Mental Health Education Discussed In Which Level Of Prevention?


Mental Health Education Discussed In Which Level Of Prevention
Tertiary prevention: helping people living with mental health problems to stay well – This helps people with mental ill-health stay well and have a good quality of life. It aims to reduce people’s symptoms, empower them to manage their well-being and reduce the risk of relapse.
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What are the levels of prevention in mental health?

THE CONCEPTS – Health promotion mainly deals with the determinants of mental health and aims to keep people healthy or become even healthier.2, 4 In other words, mental health promotion aims at enhancing individual’s ability to achieve psychosocial well-being and at coping with adversity.4 On the other hand, prevention of illnesses focuses on the causes of risk factors to avoid illness.2 There are three categories of prevention: primary prevention focuses on various determinants in the whole population or in the high risk group.

  1. Secondary prevention comprises early detection and intervention.
  2. Tertiary prevention targets for advanced recovery and reduction of relapse risk.
  3. As you see, the concepts of promotion and prevention are interrelated and overlapped.
  4. Indeed, the direct causal pathway is not generally established in most mental illnesses, but rather multiple factors including both risk and protective factors contribute to the development of them.

Therefore, mental health promotion might involve specific activities for prevention and some researchers used mental health promotion as a general term including both concepts.15 Mental health promotion and illness prevention were also taken together in the present review.
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What is primary prevention for mental health?

Primary prevention focuses on preventing the onset of mental health conditions by reducing people’s exposure to risk factors and/or increasing their exposure to protective factors for these conditions.
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What level of prevention is education?

Levels of Prevention – Three broad categories of determinants of human behavior will be discussed in this study session and you will have an opportunity to learn about the influence of these factors in determining human behavior. Prevention, as it relates to health, is really about avoiding disease before it starts.

Examples include immunization and taking regular exercise.

Secondary prevention —those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury to prevent more severe problems developing. Here health educators such as Health Extension Practitioners can help individuals acquire the skills of detecting diseases in their early stages.

Examples include screening for high blood pressure and breast self-examination.

Tertiary prevention —those preventive measures aimed at rehabilitation following significant illness. At this level health services workers can work to retrain, re-educate and rehabilitate people who have already developed an impairment or disability.

  • How do you think health education can help with the prevention of disease?
  • Do you think it will operate at all these levels?
  • Note an example of possible health education interventions at each level where you think health education can be applied.

Health Education can be applied at all three levels of disease prevention and can be of great help in maximizing the gains from preventive behavior,

  • For example at the primary prevention level — you could educate people to practice some of the preventive behaviors, such as having a balanced diet so that they can protect themselves from developing diseases in the future.
  • At the secondary level, you could educate people to visit their local health center when they experience symptoms of illness, such as fever, so they can get early treatment for their health problems.
  • At the tertiary level, you could educate people to take their medication appropriately and find ways of working towards rehabilitation from significant illness or disability.

You have learned that:

  • Primary prevention includes those preventive measures that come before the onset of illness or injury and before the disease process begins. Examples include immunization and taking regular exercise to prevent health problems developing in the future.
  • Secondary prevention includes those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury. This should limit disability, impairment or dependency and prevent more severe health problems developing in the future.
  • Tertiary prevention includes those preventive measures aimed at rehabilitation following significant illness. At this level health educators work to retrain, re-educate and rehabilitate the individual who has already had an impairment or disability.

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What methods of prevention are used with mental disorders?

Harmful or Helpful – Risks and protective factors are often used as a framework for addressing issues that impact prevention and early intervention of mental illness. Risk factors are harmful and impede recovery, while protective factors are helpful and support recovery.

  1. We have chosen to address harmful or helpful factors in four categories.
  2. While there is some overlap among the categories and no exact formula for how much a specific factor will affect an individual, these four categories provide a good framework for exploring the different ways we can support people in reaching their recovery goals.

The categories are:


Does my brain and body have the ability to do the things I need? Traumatic brain injuries, chronic illnesses, and mental health disorders are common examples of health issues that impact our body and brain’s ability to do the things we would like. Health related issues that influence mental health also include toxic exposure, nutrition, and sleep, among others.

Safety or Security

Are there environmental or interpersonal factors that affect my ability to attend to or pay attention to the things I need? Trauma like abuse, neglect, experiencing sexual or physical violence, or exposure to violence interferes with our ability to pay attention to what we need.

