A strong case for a public mental health strategy exists, given the benefits to society as a whole and to those with mental health problems. This approach requires universal interventions applied to the entire population, such that the benefits are available to the greatest number of people (Rose, 1992). The idea is to not restrict interventions only to people who have developed an illness, leaving health risks in the rest of the population unaddressed. An example of the strategy is the recent emphasis on well-being and happiness, and on symptoms of anxiety, depression and psychosis in the population that do not meet diagnostic criteria but are associated with disabilities (e.g. van Os et al, 2009; Rai et al, 2010). Effective interventions that can be used in preventive psychiatry or public mental health include preventing violence and abuse in early life and preventing age- and gender-based violence and discrimination throughout the lifespan. This would create a more balanced and empowering society in which all adults, regardless of their age, gender and cultural background, could realise their potential in the workplace and avoid long periods of sickness and illness-related absence from work. Information should be available for the population on how to maximise their good health and prevent illness by taking lifestyle, behavioural, social, psychological and physical measures. It should include not only how to minimise the impact of illness, but also how to prevent it arising, especially for groups who appear to be at high risk. Many of these interventions aim to act over the life course, protecting and promoting what has been called mental capital (Jenkins et al, 2008).

To some extent mental health professionals, including psychiatrists, are already undertaking activities that have a preventive function (Box 16.1).

Inequalities

The public health approach does not explicitly address ethnic or cultural inequalities of service use and experience. However, the aim of public health policy is to avoid the development of inequalities in general by ensuring that illness is prevented in the first place, specifically by tackling the social determinants of illness, which are unequally patterned.