personality development research to public health practice. Working with the faculty teaching public health practice to future health commissioners, he became convinced that the expanding public health system would provide the institutional opportunity to bring mental hygiene to the population. As he envisioned it, mental health practitioners in public health would use the tools of epidemiology and biostatistics to diagnose the mental health needs of the population while mental health education could produce effects analogous to immunization for mental disorders.

World War II intervened, and in 1941 Lemkau entered the Army and was assigned to Walter Reed Hospital. He continued to direct the mental hygiene study and teach at the School of Hygiene in the evenings. This led to efforts to integrate wartime psychiatric experiences into public health. Working with psychiatric casualties convinced Lemkau that early detection of mental disorders and early treatment could reduce the duration of episodes of mental illness. He observed that individuals provided with rapid short-term treatment at front-line psychiatric clinics were less likely to develop enduring neurotic disorders. Weaving these strands of experience together, Lemkau conceived the idea of locating mental hygiene activities in local health departments close to community sources of stress. He envisioned a psychiatric clinic located in each local health department. Health department psychiatric outpatient clinics would heal the sick and also prevent future disorders (Lemkau 1955). Based on his war experience, he believed that the damaged personality could be changed in outpatient treatment by the verbal reconstruction of improperly assimilated past stressful experiences. For those individuals who had sustained injury leading to a chronic mental condition, clinic treatment would return them to efficient living through education to replace missing functions. The observation that "personality tends to recover from mental disease when the etiologic agents such as stress have been removed" (p. 8) suggested that the psychiatric clinics should also work to decrease stressors in the community uncovered during the course of treatment.

Lemkau propagated the concept that mental health could be promoted by health department psychiatric clinics through educating the population about how individuals might process stressful experiences more healthfully. Training in appropriate processing would produce personalities that could better withstand stress (Lemkau, Pasamanick and Cooper 1953). He believed that the promotion of resilient early personality development was complementary to the traditional public health activity of protecting the brain from damage, and would therefore fit well with the work of public health agencies.

At a meeting of the nation's public health officers in 1948, and later as part of the committee charged with designing the new National Institute of Mental Health after passage of the National Mental Health Act, Lemkau was able to promote the idea that mental hygiene and public health belonged together. This concept was expressed in his 1949 book, Mental Hygiene and Public Health. In 1949 the Maryland State Health Department invited Lemkau to be the director of a new Division of Mental Health. Four years of experience in that position convinced him that, while the mental hygiene clinics must continue to promote activities preventing psychogenic mental illness, other agencies charged with combating extreme poverty and providing public education would reach larger segments of the population. Since these agencies were not staffed by mental health personnel, mental health personnel would have to influence these farther-reaching agencies by means of epidemiologic studies that would convince them to establish policies and programs promoting mental health. He observed that professionals operating psychiatric clinics within local health departments tended to isolate themselves from other personnel, continuing to deliver traditional outpatient psychiatric services (Mental Hygiene and Public Health, 1955 edition). He saw the need for specially trained mental health professional personnel who would work from the public health department as a base. He called for experimentation in expanding mental health professionals' roles to include education and consultation to health and other agency personnel. Mental health personnel would need new skills, including those required for changing public attitudes through mass media, for providing in-service education to human services personnel, and for consultation with community leaders and community groups.

Lemkau began an active study of the options for organization of mental health services at the national, state and local levels. Lemkau supported decentralized mental health services, with the responsibility for coordination of treatment and prevention services resting within the local health department, whether or not psychiatric hospitalization services were joined with preventive services at the state level. He proposed regionalization of public mental health services and the use of traveling clinics to improve the delivery of care to the mentally ill. Lemkau also supported the development of strong, independent, nongovernmental, voluntary mental health organizations as a political constituency to support the development of public mental health services. He saw these voluntary organizations, when they maintained their character as representatives of the people, as the most effective means for educating the public. He was aware that voluntary groups want more rapid program development than public agencies, but maintained that these sometimes stressful differences between official and non-government organizations were to the general benefit of society.

Lemkau took leave from the School of Public Health to serve as the first Director of Mental Health Services for the New York City Community Mental Health Board. The second edition of Mental Hygiene and Public Health, published in 1955, filled an important need by offering a systematic approach to organizing mental health services in a society increasingly demanding those services. Published in 12 languages, it had worldwide influence. Lemkau used the Mental Hygiene Division of the School of Public Health to create a model and personnel for his approach. The expansion of the teaching of Mental Hygiene under the auspices of the National Institute of Mental Health led to the formal designation of the division as the Department of Mental Hygiene as a regular part of the School of Hygiene and Public Health in 1963.

His work provided a firm foundation for mental hygiene and public health; it endures in mental health services throughout the world and in the Department of Mental Health at the Johns Hopkins Bloomberg School of Public Health.

Dr. Mandell wrote this article in 1995 during his tenure as department chair (1993 - 1997).

Historical perspectives on the theories, diagnosis, and treatment of mental illness

A walk through the drastic transformation of attitudes toward mental illness throughout history.

Attitudes and views toward psychopathology in the medical and larger social community have undergone drastic transformation throughout history, at times progressing through a rather tortuous course, to eventually receive validation and scientific attention. Departing from a simplistic view centred on supernatural causes, modern theories in the early 20th century began to recognize mental disorders as unique disease entities, and two main theories of psychodynamics and behaviorism emerged as potential explanations for their causes. With the increasing acceptance of mental illness as a unique form of pathology, official diagnostic classification systems were adopted, new avenues of research spawned, and modern approaches to treatment incorporating pharmaacotherapy and psychotherapy were established. Although much scientific progress has been made in the fields of diagnosing and treating mental illness, at a societal level the recent psychiatric deinstitutionalization movement has been met with mixed success, calling into question how to most effectively implement into clinical practice the knowledge that has been gained over the previous centuries.

The prevailing views of early recorded history posited that mental illness was the product of supernatural forces and demonic possession, and this often led to primitive treatment practices such as trepanning in an effort to release the offending spirit.[ 1 ] Relatively little in the way of improvements were achieved throughout the European Middle Ages, and the oppressive sociopolitical climate saw many sufferers of mental illness being submitted to physical restraint and solitary confinement in the asylums of the time.[ 2 ] It was not until the late 19th and early 20th centuries that modern theories of psychopathology began to emerge.

Around this time, two main theoretical approaches began to inform our understanding of mental illness: the psychodynamic theory proposed by Austrian neurologist Sigmund Freud (1856–1939), and the theory of behaviorism advanced by American psychologist John B. Watson (1878–1958).[ 2 ] Freud’s theory of psychodynamics centred on the notion that mental illness was the product of the interplay of unresolved unconscious motives, and should be treated through various methods of open dialogue with the patient.[ 2 ] Behaviorism, on the other hand, suggested that psychopathology was more closely related to the effects of behavioral conditioning, and that treatment should focus on methods of adaptive reconditioning, using the same principles of classical conditioning elucidated by the Russian physiologist Ivan Pavlov (1849–1936).[ 2 ]

Against the backdrop of these broad theoretical frameworks, modern approaches to the diagnosis and treatment of psychopathology began to emerge and, along with these, the need to systematically categorize mental illness became apparent. In post–Second World War North America a need for a formal classification system was recognized in order to provide more efficient and targeted mental health services for veterans.[ 3 ] This led to the creation of the first edition of the  Diagnostic and Statistical Manual of Mental Disorders  ( DSM ) in 1952, which was largely drawn from the World Health Organization’s sixth edition of the International Classification of Diseases (ICD-6).[ 3 ] Early editions of the  DSM  described mental disorders in terms of “reactions,” postulating that such illnesses should be classified with reference to antecedent socio-environmental and biological causative factors.[ 3 ] However, in 1980 with the publication of the third edition, the  DSM  shifted its focus and intentionally remained neutral on the potential etiological causes of the various forms of mental illness. This position was maintained in subsequent editions, including the current  DSM-5 , published in 2013.[ 3 ]

With theoretical frameworks and a classification system in place, the study and treatment of mental illness began to expand significantly in the mid-20th century. Important developments in this period laid the foundation for modern pharmacologic and psychotherapeutic approaches aimed at addressing mental illness. From a pharmacological perspective, the catecholamine hypothesis, published in the 1950s, was an influential milestone although perhaps overly simplistic. Following research into the actions of drugs like reserpine and monoamine oxidase inhibitors, the catecholamine hypothesis proposed that depression and other affective disorders were likely caused by decreased levels of catecholamines such as norepinephrine.[ 4 ]

The field of psychotherapy, with its early roots in Freud’s psychodynamic theory, also saw new developments in this period. In particular, individuals such as American psychologist Albert Ellis (1913–2007) and American psychiatrist Aaron T. Beck (b. 1921) began adopting treatment approaches aimed at addressing the maladaptive cognitions and emotions underlying mental disorders.[ 5,6 ] When combined with principles of behaviorism, this approach led to the eventual development of cognitive-behavioral therapy (CBT), the current gold standard psychotherapeutic approach in the treatment of anxiety disorders.[ 7 ] Taken together, the catecholamine hypothesis and the development of CBT have had a substantial impact on the modern treatment of depression and anxiety, the two disorders accounting for the highest proportion of disability-adjusted life years among mental illnesses across the globe.[ 8 ]

In the latter half of the 20th century, various factors gave rise to the more recent psychiatric deinstitutionalization movement in North America, including the advent of antipsychotic drugs and the recognition that mental health expenses could be reduced by using community-based outpatient settings in favor of inpatient care in psychiatric hospitals.[ 9 ] In response to the recommendations of the Canadian Mental Health Association in the 1960s,[ 10 ] deinstitutionalization was adopted in Canada and is ongoing today.[ 2 ] Unfortunately, throughout Canada, the increase in community-based mental health services has not kept pace with the closure of psychiatric hospitals,[ 11 ] contributing to problems of homelessness and crime among many sufferers of mental illness.[ 2 ] The closure of Riverview Hospital, a mental health facility in Coquitlam, serves as a poignant local example. Amid debates about how to best deal with addiction and mental health problems in BC, Riverview Hospital is currently slated to reopen by 2019,[ 12 ] and it will be interesting to see how other regions across the country respond to the ongoing challenges of mental health care. 

