MODULE 1: THIRD MENTAL HEALTH REVOLUTION AND THE CONCEPT OF

PRIMARY PREVENTION
Unit 1
The World Health Organization defines mental health as “ a state of well-being in which the individual realizes
his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can
make a contribution to his or her community”.

Many works have been put towards understanding the differentiation between mental well-being and mental
illness. Mental well-being is the overall state of an individual’s well-being, it involves physical, psychological
and social well-being. Mental illness is seen as an impact of mental health that affects various aspects of life.

History of Mental Health

Ancient theories about mental illness often attributed it to supernatural causes like demonic possession, curses,
or vengeful gods. Treatment primarily involved exorcism to cast out evil spirits.

Anthropological evidence dating back to 5000 BCE suggests trephining, where holes were bored into skulls to
release supposed evil spirits.

Greek philosophers like Hippocrates, Galen, and Socrates proposed the theory of four essential bodily
elements: blood, bile, black bile, and phlegm, influencing early medical thought.

From the 16th century onward, the establishment of asylums, also known as "madhouses," provided refuge and
care for people with mental illness, although conditions in these institutions varied widely.

The history of mental health spans centuries and has undergone significant transformations, often referred to as
"revolutions." These revolutions represent major shifts in societal attitudes, understanding, and treatment of
mental health issues.

1. First Mental Health Revolution (18th-19th centuries):

- During this period, mental illness was often misunderstood and stigmatized. People with mental health
issues were frequently marginalized or even subjected to inhumane treatment.
- The first revolution began with the Enlightenment era, which emphasized rationality and human rights.
Advocates like Philippe Pinel and William Tuke advocated for more humane treatment of individuals with
mental illness, leading to the establishment of asylums focused on moral treatment and compassionate care.
- This revolution marked the beginning of institutionalized psychiatric care and the gradual shift away from
cruel and punitive practices toward more humane approaches.

2. Second Mental Health Revolution (19th-20th centuries)

- The second revolution saw advancements in the understanding and treatment of mental illness, particularly
with the emergence of psychological theories and psychotherapy.
- Figures such as Sigmund Freud, Carl Jung, and others pioneered the field of psychoanalysis, exploring the
unconscious mind and the role of childhood experiences in shaping mental health.
 - This period also saw the development of psychiatric medications, such as chlorpromazine for treating
schizophrenia, which revolutionized psychiatric treatment and led to the deinstitutionalization movement,
aimed at transitioning patients from long-term psychiatric hospitals to community-based care.

3. Third Mental Health Revolution (Late 20th century-present)

- The third revolution has been characterized by a shift toward a more holistic and community-oriented
approach to mental health.
- It emphasizes the importance of mental health promotion, prevention, and early intervention, alongside the
integration of mental health services into primary care settings.
- This period has also seen significant advancements in neuroscience, genetics, and technology, leading to a
better understanding of the biological and environmental factors influencing mental health.
- Efforts to reduce stigma and promote mental health awareness have become central themes, with increased
recognition of the intersectionality of mental health with social, cultural, and economic factors.

Throughout these revolutions, progress has been made in challenging stigma, improving treatment options, and
promoting mental well-being. However, significant challenges remain, including disparities in access to care,
ongoing stigma, and the need for continued innovation in mental health research and service delivery.

Unit 2: Redefining the concept of mental health & illness.

Redefining mental health
Understanding of the definitions of wellness and illness has changed from the mid-20th century to modern
times, moving from a diagnosis-focused to a person-focused definition of mental illnesses, and from an
“absence of disease” model to one that stresses positive psychological function for mental health.
In the 1960s and 1970s, a person with a mental illness was defined by diagnosis alone, and there were few
broad classes of mental disorders.
These recent definitions use the wellness model, in which health and disease are viewed as 2 separate
dimensions.
Mental health - WHO defines mental health as a state of well-being in which a person is aware of their
potential, equipped to deal with typical life stressors, capable of productive and fruitful employment, and
capable of contributing to their community.

