PSYCHIATRY IN THE

COMMUNITY
Dr. Boniface Chitayi.
 DEFINITIONS
Community Psychiatry is concerned with the prevention and treatment of mental
disorders and rehabilitation of former patients through the use of organized
community programs.
Community mental health Services include:
 emergency outpatient services
 services for the aged,
 follow up for those hospitalized,
 alcohol and drugs rehabilitation.
BURDEN AND PREVALENCE OF MENTAL
DISORDERS IN KENYA
• Mental health : State of wellbeing in which an individual can cope with normal
stresses of life, realize their potential, work productively and contribute to the
community.
• Mental illness prevalence 10% in any population and 25% - lifetime
• 25% (outpatient) and 40% (inpatient) suffer from mental conditions (KNCHR 2011)
• Probable prevalence of psychosis – 1% (Jenkins, Kiima 2012)
• The most frequent of diagnosis of mental illnesses made in general hospital
settings are depression, substance abuse, stress related and anxiety disorders
(Ndetei et al: 2008)
• Major depressive disorder – 12.3% in a community survey (Kwobah, 2017).
BURDEN AND PREVALENCE OF MENTAL
DISORDERS IN KENYA
• Anxiety (15.7%), alcohol use disorder (10.4%), tobacco use disorder (6.8%),
Cannabis use disorder (0.8%), Khat use disorder (3.1%).
• Bipolar mood disorder – 5.2%
• Inpatient prevalence – schizophrenia (51%) bipolar mood disorder (42.3%)
• PTSD 10.6% of those exposed to traumatic event (48% of population surveyed)
PYRAMID OF CARE OF MENTAL HEALTH SERVICES
CHARACTERISTICS OF COMMUNITY
PSYCHIATRY
• Responsibility to a population for mental health care delivery
• Treatment close to the patient in community based centers.
• Provision of comprehensive services
• Multi-disciplinary team approach
• Emphasis on prevention as well as treatment
• Avoidance of unnecessary hospitalization.
BASIC PRINCIPLES OF PROVISION
• Accessible to all users
• Relevant to the need of the whole community
• Effective
• Equitable (fair)
• Socially acceptable
• Efficient and economical
COMMUNITY MENTAL HEALTH TEAM
CADRE ROLE

Psychiatrist Diagnose and formulate plan of management. Prescribe.

CMH nurse Stabilise acutely ill patient; Long term follow up.

Clinical psychologist Provide psychotherapy

Occupational therapist Increase individual ability to live independently in the community

Social worker Work as part of an interdisciplinary team to develop individualized

treatment plans. Conduct peer support groups.