Primary Prevention of Mental, Neurological and Psychosocial Disorders World Health Organization Geneva: WHO. 1998. 113 pp. SW.fr. 35-, SW.fr. 24.50 in developing countries. ISBN: 92-4-154516-X.

This fairly short document forms the latest part of the World Health Organization's (WHO) series of publications on mental disorder. It is aimed at professionals and policy makers in a variety of sectors who may be concerned with or who are in a position to influence the prevention of mental disorders. This is a welcome enterprise that can only serve to raise the profile of this neglected area.

The book provides a useful summary of our current medical knowledge of how to prevent four largely unrelated phenomena: mental retardation (i.e. learning disabilities), epilepsy, suicide and ‘burnout’. However, it is seriously flawed in terms of the brief set by the WHO. It does not really attempt to address the wider interests of policy makers, neither does it present much of a coherent strategy for the prevention of mental disorders. Indeed, it is not clear that the four ‘conditions’ chosen make sense as the focus for a prevention strategy or that they sit naturally together either conceptually or practically. In many countries the agencies concerned with the prevention and ‘treatment’ (if relevant) of these conditions will be different.

The model adopted throughout is what is often, lazily, referred to as ‘the medical model’. Information about the conditions is conceived of in purely medical terms and interventions are limited to the obvious traditional public health approaches. It is as if the authors have ignored the last 40 years of practice in terms of wider health promotion and community development, as well as broader perspectives on the conditions they address. It is telling that the concept of burnout is attributed to Freudenberger and addressed in a purely professional mental health context when the idea has been in common currency in the management literature and even general parlance for decades.

The fundamental problem is that the document starts by stating that the intention is to address a broad audience, but then jumps straight into a narrow and controversial definition of primary prevention. There is little acknowledgement of the ethical or social issues that surround the conditions discussed, or of the vastly different understandings of them that exist within and across different cultures. There is no recognition that much of the discussion is value laden and the terminology and assumptions may be inappropriate for the target audience. The concept of evidence as used in the publication is again very narrow and inappropriate to the subject and audience. To use randomised controlled trials as the gold standard for research in measuring effectiveness in burnout seems to be particularly inappropriate — although it may be much more suitable for the prevention of epilepsy.

The approach adopted means that certain interventions — iodization and reduction of alcohol intake in pregnancy in relation to mental retardation, for example — receive too much attention as opposed to wider interventions relating to public policy, education, community development and employment practices. In short, while this publication has some value in bringing together aspects of current knowledge, it fails in its objective of setting out some broad and deliverable prevention measures for mental disorders that could engage a wider audience of policy makers and practitioners. Such a text is still awaited.