Western civilization’s relationship with mental illness has had a complex and varied history, characterized by periods of relative scientific inertia and ostracism of those afflicted, as well as periods of great theoretical insight and progressive thinking. Following the abandonment of supernatural explanations/theories and with the emergence of logical thought and experimental reasoning after the Middle Ages, the stage was set for a transition to a humane method of treating mental illness. This shift led to the advent of modern theories of mental illness, dedicated classification systems, as well as theoretical approaches to treatment based on clinical evidence. Despite such progress, there remain ongoing public health concerns with respect to effectively implementing the most appropriate model of mental health care for society, and these will likely serve as major themes in the next chapter of the history of mental illness.

This article has been peer reviewed.

1.    Restak R. Mysteries of the mind. Washington, DC: National Geographic Society; 2000. 2.    Butcher JN, Mineka S, Hooley JM, et al. Abnormal psychology, first Canadian edition. Toronto, ON: Pearson Education Canada; 2010. 3.    American Psychiatric Association. DSM history. Accessed 17 January 2017. www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm . 4.    Schildkraut JJ. The catecholamine hypothesis of affective disorders: A review of supporting evidence. Am J Psychiatry 1965;122:509-522. 5.    Ellis A. Rational emotive behavior therapy. Corsini RJ, Wedding D, editors. Current psychotherapies. 8th ed. Belmont, CA: Thomson Brooks/Cole; 2008. p. 63-106. 6.    Oatley K. Emotions: A brief history. Malden, MA: Blackwell Publishing; 2004. 7.    Otte C. Cognitive behavioral therapy in anxiety disorders: Current state of the evidence. Dialogues Clin Neurosci 2011;13:413-421. 8.    Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380(9859):2197-2223. 9.    Lesage AD, Morissette R, Fortier L, et al. Downsizing psychiatric hospitals: Needs for care and services of current and discharged long-stay inpatients. Can J Psychiatry 2000;45:526-532. 10.    Tyhurst JS, Chalke FCR, Lawson FS, et al. More for the mind: A study of psychiatric services in Canada. Toronto, ON: Canadian Mental Health Association; 1963. 11.    Sealy P, Whitehead PC. Forty years of deinstitutionalization of psychiatric services in Canada: An empirical assessment. Can J Psychiatry 2004;49:249-257. 12.    BC Housing. A vision for renewing Riverview. 2015. Accessed 26 January 2017. http://renewingriverview.com/wp-contentuploads/2015/12/A-Vision-For-Rene... .

Mr Jutras is a third-year medical student at the University of British Columbia.

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1 A Brief History of Global Mental Health

• Published: November 2013
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Despite the apparent newness of global mental health as a field, concerns about mental disorders – e.g., explanatory models and approaches to treatment – have been circulating the globe for thousands of years. This chapter provides an overview of the history of the treatment and services for mental disorders from Ancient Egypt to the present day, paying particular attention to the rise and evolution of institutional care, the move to community-based care and deinstitutionalization, and the emergence of concerns about mental disorders as a public health priority in low- and middle-income countries. The chapter concludes with a discussion of the opportunities and challenges that the field of global mental health is facing currently.

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History of Mental Health and Mental Illness

• First Online: 28 September 2017

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• Michelle O’Reilly 5 &
• Jessica Nina Lester 6  

Part of the book series: The Language of Mental Health ((TLMH))

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This chapter provides a brief history of mental health and mental illness, giving particular attention to how the notions of normality–abnormality have been made ‘real’ in and through language. More specifically, we provide some context for the social construction of the boundaries of normality and social deviance (as it has been coined) by providing context of the history of the asylum and treatments for those considered to be experiencing mental illness, and we juxtapose these against a contemporary view. This chapter makes reference to some of the influential voices across time, paying attention to notions of power and coercion and how historical views have shaped our language in describing mental distress.

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Commentary on ‘Mental Health Across the Globe: Conceptual Perspectives from Social Science and the Humanities’ Section

Introduction: The Social Construction of Normality and Pathology

Introduction: The Disease Model of Mental Health: A System in Crisis

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O’Reilly, M., Lester, J.N. (2017). History of Mental Health and Mental Illness. In: Examining Mental Health through Social Constructionism. The Language of Mental Health. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-319-60095-6_2

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Mental Health Essay

Introduction

Mental health, often overshadowed by its physical counterpart, is an intricate and essential aspect of human existence. It envelops our emotions, psychological state, and social well-being, shaping our thoughts, behaviors, and interactions. With the complexities of modern life—constant connectivity, societal pressures, personal expectations, and the frenzied pace of technological advancements—mental well-being has become increasingly paramount. Historically, conversations around this topic have been hushed, shrouded in stigma and misunderstanding. However, as the curtains of misconception slowly lift, we find ourselves in an era where discussions about mental health are not only welcomed but are also seen as vital. Recognizing and addressing the nuances of our mental state is not merely about managing disorders; it's about understanding the essence of who we are, how we process the world around us, and how we navigate the myriad challenges thrown our way. This essay aims to delve deep into the realm of mental health, shedding light on its importance, the potential consequences of neglect, and the spectrum of mental disorders that many face in silence.

Importance of Mental Health

Mental health plays a pivotal role in determining how individuals think, feel, and act. It influences our decision-making processes, stress management techniques, interpersonal relationships, and even our physical health. A well-tuned mental state boosts productivity, creativity, and the intrinsic sense of self-worth, laying the groundwork for a fulfilling life.

Negative Impact of Mental Health

Neglecting mental health, on the other hand, can lead to severe consequences. Reduced productivity, strained relationships, substance abuse, physical health issues like heart diseases, and even reduced life expectancy are just some of the repercussions of poor mental health. It not only affects the individual in question but also has a ripple effect on their community, workplace, and family.

Mental Disorders: Types and Prevalence

Mental disorders are varied and can range from anxiety and mood disorders like depression and bipolar disorder to more severe conditions such as schizophrenia.

• Depression: Characterized by persistent sadness, lack of interest in activities, and fatigue.
• Anxiety Disorders: Encompass conditions like generalized anxiety disorder, panic attacks, and specific phobias.
• Schizophrenia: A complex disorder affecting a person's ability to think, feel, and behave clearly.

The prevalence of these disorders has been on the rise, underscoring the need for comprehensive mental health initiatives and awareness campaigns.

Understanding Mental Health and Its Importance

Mental health is not merely the absence of disorders but encompasses emotional, psychological, and social well-being. Recognizing the signs of deteriorating mental health, like prolonged sadness, extreme mood fluctuations, or social withdrawal, is crucial. Understanding stems from awareness and education. Societal stigmas surrounding mental health have often deterred individuals from seeking help. Breaking these barriers, fostering open conversations, and ensuring access to mental health care are imperative steps.

Conclusion: Mental Health

Mental health, undeniably, is as significant as physical health, if not more. In an era where the stressors are myriad, from societal pressures to personal challenges, mental resilience and well-being are essential. Investing time and resources into mental health initiatives, and more importantly, nurturing a society that understands, respects, and prioritizes mental health is the need of the hour.

• World Leaders: Several influential personalities, from celebrities to sports stars, have openly discussed their mental health challenges, shedding light on the universality of these issues and the importance of addressing them.
• Workplaces: Progressive organizations are now incorporating mental health programs, recognizing the tangible benefits of a mentally healthy workforce, from increased productivity to enhanced creativity.
• Educational Institutions: Schools and colleges, witnessing the effects of stress and other mental health issues on students, are increasingly integrating counseling services and mental health education in their curriculum.

In weaving through the intricate tapestry of mental health, it becomes evident that it's an area that requires collective attention, understanding, and action.

  Short Essay about Mental Health

Mental health, an integral facet of human well-being, shapes our emotions, decisions, and daily interactions. Just as one would care for a sprained ankle or a fever, our minds too require attention and nurture. In today's bustling world, mental well-being is often put on the back burner, overshadowed by the immediate demands of life. Yet, its impact is pervasive, influencing our productivity, relationships, and overall quality of life.

Sadly, mental health issues have long been stigmatized, seen as a sign of weakness or dismissed as mere mood swings. However, they are as real and significant as any physical ailment. From anxiety to depression, these disorders have touched countless lives, often in silence due to societal taboos.

But change is on the horizon. As awareness grows, conversations are shifting from hushed whispers to open discussions, fostering understanding and support. Institutions, workplaces, and communities are increasingly acknowledging the importance of mental health, implementing programs, and offering resources.

In conclusion, mental health is not a peripheral concern but a central one, crucial to our holistic well-being. It's high time we prioritize it, eliminating stigma and fostering an environment where everyone feels supported in their mental health journey.

Frequently Asked Questions

• What is the primary focus of a mental health essay?

Answer: The primary focus of a mental health essay is to delve into the intricacies of mental well-being, its significance in our daily lives, the various challenges people face, and the broader societal implications. It aims to shed light on both the psychological and emotional aspects of mental health, often emphasizing the importance of understanding, empathy, and proactive care.

• How can writing an essay on mental health help raise awareness about its importance?

Answer: Writing an essay on mental health can effectively articulate the nuances and complexities of the topic, making it more accessible to a wider audience. By presenting facts, personal anecdotes, and research, the essay can demystify misconceptions, highlight the prevalence of mental health issues, and underscore the need for destigmatizing discussions around it. An impactful essay can ignite conversations, inspire action, and contribute to a more informed and empathetic society.

• What are some common topics covered in a mental health essay?

Answer: Common topics in a mental health essay might include the definition and importance of mental health, the connection between mental and physical well-being, various mental disorders and their symptoms, societal stigmas and misconceptions, the impact of modern life on mental health, and the significance of therapy and counseling. It may also delve into personal experiences, case studies, and the broader societal implications of neglecting mental health.

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Science Watch

The roots of mental illness

How much of mental illness can the biology of the brain explain?

By Kirsten Weir

June 2012, Vol 43, No. 6

Print version: page 30

Diagnosing mental illness isn't like diagnosing other chronic diseases. Heart disease is identified with the help of blood tests and electrocardiograms. Diabetes is diagnosed by measuring blood glucose levels. But classifying mental illness is a more subjective endeavor. No blood test exists for depression; no X-ray can identify a child at risk of developing bipolar disorder. At least, not yet.

Thanks to new tools in genetics and neuroimaging, scientists are making progress toward deciphering details of the underlying biology of mental disorders. Yet experts disagree on how far we can push this biological model. Are mental illnesses simply physical diseases that happen to strike the brain? Or do these disorders belong to a class all their own?

Eric Kandel, MD, a Nobel Prize laureate and professor of brain science at Columbia University, believes it's all about biology. "All mental processes are brain processes, and therefore all disorders of mental functioning are biological diseases," he says. "The brain is the organ of the mind. Where else could [mental illness] be if not in the brain?"

