COMMUNITY MENTAL HEALTH

DR EDDIE K MBEWE
 Community Psychiatry
• Objectives
– Describe community psychiatry
– Prevention models
– Role of community mental health in PHC
– Ethical Issues
 Comm…..cont…
• Psychiatry involving the community. Looks
and takes lead in community mental health
activities. Involves the role of the family in
delivering mental health services.
• Community psychiatry also largely involves
rehabilitation measures. It also takes into
consideration the roles of NGOs in developing
the mental health services.
 Community Mental Health
• The branch of psychiatry concerned with the
provision and delivery of a coordinated
programme of mental health care to a
specified population i.e. catchment area.
• Mental Health assumes the responsibility of
catering for all the mental health needs of a
given community. These needs include but not
limited to:
 Community Mental Health Cont…
• Diagnosis
• Treatment
• Rehabilitation
• Aftercare
• Early case finding
• Promoting mental health
• Preventing mental disorder
• Deals with the stress laid on individuals by their
environmental activities and the impact
encountered from their social groups.
• Social Model: derived social psychiatry.
Concerned with identification of vulnerable
groups or individuals, at risk of developing
mental break down.
• Tends to conceptualise mental disorder in terms
of social deviance
• Or reaction to stress and environmental
factors
• Sharing things in common
• Shared cultural beliefs
• Located in a particular geographical area
 Primary prevention
• Identification of socio-cultural issues that
impact on individuals causing mental
breakdown
• The family as unit of procreation, socialization
and self actualization and ascendancy
• Identify early signs of stress and potential
mental illness
• Early warning signs and symptoms mitigation
PREVENTION STRATEGIES - CMH
• Prevention: ie the processes used in avoiding
mental illness
• Primary level aims reducing the incidence of
mental ill health in the general population
• The mode of intervention includes health
education, health promotion by raising
awareness
 Prevention cont…
• Secondary prevention aims at reducing the
duration of recognized mental ill-health;
preventing long term problems
• Mode of intervention includes early detection;
effective, responsive and active treatment
 Prevention cont…
• Tertiary level aims at preventing long-term
handicap or disability as a result of mental
illness
• Mode of intervention includes rehabilitation;
maintenance of optimum level of functioning
 Rehabilitation of a Psychiatric
Patient
• Rehabilitation is a method of treatment
designed to bring a person back to the
maximum level of functioning both physically
and mentally
• It is a process of assisting them back into
society, a way of life that makes him/her
independent and useful member of the
community
 Aims of Rehabilitation
• Promote independence
• Strengthen personal identity and self respect
• Develop daily living activities and occupational
skills
• Promote interpersonal socialised skills
 Types of Rehabilitation
• 1. Home: living with family members
• 2. Institutional: Matero After-care Centre;
Mimosa Farm, Katombora Rehabilitation,
Nsadzu
• Methods of Rehabilitation include:
– Ward activities e.g. kitchen chores, bed making
– Occupational therapy e.g. basket making, tailoring
– Social therapy: drama, dancing, singing, recreation
 Comparative advantages and
Disadvantages of Mental hospital and
Community care
• Community Care:
– Advantages:-
• patient in natural environment
• Links with community maintained
• Stigmatization reduced
• Reduced risk of institutionalization
• Preventive health care possible by early contact with
individual
• Better liaison between hospital and PHC workers
 Community care cont…
• Disadvantages
– High cost of establishing services
– Stressors of everyday living increase likelihood of
relapse in vulnerable individuals
– Violent and aggressive patients less easily
contained
– Risk of homelessness and vagrancy increased with
inadequate support
– Fragmented resources and expertise
 Community Rehab cont…
• Disadvantages:
– Problems of coordinating services
 Mental Hospitals
• Advantages:
– Supportive and protected environment
– Risk of relapse due to environmental stressors
diminished
– Disturbed individuals easily contained
– Relatively easy administrative structure
– Concentration of resources and expertise
 Hospitals cont…
• Disadvantages:
– Institutionalization and stigmatization
– More “authorisation” regimen
– Poorer access to community
– Poorer liaison between hospital and community