Modeling the Future of Prevention in Primary Mental Health Care: A Narrative Literature Review

Abstract

Introduction: Adults in the U.S. have had poor and worsening mental health for years. Poor mental health exacts a high human and economic cost.

Methods: Using PubMed, we conducted a focused narrative literature review on mental well-being and its role in mental and physical health care.

Results: Mental well-being is essential for mental and physical health. High mental well-being is associated with a lower incidence of psychiatric disorder diagnosis and better function for those who do carry a formal diagnosis. High mental well-being also improves health outcomes for several physical diseases. Cultivating mental well-being is both a primary and secondary prevention strategy for mental and physical illness. There is a growing number of low-cost and accessible interventions to promote mental well-being, rooted in the research of positive psychology. These interventions improve mental well-being in multiple populations from different cultural backgrounds. There have been some efforts to incorporate these interventions to improve mental well-being in the clinical setting.

Conclusions: Our mental healthcare system would substantially improve its ability to protect against mental illness and promote positive function if mental well-being was routinely measured in the clinical setting, and interventions to improve mental well-being were routinely incorporated into standard primary and specialty care.

Keywords: Mental health; mental well-being; positive psychology; primary prevention; secondary prevention; value-based care.

Graphical abstract

Figure 1

The 2 continua model of mental health. Mental well-being exists on a continuum from absent (or languishing) to present (or flourishing). Mental illness (e.g., a psychiatric disorder diagnosis) also exists on an intersecting, orthogonal continuum from absent (no mental illness) to present (mental illness). The figure was adapted from Keyes 2010. This figure has been updated to capture the spectra of function within each quadrant and to include the flourishing and languishing terminology. This can be found in Keyes 2013 Promoting and Protecting Positive Mental Health: Early and Often Throughout the Lifespan. We maintain this figure for simplicity and to keep the clinical descriptions.