Community Mental Health DR. AWATIF ALAM Nurah Alamro, MD. MPH. Lecturer – Community Medicine

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.

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.

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.

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.

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”.

BROAD CLASSIFICATION OF MENTAL ILLNESS : The psychoneurosis The psychosis Addictions, alcoholism, … etc. Mental retardation

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.

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.

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.

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.

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.

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.

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.”

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).

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)

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.

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.

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

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

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

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