PREVENTION IN MENTAL PREVENTION IN MENTAL HEALTHHEALTH

PRESENTERPRESENTER

ROBERT K. CONYNE, Ph.D.ROBERT K. CONYNE, Ph.D.

PROFESSOR EMERITUSPROFESSOR EMERITUS

COUNSELING COUNSELING PSYCHOLOGISTPSYCHOLOGIST

UNIVERSITY OF CINCINNATIUNIVERSITY OF CINCINNATI

LEARNING OBJECTIVESLEARNING OBJECTIVES

TO UNDERSTAND MENTAL TO UNDERSTAND MENTAL HEALTH PREVENTION HEALTH PREVENTION CONCEPTS CONCEPTS

TO DIFFERENTIATE TO DIFFERENTIATE KNOWLEDGE AND SKILLSKNOWLEDGE AND SKILLS

TO LEARN A MODEL FOR TO LEARN A MODEL FOR PREVENTIONPREVENTION

PERFORMANCE PERFORMANCE OBJECTIVESOBJECTIVES

DESCRIBE KNOWLEDGE DESCRIBE KNOWLEDGE AND SKILLS NEEDEDAND SKILLS NEEDED

KNOW WHAT TO INCLUDE KNOW WHAT TO INCLUDE IN PROGRAMSIN PROGRAMS

IDENTIFY EFEECTIVE IDENTIFY EFEECTIVE PREVENTION PROGRAMSPREVENTION PROGRAMS

Epidemiology: MentalEpidemiology: Mental IllnessIllness

AdultsAdults: (under 55): (under 55)20% of U.S. adults per year 20% of U.S. adults per year (44 million)(44 million)

Children/AdolescentsChildren/Adolescents20% of 9-17 years old per 20% of 9-17 years old per year year (U.S. Surgeon General)(U.S. Surgeon General)

SUBSTANCE ABUSESUBSTANCE ABUSE 1962: 4 MILLION TRIED 1962: 4 MILLION TRIED

ILLEGAL DRUGSILLEGAL DRUGS 1999: 87.7 MILLION…1999: 87.7 MILLION… USERS OVER AGE 12USERS OVER AGE 12::

-1979: 25.4 MILLION-1979: 25.4 MILLION

-1992: 12 MILLION-1992: 12 MILLION

-1999: 14.8 MILLION-1999: 14.8 MILLION

LITERACYLITERACY

20 MILLION ILLITERATE 20 MILLION ILLITERATE ADULTS (13%)ADULTS (13%)

20 MILLION MARGINALLY 20 MILLION MARGINALLY LITERATELITERATE

---------------------------------------------- 4 MILLION OF THESE PEOPLE 4 MILLION OF THESE PEOPLE

ARE REACHEDARE REACHED

COST OF MENTAL ILLNESSCOST OF MENTAL ILLNESS

19961996::

--DIRECT COST: DIRECT COST: $69 BILLION.$69 BILLION.

--INDIRECT COST: INDIRECT COST: $78.6 $78.6 BILLIONBILLION

(Surgeon General)(Surgeon General)

ONE POPULATION: AFRICAN ONE POPULATION: AFRICAN AMERICANSAMERICANS

POVERTY: 1999, 22%POVERTY: 1999, 22% HOMELESS: 40% OF HOMELESS HOMELESS: 40% OF HOMELESS

POPULATIONPOPULATION INCARCERATION: HALF OF INCARCERATION: HALF OF

ALL STATE & NATIONAL ALL STATE & NATIONAL PRISONERSPRISONERS

AFRICAN-AMERICANS AFRICAN-AMERICANS (CONTD)(CONTD)

ACCESS: 20% FEWER ARE ACCESS: 20% FEWER ARE COVERED BY EMPLOYER-COVERED BY EMPLOYER-BASED HEALTH INS.BASED HEALTH INS.

USE: ONLY ONE-HALF USE: ONLY ONE-HALF THAT OF WHITES; THAT OF WHITES; EMERGENCY USE HIGHEMERGENCY USE HIGH

INCIDENCEINCIDENCE

TO REDUCE DEVELOPMENT TO REDUCE DEVELOPMENT OR RATE OF DEVELOPMENT OR RATE OF DEVELOPMENT OF:OF:

NEW CASES OF A DISORDER NEW CASES OF A DISORDER OR PROBLEMOR PROBLEM

TO REDUCE INCIDENCETO REDUCE INCIDENCE

DECREASEDECREASE::STRESS + EXPLOITATIONSTRESS + EXPLOITATION

INCREASE:INCREASE:COPING SKILLS +SELF-COPING SKILLS +SELF-

ESTEEM+ESTEEM+SUPPORTSUPPORT

(Albee, modified, 1982)(Albee, modified, 1982)

PRIMARY PREVENTIONPRIMARY PREVENTION Intentional interventionIntentional intervention To reduce incidence ofTo reduce incidence of Adjustment problems inAdjustment problems in Currently normal populations, plusCurrently normal populations, plus Promotion of mental health Promotion of mental health

functioning (functioning (Durlak & Wells, 1997)Durlak & Wells, 1997)

DEGREE OF RISK DEGREE OF RISK (Institute of Medicine, 1994)(Institute of Medicine, 1994)

UniversalUniversal: for all: for all SelectiveSelective: Based on risk markers: Based on risk markers IndicatedIndicated: Based on specific risk: Based on specific risk

indicators and showing early signs, indicators and showing early signs, but no mental disorderbut no mental disorder

WHY PRIMARY WHY PRIMARY PREVENTION?PREVENTION?

