If we want more evidence-based practice, we need more practice-based evidence.*

Chapter 9
Community Mental and Social Health

Table of Contents

OBJECTIVES AND PHILOSOPHY
OVERVIEW
HEADLINES, TIMELINES, & MILESTONES
WEB PAGES AND INFORMATION SOURCES
REFERENCES - since publication of 8th edition
STUDY QUESTIONS, ACTIVITIES, AND EXERCISES


OBJECTIVES AND PHILOSOPHY

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.


OVERVIEW

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.


HEADLINES, TIMELINES, & MILESTONES

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.
 

Self-Control Comes in Limited Quantities, Must Be Replenished.  Feb. 19, 2003

Benefits of Living With Father Depend on Dad's Antisocial Behavior

Classes May Be Effective Treatment for ADHD Patients, Parents Feb. 12, 2003

Alzheimer Caregivers' Stress May Trigger Risky Blood Clots.  Jan. 30, 2003

Mail Reminders Help Patients Stick to Antidepressant Meds.  Jan. 22, 2003

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, please click here. 


 WEB PAGES AND INFORMATION SOURCES

 

Creating Safe & Drug-Free Schools: An Action Guide  

http://www.ed.gov/offices/OESE/SDFS/actguid/

Produced by the Office of Juvenile Justice & Delinquency Prevention, U.S. Department of Justice, and the Office of Elementary & Secondary Education, U.S. Department of Education, this Action Guide provides extensive background information and useful action steps to creating a safe and drug-free school.

The School Psychologists' 

Home Page
http://www.bartow.k12.ga.us/psych/psych.html

 

 

 

 

Have you ever wondered what School Psychologists do, or wanted to ask a question about your child but worried about confidentiality? Do you need "just in time" emergency information, or want to learn more about teen depression? The School Psychologist has the information that parents, school faculty or students need about the important issues affecting young people today. Features of this award-winning site include "Ask Your School Psychologist", a Crisis Intervention Resource Manual and "What is  a School Psychologist?"

New Mental Health Site http://www.hc-sc.gc.ca/hppb/mentalhealth/

 

Health Canada's new mental health Web site is designed to provide convenient access to a range of online materials related to the promotion of mental health, the  planning, delivery, cost and evaluation of mental health programs and services in Canada, and the mental health issues, problems and disorders encountered by Canadians.

Affordable Colleges Online (ACO) - Guide to suicide prevention in college

http://www.affordablecollegesonline.org/college-resource-center/college-suicide-prevention/ 

ACO has a section on its web site devoted specifically to addressing issues related to preventing suicide in college. The guide offers hope and help for those who are experiencing suicidal thoughts, as well as the friends and family who want so badly to help them

American Mental Health Fund
PO Box 17700, Washington, DC 20041
Phone: (800) 433-5959, (703) 573-2200

Television video public service announcements, consumer print ads, transit cards and posters on the Anti-Stigma Campaign.

Clearinghouse on Child Abuse and Neglect
PO Box 1182, Washington, DC 20013
Phone: (301) 251-5157

Collects, processes and disseminates information on child abuse and neglect. Responds to requests from general public and professionals.

Consumer Information Center
PO Box 100, Pueblo, CO 81002
http://www.pueblo.gsa.gov/

For specific information on schizophrenia and depression from National Institute of Mental Health, request Schizophrenia: Questions and Answers and/or Depressive Disorders: Treatments Bring New Hope free.

The Psychiatric Institute of Washington D.C.
Counsel line phone: (202) 462-6610
Brochure of tapes: (202) 467-4538

Callers ask for a tape by number to receive practical information on over 50 areas of major life stresses and changes, such as divorce, alcohol and drug abuse.

Government Printing Office
Superintendent of Documents
Washington, DC 20402
http://www.access.gpo.gov/

"Adolescence and Depression," a packet of course materials on conflicts experienced by adolescents and their linkage to depression and suicide. $1.00 each. Stock No. 017-024-01237-8, ADM 84-1337.

