Community Mental
Health
DR. AWATIF ALAM
Introduction:
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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.
CAUSES OF MENTAL ILLNESS
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The concept of multiple
factors in the causation of
psychogenic disorders has
become generally accepted.
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The factors are considered to
involve the individual,
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the family
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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).
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.
EXTENT OF MENTAL ILLNESS :
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If only clearly disabling conditions are
counted, the estimate of mental illness in the
general population will be much lower than
10%.
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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:
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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”.
BROAD CLASSIFICATION OF
MENTAL ILLNESS :
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Psychoneurosis.
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Psychosis.
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Addictions.
Alcoholism, … etc.
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Mental retardation
psychoneurosis :
Comprise a group of personality disorders, in which:
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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:
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Symptomatology has its origin
outside conscious awareness and
functioning which pre-existed in
infancy and childhood.
Psychoneurosis:
In general, the psychoneurotic reaction
represents :
 Symbolic adaptation to anxiety involving
only partially disturbed social functioning
and reality testing.
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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 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.
Psychosis:
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Represents extreme form of breakdown
in mental health,
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The individual no longer remains related
to the reality situation ,
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The patient is subjected to irrational and
disordered emotional and intellectual
process.
Psychosis:
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Psychosis will lead to aberrant behavior
recognizable by gross un-reality,
e.g. schizophrenia, manic depressive
psychosis, melancholia.
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The psychotic who violates legal and
social codes is placed under supervision
or hospitalized.
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:
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Adopting certain legal regulations; for
controlling the important and export of
narcotic drugs,
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Regulating the production and distribution of
drugs ,
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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 :
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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:
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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:
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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.