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In this brief article, I provide a personal perspective and selected literature review on the merits of giving greater attention to interventions that tackle the known social risk factors for common mental disorders. These include both universal actions targeted at the general population and more focused interventions aimed at high-risk subgroups. In practice, most effective efforts involve a combination of both strategies. Psychiatrists and other mental health professionals could have a key role in promoting prevention, working closely with governmental bodies, and nongovernmental organizations that may be in the best position to deliver the required interventions. Having evidence from gold standard randomized controlled trials may be ideal, but in practice, are extremely difficult to deliver in this field and their absence should not be taken as an excuse for inaction. [ABSTRACT FROM AUTHOR]

Purpose: A large proportion of mental health costs is inpatient care but little is known about their variation between patients. The aim of this study was to measure and identify the predictors of costs of staff contacts and activities on inpatient wards.Method: Inpatients from psychiatric hospital wards in south London were interviewed in 2008 and 2009 and staff contacts and use of activities recorded over a week and costs calculated. Regression analyses identified predictors.Results: Of 334 participants, 78% used activities and 90% had staff contacts. However, 41% reported no nurse contact. Mean staff contact and activity costs were £197 and £30 per week, respectively. Staff contact costs were inversely related to age, and activity costs were higher for patients with higher levels of education. Patient satisfaction was positively associated with both costs.Conclusions: The costs of self-reported staff contacts and use of activities account for a small amount of total inpatient costs. Patients with higher costs appeared to have higher levels of satisfaction. [ABSTRACT FROM AUTHOR]

Background: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse.Aims: To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction.Method: One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately.Results: Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups.Conclusions: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy. [ABSTRACT FROM AUTHOR]

SUMMARY: The development of effective preventions for psychosis is hindered by conceptual challenges underlying diagnosis and the fact that few of the many biological risk factors identified to date are sufficiently well understood to form the basis of a targeted intervention. On the other hand, a great deal is known of the psychosocial conditions that increase the lifetime risk of most mental illnesses: surely enough to justify better resourcing of interventions focused on antenatal care and the emotional well-being of children from the early years through adolescence, where as much as a half of all mental ill health has its roots. DECLARATION OF INTEREST: None. [ABSTRACT FROM AUTHOR]

The past 30 years have produced no discoveries leading to major changes in psychiatric practice. The rules regulating research and a dominant neurobiological paradigm may both have stifled creativity. Embracing a social paradigm could generate real progress and, simultaneously, make the profession more attractive. [ABSTRACT FROM AUTHOR]