That viewpoint is quickly gaining supporters, thanks in part to Thomas R. Insel, MD, director of the National Institute of Mental Health, who has championed a biological perspective during his tenure at the agency.

To Insel, mental illnesses are no different from heart disease, diabetes or any other chronic illness. All chronic diseases have behavioral components as well as biological components, he says. "The only difference here is that the organ of interest is the brain instead of the heart or pancreas. But the same basic principles apply."

A new toolkit

Take cardiology, Insel says. A century ago, doctors had little knowledge of the biological basis of heart disease. They could merely observe a patient's physical presentation and listen to the patient's subjective complaints. Today they can measure cholesterol levels, examine the heart's electrical impulses with EKG, and take detailed CT images of blood vessels and arteries to deliver a precise diagnosis. As a result, Insel says, mortality from heart attacks has dropped dramatically in recent decades. "In most areas of medicine, we now have a whole toolkit to help us know what's going on, from the behavioral level to the molecular level. That has really led to enormous changes in most areas of medicine," he says.

Insel believes the diagnosis and treatment of mental illness is today where cardiology was 100 years ago. And like cardiology of yesteryear, the field is poised for dramatic transformation, he says. "We are really at the cusp of a revolution in the way we think about the brain and behavior, partly because of technological breakthroughs. We're finally able to answer some of the fundamental questions."

Indeed, in recent years scientists have made many exciting discoveries about the function — and dysfunction — of the human brain. They've identified genes linked to schizophrenia and discovered that certain brain abnormalities increase a person's risk of developing post-traumatic stress disorder after a distressing event. Others have zeroed in on anomalies associated with autism, including abnormal brain growth and underconnectivity among brain regions.

Researchers have also begun to flesh out a physiological explanation for depression. Helen Mayberg, MD, a professor of psychiatry and neurology at Emory University, has been actively involved in research that singled out a region of the brain — Brodmann area 25 — that is overactive in people with depression. Mayberg describes area 25 as a "junction box" that interacts with other areas of the brain involved in mood, emotion and thinking. She has demonstrated that deep-brain stimulation of the area can alleviate symptoms in people with treatment-resistant depression (Neuron, 2005).

Maps of depression's neural circuits, Mayberg says, may eventually serve as a tool both for diagnosis and treatment. Understanding the underlying biology, she adds, could help therapists and psychopharmacologists decide which patients would benefit from more intensive therapy, and which aren't likely to improve without medication. That would be a welcome improvement, she says. "Syndromes are so nonspecific by our current criteria that the best we can do now is flip a coin. We don't do that for any other branch of medicine," she says.

Yet despite the progress and promise of her research, Mayberg isn't ready to concede that all mental illnesses will one day be described in purely biological terms. "I used to think you could localize everything, that you could explain all the variants by the biology," she says. "I think in a perfect world you could, but we don't have the tools to explain all those things because we can't control for all of the variables."

One of the biggest problems, she says, is that mental illness diagnoses are often catchall categories that include many different underlying malfunctions. Mental illnesses have always been described by their outward symptoms, both out of necessity and convenience. But just as cancer patients are a wildly diverse group marked by many different disease pathways, a depression diagnosis is likely to encompass people with many unique underlying problems. That presents challenges for defining the disease in biological terms. "Depression does have patterns," Mayberg says. "The caveat is different cohorts of patients clearly have different patterns — and likely the need for different specific interventions."

Software malfunction

When it comes to mental illness, a one-size-fits-all approach does not apply. Some diseases may be more purely physiological in nature. "Certain disorders such as schizophrenia, bipolar disorder and autism fit the biological model in a very clear-cut sense," says Richard McNally, PhD, a clinical psychologist at Harvard University and author of the 2011 book "What is Mental Illness?" In these diseases, he says, structural and functional abnormalities are evident in imaging scans or during postmortem dissection.

Yet for other conditions, such as depression or anxiety, the biological foundation is more nebulous. Often, McNally notes, mental illnesses are likely to have multiple causes, including genetic, biological and environmental factors. Of course, that's true for many chronic diseases, heart disease and diabetes included. But for mental illnesses, we're a particularly long way from understanding the interplay among those factors.

That complexity is one reason that experts such as Jerome Wakefield, PhD, DSW, a professor of social work and psychiatry at New York University, believe that too much emphasis is being placed on the biology of mental illness at this point in our understanding of the brain. Decades of effort to understand the biology of mental disorders have uncovered clues, but those clues haven't translated to improvements in diagnosis or treatment, he believes. "We've thrown tens of billions of dollars into trying to identify biomarkers and biological substrates for mental disorders," Wakefield says. "The fact is we've gotten very little out of all of that."

To be sure, Wakefield says, some psychological disorders are likely due to brain dysfunction. Others, however, may stem from a chance combination of normal personality traits. "In the unusual case where normal traits come together in a certain configuration, you may be maladapted to society," he says. "Call it a mental disorder if you want, but there's no smoking-gun malfunction in your brain."

You can think of the brain as a computer, he adds. The brain circuitry is equivalent to the hardware. But we also have the human equivalent of software. "Namely, we have mental processing of mental representations, meanings, conditioning, a whole level of processing that has to do with these psychological capacities," he says. Just as software bugs are often the cause of our computer problems, our mental motherboards can be done in by our psychological processing, even when the underlying circuitry is working as designed. "If we focus only at the brain level, we are likely to miss a lot of what's going on in mental disorders," he says.

The danger in placing too much attention on the biological is that important environmental, behavioral and social factors that contribute to mental illness may be overlooked. "By over-focusing on the biological, we are doing patients a disservice," Wakefield says. He sees a red flag in a study by Steven Marcus, PhD, and Mark Olfson, MD, that found the percentage of patients who receive psychotherapy for depression declined from 53.6 percent in 1998 to 43.1 percent in 2007, while rates of antidepressant use stayed roughly the same ( Archives of General Psychiatry , 2010).

A nuanced view

The emerging area of epigenetics, meanwhile, could help provide a link between the biological and other causes of mental illness. Epigenetics research examines the ways in which environmental factors change the way genes express themselves. "Certain genes are turned on or turned off, expressed or not expressed, depending on environmental inputs," McNally says.

One of the first classic epigenetics experiments, by researchers at McGill University, found that pups of negligent rat mothers were more sensitive to stress in adulthood than pups that had been raised by doting mothers (Nature Neuroscience, 2004). The differences could be traced to epigenetic markers, chemical tags that attach to strands of DNA and, in the process, turn various genes on and off. Those tags don't just affect individuals during their lifetime, however; like DNA, epigenetic markers can be passed from generation to generation. More recently, the McGill team studied the brains of people who committed suicide, and found those who had been abused in childhood had unique patterns of epigenetic tags in their brains ( Nature Neuroscience , 2009). "Stress gets under the skin, so to speak," McNally says.

In McNally's view, there's little danger that mental health professionals will forget the importance of environmental factors to the development of mental illness. "I think what's happening is not a battle between biological and non-biological approaches, but an increasingly nuanced and sophisticated appreciation for the multiple perspectives that can illuminate the etiology of these conditions," he says.

Still, translating that nuanced view to improvements in diagnosis and treatment will take time. Despite decades of research on the causes and treatments of mental illness, patients are still suffering. "Suicide rates haven't come down. The rate of prevalence for many of these disorders, if anything, has gone up, not down. That tells you that whatever we've been doing is probably not adequate," Insel says.

But, he adds, there's good reason to hold out hope. "I think, increasingly, we'll understand behavior at many levels, and one of those will be physiological," Insel says. "That may take longer to translate into new therapies and new opportunities for patients, but it's coming."

In the meantime, according to Insel and Kandel, patients themselves are clamoring for better biological descriptions of mental disorders. Describing mental illnesses as brain malfunctions helps minimize the shame often associated with them, Kandel says. "Schizophrenia is a disease like pneumonia. Seeing it as a brain disorder destigmatizes it immediately."

Certainly, Kandel adds, social and environmental factors are undeniably important to understanding mental health. "But they do not act in a vacuum," he says. "They act in the brain."

It's too soon to say whether we'll someday have a blood test for schizophrenia or a brain scanning technique that identifies depression without any doubt. But scientists and patients agree: The more we understand about our brain and behavior, the better. "We have a good beginning of understanding of the brain," says Kandel, "but boy, have we got a long way to go."

Kirsten Weir is a freelance writer in Minneapolis.

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• Volume 43, Issue 2
• Introduction: historical contexts to communicating mental health
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• Rebecca Wynter ,
• Leonard Smith
• History of Medicine Unit , University of Birmingham , Birmingham , UK
• Correspondence to Dr Rebecca Wynter, History of Medicine Unit, Social Studies in Medicine (SSiM), Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK; r.i.wynter{at}bham.ac.uk

Contemporary discussions around language, stigma and care in mental health, the messages these elements transmit, and the means through which they have been conveyed, have a long and deep lineage. Recognition and exploration of this lineage can inform how we communicate about mental health going forward, as reflected by the 9 papers which make up this special issue. Our introduction provides some framework for the history of communicating mental health over the past 300 years. We will show that there have been diverse ways and means of describing, disseminating and discussing mental health, in relation both to therapeutic practices and between practitioners, patients and the public. Communicating about mental health, we argue, has been informed by the desire for positive change, as much as by developments in reporting, legislation and technology. However, while the modes of communication have developed, the issues involved remain essentially the same. Most practitioners have sought to understand and to innovate, though not always with positive results. Some lost sight of patients as people; patients have felt and have been ignored or silenced by doctors and carers. Money has always talked, for without adequate investment services and care have suffered, contributing to the stigma surrounding mental illness. While it is certainly ‘time to talk’ to improve experiences, it is also time to change the language that underpins cultural attitudes towards mental illness, time to listen to people with mental health issues and, crucially, time to hear.

• Mental health care

https://doi.org/10.1136/medhum-2016-011082

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Contributors RW acted as associate editor for this special issue, co-wrote this introduction and submitted the article. LS acted as associate editor for this special issue and co-wrote this introduction.

Funding The introduction and contributions to this special issue emanate from a workshop, ‘Communicating Mental Health, c.1700-2013’, which was funded by the Institute of Advanced Studies, University of Birmingham.

Competing interests None declared.

Provenance and peer review Not commissioned; internally peer reviewed.

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The History of Mental Illness

The history of mental illness goes back as far as written records and perhaps took its first major leap forward in 400 B.C. when Greek physician, Hippocrates, began to treat mental illness  as physiological diseases rather than evidence of demonic possession or displeasure from the gods as they had previously been believed to be. Asylums for the mentally ill were established as early as the 8th century by Muslim Arabs.

