PREVENTION IN MENTAL HEALTH

PRESENTER ROBERT K. CONYNE, Ph.D. ROBERT K. CONYNE, Ph.D. PROFESSOR EMERITUS COUNSELING PSYCHOLOGIST UNIVERSITY OF CINCINNATI

LEARNING OBJECTIVES TO UNDERSTAND MENTAL HEALTH PREVENTION CONCEPTS TO UNDERSTAND MENTAL HEALTH PREVENTION CONCEPTS TO DIFFERENTIATE KNOWLEDGE AND SKILLS TO DIFFERENTIATE KNOWLEDGE AND SKILLS TO LEARN A MODEL FOR PREVENTION TO LEARN A MODEL FOR PREVENTION

PERFORMANCE OBJECTIVES DESCRIBE KNOWLEDGE AND SKILLS NEEDED DESCRIBE KNOWLEDGE AND SKILLS NEEDED KNOW WHAT TO INCLUDE IN PROGRAMS KNOW WHAT TO INCLUDE IN PROGRAMS IDENTIFY EFEECTIVE PREVENTION PROGRAMS IDENTIFY EFEECTIVE PREVENTION PROGRAMS

Epidemiology: Mental Illness Adults: (under 55) 20% of U.S. adults per year (44 million) 20% of U.S. adults per year (44 million)Children/Adolescents 20% of 9-17 years old per year (U.S. Surgeon General) 20% of 9-17 years old per year (U.S. Surgeon General)

SUBSTANCE ABUSE 1962: 4 MILLION TRIED ILLEGAL DRUGS 1962: 4 MILLION TRIED ILLEGAL DRUGS 1999: 87.7 MILLION… 1999: 87.7 MILLION… USERS OVER AGE 12: USERS OVER AGE 12: -1979: 25.4 MILLION -1992: 12 MILLION -1999: 14.8 MILLION

LITERACY 20 MILLION ILLITERATE ADULTS (13%) 20 MILLION ILLITERATE ADULTS (13%) 20 MILLION MARGINALLY LITERATE 20 MILLION MARGINALLY LITERATE MILLION OF THESE PEOPLE ARE REACHED 4 MILLION OF THESE PEOPLE ARE REACHED

COST OF MENTAL ILLNESS 1996: -DIRECT COST: $69 BILLION. -INDIRECT COST: $78.6 BILLION -INDIRECT COST: $78.6 BILLION (Surgeon General)

ONE POPULATION: AFRICAN AMERICANS POVERTY: 1999, 22% POVERTY: 1999, 22% HOMELESS: 40% OF HOMELESS POPULATION HOMELESS: 40% OF HOMELESS POPULATION INCARCERATION: HALF OF ALL STATE & NATIONAL PRISONERS INCARCERATION: HALF OF ALL STATE & NATIONAL PRISONERS

AFRICAN-AMERICANS (CONTD) ACCESS: 20% FEWER ARE COVERED BY EMPLOYER- BASED HEALTH INS. ACCESS: 20% FEWER ARE COVERED BY EMPLOYER- BASED HEALTH INS. USE: ONLY ONE-HALF THAT OF WHITES; EMERGENCY USE HIGH USE: ONLY ONE-HALF THAT OF WHITES; EMERGENCY USE HIGH

INCIDENCE TO REDUCE DEVELOPMENT OR RATE OF DEVELOPMENT OF: TO REDUCE DEVELOPMENT OR RATE OF DEVELOPMENT OF: NEW CASES OF A DISORDER OR PROBLEM NEW CASES OF A DISORDER OR PROBLEM

TO REDUCE INCIDENCE DECREASE: DECREASE: STRESS + EXPLOITATION INCREASE: INCREASE: COPING SKILLS +SELF-ESTEEM+ SUPPORT (Albee, modified, 1982)

PRIMARY PREVENTION Intentional intervention Intentional intervention To reduce incidence of To reduce incidence of Adjustment problems in Adjustment problems in Currently normal populations, plus Currently normal populations, plus Promotion of mental health functioning ( Durlak & Wells, 1997) Promotion of mental health functioning ( Durlak & Wells, 1997)