•Biomedical Model
The biomedical model is a framework for understanding and treating illness that focuses primarily on
biological factors. The biomedical model accepts mind-body dualism.
It suggests that diseases and disorders result from abnormalities or malfunctions in the body's physiological
systems, such as genetics, biochemistry, or pathology. In this model, treatment typically involves medical
interventions such as medications, surgeries, or other procedures aimed at correcting or alleviating the
underlying biological causes of the illness. It focuses on illness over health. The biomedical model tends to
prioritize objective, measurable factors and often overlooks the influence of psychological, social, and
environmental factors on health and well-being.

•Psychogenic Model (deal with neurotic problems)

In contrast to the biomedical model, the psychogenic model emphasizes psychological and environmental
factors in the development and treatment of mental health problems. It addresses neurotic conditions, which
 are typically less severe than psychotic disorders. This model focuses on understanding the individual's
psyche, including their defence mechanisms, coping strategies, and personal growth potential. Therapy often
involves exploring underlying conflicts, traumas, or unresolved issues to promote self-awareness, insight, and
adaptive coping skills.

Effective use of defence mechanisms to protect the ‘ego’ – the self, Exploring and using the human potential
to be fully functional.

•Biopsychosocial Model (WHO)

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or
infirmity.”
The biopsychosocial model views both illness and health as being the products of biological,
psychological, and social factors. The model rejects mind-body dualism, viewing physiology and psychology
as inseparably intertwined when it comes to matters of health and illness. Finally, the biopsychosocial model
emphasizes both health and illness. Health is not seen as simply the absence of illness but rather as something
that is strived for and maintained through attention to biological, psychological, and social needs.

• Positive Approach
Ryff and Singer (1998) suggest that health is not a medical concept associated with the absence of illness, but
rather a philosophical one that requires an explanation of a good life – being one where an individual has a
sense of purpose, is engaged in quality relationships with others, and possesses self-respect and mastery.
Subjective well-being
Psychological well-being
Social well-being
Seligman and his colleagues have proposed that happiness as a central focus of positive psychology can be
broken down into three components:
▪ The pleasant life
The emphasis in positive psychology is on understanding the determinants of happiness as a desired state. The
first is positive emotion; what we feel: pleasure, rapture, ecstasy, warmth, comfort, and the like.
▪ The engaged life
The second element, engagement, is about flow: being one with the music, time stopping, and the loss of self-
consciousness during an absorbing activity. The aspect of happiness focuses on active involvement in activities
and relationships with others that express our talents and strengths and that give meaning and purpose to our
lives. Such involvements promote a zestful and healthy life.
▪ The meaningful life
This aspect consists of belonging to and serving something that you believe is bigger than the self, and
humanity creates all the positive institutions to allow this: religion, political party, family etc.
Authentic Happiness Theory
Seligman and his colleagues have proposed that happiness as a central focus of positive psychology can be
broken down into three components:
• The pleasant life - The emphasis in positive psychology on understanding the determinants of happiness
as a desired state. The first is positive emotion; what we feel: pleasure, rapture, ecstasy, warmth,
comfort, and the like.
• The engaged life - The second element, engagement, is about flow: being one with the music, time
stopping, and the loss of self-consciousness during an absorbing activity. The aspect of happiness
focuses on active involvement in activities and relationships with others that express our talents and
strengths and that give meaning and purpose to our lives. Such involvements promote a zestful and
healthy life.
• The meaningful life - This aspect consists of belonging to and serving something that you believe is
bigger than the self, and humanity creates all the positive institutions to allow this: religion, political
party, family etc.

PERMA Theory (Seligman)

