If we want more evidence-based practice, we need more practice-based evidence.*
Community Mental and Social Health
Table of Contents
This chapter begins Part 3 of the book, which outlines the strategies for health promotion in the community or in populations. We begin with mental health, which becomes increasingly salient as a concern of communities as they gain greater control over threats to physical health. Mental health, expressed in community terms, reflects and influences social health. The economic stability and social supports of a community influence the stress and coping balance of individuals and families. Community health professionals and institutions can help adjust this balance when the levels of stress exceed the coping resources of individuals and families. The overall objective of this chapter is to provide you with concepts and methods useful in analyzing community mental and social health needs and in planning programs to strengthen the capacity of individuals, families and communities to prevent and treat mental health problems.
The epidemiology of mental illness, stress, and social pathology is presented in the initial sections, followed by the identification of specific community interventions to prevent or reduce the causes of mental health problems, suicide, and violent behavior. Some of these issues will be taken up again in the chapters on health promotion, community recreation and fitness, and injury control. The community mental health approach to these problems builds institutional resources to help people cope with their problems, to provide treatment facilities for those who cannot afford private psychiatric care, and to provide rehabilitation resources for those released from state mental care institutions. Primary prevention has consisted largely of public and school mental health education, but current approaches also include increasing emphasis on maternal bonding, parenting, day care facilities for the children of working women, and support groups for people facing or coping with life transitions such as divorce, unemployment and retirement. Employee Assistance Programs, once concerned primarily with alcohol and drug misuse, increasingly seek to help employees cope with family, economic and emotional problems.
For headlines, news stories, and milestones on domestic violence issues, go to www.vawnet.org and click on "In the News" for archives dating from 1993 to the present.
Major Change In Mental Healthcare Is Urged. (New York Times, July 23, 2003).
Dealing With Addiction, and What Comes After. (New York Times, July 20, 2003).
Acne Made Worse by Stress. (British Broadcasting Corporation, July 23, 2003).
Commission Finds Disarray in Mental Health
Programs. (Washington Post, July 22, 2003) - According to a report
by the New Freedom Commission on Mental Health, many users of mental health
programs are getting limited treatment and many "fall through the cracks."
Breast Implants Linked to Higher Suicide Risk. (Reuters, March 7,
2003) - Women who opt for breast implants to enhance their natural assets are
more likely to commit suicide, Dutch and Swedish scientists say.
The Case For Compensating Stress Claims.TORONTO (Globe and Mail, Margot Gibb-Clark, Workplace Reporter, June 14, 1999) Experts say the refusal by workers' compensation boards to cover stress-related cases shifts the cost burden to other parties--including the health care system--and may dissuade Canadian employers from creating a more healthful work environment. http://www.globeandmail.com
Study Finds Middle Age Enjoyable. CHICAGO (AP, Feb. 16, 1999) Far from being a time of failing health, personal turmoil and the "midlife crisis," middle age for many is the most fulfilling time of life, according to a new study. The 10-year study sponsored by the John and Catherine MacArthur Foundation, made public in several news reports Tuesday, undermines many beliefs about middle age. "We have this public image of midlife being full of stress, but (midlifers') sense of control is good and their sense of well-being is good," said social psychologist Orville Gilbert Brim, director of the MacArthur Foundation's Network on Successful Midlife Development and president of Life Trends Inc., a Florida-based consulting business hired by MacArthur to conduct the study. The MacArthur Foundation said the study is the largest ever done on midlife.
City Workers Feeling the Blues Can Call Up a "Mood Meter," An Automated Phone System That Screens For Depression.BOSTON (AP, Feb. 3, 1999) They just can't expect to talk to a live person. Callers listen to recorded descriptions of how they feel and are asked how often they feel that way. Descriptions range from "I get tired for no reason" to "I feel others would be better off if I were dead." Callers punch the digits and hear a recorded diagnosis that urges severe cases to get counseling. Officials said the hotline is valuable for the city's 18,000 workers, who are often blamed for the city's maladies.
U.S. Mental Health System in "State of Third World Collapse" Weston Got Gun Permit Despite Mental Illness. (Washington Post, July 28, 1998)
Abuse Drove Boy to Suicide. (Vancouver Sun February 13, 1997)Golden Gate Bridge to Institute Suicide Patrols. (New York Times February 25, 1996)
Indulge Yourself Ė But Donít Feel Guilty, Experts Say. (Reuter November 7, 1996. July 28, 1998)
For related news stories, pleaseclick here.
Suicide Rates to 2003. MMWR 2005: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a1.htm.
Steele, Ric G.; Roberts, Michael C. (2005). Handbook of Mental Health Services for Children, Adolescents, and Families. New York: Springer.