Since then mental illness history has taken many turns and, in the United States, has been a journey from the institutionalization of people with mental illness to moving the mentally ill into the community (modern-day Housing for the Mentally Ill: Where to Find It ).

The Early History of Mental Illness

The early history of mental illness happens in Europe where, in the Middle Ages, the mentally ill were granted their freedom in some places if they were shown not to be dangerous. In other places, the mentally ill were treated poorly and said to be witches.

In the 1600s, Europeans began to isolate those with mental illness, often treating them inhumanly and chaining them to walls or keeping them in dungeons. The mentally ill were often housed with the disabled, vagrants and delinquents.

Concern over the treatment of the mentally ill increased over the 1700s and some positive reforms were enacted. In some places, shackling of the mentally ill was now forbidden and people were allowed in "sunny rooms" and encouraged to exercise on the grounds. In other places, serious mistreatment of the mentally ill still occurred.

Mental Illness History in the 1800s

In the United States, people with mental illness were often incarcerated with criminals and left unclothed in darkness without heat or bathrooms, often to be chained and beaten. At this time, U.S. reformer, Dorothea Dix, pushed to establish 32 state hospitals for the mentally ill. Unfortunately, hospitals and humane treatment of the mentally ill did not cure them as previously expected and this led to overcrowding and an emphasis on custodial care rather than humane treatment.

In the 1880s, German psychiatrist, Emil Kraepelin, started to scientifically study mental illness and separated manic-depressive psychosis  from schizophrenia  in a way that remains to this day.

History of Mental Illness Treatment in the 20th Century

In the early 20th century, Clifford Beers released an autobiography that details the degrading and dehumanizing treatment he received in a Connecticut mental institution. He spearheaded the founding of what would become the National Mental Health Association, later renamed Mental Health America, the largest umbrella organization for mental health and mental illness in the United States today.

In the 1930s, mental illness treatments were in their infancy and convulsions, comas and fever (induced by electroshock, camphor, insulin and malaria injections) were common. Other treatments included removing parts of the brain (lobotomies). The lobotomy was performed widely from the 30s to the 40s to treat schizophrenia, severe anxiety and depression .

In 1946, Harry Truman signed the National Mental Health Act which called for the conducting of research into the mind, the brain and behavior. As a result of this law, the National Institute of Mental Health (NIMH) was formed in 1949. Also in 1949, lithium, the first truly effective drug for mental illness, was introduced and became widely used to treat manic-depression (now known as bipolar disorder ).

In 1952, the first antipsychotic drug , chlorpromazine, was discovered and a series of antipsychotics were brought onto the market. These drugs did not cure psychosis but did control its symptoms and 70% of patients with schizophrenia clearly improved on these drugs.

In the mid-1950s the numbers of hospitalized mentally ill peaked at 560,000 in the United States. This, plus the advent of effective psychiatric medication, led to many mentally ill people being removed from institutions and directed towards local mental health facilities. The number of institutionalized mentally ill dropped to 130,000 in 1980.

However, many mentally ill became homeless upon being released from institutions due to inadequate housing and follow-up care.

Also in the 1960s, many critics of psychiatry emerged such as:

• Psychiatrist Thomas Szasz who argues that schizophrenia doesn't exist.
• Erving Goffman who claims that most people in mental hospitals exhibit psychotic symptoms as a result of their hospitalization.
• Ken Kesey who says that patients don't have mental illness but, rather, they simply act in ways society deems unacceptable.

In the 1980s, advocacy groups such as the National Alliance for the Mentally Ill (NAMI) and the National Alliance for Research on Schizophrenia and Depression were formed to advocate for the mentally ill and finance research.

Modern Day Mental Illness

In the modern day, many new psychiatric medications have been introduced and successfully treat most people with mental illness. Very few people are placed in mental hospitals  for long periods of time due to lack of funding (primarily from private insurance) and because most people can be successfully treated in the community.

Homelessness and incarceration of the mentally ill continue to be major problems as does the lack of beds and resources to treat people with severe mental illness.

APA Reference Tracy, N. (2019, October 23). The History of Mental Illness, HealthyPlace. Retrieved on 2024, August 24 from https://www.healthyplace.com/other-info/mental-illness-overview/the-history-of-mental-illness

Medically reviewed by Harry Croft, MD

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Mental Health Prevention and Promotion—A Narrative Review

Associated data.

Extant literature has established the effectiveness of various mental health promotion and prevention strategies, including novel interventions. However, comprehensive literature encompassing all these aspects and challenges and opportunities in implementing such interventions in different settings is still lacking. Therefore, in the current review, we aimed to synthesize existing literature on various mental health promotion and prevention interventions and their effectiveness. Additionally, we intend to highlight various novel approaches to mental health care and their implications across different resource settings and provide future directions. The review highlights the (1) concept of preventive psychiatry, including various mental health promotions and prevention approaches, (2) current level of evidence of various mental health preventive interventions, including the novel interventions, and (3) challenges and opportunities in implementing concepts of preventive psychiatry and related interventions across the settings. Although preventive psychiatry is a well-known concept, it is a poorly utilized public health strategy to address the population's mental health needs. It has wide-ranging implications for the wellbeing of society and individuals, including those suffering from chronic medical problems. The researchers and policymakers are increasingly realizing the potential of preventive psychiatry; however, its implementation is poor in low-resource settings. Utilizing novel interventions, such as mobile-and-internet-based interventions and blended and stepped-care models of care can address the vast mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. Furthermore, employing decision support systems/algorithms for patient management and personalized care and utilizing the digital platform for the non-specialists' training in mental health care are valuable additions to the existing mental health support system. However, more research concerning this is required worldwide, especially in the low-and-middle-income countries.

Introduction

Mental disorder has been recognized as a significant public health concern and one of the leading causes of disability worldwide, particularly with the loss of productive years of the sufferer's life ( 1 ). The Global Burden of Disease report (2019) highlights an increase, from around 80 million to over 125 million, in the worldwide number of Disability-Adjusted Life Years (DALYs) attributable to mental disorders. With this surge, mental disorders have moved into the top 10 significant causes of DALYs worldwide over the last three decades ( 2 ). Furthermore, this data does not include substance use disorders (SUDs), which, if included, would increase the estimated burden manifolds. Moreover, if the caregiver-related burden is accounted for, this figure would be much higher. Individual, social, cultural, political, and economic issues are critical mental wellbeing determinants. An increasing burden of mental diseases can, in turn, contribute to deterioration in physical health and poorer social and economic growth of a country ( 3 ). Mental health expenditure is roughly 3–4% of their Gross Domestic Products (GDPs) in developed regions of the world; however, the figure is abysmally low in low-and-middle-income countries (LMICs) ( 4 ). Untreated mental health and behavioral problems in childhood and adolescents, in particular, have profound long-term social and economic adverse consequences, including increased contact with the criminal justice system, lower employment rate and lesser wages among those employed, and interpersonal difficulties ( 5 – 8 ).

Need for Mental Health (MH) Prevention

Longitudinal studies suggest that individuals with a lower level of positive wellbeing are more likely to acquire mental illness ( 9 ). Conversely, factors that promote positive wellbeing and resilience among individuals are critical in preventing mental illnesses and better outcomes among those with mental illness ( 10 , 11 ). For example, in patients with depressive disorders, higher premorbid resilience is associated with earlier responses ( 12 ). On the contrary, patients with bipolar affective- and recurrent depressive disorders who have a lower premorbid quality of life are at higher risk of relapses ( 13 ).

Recently there has been an increased emphasis on the need to promote wellbeing and positive mental health in preventing the development of mental disorders, for poor mental health has significant social and economic implications ( 14 – 16 ). Research also suggests that mental health promotion and preventative measures are cost-effective in preventing or reducing mental illness-related morbidity, both at the society and individual level ( 17 ).

Although the World Health Organization (WHO) defines health as “a state of complete physical, mental, and social wellbeing and not merely an absence of disease or infirmity,” there has been little effort at the global level or stagnation in implementing effective mental health services ( 18 ). Moreover, when it comes to the research on mental health (vis-a-viz physical health), promotive and preventive mental health aspects have received less attention vis-a-viz physical health. Instead, greater emphasis has been given to the illness aspect, such as research on psychopathology, mental disorders, and treatment ( 19 , 20 ). Often, physicians and psychiatrists are unfamiliar with various concepts, approaches, and interventions directed toward mental health promotion and prevention ( 11 , 21 ).

Prevention and promotion of mental health are essential, notably in reducing the growing magnitude of mental illnesses. However, while health promotion and disease prevention are universally regarded concepts in public health, their strategic application for mental health promotion and prevention are often elusive. Furthermore, given the evidence of substantial links between psychological and physical health, the non-incorporation of preventive mental health services is deplorable and has serious ramifications. Therefore, policymakers and health practitioners must be sensitized about linkages between mental- and physical health to effectively implement various mental health promotive and preventive interventions, including in individuals with chronic physical illnesses ( 18 ).

The magnitude of the mental health problems can be gauged by the fact that about 10–20% of young individuals worldwide experience depression ( 22 ). As described above, poor mental health during childhood is associated with adverse health (e.g., substance use and abuse), social (e.g., delinquency), academic (e.g., school failure), and economic (high risk of poverty) adverse outcomes in adulthood ( 23 ). Childhood and adolescence are critical periods for setting the ground for physical growth and mental wellbeing ( 22 ). Therefore, interventions promoting positive psychology empower youth with the life skills and opportunities to reach their full potential and cope with life's challenges. Comprehensive mental health interventions involving families, schools, and communities have resulted in positive physical and psychological health outcomes. However, the data is limited to high-income countries (HICs) ( 24 – 28 ).

In contrast, in low and middle-income countries (LMICs) that bear the greatest brunt of mental health problems, including massive, coupled with a high treatment gap, such interventions remained neglected in public health ( 29 , 30 ). This issue warrants prompt attention, particularly when global development strategies such as Millennium Development Goals (MDGs) realize the importance of mental health ( 31 ). Furthermore, studies have consistently reported that people with socioeconomic disadvantages are at a higher risk of mental illness and associated adverse outcomes; partly, it is attributed to the inequitable distribution of mental health services ( 32 – 35 ).