The PERMA Model represents the five core elements of happiness and well-being. PERMA stands for
Positive Emotion, Engagement, Relationships, Meaning, and Accomplishments.
▪ Positive emotions
Positive emotion is about feeling good and is the most direct path to being happy. When one feels good, one
feels positive. Positive emotion goes beyond that and may even involve acceptance of the past regardless of
how bad it was and anticipating positively what the future holds.
▪ Engagement
The second element in the PERMA Model is Engagement, which refers to something that an individual can get
engrossed with or absorbed in. Doing something that engages an individual also brings happiness even if it has
nothing to do at all with one’s work or if it is deemed by others as silly.
▪ Relationships
Relationships are the third element of happiness and well-being, according to the PERMA model. As human
beings, it is our natural desire to want to be connected and be part of a group such as a clique, school
organization, or a circle. We were wired to not just want but need love, affection, attention, and interaction. It
is why people need to create relationships with family, co-workers, friends, and peers because it is from these
groups that we can receive emotional support when things get rough.
▪ Meaning
Another intrinsic human quality is the search for meaning and the need to have a sense of value and worth.
Seligman (2012) discussed meaning as belonging and/or serving something greater than ourselves. Having a
purpose in life helps individuals focus on what is important in the face of significant challenges or adversity.
▪ Accomplishment
A sense of accomplishment is a result of working toward and reaching goals, mastering an endeavour, and
having self-motivation to finish what you set out to do. This contributes to well-being because individuals can
look at their lives with a sense of pride (Seligman, 2012). Accomplishment includes the concepts of
perseverance and having a passion for attaining goals. But flourishing and well-being come when
accomplishment is tied to striving toward things with an internal motivation or working toward something just
for the sake of the pursuit and improvement (Quinn, 2018).

Mental health refers to a state of overall well-being in which an individual realizes their abilities, can cope
with the normal stresses of life, can work productively and fruitfully, and can make a contribution to their
community.
Mental illnesses — also called mental health conditions or mental disorders — are diagnosable conditions.
They often involve a highly distressing change in your thinking, emotions, or behaviours and can affect how
you perform some daily activities.
To receive a diagnosis involving any mental health condition, a mental health professional will interview
you to learn about:
● the symptoms you’re experiencing

● how long they’ve been happening

● how severe they are

● potential causes of your symptoms

Public mental health promotion v/s clinical - -therapeutic approach to mental health.
The mental health of the individual interventions rely on the collaborative efforts of
clinical psychologists and the patient's cooperation
Understanding an individual's mental illness
and adherence to treatment.
involves assessing and grasping their unique
experiences and perceptions. Recovery Community mental health
Reducing mental health risks in a community institutions.
depends on strong leaders in mental health, effective
models, and support from family and other social
Public Mental Health Promotion:
• Focus: Public mental health promotion aims to improve the mental well-being of entire populations or
communities, rather than focusing solely on individuals with diagnosed mental disorders.
• Preventive Approach: It emphasizes prevention and early intervention strategies to reduce the incidence
and prevalence of mental health problems at a population level.
• Target Audience: The target audience includes everyone within a community, regardless of whether they
have a diagnosed mental illness.
• Examples of Activities: Public mental health promotion activities may include awareness campaigns,
education programs, policy advocacy for mental health-friendly environments, community support
initiatives, and destigmatization efforts.
• Goals: The primary goals are to promote mental resilience, enhance coping skills, build supportive social
networks, and create environments that foster positive mental health for all individuals.

Clinical-Therapeutic Approach to Mental Health:

• Focus: The clinical-therapeutic approach focuses on diagnosing and treating mental disorders in
individuals who are experiencing distress, impairment, or dysfunction.
• Treatment and Intervention: It involves providing evidence-based therapies, medications, and other
interventions tailored to the specific needs of individuals with diagnosed mental health conditions.
• Target Audience: The target audience includes individuals who seek help for mental health concerns or
who are referred to mental health services by healthcare providers.
• Examples of Activities: Clinical-therapeutic approaches encompass a wide range of interventions
delivered by mental health professionals, including psychotherapy (such as cognitive-behavioral therapy,
and psychodynamic therapy), medication management, psychiatric rehabilitation, and case management.
• Goals: The primary goals are to alleviate symptoms, improve functioning, enhance quality of life, and
prevent relapse for individuals with mental health disorders.

Surgeon General’s Report on Mental Health

The 1999 Surgeon General's Report on Mental Health marked a significant milestone as the first report
dedicated to mental health, emphasizing that mental well-being is essential for overall health and human
capabilities.

Key findings from the report include:

- Nearly 20% of Americans experience mental disorders annually, making them a significant cause of
disability and early death in the U.S. However, advancements in understanding the brain have led to
effective treatments for many of these conditions.

