Person-centered approaches to primary prevention in mental health: Situation-focused and competence-enhancement

Summary Situation-focused and competence-enhancement approaches represent different pathways toward a richer person-centered primary prevention in mental health. Each is valid in its own right. The utility of developing both strands rests precisely on the fact that they are different means to a common end. Thus, although the approaches have somewhat different conceptual footings (one is proactive, the other reactive), differ in immediate goals and tactics, and have characteristically different target groups and times of application, they come together around the shared ultimate goal of strengthening people's psychological well-being.How much good will accrue from energetic exploration and development of these two strands remains a moot point, around which some skepticism has already been voiced (Rappaport, 1981). The two approaches singly or in combination, do not substitute for the type of social reform and provision of life opportunities (based on the concepts of justice and distribution of power) that Rappaport advocates. Nor do they compete with it. During the long period in which informed social change will remain an ideal, surrounded by uncertainty about procedural steps and outcomes, effective development of the two person-centered primary prevention strategies considered in this article can at least help to achieve a shorter-term objective, i.e., replacing aspects of traditional mental health practice known to have limited potential for advancing psychological wellness.This paper was written under support of grants from the New York State Department of Education and NIMH (MH 14547-07), for which the author expresses appreciation. Thanks also to Dr. Richard Price, who read and contributed constructively to earlier drafts of the article. I lay exclusive claim, however, to all of its remaining sins.     

Introduction to special issue on burnout and health

Abstract

In recent years, the issue of occupational stress and burnout have received increasing research attention. Given the amount of time people spend on work-related activities and the central importance of work to one's sense of identity and self-worth, it is not surprising that occupational stress is regarded as a central area of study. Although burnout is linked to the extensive literature on occupational health, burnout goes beyond occupational health by focusing on specific stressors in the workplace to emphasize total life and environmental pressures affecting health.     

Introduction to special issue on burnout and health

Abstract In recent years, the issue of occupational stress and burnout have received increasing research attention. Given the amount of time people spend on work-related activities and the central importance of work to one's sense of identity and self-worth, it is not surprising that occupational stress is regarded as a central area of study. Although burnout is linked to the extensive literature on occupational health, burnout goes beyond occupational health by focusing on specific stressors in the workplace to emphasize total life and environmental pressures affecting health.     

The role of primary prevention in mental health services: A review and critique

Community psychology in the West has had a growing impact on mental health service provision. One facet of this development has been the advocacy of an increased focus on the primary prevention of mental illness. This paper reviews both theoretical and practical work in this area in order to assess the current role and relevance of primary preventive interventions. There is a discussion of primary prevention's historical and theoretical contexts, of its conceptualisations and definitions, of criticisms of its relevance and efficacy, and of examples of its practice. It is argued that primary prevention is inappropriately marginalised in current service provision and that there is a need to engage in the long-term planning and evaluation of primary preventive interventions in order to facilitate their fuller incorporation into national and local policies on mental health.     

Structural characteristics of the macroeconomy and mental health: Implications for primary prevention research

Recent research on the impact of economics on mental and physical health has raised fundamental questions about structural elements in the macro-economy. Specifically, five characteristics of our current economic system: instability in the business cycle, unemployment, inequality in income distribution, capital mobility, and fragmentation of the work process, appear to play some pathogenic role in the incidence of behavioral and physical disorders. These macroeconomic elements require intervention at the social policy level since they seem to be more powerful than the individual coping mechanisms of some demographic subgroups. Psychologists can play an important role in policy decisions by providing data on the relative impact of structural economic variables on human functioning. Examples of structural research are presented and the implications for primary prevention are discussed.     

Methodological issues in prevention research: An introduction to the special issue

In recent years increased attention has been directed to prevention research as a means of solving the multitude of complex social and health problems which confront individuals and their societies. Abuse of substances, behavioral dysfunctions, violence, emotional disorders, educational failures, unwanted pregnancies and sexually transmitted diseases are but a few examples of these most difficult problems. As our recognition of the need for sound prevention strategies has grown, so has our sophistication in designing prevention research studies to evaluate the effectiveness of these new strategies. And that sophistication has brought new challenges, some of which are capable of stifling progress because of their complexity. This problem is certain to grow in importance as interventions with multiple components are used more frequently to meet the challenges of the complex social and health problems we face. This special issue evolved out of the recognition that prevention researchers are confronted by a myriad of difficult methodological issues which have inhibited progress in this area. The articles in the issue present innovative methodological solutions designed to overcome these problems so the field can move forward. Editor's Note: Dr. Edward Seidman edited Methodological Issues in Prevention Research while serving as Associate Editor for Methodology.     

HIV prevention with persons with mental health problems

The HIV seroprevalence rate among persons with mental health problems (PMHP) is substantially higher than that of the general population in the United States. This study examines the efficacy over 12 months of an HIV prevention program with 99 individuals attending outpatient mental health clinics who were randomly assigned to receive either: (a) a seven-session, small-group intervention of Project LIGHT (Living in Good Health Together); or (b) a one-session video intervention. Regression analyses of data from 87% of the sample interviewed at 1-year follow-up revealed that intervention group membership was associated with significantly fewer sexual risk acts. A significant intervention effect for condom use was found for 72% of the sample who were African American, but not for Latino or Caucasian participants. Results from this study suggest that HIV risk reduction groups such as Project LIGHT may have utility in public mental health care settings.