Scope of Mental Health Promotion and Prevention in the Current Situation

Literature provides considerable evidence on the effectiveness of various preventive mental health interventions targeting risk and protective factors for various mental illnesses ( 18 , 36 – 42 ). There is also modest evidence of the effectiveness of programs focusing on early identification and intervention for severe mental diseases (e.g., schizophrenia and psychotic illness, and bipolar affective disorders) as well as common mental disorders (e.g., anxiety, depression, stress-related disorders) ( 43 – 46 ). These preventive measures have also been evaluated for their cost-effectiveness with promising findings. In addition, novel interventions such as digital-based interventions and novel therapies (e.g., adventure therapy, community pharmacy program, and Home-based Nurse family partnership program) to address the mental health problems have yielded positive results. Likewise, data is emerging from LMICs, showing at least moderate evidence of mental health promotion intervention effectiveness. However, most of the available literature and intervention is restricted mainly to the HICs ( 47 ). Therefore, their replicability in LMICs needs to be established and, also, there is a need to develop locally suited interventions.

Fortunately, there has been considerable progress in preventive psychiatry over recent decades, including research on it. In the light of these advances, there is an accelerated interest among researchers, clinicians, governments, and policymakers to harness the potentialities of the preventive strategies to improve the availability, accessibility, and utility of such services for the community.

The Concept of Preventive Psychiatry

Origins of preventive psychiatry.

The history of preventive psychiatry can be traced back to the early 1900's with the foundation of the national mental health association (erstwhile mental health association), the committee on mental hygiene in New York, and the mental health hygiene movement ( 48 ). The latter emphasized the need for physicians to develop empathy and recognize and treat mental illness early, leading to greater awareness about mental health prevention ( 49 ). Despite that, preventive psychiatry remained an alien concept for many, including mental health professionals, particularly when the etiology of most psychiatric disorders was either unknown or poorly understood. However, recent advances in our understanding of the phenomena underlying psychiatric disorders and availability of the neuroimaging and electrophysiological techniques concerning mental illness and its prognosis has again brought the preventive psychiatry in the forefront ( 1 ).

Levels of Prevention

The literal meaning of “prevention” is “the act of preventing something from happening” ( 50 ); the entity being prevented can range from the risk factors of the development of the illness, the onset of illness, or the recurrence of the illness or associated disability. The concept of prevention emerged primarily from infectious diseases; measures like mass vaccination and sanitation promotion have helped prevent the development of the diseases and subsequent fatalities. The original preventive model proposed by the Commission on Chronic Illness in 1957 included primary, secondary, and tertiary preventions ( 48 ).

The Concept of Primary, Secondary, and Tertiary Prevention

The stages of prevention target distinct aspects of the illness's natural course; the primary prevention acts at the stage of pre-pathogenesis, that is, when the disease is yet to occur, whereas the secondary and tertiary prevention target the phase after the onset of the disease ( 51 ). Primary prevention includes health promotion and specific protection, while secondary and tertairy preventions include early diagnosis and treatment and measures to decrease disability and rehabilitation, respectively ( 51 ) ( Figure 1 ).

The concept of primary and secondary prevention [adopted from prevention: Primary, Secondary, Tertiary by Bauman et al. ( 51 )].

The primary prevention targets those individuals vulnerable to developing mental disorders and their consequences because of their bio-psycho-social attributes. Therefore, it can be viewed as an intervention to prevent an illness, thereby preventing mental health morbidity and potential social and economic adversities. The preventive strategies under it usually target the general population or individuals at risk. Secondary and tertiary prevention targets those who have already developed the illness, aiming to reduce impairment and morbidity as soon as possible. However, these measures usually occur in a person who has already developed an illness, therefore facing related suffering, hence may not always be successful in curing or managing the illness. Thus, secondary and tertiary prevention measures target the already exposed or diagnosed individuals.

The Concept of Universal, Selective, and Indicated Prevention

The classification of health prevention based on primary/secondary/tertiary prevention is limited in being highly centered on the etiology of the illness; it does not consider the interaction between underlying etiology and risk factors of an illness. Gordon proposed another model of prevention that focuses on the degree of risk an individual is at, and accordingly, the intensity of intervention is determined. He has classified it into universal, selective, and indicated prevention. A universal preventive strategy targets the whole population irrespective of individual risk (e.g., maintaining healthy, psychoactive substance-free lifestyles); selective prevention is targeted to those at a higher risk than the general population (socio-economically disadvantaged population, e.g., migrants, a victim of a disaster, destitute, etc.). The indicated prevention aims at those who have established risk factors and are at a high risk of getting the disease (e.g., family history of psychiatric illness, history of substance use, certain personality types, etc.). Nevertheless, on the other hand, these two classifications (the primary, secondary, and tertiary prevention; and universal, selective, and indicated prevention) have been intended for and are more appropriate for physical illnesses with a clear etiology or risk factors ( 48 ).

In 1994, the Institute of Medicine (IOM) Committee on Prevention of Mental Disorders proposed a new paradigm that classified primary preventive measures for mental illnesses into three categories. These are indicated, selected, and universal preventive interventions (refer Figure 2 ). According to this paradigm, primary prevention was limited to interventions done before the onset of the mental illness ( 48 ). In contrast, secondary and tertiary prevention encompasses treatment and maintenance measures ( Figure 2 ).

The interventions for mental illness as classified by the Institute of Medicine (IOM) Committee on Prevention of Mental Disorders [adopted from Mrazek and Haggerty ( 48 )].

Although the boundaries between prevention and treatment are often more overlapping than being exclusive, the new paradigm can be used to avoid confusion stemming from the common belief that prevention can take place at all parts of mental health management ( 48 ). The onset of mental illnesses can be prevented by risk reduction interventions, which can involve reducing risk factors in an individual and strengthening protective elements in them. It aims to target modifiable factors, both risk, and protective factors, associated with the development of the illness through various general and specific interventions. These interventions can work across the lifespan. The benefits are not restricted to reduction or delay in the onset of illness but also in terms of severity or duration of illness ( 48 ).On the spectrum of mental health interventions, universal preventive interventions are directed at the whole population without identifiable risk factors. The interventions are beneficial for the general population or sub-groups. Prenatal care and childhood vaccination are examples of preventative measures that have benefited both physical and mental health. Selective preventive mental health interventions are directed at people or a subgroup with a significantly higher risk of developing mental disorders than the general population. Risk groups are those who, because of their vulnerabilities, are at higher risk of developing mental illnesses, e.g., infants with low-birth-weight (LBW), vulnerable children with learning difficulties or victims of maltreatment, elderlies, etc. Specific interventions are home visits and new-born day care facilities for LBW infants, preschool programs for all children living in resource-deprived areas, support groups for vulnerable elderlies, etc. Indicated preventive interventions focus on high-risk individuals who have developed minor but observable signs or symptoms of mental disorder or genetic risk factors for mental illness. However, they have not fulfilled the criteria of a diagnosable mental disorder. For instance, the parent-child interaction training program is an indicated prevention strategy that offers support to children whose parents have recognized them as having behavioral difficulties.

The overall objective of mental health promotion and prevention is to reduce the incidence of new cases, additionally delaying the emergence of mental illness. However, promotion and prevention in mental health complement each other rather than being mutually exclusive. Moreover, combining these two within the overall public health framework reduces stigma, increases cost-effectiveness, and provides multiple positive outcomes ( 18 ).

How Prevention in Psychiatry Differs From Other Medical Disorders

Compared to physical illnesses, diagnosing a mental illness is more challenging, particularly when there is still a lack of objective assessment methods, including diagnostic tools and biomarkers. Therefore, the diagnosis of mental disorders is heavily influenced by the assessors' theoretical perspectives and subjectivity. Moreover, mental illnesses can still be considered despite an individual not fulfilling the proper diagnostic criteria led down in classificatory systems, but there is detectable dysfunction. Furthermore, the precise timing of disorder initiation or transition from subclinical to clinical condition is often uncertain and inconclusive ( 48 ). Therefore, prevention strategies are well-delineated and clear in the case of physical disorders while it's still less prevalent in mental health parlance.

Terms, Definitions, and Concepts

The terms mental health, health promotion, and prevention have been differently defined and interpreted. It is further complicated by overlapping boundaries of the concept of promotion and prevention. Some commonly used terms in mental health prevention have been tabulated ( Table 1 ) ( 18 ).

Commonly used terms in mental health prevention.

Mental Health Promotion and Protection

The term “mental health promotion” also has definitional challenges as it signifies different things to different individuals. For some, it means the treatment of mental illness; for others, it means preventing the occurrence of mental illness; while for others, it means increasing the ability to manage frustration, stress, and difficulties by strengthening one's resilience and coping abilities ( 54 ). It involves promoting the value of mental health and improving the coping capacities of individuals rather than amelioration of symptoms and deficits.

Mental health promotion is a broad concept that encompasses the entire population, and it advocates for a strengths-based approach and tries to address the broader determinants of mental health. The objective is to eliminate health inequalities via empowerment, collaboration, and participation. There is mounting evidence that mental health promotion interventions improve mental health, lower the risk of developing mental disorders ( 48 , 55 , 56 ) and have socioeconomic benefits ( 24 ). In addition, it strives to increase an individual's capacity for psychosocial wellbeing and adversity adaptation ( 11 ).

However, the concepts of mental health promotion, protection, and prevention are intrinsically linked and intertwined. Furthermore, most mental diseases result from complex interaction risk and protective factors instead of a definite etiology. Facilitating the development and timely attainment of developmental milestones across an individual's lifespan is critical for positive mental health ( 57 ). Although mental health promotion and prevention are essential aspects of public health with wide-ranging benefits, their feasibility and implementation are marred by financial and resource constraints. The lack of cost-effectiveness studies, particularly from the LMICs, further restricts its full realization ( 47 , 58 , 59 ).

Despite the significance of the topic and a considerable amount of literature on it, a comprehensive review is still lacking that would cover the concept of mental health promotion and prevention and simultaneously discusses various interventions, including the novel techniques delivered across the lifespan, in different settings, and level of prevention. Therefore, this review aims to analyze the existing literature on various mental health promotion and prevention-based interventions and their effectiveness. Furthermore, its attempts to highlight the implications of such intervention in low-resource settings and provides future directions. Such literature would add to the existing literature on mental health promotion and prevention research and provide key insights into the effectiveness of such interventions and their feasibility and replicability in various settings.

