The 4As Framework was developed specifically with regard to people who have been seriously affected by mental illness. This generally means people who have experienced psychotic and major mood disorders, including psychosis, schizophrenia, bipolar affective disorder, major depressive disorders and anxiety disorders. However, it is anticipated that the elements of the Framework will apply more broadly to other mental illnesses and mental health problems.
The principles underlying the Framework and its basic elements are expected to apply for all people in Australia who have experienced mental illness. This includes children and adolescents, adults, older adults, males, females, Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds, and people who live in all settings—urban, regional, rural, and remote. Where there are unique applications of the Framework related to particular population groups, these are noted.
Otherwise, the generic Framework is expected to apply, although it is understood that it will need to be translated to suit particular purposes, contexts and localities. It is anticipated that one of the valuable outcomes of the Framework will be progress toward a 'common language' to communicate across all sectors and levels of service provision the principles of mental health promotion and illness prevention for people who have been seriously affected by mental illness.
A deliberate constraint of the Framework is that it corresponds to a specific part of the spectrum of interventions for mental health—continuing care (see figure 1). It is important to note that the Framework is not a treatment model, nor is it meant to apply prior to the development of mental illness. Nevertheless, implementing the Framework is contingent on effective actions in these segments of the spectrum and its approach is congruent with current initiatives in these areas.
The Framework takes as its ideal the promotion of mental health for people who have experienced mental illness and the prevention of further episodes of illness, and a growing body of evidence attests to potential to achieve these aims. There are three possible scenarios following an initial episode of mental illness: no further episodes; occasional recurrent episodes; or 'chronic' mental illness with recurring episodes. It is important to acknowledge that for some people further episodes of illness will occur and that an equally worthy goal is reducing the duration of further episodes and the harm they cause to the person and their family.
Recovery is an overarching principle that must underpin continuing care in all three possible scenarios. Mental health promotion is also essential to continuing care, as it applies across the entire spectrum of interventions for mental health and is equally relevant to people who have experienced mental illness. The specific interventions that make up continuing care are self-management, rehabilitation and relapse prevention.
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Figure 1. Spectrum of interventions for mental health 1
Text version of figure 1The spectrum of interventions for mental health is presented as a semi-circle, with each segment in the semi-circle representing a particular intervention.The spectrum is underpinned by mental health promotion.
The interventions that make up prevention are:
- universal (general)
- selective (at-risk)
- indicated (high-risk).
- illness identification
- early treatment
- standard treatment.
- relapse prevention