- Despite progress, over half of those requiring treatment do not receive it.

- Mental disorders, including suicide, contribute significantly to mortality rates in the U.S.

- Around 15% of adults utilize mental health services each year.

- The report underscores the diagnosable nature of mental illnesses and the availability of new treatments.
 - It emphasizes the importance of reducing stigma and debunking misconceptions surrounding mental
health.

- The goal is to enhance public awareness and understanding of mental illness while highlighting the need
for improved mental health services and providers offering state-of-the-art treatments.

Positive Psychology Approaches to Public Mental Health Promotion

•Positive Psychology focuses on the psychological states, individual traits or character strengths.

•Activities and programs that foster positive mental health also help to prevent mental illness

• Positive psychology applies a common language and an empirical approach to the study of 4 areas:

(1) Positive emotions (happiness, gratitude, fulfilment)

(2) Positive individual traits (optimism, resiliency, character strengths)

(3) Positive relationships among groups

(4)Enabling institutions (schools, worksites) that foster positive outcomes.

Positive Emotions

Positive emotions like joy, interest, and contentment reduce autonomic arousal, indicate safety and a
willingness to approach and encourage individuals to interact with their surroundings, both physically and
socially, by exploring new things, people, or circumstances.

Broaden and Build Theory

• The Broaden and Build theory of positive emotions proposes that positive emotions broaden people's
attention, expand cognition (e.g., curiosity, creativity) and behaviours (e.g., exploration, play), and
consequently foster physical, intellectual, and social resources (e.g., intelligence, mastery, social
competence) for optimal functioning.

• Moreover, positive emotions can more quickly quell or undo the adverse effects of negative experiences by
reducing stressful reactions (e.g., increased blood pressure) and returning the body to a balanced state.

According to the Broaden and Build theory, resilient people experience positive emotions more frequently
and recover more quickly from specific life stressors.

POSITIVE INDIVIDUAL TRAITS

Positive individual traits include several positive dispositions present in individuals to different degrees, such
as creativity, bravery, kindness, perseverance, and optimism, which, when cultivated, can increase resiliency,
buffer against psychological disorders and other adversities, and promote mental health.
 Resiliency and Optimism

• Resiliency is the process of positive adaptation in the context of adversity or risk.

• Promotion of resiliency can occur within persons (e.g., coping, optimism), among persons (social
support), and across social levels (public health or educational systems).

• Studies of resiliency focus on positive adaptation and achievement and stress the importance of
promoting competence (e.g., autonomy, goal-directed behaviour) through interventions.

• Substantial public health efforts are designed to promote resiliency among persons and across social
levels

• Positive psychology offers several approaches for improving individual resiliency that may be relevant
for public health interventions aimed at schools, worksites, health care settings, and Area Agencies on
Aging.

• For example, individuals can change their “explanatory style”—that is, how they interpret day-to-
day events and their interactions with others. Specifically, they can learn skills for more optimistic ways
of thinking and reacting to improve their resiliency.

• Besides certain personality characteristics (e.g., dispositional optimism) and the physical and social
environment, explanatory style can predict depression and other negative physical health outcomes.
• Skills based on learned optimism—such as challenging beliefs, avoiding thinking traps, calming
and focusing, and putting things in perspective—can improve psychological resiliency in individuals

Penn Resiliency Program (PRP)

The Penn Resiliency Program (PRP) is a group intervention that is delivered to children between the ages of
8 to 15 years after school. The program teaches resiliency skills that are based on learned optimism and has
been effectively implemented in countries like the United States, United Kingdom, Australia, China, and
Portugal, providing evidence of its effectiveness in diverse cultural settings.

Students who enrol in the program learn to adopt more optimistic explanatory styles by detecting inaccurate
thoughts, evaluating the accuracy of those thoughts, and challenging negative beliefs by considering
alternative interpretations. Additionally, students learn how to negotiate, make decisions, and relax.