Allen, D. (1999). Success And Failure In Community Placements For People With Learning Disabilities And Challenging Behaviour: An Analysis Of Key Variables. JOURNAL OF MENTAL HEALTH 8(3): 307, June.
Bartlett, C. J., & Coles, E. C. (1998). Psychological Health And Well-Being: Why And How Should Public Health Specialists Measure It? Part 1: Rationale And Methods Of The Investigation, And Review Of Psychiatric Epidemiology. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 281-287.
Bartlett, C. J., & Coles, E. C. (1998). Psychological Health And Well-Being: Why And How Should Public Health Specialists Measure It? Part 2: Stress, Subjective Well-Being And Overall Conclusions. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 288-294.
Bellamy, C. D., & Mowbray, C T. (1998). Supported Education as an Empowerment Intervention for People with Mental Illness. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5): 401-414.
Black, M. M. (1999). Commentary: Feeding Problems: An Ecological Perspective. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 217-219, June.
Brown, J. S. L., & Cochrane, R. (1999). A Comparison Of People Who Are Referred To A Psychology Service And Those Who Self-Refer To Large-Scale Stress Workshops Open To The General Public. JOURNAL OF MENTAL HEALTH 8(3): 297-306, June.
Chaney, J. M., Mullins, L. L., Uretsky, D. L., Pace, T. M., Werden, D, & Hartman, V. L. (1999). An Experimental Examination Of Learned Helplessness In Older Adolescents And Young Adults With Long-Standing Asthma. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 259-270, June.
Craft, B. J. , Johnson, D. R., & Ortega, S. T. (1998). Rural-Urban Women's Experience of Symptoms of Depression Related to Economic Hardship. JOURNAL OF WOMEN & AGING 10 (3): 3.
Cuijpers, P. (1999). The Effects Of Family Interventions On Relatives' Burden: A Meta-Analysis. JOURNAL OF MENTAL HEALTH 8(3): 275-286, June.
Jelalian, E., & Saelens, B. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Pediatric Obesity. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 223-248, June.
Kaplan, M. S., & Geling, O. (1999). Sociodemographic And Geographic Patterns Of Firearm Suicide In The United States, 1989-1993. HEALTH AND PLACE 5 (2): 179-185.
Kerwin, M. L. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Severe Feeding Problems. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 193-214, June.
Kilmer, R. P., Cowen, E. L., Magnus, K. B. (1998). Differences in Stressors Experienced by Urban African American, White, and Hispanic Children. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5): 415-428.
Kisely, S. (1998). More Alike Than Different. Comparing The Mental Health Needs Of London And Other Inner City Areas. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 318-324.
Ludermir, A. B., & Harpham, T. (1998). Urbanization And Mental Health In Brazil: Social And Economic Dimensions. HEALTH AND PLACE 4: 223-232.
McBride, T. D., Calsyn, R. J., & Allen, G. A. (1998). Duration of Homeless Spells Among Severely Mentally Ill Individuals: A Survival Analysis. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):473-490.
Neugebauer, R., Wasserman, G.A., Fisher, P.W., Kline, J., Geller, P.A., & Miller, L.S. (1999). Darryl, A Cartoon-Based Measure Of Cardinal Posttraumatic Stress Symptoms In School-Age Children. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 758-761.
Norman, J. & Peck, E. (1999). Working Together In Adult Community Mental Health Services: An Inter-Professional Dialogue. JOURNAL OF MENTAL HEALTH 8(3): 217-230, June.
Onyett, S. (1999). Community Mental Health Team Working As A Socially Valued Enterprise. JOURNAL OF MENTAL HEALTH 8(3): 245-252, June.
Peck, E. (1999). Introduction To Special Section On Community Mental Health Teams. JOURNAL OF MENTAL HEALTH 8(3): 215-216, June.
Peck, E. (1999). Tensions In Mental Health Policy? JOURNAL OF MENTAL HEALTH 8(3): 213-214, June.
Peck, E. & Norman, I.J. (1999). Working together in adult community mental health services: Exploring inter-professional role relations. JOURNAL OF MENTAL HEALTH 8(3): 231-245, June.
Pilgrim, D. & Bentall, R. (1999). The Medicalisation Of Misery: A Critical Realist Analysis Of The Concept Of Depression. JOURNAL OF MENTAL HEALTH 8(3): 261-274, June.
Richard, L., Breton, E.R., Lehoux, P., Martin, C., & Roy, D. (1999). How Public Health Professions Perceive Two Dimensions For Promoting Health: Ecological Approach And Participatory Approach. CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE 90 (2): 99-103.