DEGREE OF RISK (Institute of Medicine, 1994) Universal: for all Universal: for all Selective: Based on risk markers Selective: Based on risk markers Indicated: Based on specific risk Indicated: Based on specific risk indicators and showing early signs, but no mental disorder indicators and showing early signs, but no mental disorder

WHY PRIMARY PREVENTION? TOO MANY PROBLEMS/NOT ENOUGH HELPERS TOO MANY PROBLEMS/NOT ENOUGH HELPERS TOO MUCH AFTER-THE-FACT TOO MUCH AFTER-THE-FACT LIMITED REACH LIMITED REACH DE-CONTEXTUALIZED DE-CONTEXTUALIZED STRESSORS/STRENGTHS IGNORED STRESSORS/STRENGTHS IGNORED

PRIMARY PREVENTIVE COUNSELING ( Conyne, 2004) APPLICATION OF BROAD RANGE OF COUNSELING APPLICATION OF BROAD RANGE OF COUNSELING HEALTHY AND/OR AT RISK TARGETS HEALTHY AND/OR AT RISK TARGETS TO AVERT FUTURE PROBLEMS AND TO AVERT FUTURE PROBLEMS AND TO PROMOTE GROWTH TO PROMOTE GROWTH

PREVENTIVE COUNSELING PRECEPTS BEFORE-THE-FACT BEFORE-THE-FACT HEATHY PEOPLE/AT RISK HEATHY PEOPLE/AT RISK DEVELOP COMPETENCE DEVELOP COMPETENCE REDUCE INCIDENCE REDUCE INCIDENCE GROUP AND COMMUNITY FOCUSED GROUP AND COMMUNITY FOCUSED

PRECEPTS (Cont’d) ECOLOGICAL FOCUS ECOLOGICAL FOCUS CULTURALLY VALID CULTURALLY VALID SOCIAL JUSTICE VALUE SOCIAL JUSTICE VALUE COLLABORATIVE PROCESS COLLABORATIVE PROCESS EMPOWERING EMPOWERING

PREVENTION SKILL SETS Primary prevention perspective Primary prevention perspective Personal attributes & behaviors Personal attributes & behaviors Ethical skills Ethical skills Marketing skills Marketing skills Multicultural skills Multicultural skills Group facilitation skills Group facilitation skills

PREVENTION SKILL SET (Cont’d) Collaboration skills Collaboration skills Organizational & setting dynamic skills Organizational & setting dynamic skills Trends & political dynamic skills Trends & political dynamic skills Research & evaluation skills Research & evaluation skills (Conyne, 2004) (Conyne, 2004)

PREVENTIVE COUNSELING MODEL (Conyne, 2004) PURPOSIVE STRATEGIES PURPOSIVE STRATEGIES TARGETS TARGETS METHODS METHODS

PREVENTIVE COUNSELING MODEL (Cont’d) PURPOSIVE STRATEGIES: SEEK SYSTEM CHANGE SEEK SYSTEM CHANGE SEEK PERSON CHANGE SEEK PERSON CHANGE

MODEL (Cont’d) TARGET Individual Individual Group Group Family Family Organization Organization Community Community

MODEL (Cont’d) METHODS DIRECT: Education, Organization DIRECT: Education, Organization INDIRECT: Consultation, Media INDIRECT: Consultation, Media

EFFECTIVE PREVENTION PROGRAMS TARGETED TARGETED LIFE TRAJECTORIES CHANGED NEW SKILLS EMERGED NEW SKILLS EMERGED

EFFECTIVE PREVENTION PROGRAMS (CONT’D) SOCIAL SUPPORT DEVELOPED SOCIAL SUPPORT DEVELOPED NATURAL SUPPORT SYSTEMS IMPROVED NATURAL SUPPORT SYSTEMS IMPROVED NEW CASES REDUCED NEW CASES REDUCED

EFFECTIVENESS CRITERIA EFFECTIVENESS 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 AND/OR AT RISK PERSONS? DOES IT INVOLVE HEALTHY AND/OR AT RISK PERSONS? IS THERE SYSTEM CHANGE? IS THERE SYSTEM CHANGE?

CRITERIA (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!