In 21 studies, most of which used randomized controlled designs and comprised about 3000 children, the
PRP prevented disruptive behaviours for up to 36 months and depression and anxiety symptoms for up to 2
years, especially in students with more severe symptoms. Thus, a mental health promotion intervention like
the PRP may reduce the likelihood of the onset of mental illness in children, but it requires more study.
The PRP works equally well among boys and girls and for children of various racial/ethnic backgrounds.
Similar school-based interventions have demonstrated improvements in empathy, cooperation, assertiveness,
self-control, coping skills, resilience, and other social competencies aligned with positive mental health
outcomes.

SOCIAL-ENVIRONMENTAL FACTORS AND ENABLING INSTITUTIONS

• Social and economic factors influence health and mental health, including access to employment; safe
working conditions; education, income, and housing; stable and supportive family, social, and
community environments characterized by opportunities for autonomy, social inclusion, and freedom
from discrimination and violence; and taxation of addictive substances to prevent abuse.
• Institutions such as schools, homes, worksites, places of worship, and health care settings that have
been traditional targets for public health disease prevention and health promotion interventions
also are settings for evidence-based mental health promotion interventions.
• Policy initiatives are needed to improve mental health by addressing social and economic
determinants and implementing community-based programs.

Unit 3: Challenges and possibilities and levels of primary prevention

➢ Prevention
➢ Types of prevention
➢ Primary prevention
➢ Possibilities in mental health
➢ Challenges and issues
➢ Levels

Prevention vs Cure
Prevention: process involved in reducing the incidence and prevalence of disease in an individual where
whereas cure involves restoration of health, normality and soundness in an individual after being exposed to
a disease. It aims for recovery.
Prevention is the act of preventing something from happening.
Prevention reduces the burden on medical infrastructure and improves prognosis. Prevention is delivered to
healthy people whereas cure is given to those who are sick. Prevention is also cheaper than cure. Preventive
measures are cost-effective
Prevention occurs before people contract a disease, so preventive programs are often delivered to currently
healthy people in the general population.

Types of prevention
Primary prevention: Reducing the possibility of the disease in a susceptible population of the disease in a
susceptible population-intervening before health effects occur. The purpose of primary prevention is to
prevent a disease from ever occurring. Thus, its target population is healthy individuals.
Secondary prevention: Reduce duration, prevalence and contagiousness of disease in already ill people by
early detection and early treatment. Emphasizes early disease detection and its target is healthy-appearing
individuals with subclinical forms of the disease. Screening to identify disease at the earliest.
Tertiary prevention: Reduce the consequence of disease in individuals who already had it- managing
disease post-diagnosis to slow or stop. Tertiary prevention aims to reduce the effects of the disease once
established in an individual. They target patients, rather than healthy people.

Primordial vs primary prevention

Primordial prevention: aims at modifying the risk factors of a disease at the systematic level. It aims to
inhibit the establishment of factors such as environmental, economic, social and behavioural- avoiding the
development of risk factors in the first place. It targets determinants at the societal level rather than
modifying personal risk factors, which is the focus of primary prevention.
Primary prevention looks at modifying personal risk factors in a population. Examples: improving
sanitation, outlawing alcohol etc. Primary prevention is to stop the bad before it happens. Tries to prevent
the onset of disease by risk reduction- by altering behaviours or enhancing disease resistance.
When primary prevention is aimed at an entire community population, it is called universal prevention.
Example: childhood immunizations.
When focused on a particular at-risk population, it is called selective prevention. Example: home visitations
for low-birth-weight children

Head start program

A noteworthy example of primary prevention that started in the 1960s as part of President Lyndon Johnson's
War on Poverty is the Head Start program. This program was implemented because there were concerns that
children from low-income families in the United States were not getting enough cognitive and intellectual
stimulation to do well in school.
The goal of Head Start was to provide poor children with a level of preparation that mirrored that of their
economically more advantaged counterparts. The program also added nutritious meals, medical screenings,
and parental education.
Results: children attended Head Start for at least 3 days per week for 2 years or more, and when parents
were involved, the children experienced reliable and lasting benefits in how they interacted with others
(social development) and how well they performed in school-related activities (academic development)
(Ramey & Ramey, 1998).
Primary prevention in mental health:

● Increase the immunity of the individual

● Reduce the contact of individuals with risk

● Make changes in the community so that the risk agent will be destroyed

Challenges of primary prevention

 ● There should be effective leadership for planning, coordination and effective action

● Support from other institutions in the community, especially government support and funding.

