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Although the purpose of community mental health is a complex matter, the writer's view (which is certainly not the only valid one) is that it is there to provide a pathway towards overcoming the widespread fear, inertia(قصور) and stigma that surround the phenomenon of mental illness and to provide a beacon of hope for sufferers and their supporting caregivers.
Given the proper use of medication, suitable forms of rehabilitation and good use of new forms of care now coming to the forefront, one can with reasonable confidence make the following positive statements: • Individuals who recover from a serious episode of a mental illness can lead a quite independent life. • Those persons who have residual problems arising from their psychiatric illnesses can with appropriate assistance have the leading of independent lives as a longer term goal.
It has to be noted as a word of caution that leading an independent life is not necessarily the same thing as a cure. Possible many sufferers may therefore interpret the above comments as unrealistic or misleading, but evidence from recent researches suggests that even in severe disorders considerable improvements in social functioning occur over a period of time in the majority of instances.
The purpose of mental health care is to maximize the potential for natural improvement by implementing and carrying out effective intervention programs. To be able to do so however requires a fresh attitude from the general public, more government funding of services, and donations.
This introductory part tries to answer the following questions: • What do we mean by mental illness? • What does the concept of mental health mean, if anything? • If mental health is a tangible concept can improvements in mental health as such assist in ameliorating the effects of a mental illness? • What exactly does community mental health mean and what does this approach involve?
WHAT IS MENTAL ILLNESS? • According to APA: "An illness with psychiatric or behavioral manifestations and / or impairment in functioning due to a social psychological , genetic , physical , chemical or biologic disturbance."
Prevalence of mental illness • At the present time the overall prevalence of mental illness in Australia, based upon a number of community surveys, is indicated to be 18.4 per cent of the total population.
The age groups most affected are in the 25-44 years age range. • Such arrange of disorder amongst this key age group indicates the considerable costs to the nation because f crime, domestic disharmony , marital separation, use of non-therapeutic drugs and so on.
What is also important for the community mental health worker and many others working in community settings is the high percent age of persons presenting for medical treatment who are also likely to have a psychiatric illness.
A study by Huxley and Fitzpatrick (1984:67-73) showed that some 68 per cent of social workers' clients had some kind of psychiatric morbidity. Whilst this represents a bleak picture in that social agencies are poorly equipped to deal with psychiatric problems.
It would appear therefore that although the potential problem is very considerable in size, such matters can be dealt with effectively in reality . community mental health services are therefore a worthwhile investment in increasing community wellbeing and in reducing the burden of economic costs on the workplace
The meaning of mental health as a concept • Attempting to define the concept of mental health is unfortunately a very complex matter, and there have been various attempts n recent years to define it in either brief or elaborate ways.
As a brief indication of its meaning Colin Wilson, a seminal writer in psychology, perceives mental health as having an optimism for the way in which the future will work out. Morgan and Johnston (1976) regard mental health as the ability to adjust to new situations and to handle personal problems without marked distress and have enough energy remaining to be a constructive member of society. one could perhaps see this as a superman type of definition!
More recently the definition for mental health can be described as interactive in that mental health is seen as the outcome of interchange between the individual, the group and the community. The report also makes the valuable suggestion that mental health has its won continuum and is not simply the opposite pole of mental disorder. Thus mental health can be seen to run from poor to good, and individuals might also contain some element of psychiatric morbidity, however minor , such as a trivial phobia.
Bryant and Veroff have attempted what might be termed a negative view of mental health, as they list factors that describe feelings that would be unwanted:
unhappiness • inability to meet one's own standards. • Strain. • Vulnerability. • Uncertainty about the present and future • Isolation from society or local community • Feeling that life –problems are uncontrollable • Low self-esteem. • Feeling of being overwhelmed by adverse life events • Feeling of facing an imminent nervous breakdown.
The role of community mental health services • Irving Goffman, who assessed the horrifying effects of the institution upon its inmates, and with the anti-psychiatry movement starting from inside the profession itself with the work of Laing and Szasz, who questioned the whole emphasis upon biological factors in the causation of psychiatric illness and who wanted the most radical changes in the treatment and care of this group of people.
A summary of the major roles for community mental health as perceived by these writers: • * the way the individual functions in the community may affect the course of his/her mental illness. • * community mental health services may prevent the onset of disorder at a stage when the individual's problems are more manageable. • * Community mental health may develop a sense of community where people "experience affiliation, belonging, compassion and caring' . • *Community mental health may carry out programs of rehabilitation for the seriously mentally ill.
Community mental health services may also provide: • promotion of mental health throughout the community (this is a major emphasis of the world health organization). • A demographic study of the area geographically served, identifying factors such as age distribution, ethnic and racial groupings and rates of hospitalization. • Collaboration with community representatives to identify problems and improve perceptions about mental illness and additionally to attempt resolutions of identified problems . • A utilization of a particular community's strengths and support systems.
The use of cost-effective methods in improving mental health, for example working with groups of sufferers, families and appropriate target groups. • Consultation to other caregivers of the mentally ill, • Community education programs about the mentally ill • Assistance to sufferers in applying for services and entitlements and preserving their human rights. • Case-management services in order to facilitate access to a full range of required services. • Physical support services to allow for independent living of sufferers for as long as they are needed • Medical and mental health are as required.