After traumatic experiences, many survivors respond with hypervigilance – a heightened state of fear and attention to one’s surroundings. In this way, many children who experience trauma become like child soldiers, paying close attention to any factor that might bring imminent harm. This change in attention makes it difficult for children when they try to focus on or respond to daily demands such as school or other everyday activities.

Harmful or helpful factors in this category refer to external influences that impact how a person can lend appropriate and required attention to the things they need and want to do.


Do I have the tangibles or services available to meet my needs? This includes access to resources like adequate housing, nutritious food, finances, and education, as well as mental health services, like school based supports and mental health treatment.

As Abraham Maslow understood in his Hierarchy of Needs, physiological needs like air, water, food, and shelter are the most basic requirements for an individual to function and thrive. When youth experience the early signs of mental illness (typically around puberty), having access to needed mental health resources like therapy, peer services, supported education, case management, integrated school and community care, and sometimes medication is crucial to prevent mental illness from getting worse.

Harmful or helpful factors in this category refer to goods or services that support an individual’s physical and mental health and overall well-being.


Do I have interpersonal supports that help me meet my needs? This includes healthy and appropriate relationships with others, including caregivers, family, friends, or classmates. This also includes the extent to which the individual feels like a valued member of his or her community.

  1. While relationships can be a resource and contribute to whether we feel safe or insecure, they are given a separate category because of the special role healthy or unhealthy relationships can have for individuals.
  2. The negative effects of isolation are an all too common experience for individuals with mental illness.

Programs and policies that address isolation or family and peer support deserve extra attention. Harmful or helpful factors in this category refer to the support a person needs and receives from those around him or her that impact health and well-being.

In addition to the four categories of harmful (risk) or helpful (protective) factors, we divided early lifespan into three distinct periods where specific social, emotional, and biological changes occur: the prenatal period to early childhood, early childhood to puberty, and puberty to early adulthood.

These periods are critical times where we can take action to support children and young adults before they reach a crisis or when recovery becomes more difficult. For each stage, we provide research on important risk or protective factors and offer several policy and program options that have been shown to remove harmful factors or increase helpful factors.
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What is secondary prevention for mental health?

Secondary prevention: supporting those at higher risk of experiencing mental health problems – This focuses on supporting people who are more likely to develop mental health problems, either because of characteristics they were born with or experiences they’ve had.
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Is mental health primary or secondary care?

What is the mental health system? – The mental health system within the NHS is split into 3 tiers: primary, secondary and tertiary care. But from April 2021, the NHS has started rolling out a programme called the Integrated Care System which will change the landscape of the current healthcare system.

your GP, your local link worker through your GP. See the later section below for more information, ‘What is social prescribing?’ and talking therapy from your local Improving Access to Psychological Therapies (IAPT) service.

Secondary care, This is the next level of care in the NHS. It covers general community and hospital care. A mental health team (MHT) is part of community care. Community care means you get treatment outside of a hospital stay. You may be referred to an MHT if you need more support with your mental health.

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MHT’s are staffed with professionals such as a psychiatrist and psychologists. See the next section, ‘Are there different mental health teams?’ for more information. Hospital care includes inpatient treatment. You are an inpatient in hospital if you stay voluntarily, or if you are detained under the Mental Health Act.

Tertiary care, This is highly specialist care within the NHS. It covers specialist community and hospital care. Examples of community tertiary care are:

assertive outreach teams, and specialist national services within the Maudsley hospital in London.

The Maudsley is a national service which means that you can access it even if you live outside of London. But you will need a referral. Specialist hospital care includes secure units. Patients in secure units are usually detained under the Mental Health Act and present a level of risk greater than general mental health services could safely deal with.
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What is primary secondary and tertiary prevention?

Primary, secondary, and tertiary prevention – Chronic diseases are among the most prevalent and costly health-related problems facing the United States.4 Fortunately, the chronic conditions and risk factors that contribute the most to death and disability are also among the most preventable ( Box 47.2 ).9 There are three approaches to prevention: primary, secondary, and tertiary.

