COMMUNITY MENTAL HEALTH AND RISKY

GROUPS IN SOCIETY, INTERCULTURAL

NURSING

DR. RASİHA GÖZENKAN

• COMMUNITY MENTAL HEALTH:
• Mental health is a concept that expresses the process that
continues from early childhood to death; with thought,
communication skills, learning and emotional development, and is
strengthened by self-confidence.
• Mental health problems are so important that they hinder a
person's functionality, creativity, happiness and life satisfaction.
• When a person with any mental illness experiences problems in the
areas of emotion, thought and behavior, this situation creates
problems not only for him/herself but also for his/her family,
environment and society.
• Public Health Principles; A person's illness is also a family's
problem. A person's illness is also a society's problem.
 Within the scope of Public Health Practices, the development of
mental health, prevention of mental disorders, early diagnosis and
treatment are important.
• Characteristics That Mentally Healthy People Should Have:
• 1. Can cope with daily worries and sorrows.
• 2. Can maintain relationships with close and distant circles.
• 3. Can establish friendships outside of work relationships.
• 4. Can establish bonds based on love and respect beyond getting
along and cooperating with people.
• 5. Has values ​and beliefs that he believes in, self-confidence, and self-esteem.
• 6. Can take responsibility for his actions and endure the consequences.
• 7. Has entertaining, relaxing, and self-developing activities outside of his
profession.
• 8. Can develop himself/herself. Has acquired the feeling that he has a place
and duty in society.
• 9. Has plans for the future, hope, and the power to fight, can make decisions
on his/her own.
• Reasons for not getting help despite having a mental problem;
• Failure to recognize the illness
• The person and their environment labeling the illness as insanity
• Economic, cultural and physical conditions that determine who to turn to for help
• Other problems; Those who apply for help not receiving the correct diagnosis
(especially in applications to general practitioners)
• Incorrect and inadequate treatment given to those who receive the correct
diagnosis
• The patient not complying with the treatment
• Economic difficulties
• Causes of Mental Disorders
• 1. Uncontrolled population growth,
• 2. Rapid and unplanned urbanization due to migration,
• 3. Unemployment,
• 4. Industrialization,
• 5. Collapse of social values,
• 6. Economic decline,
• 7. Wars,
• 8. Negative effects of social chaos and political transition periods * The anxiety,
insecurity, hopelessness and pessimism created by all these affect individuals and
cause the mental health of society to deteriorate.
 • Mental Health Services
• When it comes to Mental Health Services, the first thing that comes
to mind is the treatment of psychiatric diseases. In recent years,
preventive mental health services have gained importance as a
result of contemporary developments.
• Mental Health Services in Primary Care
• Preventing diseases and protecting and improving the well-being of
individuals are priorities in improving public health. Therefore,
improving mental health and preventing mental disorders are
becoming increasingly important within the scope of public health
practices.
• In our country, mental health services are mostly carried out with a focus on
treatment, while preventive and rehabilitative services are neglected, as in many
countries.
• The reasons are;

• The fact that mental health remains at a more abstract level, despite the tangible
qualities of physical health,

• The small number of professionals in the mental health team,

• Inadequate professional training of health personnel in the field of preventive

