Primary prevention: Key issues and a competence perspective.

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 confident 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.