● Support from other disciplines

● Huge task force

● Derailment of motivation of leadership in implementing the planned action.

● Disagreement among professionals

● Bureaucratic blockages from the government

● Lack of participation by the community

● Political and religious divisions in the community

Levels of primary prevention

● In the larger society

● In the community

● Family and small group

● Individual

In the larger society: Any program with the following features provides physical, psychosocial and
sociocultural protective supplies:
▶ Increase in quality of life
▶ Fostering education
▶ Social welfare
▶ Improved medical care
▶ Job opportunities
Improved prenatal medical care for slum mothers
Urban renewal programs can provide a physically and psychologically healthy environment when human
issues are given priority.
Social programs that protect the integrity of the family like providing opportunities for working mothers.
Reducing job and housing discrimination, increasing educational and job training opportunities and
protecting civil rights.
Programs like “Headstart” can help to increase social competence and self-esteem in deprived children.
Psychologists mainly contribute at this level through research.

In the community: to alter public attitudes and to instil values favourable to positive mental health.
Development of facilities for recreation and housing. Better coordination of the services of social agencies
such that problems faced by people are not neglected.
A lot of effort has been focused on altering the social processes of school systems to make them more
suitable for emotional growth.
● Basic patterns of communication

● Organization and attitudes of teachers and administrators

● Educating teachers on the psychological problems faced by students.

To overcome feelings of apathy and powerlessness and increase capacity for collective action in the
community.

● Identifying and encouraging leadership

● Facilitation of communication and group processes.

The family and small group:

Family: character formation and development of psychological
problems. Intervention involves:
● Parent education programs: These programs aim to equip parents with the knowledge and skills
necessary for effective parenting
● Prenatal instruction: Prenatal instruction involves providing information and support to expecting
parents during pregnancy. This early intervention helps parents prepare for the responsibilities of
raising a child and fosters a positive and supportive family environment from the beginning.
● Family therapy and family crisis intervention: Family therapy focuses on improving communication
and resolving conflicts within the family unit. It recognizes that individual psychological well-being
is closely tied to family dynamics, and addressing family issues can have a positive impact on
individual mental health. Family crisis intervention involves providing immediate support during
times of crisis or significant stress. This intervention aims to stabilize the family unit, address acute
issues, and prevent further escalation of problems.
The main task is to change parental efforts before serious problems emerge in
children. In adolescents, a peer group is a primary socialization agency.
Programs to control delinquency and drug abuse are focused on peer groups.
Project community: organization for high school-age disaffected youth in Berkeley. Through social
interaction, self-exploration, quasi-therapeutic activities, and workshops, the program aims to create a
positive and supportive environment that encourages positive behaviour and personal growth.

The individual:
The main purpose of this strengthen a person’s ability to cope with stress.
Two ways: direct contact or consultation with family or friends who are involved with the person in crisis.
Direct contact: Interacting directly with the individual facing the crisis provides an immediate and personal
support system.
Consultation: Involving family or friends who are connected to the person in crisis provides a broader support
network.
Crises are an important opportunity for fostering adaptive coping for future
stress. Crises: spontaneous(death) or prediction (starting school, getting married
etc.)
Spontaneous Crises (e.g., Death): In situations like the spontaneous loss of a loved one, individuals may be
forced to confront intense emotions and find ways to cope.
Predictable Crises (e.g., Starting School, Getting Married): Even events that are anticipated, like major life
transitions, can be stressful. Navigating these transitions effectively requires adaptive coping mechanisms.

Unit 4

Brief Analysis of Community (Public Health) And Social Action Models of Mental Health

➢ Community models of mental health

● Clinical pole

● Public health pole

➢ Social action model

There are 5 models of mental health:

1. Clinical model:
Custodial

Therapeutic

2. Community model:
Clinical pole

Public mental health pole

 1. Social action model

Clinical Model

• Emphasis is on the individual in distress.

