Prioritizing Prevention
An appeal to logic, supported by evidence, can convincingly demonstrate that prevention is indeed the most effective method for mitigating mental health issues in a wide variety of community contexts. Social Network Health approaches, which emphasize community relationships, are suited for prevention by nature and design. Network health interventions target natural organizational groups to strengthen bonds, cohesion, and adaptive coping norms, all of which are proven targets for upstream suicide prevention. The side effects of focusing on prevention are, in sum, positive for entire community mental health. In the absence of effective screeners, or risk indicators available through diagnosis, broad based prevention reaches an entire community to reduce risk factors and increase protective factors.[citation needed] Preventive Interventions delivered in social systems are therefore the only likely way to reach most community members who are in need.
Most existing intervention programming focuses on detecting and remediating risk after suicidal individuals are identified. Although a critical part of an integrated system of care, that approach is insufficient on its own. According to Wyman (2020), using a network health framework, that strengthens positive social bonds and building healthy norms that incentivize adaptive coping, is a prevention model that has shows promising benefits. Expanding the focus on modifying “upstream” risk and protective processes—before the emergence of suicidal behavior—stands in contrast to current prevention programming focused on adult gatekeepers and screening after risks are identified. (Wyman 2014)
Upstream interventions, delivered through social systems in childhood and early adolescence, have the potential for reducing population-level suicide rates. By decreasing the number of adolescents with mental emotional and behavioral problems, as well as creating social environments that expose adolescents to positive coping norms, increase youth-adult connections, and reducing the impact adverse experiences. (Wyman 2014) Childhood and adolescence are key suicide “prevention window” periods. Approximately one half of emotional and behavioral disorders that are well-defined risk factors for suicide have onset of symptoms by age 14 years.
Research References to integrate:
1 - That diverse personnel benefited from the program illustrates a strength of a universal prevention strategy for military populations with members at low risk and others at higher risk who may not seek mental health services.
2 - The dual benefits for occupational functioning and mental health underline a strength of upstream prevention implemented before the detection of serious suicidal behavior: skills that strengthened the trainee’s capability to meet job-related challenges also reduced depression and suicidal ideation. Universal prevention programs that support operational and suicide prevention objectives are more likely to be sustained.
Prevention in schools:
Modern conceptions of mental health have transitioned from a predominantly problem reduction focus to a wellness promotion focus (Suldo & Shaffer, 2008). Thus, rather than exclusively targeting symptom reduction in individuals with mental illness, mental health services have gravitated towards prevention services that promote general wellness of the population (Prinz & Sanders, 2007). To attend to these issues, school-wide interventions based on the public health prevention model emerged in schools, most notably in the form of positive behavior interventions and support (PBIS; Smith, Molina, Massetti, Waschbush, & Pelham, 2007). Tier 1 systems, data, and practices support everyone across all settings. They establish the foundation for delivering regular, proactive support and preventing unwanted behaviors.
Peer-adult network structure and suicide attempts in 38 high schools: implications for network-informed suicide prevention (10,291 students)
Journal of Child Psychology and Psychiatry *: * (2019), Peter A. Wyman, Trevor A. Pickering, Anthony R. Pisani, et al.
Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial
JAMA Open Network, October, 2020