Dimensions of State Mental Health Policy

By Christopher G. Hudson; Arthur J. Cox | Go to book overview

11
Secondary Prevention: Clinical Treatment Joseph A. Walsh

WHAT IS SECONDARY PREVENTION?

Since its inception as a term proposed by Gerald Caplan ( 1964), who applied public health models to mental health concerns, secondary prevention has become familiar to all who track models of mental health service. Like many cryptic terms, secondary prevention conveys little but implies much. Secondary prevention is the provision of direct biopsychosocial services to people, patients, or significant others, affected by diagnosable mental conditions where some measurable degree of pathology containment or reversal is achieved. It will be used here to refer to the clinical mainstream of care for those who are affected by major mental distress or disability.

In contrast to primary prevention, secondary prevention signals that something -- a malady, upset, trauma -- has occurred already and is in need of attention. In contrast to tertiary prevention (cf. rehabilitation), secondary efforts convey the hope that containment, remediation, and cure are possible outcomes. What is prevented, then, is continuing disabilities that are expected to result from a mental disorder if effective intervention does not occur.

The thrust of this chapter is to consider stress and disability in light of criteria set forth in the current diagnostic and statistical manual -- DSM-III-R ( 1987). A key criterion of successful intervention with stressful or disabling conditions is whether containment or reversal of such problems has occurred. Obviously, then, there is distinction between the effort to provide secondary prevention and achieving such an objective.

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