• Thinking is mainly in terms of medical concepts.

• Psychological understanding and psychotherapy are emphasized.

Community Model

This approach represents a change in healthcare from focusing on individuals to focusing on

their social environment. It acknowledges that social factors like economic status, cultural
background, and community support are significant contributors to human problems. In patient
care, the focus extends beyond medical needs to include the values and institutions of the
community. This care takes place in settings that are adaptable to diverse needs. The goal is to
ensure that clinical services are available and accessible to everyone, regardless of their
background or circumstances. The objective is to create an inclusive healthcare system that is
responsive to the broader needs of the community.

Clinical Pole
This healthcare approach aims to help individuals while considering the needs and lifestyle of their
community. Rather than formal settings, it's informal and emphasizes collaboration among family members,
community caretakers, and trained individuals.
The primary goal is to provide brief and targeted therapy to support individuals through their current crisis
and improve their social skills. This approach does not aim to make major personality changes, making it
more cost-effective.
Clinicians play an active role in the individual's daily life, addressing their current problems and social
behaviour. They work with the individual, family members, and others to promote well-being through
relationships and environment. This approach is community-oriented and aims to provide customized and
accessible support for those in need.

Public Health Pole

Efforts are being made to improve the social conditions of entire communities. The main goal is prevention,
which means shifting interventions from being focused on individuals to being focused on populations or
social systems. By reducing stress in families, schools, police, factories, and the social environment in which
people live, we can improve the well-being of large groups of people.
Any social institution can be the target of change, but the focus is on institutions that are directly involved in
the lives of community members and are most accessible for change. For example, in the case of malaria, the
clinical approach focuses on treating the individual with malaria, while the public approach focuses on
preventing malaria by eliminating the conditions that cause the disease.

Social Action Model

This extreme social-focused view in intervention believes that the problems in society cause issues, not
individual shortcomings. The main idea is that society itself is troubled and needs changes to make things
better for everyone. Instead of trying to change individuals, the focus shifts to transforming how society is
set up.

In this view, clinical intervention (like therapy or medical treatment) is seen as getting in the way of making
big social changes. People who support this approach don't like the usual way of thinking in medicine,
which often tries to fix individual problems. Instead, they want to do things that target important social
programs and talk to people who make decisions in politics and society. The main goal is to make
significant changes in how society works to fix the main causes of human problems, aiming for a fairer and
more equal society. This way of thinking is all about being actively involved in social movements and
making big changes to improve the well-being of everyone in the community.

Unit 5: Caplan’s preventive psychiatry, Ecological model, adapting general systems theory.

Preventive psychiatry, as defined by Caplan, involves community programs to address the problems of
mentally disordered individuals. The goal of these programs is to reduce the incidence and duration of mental
disorders and the resulting impairment. The underlying assumption is that human beings require supplies
appropriate to their level of development, and deficiencies in these supplies can lead to psychological
disorders.
Three types of supplies are needed for healthy psychological development: physical, psychosocial, and
sociocultural. Physical supplies include food, shelter, protection, and sensory stimulation. Psychosocial
supplies are received through social interaction and include emotional and intellectual stimulation, love,
affection, and satisfying social encounters. Sociocultural supplies are determined by social forces, such as
community services, societal expectations, employment, and education access, and advantaged social groups
have greater input into these supplies.
Research has connected aspects of each supply category to mental health disorders: physical factors include
noise, population density, nutrition, and lack of safety; psychosocial factors include lack of social support,
family conflict, and marital conflict; and sociocultural factors include loss of role, economic effects, and
sociocultural status.
Crisis resolution is the fourth dimension, and life crises can either endanger adaptation and lead to mental
health disorders or provide opportunities for growth and development. Helping individuals overcome these
crises is an important aspect of primary prevention.
Caplan identified two levels of primary prevention action: social action and interpersonal action. Social action
involves efforts to influence legislative and social action programs that serve welfare, health, or educational
needs in society. Interpersonal action involves direct face-to-face interventions to influence individuals,
families, and communities.

