The unmet promise of prevention and early intervention

The June 2009 Time Magazine article by John Cloud entitled Staying Sane Maybe be Easier than You think may mislead some people into thinking that the prevention of severe and persistent mental illness is much simpler than it really is and inadvertently lead to the blaming of consumers and their families.

Reducing expressed emotion, the premptive use low dose anti-psychotics, family psychoeducation and teaching illness management and cognitive coping strategies are all important aspects of a comprehensive national approach to mental illness. But funding for prevention has always been problematic. It is difficult enough to get payment for treating well established cases.

Because of the importance of genetic factors Cloud also says that “we need to ensure that close relatives (particularly children) of those with mental disorders have access to rigorous screening programs” He doesn’t elaborate, but I assume this is to help identify those people at risk and perhaps in need of early intervention. I was somewhat surprised that the issue of older parents, especially older fathers, wasn’t addressed since it is such as major risk factor for many disorders.

Historically prevention has also had its dark side. Any talk of preventing disorders with a significant genetic component should give us pause, as we are reminded of American’s unhappy history with the compulsory sterilization of mental patients. My own state of Indiana became the first state to enact sterilization legislation in 1907. The Nazi regime forcibly sterilized well over 400,000 people whom they viewed as mentally and physically well into the 1940’s and killed tens of thousands more through compulsory euthanasia. While hopefully such gross violations of human rights are well behind us, growing access to individual genetic information has other risks for discrimination, stigma, and abuse.

The article does give voice to the concern that prevention programs may inappropriately "profile" some young people who are ‘merely persnickety or shy or eccentric” and be used as a form of social control to reduce diversity which is has been redefined as deviancy.

According to Cloud, it is estimated that the economic cost of mental disorders just among Americans under 25 was $247 billion in 2007. The importance and effectiveness of early intervention and prevention programs is well established and I think we would all welcome the resources to more effectively implement many of these approaches.