When I first started out in my career, I worked in community mental health, back in the heyday of the community mental health care movement. Each mental health center funded under NIMH grants was to offer 5 categories of service: inpatient, outpatient, emergency services, education, and outreach -- the last 2 being the prevention component. So we set about starting all kinds of programs in mental health education and outreach, from pairing foster grandmothers with teen mothers to teaching cooperative games to middle schoolers to consulting with tenants' rights groups. We were certain that these kinds of activities would make a difference and reduce the incidence of mental illness.
There is no doubt in my mind that the people who participated in those programs benefitted. But I seriously doubt that they made any impact at all on the need for primary and secondary mental health care. We had a couple of problems -- even then we had no theory underlying diagnosis as the move toward behavioral observation had already begun. So we had no idea what caused the problems that brought people to treatment in the first place.
Now in the current debate over funding health care and health insurance, there is a great deal of ballyhoo given to prevention. Obama and Sibelius and Harkin and all the others involved are pushing for greatly increased funding for prevention because, they say, this will reduce the need for and thus the costs of treatment. One hearing I watched had Harkin advocating funding for sidewalks as part of a prevention strategy because, he said, more sidewalks would lead more people to walk more and thus be healthier.
Why in these days of outcome based treatment guidelines is no one asking if there is evidence to support the efficacy of these prevention programs? I did a casual Google search to see what is readily available out there on the efficacy of prevention strategies and immediately turned up the following 2 articles: Does Preventive Care Save Money? Health Economics and the Presidential Candidates and Preventive care: so many recommendations, so little time. Both indicate what I have suspected -- that there is not much evidence to support a lot of the prevention activities being proposed now and very little to suggest that they will reduce costs. Am I missing something or is this push for prevention a bandwagon? And whose interests does it serve? Wouldn't putting the money into actual coverage for care and treatment accomplish more?