Phases of Prevention

By Susanna Penfield

Prevention practices encompass a wide range of activities — commonly referred to as “interventions” — that seek to reduce threats to our mental and physical health. One framework for understanding the various ways interventions can operate to promote well-being, while mitigating illness, focuses on three levels of prevention: primary, secondary, and tertiary. 

Primary prevention intervenes at the earliest stage of potential harm, working to curtail disease or injury before it has the chance to occur. This is accomplished by inhibiting exposure to any hazards or situations that may cause injury or trauma, altering an individual’s unhealthy or unsafe behavior, and increasing resistance to potential harm should exposure occur. Primary prevention can be further understood in constitutive pieces. “Universal” prevention strategies are aimed at general population groups, regardless of risk level. “Selective” prevention programs target individuals with elevated risks. Finally, “indicated” prevention activities serve individuals who do not meet all of the criteria for a disorder, but show early indicators of a problem. 

Secondary prevention aims to reduce the impact of trauma that has already occurred, such as curbing progression of a mental health disorder or treating an injury. This intervention works short term through screening, early identification, and brief treatment. In the bigger picture, it can be achieved by implementing programs to return people to their original health and function to prevent long-term problems. As more primary care providers are encouraged or mandated to screen for undiagnosed behavioral health problems such as depression, anxiety, trauma, and substance abuse, greater numbers of individuals can be provided with timely care. 

Tertiary prevention focuses on improving an individual’s overall functioning, minimizing the impact of an ongoing illness, and helping to prevent or delay further complications for people with mental health disorders and illnesses. Broader access to care, and the emphasis on care coordination and integrated health initiatives, will create additional opportunities for improving sites for intervention and linkages to service and support. 

Given the various manifestations of mental and physical illness, it is not uncommon for symptoms to go unnoticed. This is why it is crucial that prevention strategies be adaptable depending on the context and timing of recognition or diagnosis. 

In terms of prevention, there are several ways that we can push our local representatives and respective health care providers to incorporate prevention frameworks within medical structures. As citizens and recipients of health care, we can encourage an integrated model of care that incorporates mental health, substance abuse, and physical health services into coordinated care systems. We must also apply pressure for institutions to implement universal and evidence-based screening for mental health and substance use conditions. Pushing for changes such as these, in locations close to home, will ensure a more comprehensive treatment and higher levels of community health. 

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