Community Mental Health

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Community Mental Health

• DR. AWATIF ALAM

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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,
• 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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• Cause mental disturbances
• - Genetic factors
• (schizophrenia /manic depressive illnesses).

- Environmental stress, - Social deprivation
- Phenomena characterizing modern life.
- Physical causes ( disease or trauma),
- STD (syphilis) - Nutritional (advanced
pellagra).
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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.

- Estimates vary, however, depending on
the used criteria for diagnosis and the kinds
of mental conditions included.
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EXTENT OF MENTAL ILLNESS

• 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 other health authorities.
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BROAD CLASSIFICATION OF MENTAL ILLNESS

• Psychoneurosis.
• 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
• functioning which pre-existed in
• infancy and childhood.

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Psychoneurosis

• 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 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.

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• 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.

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Psychosis

• Psychosis will lead to aberrant behavior
  recognizable by gross un-reality,
• e.g. schizophrenia, manic depressive
  psychosis, melancholia.
• The psychotic who violates legal and social codes
  is placed under supervision or hospitalized.

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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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