From run-to-failure to condition-based care: a multi-domain framework for preventive psychiatry

Mental disorders are the leading cause of years lived with disability worldwide, yet the dominant clinical model remains reactive, intervening only after diagnostic thresholds are met. Drawing on the engineering distinction between run-to-failure and condition-based maintenance, this review argues that psychiatry faces a quantifiable intervention threshold gap. Synthesising recent meta-analytic evidence, we show that psychological interventions at subclinical symptom levels reduce major depression incidence by 43% at post-treatment and 33% at 12-month follow-up (individual-participant-data meta-analysis; 30 trials; N  = 7,201), that shorter duration of untreated illness is associated with 70% greater likelihood of treatment response, and that early intervention for first-episode psychosis reduces hospitalisation by 26%. We review convergent evidence across five modifiable domains — sleep and glymphatic clearance, nutritional psychiatry, allostatic load regulation, autonomic function, and psychoneuroimmunological monitoring — selected for objective measurability, meta-analytic interventional support, identified mechanistic