mental health,

• The fact that mental health services are seen as a branch of specialization that is too
high-level to be carried out at the first level.
 • The main purpose of Community Mental Health Centers is to
provide treatment, rehabilitation, education, and follow-up of
patients without re-admitting them to the hospital, without
separating them from their social environment, and to ensure that
psychotic patients become independent individuals who take an
active role in society and participate in production.
• Community Mental Health Center Team
• 1. Specialist Psychiatrist,
• 2. Mental Health and Psychiatric Nurse,
• 3. Psychologist,
• 4. Social Worker,
• 5. Ergotherapist (Occupational Therapist),
• 6. Medical Secretary,
• 7. Security Officer,
• 8. Service Personnel,
• 9. Master Instructors
 • Community Mental Health Nurse;
• Must have acquired skills and abilities such as observing and
defending patient rights, referral, education, rehabilitation, home
visit, crisis intervention, monitoring of drug applications.
• Community Mental Health Nurse in Primary Prevention
• 1. Provides health education to prevent new cases
• 2. Collects data to determine community mental health needs
• 3. Determines risk factors and combats them
• 4. Helps individuals and families develop problem-solving skills
• 5. Teaches individuals about methods of coping with stress and the
importance of exercise.
• 6. Provides social support systems to bring families and individuals
together.
• 7. Informs families if there is a genetic predisposition.
• 8. Provides counseling to individuals in new situations such as
marriage, birth and retirement.
• 9. Informs society about the effects of alcohol and substance
addiction.
 • Community Mental Health Nurse in Secondary Prevention
• 1. Finds new cases through home visits and refers them if necessary
• 2. Follows up whether those receiving early diagnosis and treatment
are using their medications
• 3. Provides care to ensure the physical and psycho-social function of
the individual
• 4. Provides support to the family
• 5. Demonstrates support services and their use
• 6. Prepares and presents educational programs for the family and the
community.
• Community Mental Health Nurse in Tertiary Protection:
• 1. Provides counseling to individuals and families after acute illnesses
• 2. Provides support during recovery and adaptation to new situations
• 3. Teaches methods of benefiting from social support systems,
establishes connections
• 4. Conducts joint studies with employers for the purpose of
reintegration into society.
DUTIES, AUTHORITIES AND RESPONSIBILITIES OF THE COMMUNITY
MENTAL HEALTH NURSE:

• a) It takes part in protecting and maintaining the mental health of all groups at risk of
mental health deterioration such as those living in regions with low socio-economic
levels, those who have migrated, those at risk of substance addiction, children,
adolescents, women, the elderly, the unemployed and the disabled, and creates
supportive programs.
• b) It knows the characteristics of the developmental period and monitors the bio-
psycho-social development of children and adolescents in line with these
characteristics.
• c) It carries out protective interventions regarding risky behaviors that may emerge
during adolescence (smoking, alcohol and substance addiction, suicide, violent
behavior, risky sexual behavior, etc.). In this context, it provides counseling to
adolescents, families and society.
 ç) Provides information to individuals in middle age and old age about the
characteristics of this period. Provides support and counseling on methods of
coping with physical, emotional and social problems that may arise during this
period.
d) Knows that mental disorders can be early symptoms of a physical disease
process or the cause of the disease and evaluates the general health level of
patients and healthy individuals, performs risk factor analysis.
e) Provides training to mothers regarding mental conditions that may develop
during pregnancy and birth.
f) Organizes social support systems to help individuals and families.
• g) Evaluates alternative medicine practices such as drugs, plants,
alternative treatments, vitamins or nutritional supplements used by
individuals in the community.
• ğ) Takes history regarding risky behaviors (suicide, violence, harming
oneself and/or others, abuse, neglect) and evaluates the level of risk.
• h) Collects data continuously and systematically, determines needs and
problems, plans and implements nursing care, using therapeutic
communication techniques and evidence-based assessment tools within
a bio-psycho-social integrity with the patient.
• ı) Provides individual or group counseling for developmental, situational and
social crises, creates support groups, and provides psychosocial support.
• i) Monitors the patient's compliance with medical treatment, the effects and
side effects of medications, and helps in coping with side effects.
• j) Ensures that the individual uses appropriate support services when
experiencing a mental health problem.
• k) Identifies situations that may cause a relapse of the psychiatric illness (lack of
information, non-compliance with treatment, stress, etc.) and cooperates with
the family to prevent exacerbations.
• l) Helps individuals with chronic psychiatric illnesses adapt to society after
discharge.
• m) Takes part in the implementation of the home program prepared for the
patient receiving psychiatric treatment after discharge, takes initiatives to
ensure the patient's social adaptation and cooperates with the rehabilitation
team.
 • n) Supports the family and the individual in the process of recovery and
adaptation to the new situation.
• o) Guides and supports individuals with mental disorders to use social support
resources.
RISKY GROUPS IN SOCIETY
 • The 1948 Universal Declaration of Human Rights included the following
statement:
• "Everyone, regardless of age, gender, race, religion, political belief or socio-
economic power, has the natural right to the highest possible level of health
care."
• It is impossible for a person to be in a state of complete well-being in societies
where work and life security cannot be ensured, where there is no possibility of
finding a job, and where the unrest caused by income distribution imbalance
cannot be resolved.
• Risk Groups in Society (Vulnerable Groups)

