Community Mental Health

Osuolale John MAKANJUOLA

 OUTLINE OF THE LECTURE
Traditional and other methods of
Concept of community mental health.
 Community resources for the
treatment and management of the
promotion of mental health. mentally ill in the community.
Identification of factors that contribute 
Organizing two-way referral
to the causation of aggravation of
mental illness within the family and system.
environment.
Follow up care/ home visit.
Aims of Community Mental Health  Community mobilisation for
Nursing. promotion of mental health
Concept of Community Mental
Health
 Community as defined by Krug (1963) is a group of people living together in the
same place under the same laws with certain interest in common settlements,
villages, cities, countries, states and nations.
 Community is a group of people who live in the same place, share the same
government, belief and have a common culture, particular dominant occupation
and historical heritage.
 Each of these communities exists and serves the purpose of meeting the needs
of the people.
Concept Cont…
 People are the unit which make up a community.

 Cooperation among them to carry out different activities develops

in them a feeling of loyalty to their community.

 From the definition there is an element of care, therapy and love.

 Concept Cont...
Thus, it may be said that a therapeutic community is a social-physiological
milieu that utilizes the dynamic living together of a group as a method of
treatment to induce social recovery, growth and adaptation of the
individual.
The therapeutic community attempts to develop, facilitate and utilize a
combination of both the organizational structure and approaches to the
uniqueness of the individual as a means of repairing ego damage and self-
esteem especially in social interaction.
 Concept Cont...
Thereby patients are not separated from their families and their social
relationship.
 It enables patients to express their feelings and freedom in unsolicited
interaction.
 For healthy living, the individual’s environment should be healthy and safe
because of the influence it has on people’s physical, social and mental health.
 Social forces such as belief, attitudes, values, customs in one way or the other
affect our physical and mental health (Dana 1995) as the environment affects how
one feels, its setting should be peaceful and there should be contentment in home
and then in the neighbourhood, so as to enhance healthy mental state of the
whole individuals.
 Concept Cont...
 Individuals living in a community are mutually dependent, they cannot
enjoy mental healthiness without co existing, consent and support of one
another.
 Quiet and orderly community, contributes immensely to emotion and
mental well being of people.
 Community members should be physically fit, provide for themselves basic
physical needs for good health such as fresh air, clean water, shelter, food,
sleep, rest protection from diseases and good clothing and should interact
with one another to ensure healthy living and general well being of
individuals.
 Concept Cont...

Community health practices aim at improving the quality of life of people, so

that individuals in the community may enjoy long, life and have maximal

productivity to the best of their abilities.

Aims of Community Care
 To provide care for patients at centres located near their homes at
a stage when their disorders have not yet become severe or chronic,
so that disruption of their lives is minimised.

 To use the support of patient’s relatives and friends where

possible and to put them in touch with the psychiatric services which
exist for guidance and treatment of such patients.
Aims Cont…
 Provide prevention, treatment and rehabilitation services for
individuals with emotional problems.

 Provide hospital care within the community in those instances

when the individual cannot be maintained on an out patient basis.
 Role of Community Psychiatric
Nurse
1. Psychiatric nurses with a generalist background are prepared to attempt to meet the needs of total
patient. The major focus is on primary prevention.
2. They serve as an individual and group therapist and a consultation and liaison person to community
agencies and hospital units.
3. Community Psychiatric nurse makes home visits and serves as a resource person, educator,
administrator and researcher.
4. They communicate clearly with other health members to maintain their significant professional
contributions.
5. She/ he is concerned with giving health education within the community.
6. She is concerned with the administration and supervision of drugs at home or health centre, and
recognition of side-effects.
7. She at times runs a supportive and works with outpatient.
Psychiatric Services in Community Psychiatry
Assignment
List the various ways/ methods that
are used in practising community
psychiatry
 Services Obtained in Community
Psychiatry
 Observation and diagnosis of patients

 Assessment of the client’s needs

 Crises intervention

 Provide direct care services to clients, including individual, family and group therapy,

medications, electro convulsive therapy, occupational therapy, and recreational therapy..

 Services Cont…
Provide a therapeutic milieu that supports the individuals during the
period of crisis and help him learn new ways of coping with the problem.
Referral to proper community agencies for necessary follow up services.
Vocational counseling.
Health screening.
Provide an educational setting for various professional groups in mental
health concepts.
 Community Resources for the Promotion of Mental Health

 These are a network of caring services from responsible people committed to assisting

vulnerable population to meet their needs and develop their potentials without being

unnecessarily isolated or excluded from the community (Turner 1986).

