Can the mental health of Australians be improved by dual strategy for promotion and prevention?

To the Editor

Australian and New Zealand Journal of Psychiatry commentators have regularly reminded readers that although Australia’s mental health policy aims to prevent mental disorders and promote mental health, measurable improvements in Australians’ mental health are still to be achieved. ANZJP commentators have often agreed that a national strategy is needed to reduce the incidence of mental disorders through prevention research and activity that identifies and intervenes to address modifiable risk factors that lead to common mental disorders.

An important consideration for future strategies is also raised by research showing that an individual’s attention is largely determined by outcome-predicting stimuli, regardless of whether the outcome is positive or negative (Anderson, 2017), and a condition for behaviour is that the individual’s attention is on a desirable outcome from the behaviour (e.g. mental health), rather than on the behaviour itself (e.g. reducing symptoms; Marien et al., 2015).

Translated to the Australian mental health context, this research suggests that measurable improvements in Australians’ mental health might be achieved by implementing strategies that focus more strongly on promoting what is wanted (mental health) than on preventing what is not (mental disorders).

The World Health Organization’s constitution states that the absence of mental disorders is not a sufficient condition for mental health. Instead, mental health is ‘a state of wellbeing that is determined by social, psychological, and biological factors, which together, enable the individual to realise their abilities, cope with the normal life stresses, work productively and contribute to their community’ (www.who.int/mediacentre/factsheets/fs220/en/, last updated 2016).

Together, the constitution and research present a strong case for Australia to also develop a national strategy for focusing Australians’ attention on what their abilities can be, how to use coping strategies to manage distressing and overwhelming experiences and how to connect and contribute beyond one’s self and own mental state (Stallman, 2017). Placing a symptom and risk reduction (‘what is not wanted’) prevention strategy within a strong mental health (‘what is wanted’) promotion strategy may have more success for reducing the incidence of mental disorders in Australia than a prevention (‘what is not wanted’) strategy alone.