• Vulnerability:

• Needing help to perform basic functions (dependency);

• Being in a situation that prevents communicating with others;

• Being unable to protect oneself from attacks, bad behaviors, and abuse.
• People Considered Vulnerable:
• • Children aged 18 and under,
• • Pregnant women,
• • The elderly and frail,
• • Those with learning disabilities,
• • Those with mental illnesses (Dementia, etc.),
• • Those with physical disabilities,
• • Drug users,
• • Children living on the streets.
• • Prisoners,

• • Those who engage in unhealthy sexual intercourse (sex workers, homosexuals),

• • Those with limited or no education (those who have difficulty understanding

informed consent information),
• • Those with limited access to health resources,

• -people with low economic status,

• • Homeless,

• • Asylum seekers, refugees

• What Can Be Done for Vulnerable Groups

• The basic and oldest moral principle regarding the strong protecting the weak
imposes duties on each person to;
• • Protect the weak,

• • Allow them to use their rights,

• • Prevent them from being harmed.

What Can Be Done for Vulnerable Groups
• The state creates a circle of protection through laws in order to
enable people who are more vulnerable to use their rights and to
prevent them from being abused physically, psychologically,
economically and even socially.
What Can Be Done for Vulnerable Groups
• Legal regulations should be put in place to deter bad behavior that
could cause these people to get hurt (such as visits and checks to
Child and Elderly Care Homes). However, this is not enough.
• In order to minimize the damage that these people may suffer;
• • Society should be organized, Special training should be provided,
• • Individual responsibility as well as institutional responsibility
should be developed, Ethical sensitivity should be increased.
• Civil society organizations can be established for vulnerable groups.
• • These NGOs can organize special training and courses for them,
• • They can provide shelter and food aid,
• • They can provide economic support.
• For example; associations established to meet the basic needs of
children and young people who have to live and work on the streets,
such as shelter, health, and education
• - Turkey Street Children Foundation.
• Healthcare professionals have a duty to protect the interests of
vulnerable people and to prevent them from being harmed.
• • Informing vulnerable people about what will be done to them, or
at least informing them, and obtaining their informed consent.
• • Involving them in decisions even if they cannot care for
themselves.
• Rights of Vulnerable Adults:
• • Vulnerable people have the same rights as other adults. All adults,
regardless of age and mental capacity, have the following rights.
Every person has the right to:
• • The right to live in dignity and safety and to be protected from
medical malpractice,
• • The right to have their physical and emotional needs met,
• • The right to make his/her own decisions,
• • The right to choose visitors according to his/her own wishes,
• • The right to maintain/protect his/her autonomy (to the extent
that his/her health condition allows).
• Primary Protection for Vulnerable Groups:
• • Providing shelter and health services to refugees and the homeless,
• • Providing food aid to the poor,
• • Providing shelter, food and education opportunities to children
living on the streets,
• • Taking precautions to protect the elderly from accidents,
• • Health education.
• Secondary Protection for Vulnerable Groups:
• • Screening prisons for tuberculosis,
• • Performing the TORCH* test before pregnancy,
• • Screening drug users for blood-borne diseases,
• • Screening sex workers for STDs
• Tertiary Protection for Vulnerable Groups:
• • Special education for those with learning disabilities,
• • Rehabilitation of drug users after they quit using drugs,
• • Prevention of complications of chronic diseases,
• • Physical and social rehabilitation for the elderly.
TRANS-CULTURAL NURSING
• Today, nurses must be knowledgeable about and sensitive to
cultural differences and similarities when providing care to
individuals.
• To provide adequate cultural care in nursing, Leininger and other
expert nurses continue their work to develop numerous cultural
theories, models and assessment guides that can be used
internationally and to simplify these guides. What should be
emphasized in culturally approachable nursing care is to seek an
answer to the question "how different is this group from my group?"
 • Healthcare professionals should know the characteristics of
individuals from different cultures. However, it is not possible for
nurses to know the cultural background and characteristics of all
individuals, and it is unnecessary to make a complete cultural
diagnosis for each patient. Instead, it is important and necessary for
nurses to collect sufficient basic cultural data in diagnosis.
 • In nursing, Peplau first mentioned in 1950 that culture is an
important variable on mental health. Leininger tried to popularize