Ecological Systems Theory

Urie Bronfenbrenner believed that development is a complex process that happens when an individual
interacts with their surroundings. He suggested studying and intervening in natural settings and proposed five
contextual systems to explain these interactions.

The five systems are:

1. The microsystem: where people interact daily, such as at home, school, and work settings.
2. The mesosystem: how different microsystems connect and interact with each other.
3. The exosystem: how the environment indirectly affects an individual through their connections to other
settings.
4. The macrosystem: the cultural patterns such as beliefs, customs, and systems that influence development.
5. The chronosystem: how time and change affect development.

Bronfenbrenner's ecological system theory has several key features. Protective factors are present in each
system, and positive interactions are essential for normal development. It is crucial to focus on naturalistic
studies and interventions for mental health.

The ecological model has been applied to different areas, such as child abuse and Type A behaviour. A
behavioral-environmental model of health problems has also been developed and applied to health promotion
issues.

Ecological Model
The Ecological Model, developed by McLeroy et al in 1988, says that health is everyone's responsibility, not
just the individual's. It also says that behaviour is influenced by and affects the social environment. This
means that five levels impact behaviour and well-being: the intrapersonal level, the interpersonal level, the
organizational level, the community level, and the policy level.

The intrapersonal level is about the individual's knowledge, attitudes, behaviour, self-concept, and skills, and
how they can influence their health. To help with this, programs like education, support groups, and
counselling can help change the individual's behaviour.

At the interpersonal level, social networks and social support systems are important. Social relationships
provide social resources that help fulfil social and personal obligations and responsibilities. Programs that
focus on changing individuals through social influences, increasing social capital, and training in
interpersonal relationship skills can help.

The organizational/institutional level includes institutions like employment organizations, educational

institutions, and religious institutions. Programs that target this level can help create healthier environments,
increase social support, and institutionalize successful health promotion programs.

The community level is about how people interact based on norms and values. Programs that use mediating
structures to deliver services, increase coordination among community agencies, and increase access to
political and power structures of the community can help.

The policy level is about local, state, and national laws and policies that impact basic needs like housing
facilities, employment opportunities, and education access. Programs that increase public awareness about
health and policy issues, develop laws and policies to educate citizens, and conduct studies examining the role
of social measures and socioeconomic factors on mental health can help.

General Systems Theory

Communities are made up of interconnected networks of human, social, and environmental
systems. Changes in one system affect and are influenced by changes in others. System theory
aims to study the properties of a system, its interrelated parts, and its relations to other systems.

System theory is a way of understanding how living things are organized and interact with their
surroundings. It was introduced by Bertalanffy, a biologist, in 1968. The theory helps us study
the different parts of a system, how they work, and how they interact with other systems.
Systems are open because they receive input and output from other systems. To study systems,
we use different approaches.

Using system theory, we can systematically plan for community mental health. We can analyze
different systems and their interactions to understand how to improve mental health in our
communities. For example, if the problem is depression among the elderly population in an
urban area, factors such as a noisy and polluted environment, limited opportunities for
recreation, and isolation due to a lack of intellectual and emotional stimulation should be
considered. Possible solutions could include the establishment of religious centres, social
action forums, and government policies and funds for the welfare of elderly people.

To apply a system-analytic approach, we must follow these steps:

1. Decide on the goal or mission of the program.
2. Describe the system boundaries and subsystems that make it up.
3. Understand how system change occurs and the factors underlying it.
4. Develop a model that considers all elements of the system, including stable and unstable
properties.
5. Use the model to generate theoretical changes of different kinds and see what possible
outcomes might result when we make alterations.
6. Select the most desirable outcome for the goal set and carry out the action model to reach the
goal.
7. Cut costs, clarify doubts, and avoid waste before the intervention.
System theory is particularly useful in preventing problems that are well-defined and have a
limited scope. The goals are clear, and relevant variables are known and quantified. Applying
system theory to study and intervene in the mental health problem of small, less complex
communities can be effective.

However, one limitation of system theory is that its application is often limited to studying
problems and generating alternative solutions. Expertise is needed for sophisticated steps.