 All these resources when fully utilized by community members will be of great assistance to

the promotion of mental health of individuals and families in the community.

Resources Available in Communities
Resources for parents and elders
Resources available for children and youths
Resources for health workers
Resources for the mentally ill individuals and family
Resources through the activities of Nations for Mental
Health
 Resources for Parents and
Elders
Resources like individual and family counseling services,
marriage counseling for the expectant parents,
parent discussion and family forum or circle,
guidance services,
promotion of cultural interest,
recreational programmes
general health information
consulting services and family life education.
 Resources Available for Children and
Youths

Resources available for children and youths are provided largely in

schools and via other agencies such as psychological testing and
diagnosis services,
counseling,
remedial programmes,
 mental health instructions,
 recreational programmes,
coordinated community-school mental health programme.
 Resources for Health Workers

 In-service training,

consultation services for all citizens,

marriage and family counseling services,

 utilization of voluntary services.

 Resources for the Mentally Ill Individuals and Family

Rehabilitation services (restoration to the fullest physical,

mental, social vocational and economic usefulness of which he
or she is capable)
Another measure is through the use of combined mental
health services,
through recognition of the role played by the traditional
healers and spiritual healers in supporting people with mental
health problem
 Resources through the activities of Nations for Mental Health,

Resources through the activities of Nations for Mental Health a relatively new
programme initiated by the division of suicide, abuse of the W.H.O in collaboration
with other specialized agencies in U.N and the Department of social Medicine.
Their concerns are to help children in difficult circumstances,
abused women (widowhood practice),
violence traumatized people,
people addicted to alcohol and drugs,
people living in extreme poverty,
those suffering from chronic mental.
 Identification of Factors that contribute to the causation or Aggravation of Mental Illness within the Family and Environment

It is a known fact that mental illness just

like physical illness affects the patience,
their family, their neighborhood, the
community, employers and the nation as a
whole.
 Family
 Instant distress contributes, to mental illness and every situation need to
be assessed individually, to determine what brought about the distress.
Some of the important causes are;
 An accident during pregnancy, at birth or soon after especially if this
leaves the child with some physiological problems.
 Genetic factors that pass a vulnerability to mental illness from one
generation to another.
 Maltreatment, such as neglect, abuse or rejection
 Family discord, inconsistent and harsh discipline .
Family Cont...
 Loss of something precious or someone through death, divorce,
abandonment
 Poverty, unemployment, homelessness, and general insecurity or
threat to life and property.
 Serious illness, especially chronic and debilitating illness
 Unresolved conflict, chaos and overt hostility.
 Excessive competition among siblings, and expectation from parents
Increased tension in family and persistent irritation.
Environments Factors
 Extreme hostility, neglect and abandonment are all among the problems of co habitation.
 Poor support network
 Lack of recreational amenities for leisure activities
 Stigmatization and frustration
 Curfews and night raids by armed robbers and secret cult people
 House demolition, arrest of individuals, maltreatment (beaten up, whisked away, imprisoned,
raped).
 Guerrilla warfare, civil disobedience, political violence, ethnic conflicts, religious intolerance.
 The above mentioned causes anxiety, despair, desolation and wastage in all aspects of human life.
Recognition and Management of
Psychiatric Emergencies within the
Community
Psychiatric emergency is an urgent serious disturbance of behavior, affect or
thought, which makes the patient unable to cope with the situations and
interpersonal relationship such a patient may be the following:
• Over active patient
• Violent patient
• Under active patient
• Depressed patient
• Suicidal patient
Any of the above mentioned behavior could cause personal harm or injury in others.
Over Active Patients

The over-active patient will display disturbed uncooperative paranoid behavior; there
is a lot of anxiety and panic feeling.

They may be prone to assaultive and destructive, impulses and abnormal social
behavior (like he will attack this person and the other person and always find faults
with people’s idea, insists on his own).

There is this intense nervousness, depression and crying out.

There is disturbed behavior, may be compounded by alcoholics or drug intoxication.

over active patients Cont...
Emergency Treatment
Number one line of action
Attempt to find out the reason for the behavior, (that is why he is
behaving the way he is behaving), like history of mental illness,
under drug, or alcohol, signs of intra cyclic conflict, conflict in the
home, hospital or injuries, medical problems that may precipitate
such behavior is ruled out.
If mentally ill patient, ascertain whether he has been off
treatment, any crisis in interpersonal relationship.
over active patients Cont...
Second line of Action
Try to gain control of the situation. Approach your patient in a calm,
confident and firm manner.
Try to introduce yourself to him, try to address him by name and
title, keep repeating it and personalize it.
Tell your patient that you are there to help him, speak in one thought
sentence over and over time, be consistence.
over active patients cont...
Give patient space and let him slow down, himself and allow him
become compliant.
Be interested and listen to what the patient is saying because as he is
talking, some of the thoughts and feelings are followed and
sometimes, he will accuse you and people around.
You have to offer reasons and explanations that are truthful and
appropriate to gain control of the situation
 over active patients Cont...