Riekert, K. A., & Drotar, D. (1999). Who Participates In Research On Adherence To Treatment In Insulin-Dependent Diabetes Mellitus? Implications And Recommendations For Research. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 253-258, June.
Santos, S. J., Bohon, L. M., Sanchez-Sosa, J. J. (1998). Childhood Family Relationships, Marital and Work Conflict, and Mental Health Distress in Mexican Immigrants. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):491-.
Saunderson, T., Haynes, R., & Langford, I. H. Urban-rural variations in suicides and undetermined deaths in England and Wales. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 261-267.
Smith, J. A., Hughes, C. T., & Budd, R. J. (1999). Non-Compliance With Anti-Psychotic Depot Medication: Users' Views On Advantages And Disadvantages. JOURNAL OF MENTAL HEALTH 8(3): 287-296, June.
Snowden, L. R. (1998). Racial Differences in Informal Help Seeking for Mental Health Problems. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):429-438.
Sommer-Rotenberg, D. (1998). Suicide And Language. CANADIAN MEDICAL ASSOCIATION JOURNAL 159 (3): 239-40.
Stark, L. J. (1999). Commentary: beyond feeding problems: the challenge of meeting dietary recommendations in the treatment of chronic diseases in pediatrics. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 221-222, June.
Tannahill, A. (1998). Commentary. The Scottish Green Paper: Beyond A Healthy Mind In A Healthy Body. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 249-252.
Mental Retardation Following Diagnosis of a Metabolic Disorder in Children Aged 3--10 Years --- Metropolitan Atlanta, Georgia, 1991--1994.Morbidity and Mortality Weekly Report 48(17), May 7, 1999. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4817a3.htm
One of the largest population-based disease intervention programs in the United States is newborn metabolic screening. Since the mid- to late 1970s, newborns have been screened routinely for one or more metabolic disorders (1-4). The goal of early identification and treatment of metabolic disorders is prevention of the serious medical and developmental consequences of the disorders (e.g., mental retardation [MR]). Despite this goal, the United States has no mechanism for systematic surveillance of the developmental status of children who screen positive for and subsequently have metabolic disorders diagnosed. To determine the number of selected developmental disabilities attributable to metabolic disorders detected by newborn screening, CDC conducted a preliminary investigation of children with developmental disabilities and metabolic disorders in the metropolitan Atlanta area using data from the Metropolitan Atlanta Developmental Disabilities Surveillance Program (MADDSP). This report summarizes the results of this investigation, which indicate that newborn screening is highly effective in reducing the burden of MR associated with these disorders. References cited:
1. Taeusch WH, Ballard RA, Avery ME. Diseases of the newborn. Philadelphia, Pennsylvania: WB Saunders Co.,1991:111-46.
2. Fisher DA, Dussault JH, Foley TP Jr, et al. Screening for congenital hypothyroidism: results of screening 1 million North American infants. J Pediatr 1979;94:700-5.
3. American Academy of Pediatrics. Newborn screening fact sheets. Pediatrics 1996;98:467-72.
4. Fernhoff PM, Fitzmaurice N, Milner J. Coordinated system for comprehensive newborn metabolic screening. South Med J 1982;75:529-32.
1. Computers and technostress. Computers have become a fact of life for many, but for those with limited technological skills they may arouse feelings of inadequacy, anxiety, and stress. Consider how a community health education program might address this issue. Does the increased pace of work afforded by the efficiencies of computers create more time for reflection and relaxation, or does it merely result in taking on more work? Consider John Naisbitt's, "We are drowning in information but starved for knowledge."
2. Powerlessness and stress. The public's fear of contracting AIDS has reached epidemic proportions in the United States, producing problems for employers, school officials, and government agencies. Some people believe that information in the mass media and on web sites, regarding contagion and prevention, has increased rather than diminished the public's anxiety. Develop a community health strategy that would (1) inform and protect citizens and (2) prevent isolation of the AIDS victim.
3. Self help groups. Attend a meeting of a mutual self-help group in the community (with their permission) and observe the strategies employed to change or reinforce behavior. Again, you can use the PRECEDE model introduced in chapter 4 to explore how these groups predispose, enable and/or reinforce change.
4. Gender and mental health. Women are more likely to discuss their feelings of distress and anxiety than men and are also more likely to be medicated for these complaints. How do social roles affect mental health? How has your community prepared itself to address the mental health needs of men and women?
5. Suicide and youth. While Figure 9-2 shows that some progress is being made on suicide, attempts at suicide among adolescents is moving in the wrong direction. Explore the suicide rates among adolescents and youth for their own community. Then have them identify resources, such as community agencies and hotlines, set up to deal with the issues around youth suicide.