Methodology

For the current review, key terms like “mental health promotion,” OR “protection,” OR “prevention,” OR “mitigation” were used to search relevant literature on Google Scholar, PubMed, and Cochrane library databases, considering a time period between 2000 to 2019 ( Supplementary Material 1 ). However, we have restricted our search till 2019 for non-original articles (reviews, commentaries, viewpoints, etc.), assuming that it would also cover most of the original articles published until then. Additionally, we included original papers from the last 5 years (2016–2021) so that they do not get missed out if not covered under any published review. The time restriction of 2019 for non-original articles was applied to exclude papers published during the Coronavirus disease (COVID-19) pandemic as the latter was a significant event, bringing about substantial change and hence, it warranted a different approach to cater to the MH needs of the population, including MH prevention measures. Moreover, the COVID-19 pandemic resulted in the flooding of novel interventions for mental health prevention and promotion, specifically targeting the pandemic and its consequences, which, if included, could have biased the findings of the current review on various MH promotion and prevention interventions.

A time frame of about 20 years was taken to see the effectiveness of various MH promotion and protection interventions as it would take substantial time to be appreciated in real-world situations. Therefore, the current paper has put greater reliance on the review articles published during the last two decades, assuming that it would cover most of the original articles published until then.

The above search yielded 320 records: 225 articles from Google scholar, 59 articles from PubMed, and 36 articles from the Cochrane database flow-diagram of records screening. All the records were title/abstract screened by all the authors to establish the suitability of those records for the current review; a bibliographic- and gray literature search was also performed. In case of any doubts or differences in opinion, it was resolved by mutual discussion. Only those articles directly related to mental health promotion, primary prevention, and related interventions were included in the current review. In contrast, records that discussed any specific conditions/disorders (post-traumatic stress disorders, suicide, depression, etc.), specific intervention (e.g., specific suicide prevention intervention) that too for a particular population (e.g., disaster victims) lack generalizability in terms of mental health promotion or prevention, those not available in the English language, and whose full text was unavailable were excluded. The findings of the review were described narratively.

Interventions for Mental Health Promotion and Prevention and Their Evidence

Various interventions have been designed for mental health promotion and prevention. They are delivered and evaluated across the regions (high-income countries to low-resource settings, including disaster-affiliated regions of the world), settings (community-based, school-based, family-based, or individualized); utilized different psychological constructs and therapies (cognitive behavioral therapy, behavioral interventions, coping skills training, interpersonal therapies, general health education, etc.); and delivered by different professionals/facilitators (school-teachers, mental health professionals or paraprofessionals, peers, etc.). The details of the studies, interventions used, and outcomes have been provided in Supplementary Table 1 . Below we provide the synthesized findings of the available research.

The majority of the available studies were quantitative and experimental. Randomized controlled trials comprised a sizeable proportion of the studies; others were quasi-experimental studies and, a few, qualitative studies. The studies primarily focussed on school students or the younger population, while others were explicitly concerned with the mental health of young females ( 60 ). Newer data is emerging on mental health promotion and prevention interventions for elderlies (e.g., dementia) ( 61 ). The majority of the research had taken a broad approach to mental health promotion ( 62 ). However, some studies have focused on universal prevention ( 63 , 64 ) or selective prevention ( 65 – 68 ). For instance, the Resourceful Adolescent Program (RAPA) was implemented across the schools and has utilized cognitive-behavioral and interpersonal therapies and reported a significant improvement in depressive symptoms. Some of the interventions were directed at enhancing an individual's characteristics like resilience, behavior regulation, and coping skills (ZIPPY's Friends) ( 69 ), while others have focused on the promotion of social and emotional competencies among the school children and attempted to reduce the gap in such competencies across the socio-economic classes (“Up” program) ( 70 ) or utilized expressive abilities of the war-affected children (Writing for Recover (WfR) intervention) ( 71 ) to bring about an improvement in their psychological problems (a type of selective prevention) ( 62 ) or harnessing the potential of Art, in the community-based intervention, to improve self-efficacy, thus preventing mental disorders (MAD about Art program) ( 72 ). Yet, others have focused on strengthening family ( 60 , 73 ), community relationships ( 62 ), and targeting modifiable risk factors across the life course to prevent dementia among the elderlies and also to support the carers of such patients ( 61 ).

Furthermore, more of the studies were conducted and evaluated in the developed parts of the world, while emerging economies, as anticipated, far lagged in such interventions or related research. The interventions that are specifically adapted for local resources, such as school-based programs involving paraprofessionals and teachers in the delivery of mental health interventions, were shown to be more effective ( 62 , 74 ). Likewise, tailored approaches for low-resource settings such as LMICs may also be more effective ( 63 ). Some of these studies also highlight the beneficial role of a multi-dimensional approach ( 68 , 75 ) and interventions targeting early lifespan ( 76 , 77 ).

Newer Insights: How to Harness Digital Technology and Novel Methods of MH Promotion and Protection

With the advent of digital technology and simultaneous traction on mental health promotion and prevention interventions, preventive psychiatrists and public health experts have developed novel techniques to deliver mental health promotive and preventive interventions. These encompass different settings (e.g., school, home, workplace, the community at large, etc.) and levels of prevention (universal, selective, indicated) ( 78 – 80 ).

The advanced technologies and novel interventions have broadened the scope of MH promotion and prevention, such as addressing the mental health issues of individuals with chronic medical illness ( 81 , 82 ), severe mental disorders ( 83 ), children and adolescents with mental health problems, and geriatric population ( 78 ). Further, it has increased the accessibility and acceptability of such interventions in a non-stigmatizing and tailored manner. Moreover, they can be integrated into the routine life of the individuals.

For instance, Internet-and Mobile-based interventions (IMIs) have been utilized to monitor health behavior as a form of MH prevention and a stand-alone self-help intervention. Moreover, the blended approach has expanded the scope of MH promotive and preventive interventions such as face-to-face interventions coupled with remote therapies. Simultaneously, it has given way to the stepped-care (step down or step-up care) approach of treatment and its continuation ( 79 ). Also, being more interactive and engaging is particularly useful for the youth.

The blended model of care has utilized IMIs to a varying degree and at various stages of the psychological interventions. This includes IMIs as a supplementary approach to the face-to-face-interventions (FTFI), FTFI augmented by behavior intervention technologies (BITs), BITs augmented by remote human support, and fully automated BITs ( 84 ).

The stepped care model of mental health promotion and prevention strategies includes a stepped-up approach, wherein BITs are utilized to manage the prodromal symptoms, thereby preventing the onset of the full-blown episode. In the Stepped-down approach, the more intensive treatments (in-patient or out-patient based interventions) are followed and supplemented with the BITs to prevent relapse of the mental illness, such as for previously admitted patients with depression or substance use disorders ( 85 , 86 ).

Similarly, the latest research has developed newer interventions for strengthening the psychological resilience of the public or at-risk individuals, which can be delivered at the level of the home, such as, e.g., nurse family partnership program (to provide support to the young and vulnerable mothers and prevent childhood maltreatment) ( 87 ); family healing together program aimed at improving the mental health of the family members living with persons with mental illness (PwMI) ( 88 ). In addition, various novel interventions for MH promotion and prevention have been highlighted in the Table 2 .

Depiction of various novel mental health promotion and prevention strategies.

a/w, associated with; A-V, audio-visual; b/w, between; CBT, Cognitive Behavioral Therapy; CES-Dep., Center for Epidemiologic Studies-Depression scale; CG, control group; FU, follow-up; GAD, generalized anxiety disorders-7; IA, intervention arm; HCWs, Health Care Workers; LMIC, low and middle-income countries; MDD, major depressive disorders; mgt, management; MH, mental health; MHP, mental health professional; MINI, mini neuropsychiatric interview; NNT, number needed to treat; PHQ-9, patient health questionnaire; TAU, treatment as usual .

Furthermore, school/educational institutes-based interventions such as school-Mental Health Magazines to increase mental health literacy among the teachers and students have been developed ( 80 ). In addition, workplace mental health promotional activities have targeted the administrators, e.g., guided “e-learning” for the managers that have shown to decrease the mental health problems of the employees ( 102 ).

Likewise, digital technologies have also been harnessed in strengthening community mental health promotive/preventive services, such as the mental health first aid (MHFA) Books on Prescription initiative in New Zealand provided information and self-help tools through library networks and trained book “prescribers,” particularly in rural and remote areas ( 103 ).

Apart from the common mental disorders such as depression, anxiety, and behavioral disorders in the childhood/adolescents, novel interventions have been utilized to prevent the development of or management of medical, including preventing premature mortality and psychological issues among the individuals with severe mental illnesses (SMIs), e.g., Lets' talk about tobacco-web based intervention and motivational interviewing to prevent tobacco use, weight reduction measures, and promotion of healthy lifestyles (exercise, sleep, and balanced diets) through individualized devices, thereby reducing the risk of cardiovascular disorders ( 83 ). Similarly, efforts have been made to improve such individuals' coping skills and employment chances through the WorkingWell mobile application in the US ( 104 ).

Apart from the digital-based interventions, newer, non-digital-based interventions have also been utilized to promote mental health and prevent mental disorders among individuals with chronic medical conditions. One such approach in adventure therapy aims to support and strengthen the multi-dimensional aspects of self. It includes the physical, emotional or cognitive, social, spiritual, psychological, or developmental rehabilitation of the children and adolescents with cancer. Moreover, it is delivered in the natural environment outside the hospital premises, shifting the focus from the illness model to the wellness model ( 81 ). Another strength of this intervention is it can be delivered by the nurses and facilitate peer support and teamwork.

Another novel approach to MH prevention is gut-microbiota and dietary interventions. Such interventions have been explored with promising results for the early developmental disorders (Attention deficit hyperactive disorder, Autism spectrum disorders, etc.) ( 105 ). It works under the framework of the shared vulnerability model for common mental disorders and other non-communicable diseases and harnesses the neuroplasticity potential of the developing brain. Dietary and lifestyle modifications have been recommended for major depressive disorders by the Clinical Practice Guidelines in Australia ( 106 ). As most childhood mental and physical disorders are determined at the level of the in-utero and early after the birth period, targeting maternal nutrition is another vital strategy. The utility has been expanded from maternal nutrition to women of childbearing age. The various novel mental health promotion and prevention strategies are shown in Table 2 .

Newer research is emerging that has utilized the digital platform for training non-specialists in diagnosis and managing individuals with mental health problems, such as Atmiyata Intervention and The SMART MH Project in India, and The Allillanchu Project in Peru, to name a few ( 99 ). Such frameworks facilitate task-sharing by the non-specialist and help in reducing the treatment gap in these countries. Likewise, digital algorithms or decision support systems have been developed to make mental health services more transparent, personalized, outcome-driven, collaborative, and integrative; one such example is DocuMental, a clinical decision support system (DSS). Similarly, frameworks like i-PROACH, a cloud-based intelligent platform for research outcome assessment and care in mental health, have expanded the scope of the mental health support system, including promoting research in mental health ( 100 ). In addition, COVID-19 pandemic has resulted in wider dissemination of the applications based on the evidence-based psycho-social interventions such as National Health Service's (NHS's) Mind app and Headspace (teaching meditation via a website or a phone application) that have utilized mindfulness-based practices to address the psychological problems of the population ( 101 ).

