Community Mental Health

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Community Mental Health

• DR. AWATIF ALAM
• Nurah Alamro, MD. MPH.
• Lecturer Community Medicine

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Introduction

• Community health service was concerned mainly
  with the control of communicable diseases.
• In the course of development, it has become
  increasingly concerned with every health aspect
  of life of individuals in the community.
• Psychiatry, has developed as a personal service
  to the
• mentally ill individual,
• Only recently psychiatrists have attempted to
  contribute to preventive aspects of mental
  illness.
• However, preventive psychiatry remains in its
  infancy and needs much community efforts to be
  well developed.

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CAUSES OF MENTAL ILLNESS

• The concept of multiple factors in the causation
  of psychogenic disorders has become generally
  accepted.
• The factors are considered to involve the
  individual, the family and the community.

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• Genetic factors play a causative role in
  schizophrenia and in some manic depressive
  illnesses.
• Stress Social and environmental
• Social deprivation and other phenomena which
  characterize modern life.
• Physical causes, as disease or trauma

The roles of syphilis and advanced pellagra are
well known to cause mental disturbances.
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EXTENT OF MENTAL ILLNESS

• It is estimated that one person in every ten, has
  some form of mental or emotional illness, from
  mild to severe, that could benefit from
  professional help or treatment.
• Estimates vary, however, depending on the
  criteria used for diagnosis and the kinds of
  mental conditions included.
• If only clearly disabling conditions are counted,
  the estimate of mental illness in the general
  population will be much lower than 10. If milder
  emotional upsets, psychosomatic complaints and
  any of the various problems of living are
  included, a much larger proportion of the
  population will be found to have some form of
  emotional disorder.

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OBJECTIVES

• Promote mental health in the community.
• Maintain if possible the mentally ill
  within the community itself.
• Avoid un-necessary admission and restraint in
  special hospitals.
• Provide social therapy.

Community mental service is provided in
hospitals, mental health centers, by general
practitioners and health authorities (local and
central) all working in harmony.
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BROAD CLASSIFICATION OF MENTAL ILLNESS

• The psychoneurosis
• The psychosis
• Addictions, alcoholism, etc.
• Mental retardation

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Psychoneurosis

• Comprise a group of personality disorders, in
  which
• behavior traits,
• thought processes,
• emotional responses and
• somatic functions
• occur in a repetitive pattern maladaptive
  and inappropriate to the ordinary stresses and
  demands of environment and living.

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Psychoneurosis

• Symptomatology has its origin outside conscious
  awareness and is traceable to modes of
  personality functioning which pre-existed in
  infancy and childhood.

• In general, the psychoneurotic reaction
  represents
• Symbolic adaptation to anxiety involving only
  partially disturbed social functioning
  and reality testing.
• The psychoneurotic in contrast to the
  psychotic, maintains the capacity to perceive and
  adapt to environmental realities.

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• Legally, the psychoneurotic is responsible for
  his actions.

• The psychotic who violates legal and social
  codes is
  placed under supervision or hospitalized.
• The onset of psychoneurosis occurs usually in
  early adult life.
• The course tends to be chronic.
• Appearance of these disorders, for the first
  time, after 45 years of age is unusual.

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• Usually symptoms express themselves in the period
  of active sexual reproductivity and social
  responsibility.

• Psychoneurotic disturbances manifest
  themselves in the predisposed individual as a
  consequence of exposure to anxiety arousing
  situations.

• The genetic and constitutional factors determine
  both the capacity of the personality to withstand
  stress and the determination of the organ systems
  which respond to stress.

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• The initial stage of personality development
  takes place during the early years of life,
  during which time the infant is wholly dependent
  upon his mother or a mother substitute.

• If the child is pushed and urged beyond his
  maturational limits, the beginning of self-doubt
  and shame are implanted .
• The child enters into the society of equals
  through various interactions ( sibs) , and their
  play is the introduction to the life of society
  in general.
• The child starts to learn to adjust to the needs
  and desires of others.
• He always strives for success.

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Psychosis

• Represents extreme form of breakdown in mental
  health,
• The individual no longer remains related to the
  reality situation ,
• The patient is subjected to irrational and
  disordered emotional and intellectual process.
• Psychosis will lead to aberrant behavior
  recognizable by gross un-reality,
• e.g. schizophrenia, manic depressive
  psychosis, melancholia.

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Addictions, alcoholism, and other behavior
disorders

• The drugs that can affect mental processes and
  behavior are classified into three general
  groups
• Depressants e.g. Valium, Librium, barbiturates.
• ( alcohol is the most commonly used and abused ).

• Stimulants include amphetamines, nicotine in
  tobacco .
• Hallucinogens include marijuana and lysergic
  acid
• diethylamide.
• Individuals must be fully informed of the
  possible hazard to health involved in alcohol and
  drug abuse.

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The governmental role in control of alcohol and
drug abuse

• Adopting certain legal regulations for
  controlling the important and export of narcotic
  drugs,
• Regulating the production and distribution of
  drugs ,
• Establishing penalties for illegal possession or
  sale of dangerous drugs.
• The provision of programs including
• - treatment,
• - rehabilitation,
• - research and education
• (designed to prevent and combat the adverse
  personal and social consequences of drug abuse).

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Mental Retardation

• A person may be retarded in
• intelligence level,
• in adaptive behavior,
• in academic achievement ,
• in a combination of these elements.

Mental retardation can be caused by any condition
that interferes with development - before
birth,(gene incompatab., x-ray, infections) -
during birth ( birth injury ) - in early
childhood (meningitis, polio, lead poisoning)
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The field of action for prevention encompasses

• Protection of the very young, through promotion
  of family life.
• Prevention of social stress and insecurity.
• Protection of the aged who may suffer from
  cerebral degeneration, depression and/or
  psychopathic states.
• Prevention of brain damage e.g. control of
  syphilis and alcoholism.
• Public education in mental health.

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The field of action for prevention encompasses

• Pre-marital consultations and medical
  examinations.
• Provision of suitable institutions for the care
  of the mentally ill.
• Legislation as regards drug abuse, compulsory
  admission to residential hospitals and
  guardianship.
• Rehabilitation.

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Quiz

• Individual factors in mental illness causation
  include except
• Genetics
• Trauma
• Environmental stress
• Infectious disease

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• Mental illness estimates vary depending on
• Criteria used for diagnosis
• Hospitalization
• Recreation drugs use
• Family history

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• Classification of mental illness include
• Psychoneurosis
• Psychosis
• Addiction
• Mental retardation
• All of the above

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• Prevention of mental illness approach is
• Health based
• Social Based
• Multisectoral based
• Drug based

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