Prevention of mental health problems: rationale for a universal approach.

BACKGROUND AND OBJECTIVE: Mental health problems are a public health issue affecting as many as 20% of children in modern communities. Risk factors for externalising and internalising problems can occur in infancy. Infants at high risk live in stressed families with parent mental health problems, substance misuse, relationship conflict, social isolation, financial problems or infant temperamental difficulty. Although current prevention programmes target services to high-risk groups, targeting can stigmatise families and miss many children in need. The addition of universal prevention programmes for all families could address these concerns. This survey assessed the prevalence of infants at risk attending a primary care service as a delivery point for universal prevention. DESIGN: Survey of mothers of 6-month-old infants attending well-child clinics across six government areas of Melbourne, Victoria, Australia, between August and September 2004. A brief survey measured sociodemographic characteristics and the following family risks: maternal depression, anxiety, stress, substance misuse, violence at home, social isolation and infant temperamental difficulty. RESULTS: The survey was completed by 733 mothers, representing 69% of infant births presented to the primary care service. Of these, 39% of infants were classified as at risk for developing mental health problems. The percentage of infants classified as at risk was not markedly dissimilar across socioeconomic levels (low, 42%; middle, 40%; high, 35%). CONCLUSIONS: A substantial number of infants attending routine universal primary care are at risk of developing mental health problems. This primary care setting could provide an ideal platform for preventing early externalising and internalising problems via a universally offered, evidence-based parenting programme.

Predicting intentions to seek help from professional mental health services.

OBJECTIVE: This study investigates the factors related to the intention to seek professional help for psychological problems utilising Ajzen and Fishbein's theory of reasoned action. Many of the variables identified in previous studies can be subsumed within this theory, which emphasises the importance of the subjective point of view of the individual. METHOD: One hundred and forty-two patients waiting for consultations at a community based general practice completed a questionnaire designed to assess the components of this theory as they relate to seeking help from mental health professionals. RESULTS: The results of this study supported the prediction of the intention to seek help from a mental health professional from the variables 'attitude toward the behaviour' and 'subjective norm'. However, personal attitudes toward seeking help were found to be more important than the approval or disapproval of significant others in predicting help-seeking intentions. CONCLUSIONS: Overall, the findings indicate that a significant factor influencing people's decisions to utilise professional mental health services in Australia may be the belief that mental health professionals are not actually able to provide a great deal of help or support for people's difficulties.