The Value of Model Programmes in Mental Health Promotion and Mental Disorder Prevention (original) (raw)

1999, Journal of Public Mental Health

ne's response to this article depends very much on the stance one brings to it. Its subject matter is primarily about relatively large-scale, quantitative, experimental or quasiexperimental prevention research projects. Although the term 'mental health promotion' (MHP) is used, and indeed some of the individual projects mentioned, such as the Community Mothers Programme (Johnson et al., 1993) could fall into this category, the emphasis is clearly on prevention rather than health promotion. This view is reinforced by statements throughout the article. At the beginning, the history of model programmes in the mental health area is traced from 'prevention' researchers and other preventionists in the United States in the 1980s. On p10, we see that outcome criteria, referred to as 'a central feature of model programmes', are related to 'reductions in prevalence and incidence' in a 'targeted population'. In the final section, the need is seen for national and international collaboration for the 'successful use [of] a model programme strategy for increasing the effectiveness of prevention', for 'evidence-based prevention programmes', and the development of 'effective preventive practices and a supporting prevention science'. Within the framework of such a prevention approach, the article is timely, clear and very useful. There is clearly now a substantial literature to support the use of mental health interventions in at-risk populations, and many of these derive from research trials which meet the criteria of 'model programmes'. It is good to have these criteria examined and spelt out. Obviously, controlled studies with statistically significant quantitative outcomes and clearly defined procedures which can be adapted to other contexts, and for wide-scale dissemination, are the benchmark. At the same time, we are told that 'there is still no evidence available that their large-scale implementation on a district or national level has significantly improved the health status of populations at risk as a whole'. There are several reasons given for this rather pessimistic finding: the whole area is still too new for definitive statements about it, dissemination attempts may be faulty, or the programmes not readily translatable into other or larger settings, or to other cultures. In addition, the dissemination process has to be carried out in a stepwise, systematic way, and the authors' emphasis on this is one of the key contributions of their article. However, from a health promotion perspective-the one with which both commentators identify-there is little here which seems to fulfil the assertion that model programmes have something to offer for mental health promotion, as distinct from prevention. Our view is that the prevention vs promotion debate will dominate the MHP arena in the coming decade, and, unfortunately,