The primary prevention approach focuses on preventing disease before it develops; secondary prevention attempts to detect a disease early and intervene early; and tertiary prevention is directed at managing established disease in someone and avoiding further complications.10 The goal of primary prevention is to take action to prevent the development of a disease or injury in a person who is “well.” Primary prevention has the potential to reach large portions of the population, and can therefore have a substantial impact on the population’s health while remaining cost effective.11 Examples include the routine immunization of healthy people against communicable diseases such as measles and influenza.

Primary prevention efforts can take place at both the individual and population/policy development levels. For example, although selection of fruits and vegetables, whole grains, and low-fat foods are individual-level prevention measures, taxation of sugar-sweetened beverages and requirements that calorie counts be included on fast-food restaurant menus are policy-level measures aimed at promoting healthy choices and primary prevention.

  1. The goal of secondary prevention is to identify individuals for whom a disease process has already begun, but who remain asymptomatic.
  2. Secondary prevention includes following the United States Preventive Services Task Force (USPSTF)’s evidence-based recommended screenings for cancer, diabetes, obesity, hypertension, and the like, with the aim of identifying a disease when it is still asymptomatic.

Early identification of a disease through screening permits earlier intervention, and ideally, an improved chance of a cure and/or reductions in morbidity and mortality associated with the disease. Tertiary prevention involves the prevention of complications in people who have already developed disease, and in whom disease prevention is no longer an option.

  1. For these patients, the goal of tertiary prevention is to maximize the outcomes and prevent further morbidity from the disease process.
  2. An example might include initiating cardiac therapy and rehabilitation in a patient who experienced a myocardial infarction.
  3. The damage to the heart cannot be reversed; however, with appropriate cardiac therapy and rehabilitation, the patient will be able to maximize his or her cardiac output and prevent further morbidity and mortality associated with the myocardial infarction.

Historically, the majority of health care time and resources have been provided in the tertiary prevention stage, but to decrease health care expenditures and have the greatest impact on improving the health of both individuals and the population, all three of these prevention methods should be optimized ( Table 47.1 ).
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What are examples of secondary prevention?

The three levels of prevention are primary, secondary, and tertiary. In primary prevention, a disorder is actually prevented from developing. Vaccinations, counseling to change high-risk behaviors, and sometimes chemoprevention are types of primary prevention.

  • In secondary prevention, disease is detected and treated early, often before symptoms are present, thereby minimizing serious consequences.
  • Secondary prevention can involve screening programs, such as mammography to detect breast cancer and dual x-ray absorptiometry (DXA) to detect osteoporosis.
  • It can also involve tracking down the sex partners of a person diagnosed with a sexually transmitted infection (contact tracing) and treating these people, if necessary, to minimize spread of the disease.

In tertiary prevention, an existing, usually chronic disease is managed to prevent complications or further damage. For example, tertiary prevention for people with diabetes focuses on control of blood sugar, excellent skin care, frequent examination of the feet, and frequent exercise to prevent heart and blood vessel disease.

  • Tertiary prevention for a person who has had a stroke may involve taking aspirin to prevent a second stroke from occurring.
  • Tertiary prevention can involve providing supportive and rehabilitative services to prevent deterioration and maximize quality of life, such as rehabilitation from injuries, heart attack, or stroke.

Tertiary prevention also includes preventing complications among people with disabilities, such as preventing pressure sores in those confined to bed.
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What is primary secondary & tertiary prevention of stress?

Abstract – This article explores a range of sources of workplace stress and a three-prong intervention strategy for managing pressures at work. The three approaches highlighted are primary, secondary, and tertiary prevention interventions. Primary is concerned with stressor reduction, secondary with stress management and tertiary with remedial support.
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Is educating primary prevention?

Primary prevention – Primary prevention aims to prevent disease or injury before it ever occurs. This is done by preventing exposures to hazards that cause disease or injury, altering unhealthy or unsafe behaviours that can lead to disease or injury, and increasing resistance to disease or injury should exposure occur. Examples include:

legislation and enforcement to ban or control the use of hazardous products (e.g. asbestos) or to mandate safe and healthy practices (e.g. use of seatbelts and bike helmets) education about healthy and safe habits (e.g. eating well, exercising regularly, not smoking) immunization against infectious diseases.

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Is education secondary prevention?

