european psychiatric association

Prevention of Mental Disorders

Section committee

RABALLO Andrea RABALLO Andrea , Chair
MARIC Nadja P. MARIC Nadja P., Co-Chair
SILE Liene SILE Liene, Secretary
SCHULTZE-LUTTER Frauke SCHULTZE-LUTTER Frauke, First Other Councillor
WINKLER Petr, Second Other Councillor

Section mission

This Section's mission is to:

This section deals with primary and secondary prevention of mental disease.

Primary prevention denotes an action to prevent the development of a disease in persons who are well, thereby aiming to lower the incidence of this disease in the population. The appropriate strategies for achieving this aim are risk detection and prevention.

Primary prevention has three levels:

  1. universal prevention, targeting the general public (e.g. actions against illegal drug use will result in lower prevalence of drug addicts),
  2. selective prevention, targeting groups or individuals who are at higher risk of developing a mental disorder (e.g. soldiers in war or persons with a family history for certain mental disorders)
  3. indicated prevention, targeting individuals with prodromal signs or symptoms but without an actual or previous full blown syndrome of the disease.

Secondary prevention is directed at people who have already developed the disease and are still in an early stage (e.g. first episode). Secondary prevention intends to:

  1. reduce disability (e.g. early treatment of dementia or psychosis)
  2. prevent relapses (e.g. needs-adapted interventions in first-episode schizophrenia)


For many years prevention of mental illness has been conceptualized as universal prevention focussing on the general population of socially defined subgroups (e.g. work place, school classes). In industrialized countries many of these programmes revealed disappointing results. Thus psychiatrists were not convinced that preventive psychiatry, particularly primary prevention before the first manifestation of the disorder is an option. Yet, since 2 decades primary as well as secondary prevention of mental disorders became viable through new scientific insights and new service initiatives:

• Primary prevention:

The target-populations of primary prevention were shifted from the general population to subjects without fulfilling the full criteria for mental disorders, but with either predisposing risk factors (including other medical disorders) or prodromal signs and symptoms (including subthreshold conditions).; the first approach is called “selective prevention”, the second “indicated prevention”. Due to the research in premorbid course and risk factors and due to the establishment of early recognition programmes preventive measures were developed for several disorders. There is now steadily growing evidence that preventive intervention are successful in a series of mental disorders: metaanalysis have proven that full-blown depression can be prevented through psychosocial interventions in subthreshold depression and there is mounting evidence that psychosis can be prevented or at least delayed in a prodromal stage. Community based prevention programs have been shown to lower the incidence of suicidal acts and have already been implemented in more than 100 European regions. Selective or indicated prevention for other indications like bipolar disorder are just in a phase of promising beginning.

• Secondary prevention:

Efficient secondary prevention is now feasible through successful first episode programmes: they strive for early diagnosis and early treatment. The final goal is to achieve more beneficial medical and social outcomes for mental disorders. It is now well recognized and often reported that mental disorders have a better outcome when they are treated earlier. It is generally recognized that early intervention alleviates remission; this is important given that e.g. 30-50% of treated depressed patients turn out as non- or partial remitters.

The prevention of mental disorders therefore became conceptually and practically feasible.

Need for action

The following actions are needed in order to promote prevention of mental disorders in Europe:

• Implementation of primary prevention:

Early detection and early intervention are important tasks for mental health professionals. Targeted programmes currently are nearly exclusively developed on a research basis. Transfer in the clinical care is still widely missing.

• Implementation of secondary prevention:

First episode programmes are not available in most places where mentally ill subjects seek treatment. Therefore widespread transformation into clinical practice is required.

• Fostering of expertise and identity:

Selective and indicated prevention as well as first episode programmes require disease specific expertise and the participation of psychiatrists. These upcoming prevention strategies require individualized medical care for the at risk person what is only possible in the medical service system. Thus, psychiatrists are dedicated to be the main drivers of prevention of mental diseases. These new tasks must become a core element of the professional identity.

• Financing of prevention programmes:

Despite of this progress in prevention and early intervention of mental illness, ongoing financial investments in research are needed, as well as continued reimbursement of preventive services in regular care. In many EU-countries, prediction and prevention as well as early recognition and intervention programmes are only financed by research funds but should be disseminated into general health care. The current state in this respect is insufficient.

• Stimulation of EU activities:

The EU is an important stakeholder in this respect because of the following reasons:

(a) prevention is (in contrast to patient care for full blown disorders) by constitution a European responsibility and (b) the EU has actively formulated this priority goal in several documents (e.g. the “Green Book”).

Research Development and Translation:

The very active research is to be expanded in order to address the following issues:

- to promote the understanding of the neurobiological basis of at risk states as well as of resilience

- to translate the progress of knowledge on vulnerability and on risk factors into more efficient risk detection, risk prediction, early recognition and prevention strategies.

- to explore factors contributing to resilience in spite of an accumulation of risk and vulnerability factors in longitudinal studies

- to expand research and services for preventive psychiatry.

These statements are valid for all major mental disorders with some areas of indication being more advanced than others.

Section objectives

  1. Increase awareness for the possibility and for the need of selective and indicated prevention of mental illness among psychiatrists and other medical disciplines (particularly primary care).
  2. Argue for and contribute to the introduction of risk related syndroms in official classification systems for promoting research on causes and interventions and for providing persons in need for care g
  3. Disseminate the growing progress in knowledge about the pathogenesis and the prevention of mental disorders on conference and through publications (particularly in an EAP context with yearly symposia)
  4. Disseminate the knowledge of service strategies in recognition of risk states, of early signs of mental diseases and of possible preventive interventions through symposia and seminars
  5. Bring together specialists of risk detection and prevention as well as early recognition and early intervention in the various indication areas to create a European body of expertise and stimulate exc
  6. Simulate and offer programmes to educate young psychiatrists risk detection and prevention as well as early recognition and early intervention of mental illness (e.g. at EPA-congresses and through coo
  7. Stimulate European wide prevention and early intervention trials and associated research efforts (with hopefully successful national and EU lobbying)
  8. Offer evidence and expert guided device on prevention and early intervention to the EPA-boards and - through these boards - also to EU commissions in charge

Annual reports