A call for primary prevention: reality or utopia.

The efficacy of primary prevention of mental disorders has been debated over the years. The debate is complicated by ideology, semantic confusion, methodological difficulties and a paucity of good evaluative studies. This paper reviews newer concepts of primary prevention and mental health promotion, methodological issues, model programs, and inherent ethical concerns. Further evaluative studies and an increased contribution of psychiatrists to the primary prevention debate are recommended as necessary steps in further evolution of the field.