Arguably the greatest victories in modern medicine have come in the arena of prevention. The most spectacular successes have been in vaccination, but even in the noncommunicable diseases, such as cardiovascular disease and cancer, this has been true. In cardiovascular disease, the greatest contribution to survival rates has been through smoking cessation programs and blood pressure and lipid monitoring and control, rather than through better treatment of myocardial infarction. Equally, in cancer, survival from metastatic disease remains poor; the advances have been in preventive strategies, early detection and intervention at the earliest stages when prognosis is better. In the mental health arena, we have an increased understanding of the operative risk factors in many psychiatric disorders, including schizophrenia. However, a larger and more diverse array of risk factors operates in psychiatric illnesses, and the individual contribution of these risk factors to disorders is smaller. The question then becomes, is the prevention of schizophrenia a realistic goal?