Journal of Primary Prevention, 5(4), Summer, 1985 Primary Prevention: Key Issues and A Competence Perspective MARTIN E. FORD At a superficial level, one might characterize the primary prevention debate as centering on the question of whether primary prevention has been demonstrated to be an effective means of promoting mental health. This interpretation is supported by the clarity and strength of the con- fident generalizations of primary prevention proponents such as Dr. Albee ("We have a lot of evidence on the effectiveness of primary prevention ... it is available in the literature for all to read") and primary prevention critics such as Dr. Lamb ("... The major functional mental illnesses, as well as the frequently occurring diagnosable minor illnesses, remain untouched by efforts to strengthen mental health."). However, it seems clear that the disagreement is not primarily a matter of differences in data interpretation (although this is clearly a part of the problem). Rather, it seems to be mostly a function of differences at the level of basic assumptions about the nature of mental illness and the appropriate scope of activity for mental health professionals. Critics of primary prevention typically make a rather sharp distinction between nonnormative, "diagnosable" mental illnesses and normative "problems of living" both in terms of causation and implications for treatment. Alternatively, proponents of primary prevention tend to emphasize the continuity in the causes and appropriate responses to both more severe and less severe manifestations of personal and in- terpersonal distress. The first view suggests a scenario in which there are relatively few people who have "real" mental illnesses, with such illnesses being caused primarily by specific genetic or biochemical fac- tors. From this perspective, primary prevention does not seem to be a particularly compelling strategy, since mental illness is not seen as a "mass disorder," nor is it viewed as something that could be prevented easily. In contrast, the second view implies that many people are likely to have or be at risk for some sort of mental illness, with the cause of such illness more likely to be social than personal. From this per- spective, primary prevention is viewed as an essential intervention strategy, since there are far more people in need of mental health ser- vices than could possibly be served by secondary prevention strategies, and since mental illness is regarded as something that is typically much harder to treat than to prevent. The use of the phrase "basic assumptions" to describe these views is intended to emphasize the large degree to which the validity of these 264 ©1985 Human Sciences Press