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Course: Mental Health Nursing

Topic: Community Mental Health

The Nurses International Community

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COPYRIGHT

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Module Goals

Learners will be able to:

Describe the community mental health treatment systems.
Discuss the primary, secondary and tertiary prevention of mental illness in the community.
Describe the role of the nurse in community mental health.

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What is Community Mental Health?

Promotion of mental health through activities undertaken in the community, rather than in institutional settings.

Focuses on the total population of a single area.

Involves overall planning and demographic analyses of the area’s mental health needs.

Emphasizes preventive services (e.g., by identifying sources of stress within the community).

American Psychological Association, n.d.

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What is Community Mental Health?

Seeks to provide a continuous, comprehensive system of services designed to meet the mental health needs in the community.

Mental health approached indirectly through consultation and education.

With an emphasis on:

Brief psychotherapy
Crisis intervention
Using such workers as paraprofessionals and indigenous mental health workers.

American Psychological Association, n.d.

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Community Mental Health Care Definition

Thornicroft and his friends (2016) define community mental health care as follows:

Addressing population needs in ways that are accessible and acceptable.
Building on the goals and strengths of people who experience mental illnesses.
Promoting a wide network of supports, services and resources of adequate capacity.
Emphasizing services that are both evidence‐based and recovery‐oriented.

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Community Mental Health Care Systems

Residential: Client reside for longer period in more comfortable and less hospital-like environment.

Psychiatric residential centers, Alcohol and drug rehabilitation facilities, Nursing home.

Outpatient: Office visits without overnight stay.

Community Mental Health Centers, Partial Hospitalizations Programs, Intensive Outpatient Programs, Outpatient Clinics, Telepsychiatry/Tele Mental Health Services.

North Texas Help, n.d.

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Community Mental Health

Preventive measures in community settings can help support individuals who are at risk of or living with mental health conditions

Substance Abuse and Mental Health Services Administration (SAMHSA) provides a model of Eight Dimensions of Wellness

Emotional
Environmental
Financial
Intellectual
Occupational
Physical
Social
Spiritual

Rural Health Information Hub, n.d.

SAMHSA, 2016

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Social Determinants of Mental Health

World Health Organization [WHO](2014) lists the following as social determinants of mental wellness:

Life-course: perinatal periods, early childhood, adolescence, working and family-building years, older ages, also related to gender.

Parents, families, and households: parenting behaviors/attitudes; material conditions (income, access to resources, food/nutrition, water, sanitation, housing, employment), employment conditions and unemployment, parental physical and mental health, pregnancy and maternal care, social support.

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Social Determinants of Mental Health (Continued)

Community: Community participation, trust/safety, violence/crime, environmental infrastructure, neighbourhood deprivation.

Local services: Early years care, schools, youth/adolescent services, health care, social services, clean water, and sanitation.

Country level factors: poverty reduction, inequality, discrimination, governance, human rights, armed conflict; national policies on access to education, employment, health care, housing and services, social protection policies that are universal and proportionate to need.

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Community Mental Health

Social determinants of mental health influence the risks of mental disorder.

Also present opportunities to reduce risks.

Communities can prevent adverse mental health outcomes and promote recovery of individuals with mental health disorders by focusing and maintaining wellness across all dimensions of wellness, and in areas of social determinants of mental health.

WHO, 2014

Rural Health Information Hub, n.d.

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Critical Thinking Question:

Which community has the most risk for increased mental health problems?

A community that has no pre-school programs for toddlers
A rural community with a higher unemployment rate than surrounding areas
A community with only three houses of worship
A community that does not have a wellness program associated with the community gym

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Community Mental Health

Research evidence shows that mental health problems are not inevitable.

Can be prevented through interventions that address the risk and protective factors that drive mental health problems.

Scientific evidences show that following mental health conditions can be prevented

Depression
Anxiety conditions
Certain behavioural disorders
Alcohol and substance use disorders

Carbone, 2020

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Community Mental Illness Prevention

Primary Prevention

Stopping onset of a condition from occurring in the first place
Targeted at and benefitted by everyone in the community.

Secondary Prevention

Detection and treatment at earliest possible stage of mental disorder to reduce its duration and severity.

Tertiary Prevention

Reducing impact of mental health disorder on individual’s functioning, improve quality of life and longevity.

Carbone, 2020

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Primary Prevention of Mental Illness

Works by changing modifiable underlying risk and protective factor.

Risks factors increase probability of developing mental health problems.
Protective factors enhance and protect mental health and wellbeing.

Buffer against exposure to risk factors.

Possible to reduce occurrence of mental health problems by:

Reducing exposure to risk factors.
Increasing exposure to protective factors.

Carbone, 2020

Prevent Mental Illness

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Primary Prevention of Mental Health Illness in Community

Home visiting programs.

Practical support, emotional support, advice, instruction, and role modeling of positive parenting skills.