Consider the following situations and select the most appropriate answer: – Case Scenario 1. Ms. Leonard is a 72-year-old woman with chronic obstructive pulmonary disease who is a former cigarette smoker with a 60 pack-year history. Her medications include a long-acting beta 2 -agonist with inhaled corticosteroid and as-needed use of a short-acting beta 2 -agonist.

Reviewing appropriate use of her medications Administration of annual influenza immunization Obtaining spirometry measurement Periodic colonoscopy

The correct response in Ms. Leonard’s scenario is B. Of the options listed, influenza vaccine is the only activity that is aimed at disease prevention. Educating patients about their medications and assessment of pulmonary function are part of treating established disease.

Administration of appropriate pneumococcal vaccine Mammography Discussion of home safety to minimize fall risks Assessment for the presence of abnormalities on the cardiac exam

The correct response in Ms. Giordano’s scenario is B. Secondary prevention activities are aimed at early disease detection; mammography is an example. Pneumococcal vaccine is an example of primary prevention, as is education to minimize falls. Assessing for abnormalities on the cardiac exam, such as the presence of the S 4, which is indicative of diastolic dysfunction and frequently found in the presence of protracted blood pressure elevation, is part of the ongoing evaluation of the person with established hypertension.

The goal of treating a person with hypertension is not simply to achieve normotensive status. Rather, tertiary prevention measures for such patients include avoiding or minimizing damage in the target organs of hypertension: brain, eye, cardiovascular system, and kidney. Whether preparing for NP certification or practice, keep in mind the patient’s primary, secondary, and tertiary prevention needs.

These concepts help prioritize and guide care.
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Is education a primary prevention?

The Difference Between Primary, Secondary, and Tertiary Prevention Prevention is divided into three categories: primary, secondary, and tertiary prevention. ” Primary prevention targets individuals who may be at risk to develop a medical condition and intervenes to prevent the onset of that condition.

Examples include childhood vaccination programs, water fluoridation, anti-smoking programs, and education about safe sex. Secondary prevention targets individuals who have developed an asymptomatic disease and institutes treatment to prevent complications, Examples include routine Papanicolaou tests and screening for hypertension, diabetes mellitus, or hyperlipidemia.

Tertiary prevention targets individuals with a known disease, with the goal of limiting or preventing future complications. Examples include screening patients with diabetes for microalbuminuria, rigorous treatment of diabetes mellitus, and post-myocardial infarction prophylaxis with b-blockers and aspirin.” ABFM question critique Further Reading Roadmaps for clinical practice: A primer on population-based medicine.
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Which is an example of tertiary prevention in community mental health?

When: Primary, Secondary, and Tertiary Prevention – The first framework centers on when in the course of a disease the preventive intervention is provided. Primary prevention occurs before any evidence of disease and aims to reduce or eliminate causal risk factors, prevent onset, and thus reduce incidence of the disease.

Well-known examples include vaccinations to prevent infectious diseases and encouraging healthy eating and physical activity to prevent obesity, diabetes, hypertension, and other chronic diseases and conditions. Secondary prevention occurs at a latent stage of disease—after a disease has begun but before the person has become symptomatic.

The goals, which ultimately reduce the prevalence of the disease, are early identification through screening as well as providing interventions to prevent the disease from becoming manifest. Screening tools and tests (e.g., checking body mass index, mammography, HIV testing) are examples of secondary prevention.

Finally, tertiary prevention is an intervention implemented after a disease is established, with the goal of preventing disability, further morbidity, and mortality. Medical treatments delivered during the course of diseases can be considered tertiary prevention. This is the bulk of the work carried out by today’s medical field, including psychiatry.

Relapse prevention is another form of tertiary prevention. In psychiatry, primary, secondary, and tertiary prevention are exemplified, respectively, by eliminating certain forms of dementia that stem from vitamin deficiencies, screening for problematic drinking that precedes alcohol use disorder, and providing psychosocial treatments to reduce disability among individuals with serious mental illnesses.
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In what ways is tertiary prevention a form of mental illness prevention?

Tertiary prevention addresses the treatment and management of ongoing illness. In psychiatry, efforts to improve prognosis, prevent relapse, decrease disability and functional impairment, limit morbidity and mortality, and generally decrease the negative impact of mental illness are all forms of tertiary prevention.
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What is secondary prevention of depression?

