Mental Health: A Report by the Surgeon General

The term “prevention” has different meanings to different people. It also has different meanings to different fields of health. The classic definitions used in public health distinguish between primary prevention, secondary prevention, and tertiary prevention (Commission on Chronic Illness, 1957). Primary prevention is the prevention of a disease before it occurs; secondary prevention is the prevention of recurrences or exacerbations of a disease that already has been diagnosed; and tertiary prevention is the reduction in the amount of disability caused by a disease to achieve the highest level of function.

The Institute of Medicine report on prevention identified problems in applying these definitions to the mental health field (IOM, 1994a). The problems stemmed mostly from the difficulty of diagnosing mental disorders and from shifts in the definitions of mental disorders over time (see Diagnosis of Mental Illness). Consequently, the Institute of Medicine redefined prevention for the mental health field in terms of three core activities: prevention, treatment, and maintenance (IOM, 1994a). Prevention, according to the IOM report, is similar to the classic concept of primary prevention from public health; it refers to interventions to ward off the initial onset of a mental disorder. Treatment refers to the identification of individuals with mental disorders and the standard treatment for those disorders, which includes interventions to reduce the likelihood of future co-occurring disorders. And maintenance refers to interventions that are oriented to reduce relapse and recurrence and to provide rehabilitation. (Maintenance incorporates what the public health field traditionally defines as some forms of secondary and all forms of tertiary prevention.)

The Institute of Medicine’s new definitions of prevention have been very important in conceptualizing the nature of prevention activities for mental disorders; however, the terms have not yet been universally adopted by mental health researchers. As a result, this report strives to use the terms employed by the researchers themselves. To avoid confusion, the report furnishes the relevant definition along with study descriptions.

When the term “prevention” is used in this report without a qualifying term, it refers to the prevention of the initial onset of a mental disorder or emotional or behavioral problem, including prevention of comorbidity. First onset corresponds to the initial point in time when an individual’s mental health problems meet the full criteria for a diagnosis of a mental disorder.

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