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The clinical practice of tomorrow already is being reshaped. Prevention will be as much a part of practice as treatment is now. Prevention practice will be based on exciting new scientific developments, such as new methods for identifying at-risk people, new empirically based interventions delivered in a variety of settings, innovative methods of engaging people and communities, and new outcome evaluation strategies. The complexity of the knowledge and skills that are necessary for the promotion of mental health and the prevention of the first onset of mental and behavioral disorders requires that psychiatrists and other mental health practitioners work together to formulate an integrated, science-based, biopsychosocial understanding of problems and their solutions.
Even though there are not enough clinicians providing treatment, especially in rural areas, there are even fewer providing clinical preventive services. One way this situation will change is by a reorientation and learning process that enables clinicians to enhance their practices gradually to include preventive services and consultation, thus reaching many more people. Becoming a preventionist enables a clinician to take measures in advance to guard against the possible or probable first onset of mental and behavioral disorders in patients and their family members.
This overview provides practicing psychiatrists with a six-step approach to incorporating prevention into clinical practice. The steps outlined below are suggestions, not dogma. The ways of becoming a preventionist cannot be followed like a cookbook, but the six steps provided, which are not necessarily sequential, represent a pedagogical vehicle for incorporating prevention into general psychiatric practice.
INCORPORATING PREVENTION INTO MENTAL HEALTH PRACTICE
Step 1. Provide Prevention-Minded Treatment: Indirect Interventions for Family Members
The first step in becoming a preventionist is to practice prevention-minded treatment.1 With this approach, the practitioner provides the usual treatment for the patient/client in the consultation room, and the practitioner also: 1) is consciously open to considering effects on family members who are not in the room, and 2) provides indirect preventive interventions through the patient to the family member. The therapist may not have intended specifically to undertake preventive interventions in the course of the treatment, but he or she may do so when the need and opportunity arises. Prevention can occur within the context of a therapeutic relationship with a prevention-minded therapist. The therapist...