Third line of Action

For a known psychotic patient give him psychotic drugs like
.
chlorpromazine or haloperidol.
Restraint is used only as a last result.
Immediate arrangement for transfer to psychiatric clinic at our
patient level
The Violent Patient and
Aggressive Behaviour
This condition is usually episodic and a way of expressing feeling of
anger, hopelessness of fear. Patient has a history of rage, temper
tantrums. Family members are victims of his aggression.
Types
Psychotic especially the functional type with no physical ailment
Those with toxic psychotic toxemia, brain damage, organic damage,
drug withdrawal syndrome.
Emergency Treatment
First of all take precautions, such a person should never be approached
alone but with two or more people.
Try to remove objects, which he could use as weapon like knife, stick,
bottle don’t it block the exit to the door, because the patient will feel
closed in and threatened and will strike.
Give the patient space, do not make sudden movement.
If the patient picks any weapon, ask him to drop it, you can use somebody
to make him comply.
Emergency Treatment Cont...
Calm the patient down, by talking and listening to his talk, give patient opportunity to ventilate
his anger verbally.
Convey the message that you are available to help him, let him understand that his behaviours
are frightening other people.
During help if the patient does not appear to responsive, call or resort for security personnel to
assist you. The police may intervene.
Restraint could also be used but in minimal form, but this is done using so many aids, from
people around even to assist in holding him for injection.
Use largactile 200mg to calm him down, in serious cases.
Once he is calm, you can now take patient to hospital for admission and for other treatment.
 Under Active or Depressed
Patient
These patients will be very slow, slow to respond to any
situation, very depressed, fed up with life, feelings of
hopelessness, worthlessness, guilt,
Ambivalence, insomnia, indecision, mood is worsened, anger
turned in wards, withdrawn, feeling of isolation, down spirit.
Always very difficult to arouse and stimulate.
Has poor social interaction, very fearful, sad facial expression .
Emergency Treatment
Very unhurried manner of approach.
Listen to them, be patient in management of this partied pay attention to him at all times
Such patients are very sensitive
Do not make any judgement statement; allow him to ventilate his feelings.
Pay attention to suicidal gestures.
Ask questions to expose his suicidal gestures and moves
Notify the relations, warn them never to leave him alone or allow items he can use to harm
himself if in this environment
Find out, if there is any illness perceived or real, in order to find out what precipitated the
condition.
Emergency Treatment Cont...
If there is real problem or real illness, try and clear individual’s wrong
impression and misconception.
Through this, the mood can be elevated
So give him, that kind off assurance that something can still be done to
help him
If in a known depressive patient.
Give anti depressive drugs
Further line of management is to refer to a psychiatrist for proper
management.
Suicide Patients
Aggressive acts, stems from depression reaction, are usually against self.
Precipitating Factors
Lost of dear one, objects, property. The person may feel that life is unworthy
More males than females attempt suicide
Unemployed people
More in people above 45years
Divorced patients or those living alone.
Any patient with previous history of suicidal attempt can repeat it.
Emotionally predisposed individuals.
Emergency Treatment

Look out for the emergency reactions, such as where suicide attempt has been made.

Some must have hanged self and sustained some injuries created by the suicidal, about to be

checked, so may need respiratory assistance.

Others might try to bleed themselves to death through a cut on major artery, there may be

poisoning, negating gastric lavage.

Emergency Treatment Cont...
Prevent further self injury
Arrest the situation and quickly send such a person to
the emergency care unit, crisis intervention unit or
intensive care unit section in a hospital setting, to
ensure urgent attention to save life and restore
normal functioning.
Prevention of Suicide Attempts
Look out for at risk patients and monitor them, or factors that suggest the risk of
suicide (like total withdraw from the world, any recent loss or statement of
suicidal intent). A patient who is always talking of death, or thought that the life
is not worth living or attempted suicide or with family history of loss through
suicide.
All these comments should be reported and monitored closely, supportive
psychotherapy and divertional therapy can be employed.
Patients can be actively engaged on leisure activities
Other measures employed include; ensure doors are open, no bolts on the
patient’s door, remove harmful weapon, patient is never left alone, and involve
recreational and social therapy.
Thanks for
listening