National Alliance for the Mentally Ill
1901 North Fort Myer Drive, Suite 500
Arlington, VA 22209
Phone: (703) 524-7600
http://www.nami.org/

For the name and location of the nearest support group, or the address and phone of the state chapter of NAMI (in all 50 states, D.C., and Puerto Rico).

National Mental Health Association  http://nmha.org/

 

Canadian Mental Health Association  http://www3.sympatico.ca/cmha.toronto

 

Information to Help Manage and Provide Solutions to Stress.  http://www.stressfree.com

 


REFERENCES

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.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax.09638237/v8n3/contp1-1.htm.

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.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/content/abstract/24/3/259.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Jelalian, E., & Saelens, B. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Pediatric Obesity. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 223-248, June.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

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.
    For the Journal's website, go to:
http://www.elsevier.nl/locate/jnlnr/03092 .

Kerwin, M. L. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Severe Feeding Problems. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 193-214, June.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

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.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

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. 
    For abstracts, go to:
http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/.

Ludermir, A. B., & Harpham, T. (1998).  Urbanization And Mental Health In Brazil: Social And Economic Dimensions.  HEALTH AND PLACE 4: 223-232. 
    For the Journal's website, go to:
http://www.elsevier.nl/locate/jnlnr/03092 .

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.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

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.
    ABSTRACT: Objectives. This report examines the reliability and validity of Darryl, a cartoon-based measure of the cardinal symptoms of posttraumatic stress disorder (PTSD). Methods. We measured exposure to community violence through the reports of children and their parents and then administered Darryl to a sample of 110 children aged 7 to 9 residing in urban neighborhoods with high crime rates. Results. Darryl's reliability is excellent overall and is acceptable for the re-experiencing, avoidance, and arousal subscales, considered separately. Child reports of exposure to community violence were significantly associated with child reports of PTSD symptoms. Conclusions. Darryl possesses acceptable psychometric properties in a sample of children with frequent exposure to community violence.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Onyett, S. (1999). Community Mental Health Team Working As A Socially Valued Enterprise. JOURNAL OF MENTAL HEALTH 8(3): 245-252, June.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Peck, E. (1999). Introduction To Special Section On Community Mental Health Teams. JOURNAL OF MENTAL HEALTH 8(3): 215-216, June.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Peck, E. (1999). Tensions In Mental Health Policy? JOURNAL OF MENTAL HEALTH 8(3): 213-214, June.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

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.
    ABSTRACT: The aim of this paper is to explore public health professionals' perceptions regarding two dimensions of the new health promotion movement; the ecological approach and the principle of community participation. Data were collected by focus-groups of public health professionals (n = 22) in one Public Health Directorate in Quebec. Results indicate a fair degree of integration of these two dimensions into the respondents' professional practice. However, limitations related to the work environment and to the theoretical underpinnings of these two components might impede the respondents' ability to integrate them into their practice.

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.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

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-.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

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. 
    For abstracts, go to:
http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/.

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.
    The Journalís website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Snowden, L. R.  (1998).  Racial Differences in Informal Help Seeking for Mental Health Problems. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):429-438.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

Sommer-Rotenberg, D.  (1998).  Suicide And Language. CANADIAN MEDICAL ASSOCIATION JOURNAL 159 (3): 239-40.
    For the Journal's website, go to:
http://www.cma.ca/cmaj/.

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.
For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

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. 
    For abstracts, go to:
http://www.oup.co.uk/pubmed/hdb/Volume_20/Issue_03/.

 

 Other References


 
Hammen, C., Brennan, P.  (2003).  Severity, Chronicity, and Timing of Maternal Depression and Risk for Adolescent Offspring Diagnoses in a Community Sample.  
Archives of General Psychiatry, 60(3).

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.


STUDY QUESTIONS, ACTIVITIES, AND EXERCISES

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.


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