Background – Major depression is one of the world’s leading causes of disability in adults with long‐term physical conditions compared to those without physical illness. This co‐morbidity is associated with a negative prognosis in terms of increased morbidity and mortality rates, increased healthcare costs, decreased adherence to treatment regimens, and a substantial decline in quality of life.

Therefore, preventing the onset of depressive episodes in adults with long‐term physical conditions should be a global healthcare aim. In this review, primary or tertiary (in cases of preventing recurrences in those with a history of depression) prevention are the focus. While primary prevention aims at preventing the onset of depression, tertiary prevention comprises both preventing recurrences and prohibiting relapses.

Tertiary prevention aims to address a depressive episode that might still be present, is about to subside, or has recently resolved. We included tertiary prevention in the case where the focus was preventing the onset of depression in those with a history of depression (preventing recurrences) but excluded it if it specifically focused on maintaining an condition or implementing rehabilitation services (relapse prevention).
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What are primary secondary and tertiary mental health services?

Tertiary Care – Tertiary care is often prescribed to hospitalised patients, patients with chronic conditions and patients with severe diseases. Tertiary care requires highly specialised and specific equipment and expertise. Procedures that patients receive in tertiary care include coronary artery bypass surgery, plastic surgeries, severe burn treatments, dialysis, neurosurgeries, and other complex treatments.

A small local hospital may be unable to provide certain tertiary care services, and patients may often have to go to facilities that offer advanced care. Within the UK, the levels of care relate to many different requirements and criteria such as the severity of conditions, required treatments and specialisations, qualification of the healthcare worker and many other important factors.

Primary care involves patients’ primary healthcare providers, secondary care deals with specialists and tertiary care is a higher level of specialised care within a hospital. Knowing these levels of healthcare is important for anyone looking to work in the healthcare industry.
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What is a tertiary prevention for depression?

Tertiary prevention focuses on the period after a mental health disorder or crisis has already occurred. The focus at this point is to help promote the patient’s recovery as well as to prevent further complications.
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What does tertiary mean in mental health?

Tertiary care program elements include psychosocial rehabilitation, sophisticated medication management, and behavioural approaches. Tertiary care may be delivered through assertive community treatment and/or specialized outreach teams, community residential programs, or hospital-based services.
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Are mental health services secondary care?

Secondary care is services which generally will need a referral from a GP. Examples of secondary mental health services are hospitals, some psychological wellbeing services, community mental health teams (CMHTs), crisis resolution and home treatment teams (CRHTs), assertive outreach teams and early intervention teams.
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Are mental health services primary care?

Primary care mental health – Healthy London Partnership The vast majority of people with mental health problems who get treatment for their mental health are seen within primary care, with 90 per cent of people receiving the treatment and care solely in primary care settings” (Mind).

Providing high-quality mental health care in primary care, including GP practices, can make a big difference for service users, carers and professionals involved in their care. Receiving mental healthcare in a GP practice or other primary care setting can be less stigmatising for service users, compared with a hospital or specialist service: an individual’s mental health needs can be seen as a long-term condition requiring ongoing primary care support, much like diabetes or respiratory conditions.

Physical and mental health can be treated in the same place, resulting in more joined-up care that is better for patients and more cost-effective. Making better use of primary care for mental health means specialist mental health services are more available to people who really need.

There will be shorter waiting time for treatment and a clear pathway to primary care services when their health improves. This can be part of a positive recovery plan where people are supported as they move from specialist to primary care. We are working with the London Mental Health Clinical Network on a set of guiding principles for CCGs and GPs for developing and improving mental healthcare in primary care.

These will explore and share learning from current mental health care models in primary care. GP clinical leads across London are involved along with service users from Mind and local representatives. We have already completed a scoping exercise to understand current developments in primary care mental health models across the capital.

We found CCGs in London are at various stages of developing and rolling out mental health care models in primary care. There are many new initiatives where specialist and primary care staff are working together with community-based organisations for a more holistic, enhanced primary care mental health offer.

: Primary care mental health – Healthy London Partnership
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Is community mental health secondary care?

