Applied Public Mental Health: Bridging The Gap Between Evidence And Clinical Practice

Weissman, Myrna M.

Wahlbeck describes a public mental health approach at a population level. His proposal is far reaching, including not only the reduction of mental illness or specific psychiatric disorders, but the promotion of mental wellbeing, positive mental health and happiness. The targets vary widely, including parenting, education, housing, employment, justice, etc. The interventions include relaxation, meditation, mindfulness training, job stress management, cognitive behavioral therapy, biofeedback, exercise, health education, social networking, etc. The strategies include health promotion, improvement of mental health services, reduction of stigma, fight for human rights, etc. The author concludes that challenges remain in identifying risk, protective and resilience factors for mental health problems across the lifespan, and developing effective and evidence-based public mental health interventions.

One cannot disagree with the mandate. However, the breadth is overwhelming. Many of the actions described require partnerships well beyond public health, psychiatry or even medicine, and fall in the domain of social policy, government, and the will of the people in a functioning democracy. The actions impinge upon social values and the limits of governmental reach, which vary considerably by culture or country. Consider the public health problems of violence, which are often related to firearms. Prevention may engage issues such as enforcement of gun control legislation, raising minimum age requirements for gun ownership, reforming gun licensing, and imposing restrictions on gun purchases. Identifying the risk factors and health education alone may be insufficient.

Safe food practices, immunization, public health education, and improved sanitation have been successful over the past century in increasing life expectancy and improving quality of life. Parallel public health initiatives for mental wellness will require a similar mobilization of government and business efforts based on known risks. Although social change itself may improve mental health, there will need to be a confluence of the common good for this to happen. Even then, there is little guarantee that programs will be effective or resources sufficient to sustain them.


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World Psychiatry

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February 1, 2022