Challenges in Implementing Novel MH Promotion and Prevention Strategies

Although novel interventions, particularly internet and mobile-based interventions (IMIs), are effective models for MH promotion and prevention, their cost-effectiveness requires further exploration. Moreover, their feasibility and acceptability in LMICs could be challenging. Some of these could be attributed to poor digital literacy, digital/network-related limitations, privacy issues, and society's preparedness to implement these interventions.

These interventions need to be customized and adapted according to local needs and context, for which implementation and evaluative research are warranted. In addition, the infusion of more human and financial resources for such activities is required. Some reports highlight that many of these interventions do not align with the preferences and use the pattern of the service utilizers. For instance, one explorative research on mental health app-based interventions targeting youth found that despite the burgeoning applications, they are not aligned with the youth's media preferences and learning patterns. They are less interactive, have fewer audio-visual displays, are not youth-specific, are less dynamic, and are a single touch app ( 107 ).

Furthermore, such novel interventions usually come with high costs. In low-resource settings where service utilizers have limited finances, their willingness to use such services may be doubtful. Moreover, insurance companies, including those in high-income countries (HICs), may not be willing to fund such novel interventions, which restricts the accessibility and availability of interventions.

Research points to the feasibility and effectiveness of incorporating such novel interventions in routine services such as school, community, primary care, or settings, e.g., in low-resource settings, the resource persons like teachers, community health workers, and primary care physicians are already overburdened. Therefore, their willingness to take up additional tasks may raise skepticism. Moreover, the attitudinal barrier to moving from the traditional service delivery model to the novel methods may also impede.

Considering the low MH budget and less priority on the MH prevention and promotion activities in most low-resource settings, the uptake of such interventions in the public health framework may be lesser despite the latter's proven high cost-effectiveness. In contrast, policymakers may be more inclined to invest in the therapeutic aspects of MH.

Such interventions open avenues for personalized and precision medicine/health care vs. the traditional model of MH promotion and preventive interventions ( 108 , 109 ). For instance, multivariate prediction algorithms with methods of machine learning and incorporating biological research, such as genetics, may help in devising tailored, particularly for selected and indicated prevention, interventions for depression, suicide, relapse prevention, etc. ( 79 ). Therefore, more research in this area is warranted.

To be more clinically relevant, greater biological research in MH prevention is required to identify those at higher risk of developing given mental disorders due to the existing risk factors/prominent stress ( 110 ). For instance, researchers have utilized the transcriptional approach to identify a biological fingerprint for susceptibility (denoting abnormal early stress response) to develop post-traumatic stress disorders among the psychological trauma survivors by analyzing the expression of the Peripheral blood mononuclear cell gene expression profiles ( 111 ). Identifying such biological markers would help target at-risk individuals through tailored and intensive interventions as a form of selected prevention.

Similarly, such novel interventions can help in targeting the underlying risk such as substance use, poor stress management, family history, personality traits, etc. and protective factors, e.g., positive coping techniques, social support, resilience, etc., that influences the given MH outcome ( 79 ). Therefore, again, it opens the scope of tailored interventions rather than a one-size-fits-all model of selective and indicated prevention for various MH conditions.

Furthermore, such interventions can be more accessible for the hard-to-reach populations and those with significant mental health stigma. Finally, they play a huge role in ensuring the continuity of care, particularly when community-based MH services are either limited or not available. For instance, IMIs can maintain the improvement of symptoms among individuals previously managed in-patient, such as for suicide, SUDs, etc., or receive intensive treatment like cognitive behavior therapy (CBT) for depression or anxiety, thereby helping relapse prevention ( 86 , 112 ). Hence, such modules need to be developed and tested in low-resource settings.

IMIs (and other novel interventions) being less stigmatizing and easily accessible, provide a platform to engage individuals with chronic medical problems, e.g., epilepsy, cancer, cardiovascular diseases, etc., and non-mental health professionals, thereby making it more relevant and appealing for them.

Lastly, research on prevention-interventions needs to be more robust to adjust for the pre-intervention matching, high attrition rate, studying the characteristics of treatment completers vs. dropouts, and utilizing the intention-to-treat analysis to gauge the effect of such novel interventions ( 78 ).

Recommendations for Low-and-Middle-Income Countries

Although there is growing research on the effectiveness and utility of mental health promotion/prevention interventions across the lifespan and settings, low-resource settings suffer from specific limitations that restrict the full realization of such public health strategies, including implementing the novel intervention. To overcome these challenges, some of the potential solutions/recommendations are as follows:

• The mental health literacy of the population should be enhanced through information, education, and communication (IEC) activities. In addition, these activities should reduce stigma related to mental problems, early identification, and help-seeking for mental health-related issues.
• Involving teachers, workplace managers, community leaders, non-mental health professionals, and allied health staff in mental health promotion and prevention is crucial.
• Mental health concepts and related promotion and prevention should be incorporated into the education curriculum, particularly at the medical undergraduate level.
• Training non-specialists such as community health workers on mental health-related issues across an individual's life course and intervening would be an effective strategy.
• Collaborating with specialists from other disciplines, including complementary and alternative medicines, would be crucial. A provision of an integrated health system would help in increasing awareness, early identification, and prompt intervention for at-risk individuals.
• Low-resource settings need to develop mental health promotion interventions such as community-and school-based interventions, as these would be more culturally relevant, acceptable, and scalable.
• Utilizing a digital platform for scaling mental health services (e.g., telepsychiatry services to at-risk populations) and training the key individuals in the community would be a cost-effective framework that must be explored.
• Infusion of higher financial and human resources in this area would be a critical step, as, without adequate resources, research, service development, and implementation would be challenging.
• It would also be helpful to identify vulnerable populations and intervene in them to prevent the development of clinical psychiatric disorders.
• Lastly, involving individuals with lived experiences at the level of mental health planning, intervention development, and delivery would be cost-effective.

Clinicians, researchers, public health experts, and policymakers have increasingly realized mental health promotion and prevention. Investment in Preventive psychiatry appears to be essential considering the substantial burden of mental and neurological disorders and the significant treatment gap. Literature suggests that MH promotive and preventive interventions are feasible and effective across the lifespan and settings. Moreover, various novel interventions (e.g., internet-and mobile-based interventions, new therapies) have been developed worldwide and proven effective for mental health promotion and prevention; such interventions are limited mainly to HICs.

Despite the significance of preventive psychiatry in the current world and having a wide-ranging implication for the wellbeing of society and individuals, including those suffering from chronic medical problems, it is a poorly utilized public health field to address the population's mental health needs. Lately, researchers and policymakers have realized the untapped potentialities of preventive psychiatry. However, its implementation in low-resource settings is still in infancy and marred by several challenges. The utilization of novel interventions, such as digital-based interventions, and blended and stepped-care models of care, can address the enormous mental health need of the population. Additionally, it provides mental health services in a less-stigmatizing and easily accessible, and flexible manner. More research concerning this is required from the LMICs.

Author Contributions

VS, AK, and SG: methodology, literature search, manuscript preparation, and manuscript review. All authors contributed to the article and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.898009/full#supplementary-material

Essay on Mental Health

Students are often asked to write an essay on Mental Health in their schools and colleges. And if you’re also looking for the same, we have created 100-word, 250-word, and 500-word essays on the topic.

Let’s take a look…

100 Words Essay on Mental Health

Understanding mental health.

Mental health is as important as physical health. It refers to our emotional, psychological, and social well-being. It affects how we think, feel, and act.

The Importance of Mental Health

Good mental health allows us to handle stress, make choices, and relate to others. It’s crucial at every stage of life, from childhood to adulthood.

Factors Affecting Mental Health

Many factors can impact mental health, including biological factors, life experiences, and family history of mental health issues.

Mental Health and Stigma

Unfortunately, there’s a stigma around mental health. People with mental health problems are often misunderstood and judged.

Mental Health Care

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250 Words Essay on Mental Health

Introduction.

Mental health, an often overlooked aspect of overall well-being, is as significant as physical health. It encompasses our emotional, psychological, and social well-being, affecting how we think, feel, and act.

Mental health is integral to living a balanced, fulfilling life. It influences our ability to cope with stress, relate to others, and make decisions. In the college years, mental health is especially crucial as students deal with academic pressure, social changes, and the transition into adulthood.

Challenges to Mental Health in College

College students face unique mental health challenges. The pressure to perform academically, social anxiety, and the struggle to fit into new environments can all contribute to mental health issues. These can manifest as depression, anxiety disorders, eating disorders, and more.

The Role of Society and Institutions

Society and institutions play a substantial role in promoting mental health. By creating an environment that acknowledges mental health issues and provides support, we can help mitigate these challenges. Colleges should provide mental health resources and encourage students to seek help when needed.

500 Words Essay on Mental Health

Mental health, a critical aspect of overall wellbeing, is often overlooked in the hustle and bustle of modern life. It’s a broad term encompassing our emotional, psychological, and social well-being. It affects how we think, feel, and act, influencing our handling of stress, relationships, and decisions.

Mental health is as vital as physical health. It contributes to our cognitive functions, behavioral patterns, and emotional stability. Good mental health enhances our productivity, effectiveness, and ability to contribute to our community. Conversely, poor mental health can lead to severe complications like depression, anxiety, and even suicide.

Stigma and Mental Health

Stigma is a significant barrier to mental health care. It can lead to discrimination and misunderstanding, discouraging individuals from seeking help. Education is crucial to dispel myths and stereotypes, fostering a more supportive and understanding society.

Mental Health in College Students

College students are particularly vulnerable to mental health issues. They face unique challenges such as academic pressure, social struggles, and the stress of transitioning into adulthood. Colleges should prioritize mental health services, providing resources and support to students in need.

The Role of Therapy

Mental health and technology.

Technology has revolutionized mental health care. Digital platforms provide access to therapy and self-help tools, making mental health resources more accessible. However, the overuse of technology can negatively impact mental health, highlighting the need for balance.

In conclusion, mental health is an integral part of our lives. It’s crucial to understand its importance, recognize the factors that affect it, and work towards reducing stigma. As society becomes more aware of mental health, we can hope for a future where mental health care is as mainstream and accepted as physical health care.