transcultural nursing movements. More importance was given to
the care of individuals from different cultures in the 1960s. In 1962,
King stated that psychopathological behaviors differ from culture to
culture.
• In 1969, the International Council of Nursing (ICN) began using
cultural content in nursing. In 1974, the Transcultural Nurses
Association was established for the first time, followed by the
publication of the “Journal of Transcultural Nursing” in 1990. After
this, members of the Transcultural Nursing Association became
pioneers of general information about culturally-inclusive care.
• Transcultural Nursing The term “Transcultural Nursing” was first
used by Leininger in 1979.
• Leninger (1999) defined Transcultural Nursing as "a branch or sub-
branch of nursing that provides cultural universality and culture
specificity in nursing care, is based on comparative research and
analysis of different cultures, analyzes differences in subcultures and
cultures around the world in a way that respects health-disease,
care, beliefs and values, and focuses on comparative study."
• The purpose of transcultural nursing is to provide sensitive and
effective nursing care to meet the cultural needs of individuals,
families and groups, and to ensure that nursing knowledge and
practices are conceptualized and used culturally.
• There are four key concepts of nursing from a transcultural
perspective.
• * Nursing is a profession that provides transcultural services, aiming
to provide meaningful, appropriate, culturally and life-style-
respectful, humane services to individuals.
• * The individual is a cultural being and cannot be considered
separately from his/her cultural background.
• * The individual is a whole with his/her environment and the
environment is an inseparable part of the culture. Generally, they
are in constant interaction as physical, ecological, socio-political
and/or cultural entities.
• * Health is a concept that varies from culture to culture.
• Some researchers have emphasized the importance of cultural
values, beliefs, practices and attitudes in effectively meeting the
needs of patients and reported that these are necessary for a
holistic approach.
• According to Leininger (1996), nurses can prevent cultural shock by
increasing their knowledge of different cultures and providing
patients with care that is appropriate to their own culture and free
of prejudice.
• People with different cultures may have different health needs. It is
a basic human right for all people to express their cultural existence
openly. The cultural values ​of all individuals should be respected and
the necessary nursing care should be provided accordingly. For this
reason, Leininger and other modelists have emphasized the
importance of training nurses who can provide appropriate care to
individuals with different cultures.
• Nurses’ recognition and evaluation of the cultural structure of the
society they serve will play an important role in increasing the
quality of nursing care they will provide. Transcultural Nursing
Models are a guide for nurses in recognizing and evaluating the
cultural structure of society. It is thought that using the model will
be beneficial for nurses to deeply recognize and evaluate the society
they provide care to, to access cultural data in more systematic and
standardized ways, and to increase knowledge in the field of
transcultural nursing.
• In recent years, awareness of the importance of cultural care and
cultural data collection has increased in Turkey. In a study conducted
with nursing students in our country, almost all of the students
(91.2%) stated that they took the cultural characteristics of the
patient into consideration during the nursing care process. However,
there is no model, theory or guide developed in Turkey for culturally
competent care and cultural data collection. However, many expert
nurses abroad, such as Purnell, Camphina-Bacote and Leininger,
have developed cultural models and guides.
• Purnell's Cultural Competence Model
• Developed by nurse modeler Larry Purnell in 1995 to be used as a
clinical assessment tool by student nurses. In the following years, a
schema, meta-paradigm content and cultural competence scale
were added to the model. It is a model created to improve health
promotion and cultural understanding of people's situation in the
disease process.
• Cultural Care Differences and Similarities Theory
• Madeline Leininger is the first researcher in transcultural nursing
and the first theory developed regarding transcultural nursing. This
theory has contributed to the advancement of research in the field
of transcultural nursing since the 1950s.
• The theory focuses on differences and similarities between cultures.
It focuses on the conditions that affect health care, such as the
environment, language, gender, race, belief, politics, economy and
culture. In this theory, it is stated that the patient's culture is the
basis for determining the patient's understanding of health and
well-being. Leininger's theory is in a position to guide nurses in
cultural care.