The dilemma of primary prevention in mental health services: Rationalize the status quo or bite the hand that feeds you

That primary prevention has been ‘inappropriately marginalised’ is seen to be an inevitable outcome of reliance on government support. Policy makers and service providers can never be expected to give prevention a higher priority than direct service. Preventionists have developed two strategies for doing their work. One, based on the logical positivist ideal, seeks specific causal models for specific disorders. This sort of prevention research, while it will always remain less well funded than direct services, tends not to challenge the status quo belief in individual responsibility, or the acceptable methods of mainstream science, and thus will tend to be more acceptable than other forms of prevention research and services. An alternative, based on a social constructivist paradigm engages in social action research through collaboration with a variety of grass roots organizations and people outside the mainstream of power. This latter approach, brings to preventionists ideas from feminists, ethnic minority leaders, neighborhood organizers, and self and mutual help group leaders. It is a sensible way to use the resources available to those professionals interested in social change oriented prevention.