APPROACHES TO COMMUNITY MENTAL HEALTH ASSESSMENT
Mental Health Research : “Mental health is used positively to indicate a state of psychological well being, negatively to inciate its opposite (as in ‘mental health problems') or euphemistically to indicate facilities used by or imposed upon people with mental health problems (as in mental health services) (Pilgrim 2005). The research here is an investigation of the priorities given locally to these conditions. The research is not an accounting of psychological disfunction or organic psychiatric disease.
Mental health is more than the absence of a diagnosis of mental illness. The WHO emphasises mental health as a state of well being. In a summary report (2003) the WHO explains the cultural context of mental health by citing Jahoda who in 1958 elaborated on the WHO's own declaration that “health is not merely the absence of illness but a complete state of physical, psychological and social well-being” by separating mental health into three domains. "First, mental health involves self-realization in that individuals are allowed to fully exploit their potential. Second, mental health includes a sense of mastery by the individual over their environment, and, finally, that positive mental health also means autonomy, as in individuals having the ability to identify, confront, and solve problems. Others, like HB Murphy (1978), argued that these ideas were laden with cultural values considered important by North Americans. The definition of mental health is clearly influenced by the culture that defines it. Mental health has different meanings depending on setting, culture, socioeconomic and political influences."
Obervations by psychiatric mental health nurses and other professionals in the community indicate that people living in the community do not have appropriate and adequate awareness of mental health problems, knowledge of remedial therapies, or access to psychiatric or mental health services. Mental health care providers often overlook planning for the care of people with mental illness when they are not in the hospital. For people with psychiatric illness, the problems faced in the community include a lack of continuing care after hospital discharge, lack of health services in crisis intervention, depression, attempted suicide, and stress and anxiety management.
After a community assessment, Soonthornchaiya (2004) found that health care providers lack both knowledge how to continue taking care clients with mental illness and lack mechanisms of collaboration between clients, family members, and health care providers. The chain of lack of knowledge and collaboration in the community results in inappropriate and insufficient mental health care. As a result, the care of people with mental illness in the community leads to complicated mental health problems. In part of this proposal we will also look at the research that is being done, largely by graduate nurses, regarding the adapatations and integration into the community of persons who have experienced mental illness requiring hospital or intensive outpatient treatment. Although such persons make up a small part of the population at risk for psychosocial problems, the severity of their problems and their visibility makes allows them to be recipients of a considerable share of the mental health service and research budget.
2> DETERMINING AND RANKING MENTAL HEALTH INDICATORS
DESCRIPTION OF THE ENVIRONMENT
It is possible to use epidemiologic methods to measure the extent of mental illness within a geographic area. However, ideas about mental health, quality of life, or local health knowledge, habits and practices vary from place to place, time to time, person to person, and among cultural groups. These ideas have not been standardized, thus data about these qualities are not recorded as part of standard procedures by governments or agencies.
However, some types of data are kept which may indicate community health and quality of life. But indicators of positive mental health for one community may not apply to all communities. Thus, standard measures or proxy measures for mental health have not been selected nationally or internationally. The measures that we choose to use as proxy for community mental health status will depend on what is important to a community, and what is available for comparison or use in describing mental health, coping, and other porblems that may exist in a community.
The following link will take you to a worksheet that we will use to develop
proxy measurements for mental health.
3> FINDING INDICATORS OF HEALTH WITH COMMUNITY INPUT
Cultural differences in health conditions are often highlighted by patients and professionals. Many studies have shown that variation in socialization and support from the people around us can affect health outcomes. These same socialization and support variables are often related to ethnic and cohort differences. For example, many Asian cultures value group integrity over personal accomplishement. People from such cultures often identify problems and solutions as rooted in the individual, rather than looking outward to the social environment to explain the problem. Another Asian value is that the priority activities of individuals are rooted in a social contract more often than being determined by a role in a formally structured organization or event. For example, a handshake transaction may engender more commitment (i.e. have as much or more meaning) than a formal written contract.
The conceptualizations of mental health, mental problems, and mental illness are culturally determined. We can also expect community reactions to particular conditions to be different from place to place and from time to time.
Thus, meaningful research requires involving the community in defining mental health and identifying what is problematic for the people there.
Focus groups and expert panels can be used to quickly indentify the attitudes and viewpoints of the community, and to gain insights into their understanding and perspectives about health, illness, and therapy.
Promoting Mental Health:
Summary Report (2003). A Report of
the World Health Organization, Department of Mental Health and Substance
Abuse in collaboration with the Victorian Health Promotion Foundation
and The University of Melbourne. World Health Organization,
Pilgrim, David (2005) Key Concepts in Mental Health, Sage Publications, London
Parkinson, Jane, (2003) Indicators of Mental Health and Well-being - Background Paper, NHS Scotland available at http://www.phis.org.uk/ (Healthy Scotland)
Soonthornchaiya, R (2004) "Assessment of Community Mental Health Services in Thailand" unpublished paper, Chulalongkorn University - Faculty of Nursing.
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