Treatment at the Community Mental Health Team –

Assessment for treatment When you are referred for support or treatment through the CMHT, especially if referred for psychological treatment, you will be assessed by a mental health professional. The assessor will get a full picture of what you are experiencing and discuss treatment options. At this stage, if something different is offered, it can help to remember that CBT with ERP is the most effective treatment for OCD and what is recommended by the NICE guidelines. These types of assessment do not typically result in an official diagnosis, but the service can recognise OCD symptoms and acknowledge them in your records. After the assessment, you would either be placed on a waiting list or referred to a more appropriate service if the assessor does not believe the CMHT is the best option. CBT with ERP with a Clinical psychologist A clinical psychologist has years of training and experience working in the mental health system and offering psychological treatments to people with a range of needs. They will usually have a doctorate but are not medical doctors. They can offer more specialised CBT with ERP to you if you have severe symptoms or might be struggling with other problems that make the OCD harder to treat. Often, clinical psychologists will have training in a number of psychological treatments. This usually includes CBT but that might not be the main therapy they are experienced in. What is important is that they have training in OCD and ERP, as outlined in the treatment guidelines. Medication and Assessment for diagnosis with a Psychiatrist A psychiatrist is a medical doctor who has specialised and trained in working with mental health conditions. The main services offered by psychiatry are assessment and medication. Your psychiatrist might also be the clinician overseeing your case, also known as your ‘consultant’. If you haven’t responded to initial medication recommendations and are exploring more complex options like combinations, this will most likely be done with a psychiatrist. They might also be asked to consult on your medication as a one-off, while your GP remains in charge of prescribing and monitoring symptoms. An assessment with a psychiatrist is a one-off appointment which would result in a report of your symptoms, a diagnosis, and recommendations for your treatment. These are quite rare and only needed if there is uncertainty about what you are struggling with.

Mental health nursing and support Community Psychiatric Nurses (CPN) and Mental Health Nurses (MHN) are trained in mental health and can offer you emotional and practical support, either at the CMHT or through home visits. Depending on their training and experience, this might include guiding you through CBT strategies or self-help resources for OCD. They can also give medication and monitor its effects. Occupational Therapy An Occupational Therapist (OT) provides assessments, information, and practical support around self-care, everyday tasks, work, and leisure to help an individual live independently. For example, if you are getting extra support at work because of your OCD, or have had to reduce your workload because of it, your employer might request an OT assessment. Their report would focus on the concrete and abstract obstacles brought on by your symptoms, as well as what adjustments would be appropriate. Social services Social workers bring a social perspective to the team’s working. They help people to talk through their problems, give them practical advice and emotional support, and can provide some psychological support such as CBT strategies. They are often able to give expert practical help with money, benefits, and housing issues. Being under the care of a CMHT does not mean you will necessarily interact with a social worker. You should never be referred to social services only because of the themes of your intrusive thoughts, because these are not signs of risk. Care coordination with any of the above Also sometimes referred to as a key worker, a care coordinator is your main point of contact as a patient. They might speak to you regularly, monitor your mental health, offer information about the condition or services available, and, most importantly, coordinate your treatment plan and speak to professionals on your behalf. Crisis support with the Crisis team The crisis team offers short-term support aimed at preventing someone who is having a mental health crisis from needing hospitalisation. They can offer medication, home visits, and coping strategies, and should also support you to be in touch with other services for treatment and more long-term support. If you feel at risk of seriously hurting yourself you can get crisis support through your GP, calling 111, or calling your local urgent mental health helpline,

The NICE guidelines say that if you are ‘in remission’, which means your symptoms have improved and are not affecting your quality of life, you should be offered appointments over the next 12 months to monitor this. How often these will happen will depend on the individual case.

  • If, after 12 months, you’ve kept up your recovery, you will be discharged back to your GP.
  • The NICE guidelines also offer specific steps as to what treatments and care should be offered at each stage, if the previous treatments didn’t work.
  • If the recommend treatment plan at this level (CBT with ERP combined with anti-obsessional medication) hasn’t brought on any or enough of a positive change in symptoms, then a multidisciplinary review is needed to discuss the next steps in your treatment, including the possibility of a referral to a specialist service.
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If you have tried a combination of CBT with ERP and anti-obsessional medication, and within that have tried both an SSRI drug and Clomipramine, then the next step should be a referral to a multidisciplinary team with expertise in OCD or BDD. This expert team should assess you and recommend a treatment plan.
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What are the 3 levels of prevention explain each?