Perinatal care for those at risk of poor parental skills and substance misuse.

Home visits, healthy behaviors, social and emotional skills, self-care skills and resilience, routine screening.

Various skills-building parenting programs:

To promote secure attachment, positive child-parent interactions, and positive family climate.

Carbone, 2020

Substance Abuse and Mental Health Services Administration, 2007

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Primary Prevention (Continued)

School programmes:

Classroom-based psychosocial skills-building programs
Self-care strategies
Anti-bullying, reducing sexual violence among young people
Health promotion initiatives to enhance mental health literacy, social and emotional skills and resilience through classroom-based activities and role modelling; creating a positive school climate; and building partnerships with parents and external services.

Carbone, 2020

Substance Abuse and Mental Health Services Administration, 2007

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Primary Prevention (Continued)

Various older person’s social support programs.
Public education campaigns on intimate partner violence, anti-racism.
Health promotion interventions on healthy diet, physical activities, non-smoking, low alcohol intake.
Laws, regulations, and public policies that:

Ensures gender equality, income security and equality
Improve nutrition
Prevent intimate partner violence, discrimination
Prevent unemployment, homelessness, debt, etc.

Carbone, 2020

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Primary Prevention (Continued)

Suicide prevention interventions:

Removing access to means for suicide:

Detoxification of domestic gas and car exhaust.
Safety measures on high buildings and bridges, control of availability of sedatives and analgesics.
Restricted access to pesticides.

Media campaign to improve mental health literacy about depression and reduce stigma.

Collings et al., 2018

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Secondary Prevention of

Mental Health Illness in Community

Early interventions for children exposed to adverse childhood experiences
Screening and early identification strategies:

Primary care providers trained at and encouraged to screen for potential behavioral health problems

Early referral to specialists or intervention programs

Collings and friends (2018) suggest suicide prevention interventions:

Media education to reduce stigma, encourage seeking treatment
Access to suicidal crises management
Aftercare resources, support through self-help groups.

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Critical Thinking Question:

Provide an example of Primary Mental Health in your community.

Discuss its impact on the community.

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Tertiary Prevention of

Mental Health Illness in Community

Community-based rehabilitation program.

Use of local cultural idioms by service provider leads to more effective psychosocial support.

Improved adherence to treatment found in a study conducted in India.

Community-based group interpersonal psychotherapy for depression.

Improved women’s economic productivity in Uganda.

Asynchronous telepsychiatry via primary care workers.

Found to be more cost-effective in prisons compared to synchronous telepsychiatry with psychiatrists in Columbia.

Kohrt et al., 2018

Chatterjee et al., 2003

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Tertiary Prevention (Continued)

Mobile phone-based psychotherapy

Face-to-face engagement, telephone calls, and encouraging text messages used in Sri Lanka to monitor suicide risk and early intervention.

Community-based case management

Assertive Community Treatment: Mobile, multi-disciplinary team provide services in community settings.
Home-based aftercare: Mental health specialist, nurse, social worker, and peer support make home visits after hospital discharge for continuity of care.

Kohrt et al., 2018

New York State, Office of Mental Health, n.d.

Sharifi et al., 2012

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Tertiary Prevention (Continued)

Outreach and educational activities by behavioral health professionals trained in disaster response to facilitate the resiliency and recovery of survivors and responders.

Providing psycho-education on physical and environmental hazards.
Engaging in active supportive listening and empathy.
Screening individuals at greater risk for longer-term adverse reactions.
Ensuring referral to appropriate medical, psychological, or tangible services.

Public Health Emergency, 2020

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Tertiary Prevention (Continued)

For children and adolescents:

Generic counseling, classroom-based interventions, and trauma-focused treatments with an emphasis on the verbal processing of past experiences.
Community group treatments for adolescent with mental disorder.

Personnel involved in community-based care of individual with mental health disorders:

Community mental health workers
Other health professionals
Formal providers outside the health system
Non-formal providers (laypersons and peers)

Kohrt et al., 2018

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Critical Thinking Question:

Provide an example of a Tertiary Mental Health in your community.

Discuss its impact on the community.

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Nurse’s Role in Community Mental Health

First step is to build therapeutic relationship of trust with the client.

Sets foundation for effective nurse-client communication, partnership, and treatment adherence.

Ensure client’s human rights are protected

Know international/national/local laws and regulation surrounding mental illness treatment, coercion, and seclusion.
Weigh damage done with and without coercion

Consider use of best practices, multidisciplinary approach and other available resources to find alternative options.

Vanner & Keet, 2019

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Nurse’s Role in Community Mental Health

Ensure smoke-free and safe environment for client’s as well as people around them.

Assess client’s needs, create care plans, and a visiting schedule based on how acute and at risk the client is

Client should be the lead decision-maker of the care plan.
Provide hope for recovery.
Assist client to focus on strengths, talents, ambitions instead of on what is wrong.
May need to visit client twice a day depending on the need.