TOO MANY PROBLEMS/NOT TOO MANY PROBLEMS/NOT ENOUGH HELPERSENOUGH HELPERS

TOO MUCH AFTER-THE-FACTTOO MUCH AFTER-THE-FACT LIMITED REACHLIMITED REACH DE-CONTEXTUALIZEDDE-CONTEXTUALIZED STRESSORS/STRENGTHS STRESSORS/STRENGTHS

IGNOREDIGNORED

PRIMARY PREVENTIVE PRIMARY PREVENTIVE COUNSELING (COUNSELING (Conyne, 2004)Conyne, 2004)

APPLICATION OF BROAD APPLICATION OF BROAD RANGE OF COUNSELINGRANGE OF COUNSELING

HEALTHY AND/OR AT RISK HEALTHY AND/OR AT RISK TARGETSTARGETS

TO AVERT FUTURE PROBLEMS TO AVERT FUTURE PROBLEMS ANDAND

TO PROMOTE GROWTHTO PROMOTE GROWTH

PREVENTIVE COUNSELING PREVENTIVE COUNSELING PRECEPTSPRECEPTS

BEFORE-THE-FACTBEFORE-THE-FACT HEATHY PEOPLE/AT RISKHEATHY PEOPLE/AT RISK DEVELOP COMPETENCEDEVELOP COMPETENCE REDUCE INCIDENCEREDUCE INCIDENCE GROUP AND COMMUNITY GROUP AND COMMUNITY

FOCUSEDFOCUSED

PRECEPTS (Cont’d)PRECEPTS (Cont’d)

ECOLOGICAL FOCUSECOLOGICAL FOCUS CULTURALLY VALIDCULTURALLY VALID SOCIAL JUSTICE VALUESOCIAL JUSTICE VALUE COLLABORATIVE PROCESSCOLLABORATIVE PROCESS EMPOWERINGEMPOWERING

PREVENTION SKILL SETSPREVENTION SKILL SETS

    Primary prevention perspectivePrimary prevention perspective     Personal attributes & behaviorsPersonal attributes & behaviors Ethical skillsEthical skills Marketing skillsMarketing skills Multicultural skillsMulticultural skills Group facilitation skillsGroup facilitation skills

PREVENTION SKILL SETPREVENTION SKILL SET (Cont’d)(Cont’d)

Collaboration skillsCollaboration skills Organizational & setting dynamic Organizational & setting dynamic

skills skills Trends & political dynamic skillsTrends & political dynamic skills Research & evaluation skillsResearch & evaluation skills

(Conyne, 2004) (Conyne, 2004) 

PREVENTIVE COUNSELING PREVENTIVE COUNSELING MODEL (Conyne, 2004)MODEL (Conyne, 2004)

PURPOSIVE STRATEGIESPURPOSIVE STRATEGIES

TARGETSTARGETS

METHODSMETHODS

PREVENTIVE COUNSELING PREVENTIVE COUNSELING MODEL MODEL (Cont’d)(Cont’d)

PURPOSIVE STRATEGIESPURPOSIVE STRATEGIES::

SEEK SEEK SYSTEMSYSTEM CHANGE CHANGE

SEEK SEEK PERSONPERSON CHANGE CHANGE

MODELMODEL (Cont’d)(Cont’d)

TARGETTARGET IndividualIndividual GroupGroup FamilyFamily OrganizationOrganization CommunityCommunity

MODELMODEL (Cont’d)(Cont’d)

METHODSMETHODS

DIRECTDIRECT: Education, : Education, OrganizationOrganization

INDIRECTINDIRECT: Consultation, Media: Consultation, Media

EFFECTIVE PREVENTION EFFECTIVE PREVENTION PROGRAMSPROGRAMS

TARGETEDTARGETED

LIFE TRAJECTORIES LIFE TRAJECTORIES CHANGEDCHANGED

NEW SKILLS EMERGEDNEW SKILLS EMERGED

EFFECTIVE PREVENTION EFFECTIVE PREVENTION PROGRAMSPROGRAMS (CONT’D) (CONT’D)

SOCIAL SUPPORT SOCIAL SUPPORT DEVELOPEDDEVELOPED

NATURAL SUPPORT NATURAL SUPPORT SYSTEMS IMPROVEDSYSTEMS IMPROVED

NEW CASES REDUCEDNEW CASES REDUCED

EFFECTIVENESS CRITERIAEFFECTIVENESS CRITERIA

WHAT’S BEING PREVENTED?WHAT’S BEING PREVENTED? WHAT’S BEING PROMOTED?WHAT’S BEING PROMOTED? IS IT BEFORE-THE-FACT?IS IT BEFORE-THE-FACT? DOES IT INVOLVE HEALTHY DOES IT INVOLVE HEALTHY

AND/OR AT RISK PERSONS?AND/OR AT RISK PERSONS? IS THERE SYSTEM CHANGE?IS THERE SYSTEM CHANGE?

CRITERIACRITERIA (Cont’d) (Cont’d) IS IT FEASIBLE?IS IT FEASIBLE? USE EXISTING RESOURCES?USE EXISTING RESOURCES? IS IT COLLABORATIVE?IS IT COLLABORATIVE? STRESSORS & STRENGTHS?STRESSORS & STRENGTHS? IS THE METHOD SPECIFIED?IS THE METHOD SPECIFIED? INTERVENOR ROLES? INTERVENOR ROLES? ARE THERE RESULTS?ARE THERE RESULTS?

HAPPY PREVENTION!HAPPY PREVENTION!