The three levels of prevention are primary, secondary, and tertiary. In primary prevention, a disorder is actually prevented from developing. Vaccinations, counseling to change high-risk behaviors, and sometimes chemoprevention are types of primary prevention.

In secondary prevention, disease is detected and treated early, often before symptoms are present, thereby minimizing serious consequences. Secondary prevention can involve screening programs, such as mammography to detect breast cancer and dual x-ray absorptiometry (DXA) to detect osteoporosis. It can also involve tracking down the sex partners of a person diagnosed with a sexually transmitted infection (contact tracing) and treating these people, if necessary, to minimize spread of the disease.

In tertiary prevention, an existing, usually chronic disease is managed to prevent complications or further damage. For example, tertiary prevention for people with diabetes focuses on control of blood sugar, excellent skin care, frequent examination of the feet, and frequent exercise to prevent heart and blood vessel disease.

  • Tertiary prevention for a person who has had a stroke may involve taking aspirin to prevent a second stroke from occurring.
  • Tertiary prevention can involve providing supportive and rehabilitative services to prevent deterioration and maximize quality of life, such as rehabilitation from injuries, heart attack, or stroke.

Tertiary prevention also includes preventing complications among people with disabilities, such as preventing pressure sores in those confined to bed.
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What are the 3 levels of mental health?

Journal List World Psychiatry v.14(2); 2015 Jun PMC4471980

World Psychiatry.2015 Jun; 14(2): 231–233. According to the World Health Organization (WHO), mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” ( 1 ).

This definition, while representing a substantial progress with respect to moving away from the conceptualization of mental health as a state of absence of mental illness, raises several concerns and lends itself to potential misunderstandings when it identifies positive feelings and positive functioning as key factors for mental health.

In fact, regarding well-being as a key aspect of mental health is difficult to reconcile with the many challenging life situations in which well-being may even be unhealthy: most people would consider as mentally unhealthy an individual experiencing a state of well-being while killing several persons during a war action, and would regard as healthy a person feeling desperate after being fired from his/her job in a situation in which occupational opportunities are scarce.

People in good mental health are often sad, unwell, angry or unhappy, and this is part of a fully lived life for a human being. In spite of this, mental health has been often conceptualized as a purely positive affect, marked by feelings of happiness and sense of mastery over the environment ( 2 – 4 ).

Concepts used in several papers on mental health include both key aspects of the WHO definition, i.e. positive emotions and positive functioning. Keyes ( 5, 6 ) identifies three components of mental health: emotional well-being, psychological well-being and social well-being.

Emotional well-being includes happiness, interest in life, and satisfaction; psychological well-being includes liking most parts of one’s own personality, being good at managing the responsibilities of daily life, having good relationships with others, and being satisfied with one’s own life; social well-being refers to positive functioning and involves having something to contribute to society (social contribution), feeling part of a community (social integration), believing that society is becoming a better place for all people (social actualization), and that the way society works makes sense to them (social coherence).

However, such a perspective of mental health, influenced by hedonic and eudaimonic traditions, which champion positive emotions and excellence in functioning, respectively ( 7 ), risks excluding most adolescents, many of whom are somewhat shy, those who fight against perceived injustice and inequalities or are discouraged from doing so after years of useless efforts, as well as migrants and minorities experiencing rejection and discrimination.

The concept of positive functioning is also translated by several definitions and theories about mental health into the ability to work productively ( 1, 8 ), and may lead to the wrong conclusion that an individual at an age or in a physical condition preventing her/him from working productively is not by definition in good mental health.

Working productively and fruitfully is often not possible for contextual reasons (e.g., for migrants or for discriminated people), which may prevent people from contributing to their community. Jahoda ( 9 ) subdivided mental health into three domains: self-realization, in that individuals are able to fully exploit their potential; sense of mastery over the environment; and sense of autonomy, i.e.

Ability to identify, confront, and solve problems. Murphy ( 10 ) argued that these ideas were laden with cultural values considered important by North Americans. However, even for a North American person, it is hard to imagine, for example, that a mentally healthy human being in the hands of terrorists, under the threat of beheading, can experience a sense of happiness and mastery over the environment.

The definition of mental health is clearly influenced by the culture that defines it. However, as also advocated by Vaillant ( 11 ), common sense should prevail and certain elements that have a universal importance for mental health might be identified.
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What are the 4 P’s in mental health?