Vanner & Keet, 2019

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Nurse’s Role in Community Mental Health

Acknowledge important role of local stakeholders in client’s recovery.

Collaborate with resource personnel like family/friends, at work, at schools in the community.

Promote mental wellness and de-stigmatization of mental illness:

Local and public educational programs
Encourage public to seek treatment for mental health problems
Advocating for laws, regulation for rights to:

Safe and inclusive mental health care services.
Support for education, housing, employment.

Vanner & Keet, 2019

Tay et al., 2018

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Nurse’s Role in Community Mental Health

Work in close collaboration with ambulatory and hospital teams.

May include Psychiatrist, General practitioner, Medical Specialist, Physiotherapist, Social Services, Client/Patient Advocacy Groups, Law enforcement.
Participate in interdisciplinary diagnosis and treatment.

Share professional experiences among peer professionals for ongoing professional development.

May share personal narratives.
Collaborate on improving processes in treatment of clients focused on recovery-oriented care.

Vanner & Keet, 2019

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What Would the Nurse Do?

Which of the following is the first step in providing effective mental health nursing in a community?

Assess community mental health resources
Assure that there are adequate programs related to mental health wellness
Establish open and trusting communication/relationships with clients
Determine the unemployment rate of the community

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References

American Psychological Association. (n.d.). APA Dictionary of Psychology, community mental health. https://dictionary.apa.org/community-mental-health

Carbone, S. (2020) Evidence review: The primary prevention of mental health conditions. Victorian Health Promotion Foundation, Melbourne. https://www.vichealth.vic.gov.au/-/media/ResourceCentre/Evidence-review-prevention-of-mental-health-conditions-August-2020.pdf?la=en&hash=6CDC96F267CBED73CC3EFB8803C2E6EBCD169C43

Chatterjee, S., Patel, V., Chatterjee, A., & Weiss, H. (2003). Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India. British Journal of Psychiatry, 182(1), 57-62. doi:10.1192/bjp.182.1.57

Collings, S., Jenkin, G., Stanley, J. McKenzie, S., & Hatcher, S. (2018). Preventing suicidal behaviours with a multilevel intervention: a cluster randomised controlled trial. BMC Public Health, 18 (140). https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5032-6#citeas

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References

Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M., Mutamba, B. B., Nadkarni, A., Pedersen, G. A., Singla, D. R., & Patel, V. (2018). The Role of Communities in Mental Health Care in Low- and Middle-Income Countries: A Meta-Review of Components and Competencies. International journal of environmental research and public health, 15(6), 1279. https://doi.org/10.3390/ijerph15061279

New York State, Office of Mental Health. (n.d.). Assertive Community Treatment (ACT). https://omh.ny.gov/omhweb/act/

North Texas Help. (n.d.). Types of mental health treatment settings and levels of care. https://www.northtexashelp.com/mental-health-treatment-settings.html

Public Health Emergency. (2020, September 8). Disaster Behavioral Health. https://www.phe.gov/Preparedness/planning/abc/Pages/disaster-behavioral.aspx

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References

Rural Health Information Hub. (n.d.). Prevention and Community Education. https://www.ruralhealthinfo.org/toolkits/mental-health/2/prevention-and-community-education

Sharifi, V., Tehranidoost, M., Yunesian, M. et al. (2012). Effectiveness of a Low-Intensity Home-Based Aftercare for Patients with Severe Mental Disorders: A 12-month Randomized Controlled Study. Community Ment Health J, 48, 766–770 https://doi.org/10.1007/s10597-012-9516-z

Substance Abuse and Mental Health Services Administration [SAMHSA]. (2016). Learn the eight dimensions of wellness [PDF]. https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4953.pdf

Substance Abuse and Mental Health Services Administration, Center for Mental Health Services (2007). Promotion and Prevention In Mental Health: Strengthening Parenting and Enhancing Child Resilience [PDF]. DHHS Publication No.CMHS-SVP-0175. https://store.samhsa.gov/sites/default/files/d7/priv/svp07-0186.pdf

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References

Tay,J.l., Tay, Y.F., & Klainin-Yobas. (2018). Mental health literacy levels. Archives of Psychiatric Nursing, 32,757-763. https://www.sciencedirect.com/science/article/abs/pii/S0883941717305599

Thornicroft, G., Deb, T., & Henderson, C. (2016). Community mental health care worldwide: current status and further developments. World psychiatry : official journal of the World Psychiatric Association (WPA), 15(3), 276–286. https://doi.org/10.1002/wps.20349

Vanner, S. & Keet, R. (2019). The role of nursing in community mental health. American Journal of Nursing Studies, 1 (1002). http://www.medtextpublications.com/open-access/the-role-of-nursing-in-community-mental-health-273.pdf

World Health Organization. (2014). Social Determinants of Mental Health. https://apps.who.int/iris/handle/10665/112828

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