Primary care options to prevent mental illness

The common mental disorders, mainly anxiety and depression, constitute a ma jor public health problem, incurring considerable costs in terms of use of health services and time lost from work. Risk factors include low socioecon omic status, poverty and poor housing, as well as stressful life events and difficulties such as demanding child care, separation or divorce, bereavem ent, loss of employment and caring for a dependant relative. Population app roaches are probably necessary to reduce significantly the burden of such m ental health problems, but health care measures are far from negligible. Pr imary care professionals have regular opportunities to identify people at r isk of mental health problems and refer them to welfare and social support services (primary prevention). A number of interventions among high-risk gr oups have been shown to be effective, including problem-solving training an d cognitive-behavioural approaches. The most important tasks in primary car e are to identify people with depression, alcohol and drug misuse and eatin g disorders as early as possible in the course of their illness and to inst itute effective treatment (secondary prevention). Primary care teams should also join in shared care arrangements for patients with chronic disabling mental illnesses, in order to prevent recurrences and relapses (tertiary pr evention).