Introduction – Healthy children experience frequent medical procedures such as immunization and blood draws ( Public Health Agency of Canada, 2006 ). Many young children experience high levels of pain and distress during these procedures, and adequate pain management strategies are seldom used ( Lisi, Campbell, Pillai Riddell, Garfield, & Greenberg, 2013 ).

  • Many children also experience distress and anxiety before the procedure even begins ( Blount, Sturges, & Powers, 1990 ).
  • This is called anticipatory distress.
  • Anticipatory distress has been identified as occurring as early as infancy.
  • Newborn infants who have been exposed to several painful procedures can learn to anticipate pain and exhibit more intense pain responses ( Taddio, Shah, Gilbert-MacLeod, & Katz, 2002 ).

Anticipatory distress and fear of medical procedures have also been identified as concerns in preschool and school-aged children. One study found that 22% of 4–6-year-old children experience serious distress during the preparatory phase of an immunization ( Jacobson et al., 2001 ).

  • Another recent study found that more than half of children under the age of 8 years have needle fear ( Taddio et al., 2012 ).
  • This finding is particularly concerning as anticipatory distress has been associated with several negative sequelae ( Bijttebier & Vertommen, 1998 ; Palermo & Drotar, 1996 ; Tsao et al., 2004 ; Wright, Yelland, Heathcote, Ng, & Wright, 2009 ).

These negative outcomes could lead to avoidance of painful medical procedures and reduced compliance with preventative medical care ( Taddio et al., 2012 ). Despite the important implications of anticipatory distress to painful medical procedures for children, little empirical work has investigated the factors that lead to its development.

  • Several models in the developmental literature have outlined the pathways that lead to the development of maladaptive anxiety and anxiety-related problems ( Cicchetti & Cohen, 1995 ; Rachman, 1977 ; Vasey & Dadds, 2001 ).
  • Within the pediatric pain literature, some work has examined the preprocedural child factors that impact a child’s pain response ( Kleiber & McCarthy, 2006 ; Young, 2005 ); however, these models focus on pain responses rather than anxiety and anticipatory distress.

Previous models share a common emphasis on the transactional and developmental nature of anxiety or fear over time and highlight the dynamic interaction between the individual child and his/her environment. The four “Ps” of case formulation (predisposing, precipitating, perpetuating, and protective factors) also provide a useful framework for organizing the factors that may contribute to the development of anticipatory distress ( Barker, 1988 ; Carr, 1999 ; Winters, Hanson, & Stoyanova, 2007 ).

  • Predisposing factors are those that put a child at risk of developing a problem (in this case, high anticipatory distress).
  • These may include genetics, life events, or temperament.
  • Precipitating factors refer to a specific event or trigger to the onset of the current problem.
  • Perpetuating factors are those that maintain the problem once it has become established.

Finally, protective factors are strengths of the child or reduce the severity of problems and promote healthy and adaptive functioning. Another “P” that can be relevant in case formulation are “present” factors, that is, those that are operating during the time of the event-eliciting distress.

  • Present factors are relevant due to the emphasis on “procedure” or context in the literature.
  • Additionally, factors that are considered protective can be collapsed within predisposing, perpetuating, and present factors.
  • The objective of this review is to summarize the findings of studies that examine factors that predict anticipatory distress to painful medical procedures in children.

This systematic review is a qualitative synthesis and summarizes the findings from the search in a summary figure. The goal of the summary figure ( Figure 2 ) is to provide an overview for researchers and clinicians of the current literature as well as highlight gaps in the literature.

Based on the developmental psychopathology perspective, factors in this review were hypothesized to fall under the four Ps of case formulation: predisposing (e.g., genetics and temperament), precipitating (e.g., negative pain experiences), perpetuating (e.g., parent behavior, parent anxiety, child behavior, and child cognitions), and present factors (e.g., health care professional behavior).

This review also evaluated the included studies for risk of bias and identified methodological limitations of current studies. Promising directions for future research in this area are outlined. Summary figure of results. FS = findings synthesis; ROB = risk of bias; + = factor has a positive relationship with anticipatory distress; − = factor has a negative relationship with anticipatory distress; ∅ = no effect or significant relationship; ? = inconclusive results; U = unclear risk of bias; L = low risk of bias; H = high risk of bias; # = number of studies.
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