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A History of Child and Adolescent Psychiatry in the United States

The American Academy of Child & Adolescent Psychiatry will hold its 50th anniversary meeting in October, but the field can trace its U.S. origins to Chicago in 1899. Learn how the specialty has developed over the years in this historical essay.

Next month in Miami, the American Academy of Child and Adolescent Psychiatry will hold its 50th anniversary meeting. In recognition of this event, the following is a brief history of the organization and of this subspecialty (Schowalter, 2000, 1994).

Most historians of child psychiatry date its beginning in this country to 1899, when Illinois established the nation's first juvenile court in Chicago. This occurrence set forth the following sequence of events. A group of influential, socially concerned women on the board of directors of Jane Addam's Hull House was shocked by juvenile delinquency. They wanted to understand its origin, prevention and treatment. These women were approximately 90 years ahead of the Centers for Disease Control and Prevention's decision to accept violence as a public health problem. In 1909, these foresighted women created the Juvenile Psychopathic Institute and hired a neurologist, William Healy, M.D., to be its first director. Although a neurologist interested in studying the delinquents' brain functioning and IQ, the perspective of the settlement house's board of directors made sure that attention also was paid to the delinquents' social factors, attitudes and motivations. To accomplish these broad evaluations and treatment strategies, Healy formed teams composed of a neuropsychiatrist, a psychologist and a social worker. This approach became the template used by most child guidance clinics for most of the 20th century. Child psychiatry's roots became implanted in the community, rather than in medical schools, and colleagues were more likely to be teachers, judges, social workers and social scientists, rather than physicians.

Child guidance clinics blossomed in essentially all U.S. cities during the next two generations. The influence of European child psychoanalysts such as Hermine Hug-Hellmuth, Anna Freud and Melanie Klein became pervasive in this country. In the 1920s, Americans went abroad to study, and during the 1930s and 1940s, many psychoanalytically minded clinicians immigrated to the United States to escape religious persecution. Many, if not most, of these clinicians were women.

At the edges of the dominant psychodynamic and psychosocial viewpoints were organic psychiatry and behaviorism. Organic, or biologic, psychiatry was widely considered a failed pathway espoused by forgotten old men near retirement age. Behaviorism became popular in academic psychology, with John Watson and B.F. Skinner being articulate advocates. However, translations of strict academic behavioral paradigms to clinical use mainly failed. The majority of clinicians believed the behaviorists were so narrow and dogmatic that the "whole child" was lost. Anna Freud's The Ego and the Mechanisms of Defense , first published in German in 1936 and in English in 1946, and the first edition of Child Psychiatry by Leo Kanner, M.D., in 1935 were very influential. Kanner took the name from the German term Kinderpsychiatrie .

While it might seem curious, World War II helped child psychiatry in a number of ways. Because of the huge military draft, background histories were available for hundreds of thousands of late adolescents and young adults with varied backgrounds and socioeconomic levels--rich, poor, white, African-American, educated, uneducated, urbanite and farmer. By the end of the war, it was obvious that soldiers who had behavior problems as children were much more likely to be prematurely discharged, disciplined, wounded or killed. It was a statistic that could not be ignored.

On July 3, 1946, President Harry Truman declared war on mental illness when he signed the National Mental Health Act. Three years later, the National Institute of Mental Health was born. Prevention was an important goal and the quality of mothering was considered key. Women's magazines cropped up like mushrooms. If mothers failed, professionals were needed to be available to intervene. A cadre of experts was building. Increasing numbers of trained psychiatrists spilled over into a greater number of child psychiatrists. At the same time, many pediatricians found that the new antibiotics made their specialty consist largely of well child care. Some found this boring. Federal training funding became available to convert pediatricians into pediatric psychiatrists.

The American Academy of Child Psychiatry was founded in 1953. It was preceded by two organizations interested in children's mental health. One such organization, the American Orthopsychiatric Association (AOA), was formed in 1924. It was multidisciplinary, and its main focus was prevention. Politically, members often leaned to the left and tended to view diagnoses as hurtful labels. In 1948, 54 child guidance clinics created an organization of clinics. The foci of this group, the American Association of Psychiatric Clinics for Children (AAPCC), were to develop standards for clinical care and for training. Before child psychiatry residencies, the gold standard credential for child psychiatry was an AAPCC certificate of training.

The movement toward subspecialization picked up speed in 1943 when the American Psychiatric Association converted its section on Mental Deficiency to the Section on Child Psychiatry. Six years later, the Section was elevated in status to the Standing Committee on Child Psychiatry. In 1947, the Group for the Advancement of Psychiatry appointed a Committee on Child Psychiatry. In 1951, the presidents of AAPCC and AOA--George Gardner, M.D., and James Cunningham, M.D.--called together 17 psychiatrists who worked with children to discuss the formation of a separate organization for child psychiatrists. The following year, 96 psychiatrists met in Atlantic City, N.J. They agreed to form the American Academy of Child Psychiatry (AACP) and have membership by invitation only. There were 107 charter members. Subsequent members were required to have three member sponsors and American Board of Psychiatry and Neurology (ABPN) certification. Members applying were also required to have made an "outstanding contribution to the field of child psychiatry," as reflected by unanimous approval by the AACP Council and a two-thirds majority of the members. (The requirements have changed; for more information, please visit <www.aacap.org/membership/joinaacap.htm>.)

In 1948, Frederick Allen, M.D., proposed that child psychiatry be recognized by the ABPN; however, nothing came of his proposal. Although some child psychiatrists favored an autonomous specialty, similar to pediatrics' break from internal medicine, this did not seem feasible. There was some debate as to whether the new specialty would be pediatric psychiatry or child psychiatry, but a vote by AAPCC clinic directors overwhelming favored a link to psychiatry rather than to pediatrics.

In 1958, six child psychiatrists met with the ABPN's president and secretary to discuss the possible particulars for a new psychiatric discipline. There was agreement on a two-year child psychiatry residency, with the option to replace the third year of general psychiatry residency with the first year of child psychiatry training. The subspecialty was approved in February 1959. As a result, a six-person ABPN Committee on Certification in Child Psychiatry was formed. The American Board of Pediatrics (ABP), through the American Board of Medical Specialties, demanded that there always be an ABP non-voting observer on the committee to ensure that the ABPN treated child psychiatry right, and an ABP observer remains today. About 160 clinicians were grandfathered into the subspecialty.

The first certifying exam was in the form of essay questions. The committee found them impossible to grade, so it announced there would be a follow-up oral examination. There are those today who are still hot with anger about first missing the cut to be grandfathered, then taking the essay exam, and then being forced to take a not previously announced oral exam. Nonetheless, in April 1960, 101 candidates passed the first child psychiatry boards. Also in 1960, the Accreditation Council for Graduate Medical Education's Residency Review Committee (RRC) in Psychiatry approved 11 child psychiatry residency programs. The stipulation that child psychiatry residencies must be linked to psychiatry residencies and that these must be linked to medical centers was an occurrence of extreme importance. It forced child psychiatry, sometimes kicking and screaming, from community child guidance centers to hospitals and medical schools. In my opinion, this saved child psychiatry from being marginalized. If it had not been pulled into medicine, it would have been replaced by a new iteration born in medicine.

During the 1960s, the AACP struggled with its identity. The Journal of the American Academy of Child Psychiatry was launched in 1962, granting the field its own publication. However, as more and more clinicians were trained and certified, they wanted to have an organization of their own. Regional organizations formed, and there was the beginning of a push for an open, not invitation-only, national association. The AACP, after much debate and a 176-11 vote, opened its organization in 1969 to include members on the basis of their practice and training in child psychiatry (Bemman, 1970). That year, its membership tripled from 218 to 688.

Although leadership of the American Psychiatric Association was ambivalent about this somewhat unexpected "child," in 1969, then Medical Director Walter Barton, M.D., offered rental space in the APA building, and eight file drawers of records were moved in. In 1973, Virginia Anthony was hired and she remains the academy's executive director. In 1983, the academy published Child Psychiatry: A Plan for the Coming Decades . It was the summary of five years' work by 100 consultants to, and members of, six task forces. These were not only child psychiatrists, but also included nationally known general psychiatrists; pediatricians; deans; professors of epidemiology, nursing, psychology and law; leaders of the NIMH; and various child advocates. Recommendations were made for man power, clinical service delivery and training; the most important recommendation, however, was the challenge to develop research strategies that would allow data-based understanding and treatment of the mental illnesses of children. While child psychiatry had long gathered anecdotal data, particularly about social and psychodynamic influences, it was 10 years behind general psychiatry in biological and epidemiological research. Indeed, this document changed the field.

In the past 20 years, there has been a steady increase in residents who choose child psychiatry, and academy membership now numbers almost 7,000. In 1986, the academy voted to expand its name to the American Academy of Child and Adolescent Psychiatry and within a few years, this expansion was approved by the ABPN and the Psychiatry RRC.

Besides its journal, the AACAP has published books, both for professionals and the laity, approximately 50 policy statements and over 200 "Facts for Families." The latter are available to families and are printed in English, French, Spanish, German, Polish and Icelandic. The AACAP collaborates closely with the APA, the American Academy of Pediatrics and other organizations in regard to clinical, policy and research issues. During the past decade, the academy was awarded funding from both the NIMH and the National Institute on Drug Abuse to oversee five-year K-12 training grants for young investigators in child and adolescent psychiatry.

During the past 50 years, evolving interest in and understanding of developmental psychopathology have shown how intertwined developmental stages are for patients' diagnosis and treatment. In the decades to come, genetics, neuroimaging and other new techniques will not only affect our work with children, but also determine the type and number of professional organizations that will be needed to treat children and adolescents with mental illnesses.

References:

AACP (1983), Child Psychiatry: A Plan for the Coming Decades. Washington, D.C.: American Academy of Child Psychiatry.

Bemman S (1970), Epilogue and a new beginning. J Am Acad Child Psychiatry 9(2):193-201.

Freud A (1946), The Ego and the Mechanisms of Defense. New York: International Universities Press Inc.

Kanner L (1935), Child Psychiatry. Springfield, Ill.: C. C. Thomas.

Schowalter JE (1994), The History of Child and Adolescent Psychiatry. In: Psychiatry, vol. 2, Michels R, Cooper A, Guze S et al., eds. Philadelphia: JB Lippincott, pp1-13.

Schowalter JE (2000), Child and Adolescent Psychiatry Comes of Age. In: American Psychiatry After World War II (1944-1994), Menninger R, Nemiah J, eds. Washington, D.C.: American Psychiatric Press, pp461-480.

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