Role of Community in Identification and Prevention of Mental Illness

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Community, in its most basic essence, is all about connection. It is not only an entity or a group of people but also a true sense of belonging. It is a feeling - of being connected, being accepted for who we are and being supported. In other words, a group we identify as being a part of, where there is nothing we have to change about ourselves. Instead, we are embraced and appreciated for our unique qualities.


Community psychology is a branch of psychology that deals with the environment’s potential and interventions with the aim of improving people’s health and well-being. This is achieved through a series of coordinated changes. Rather than narrowing down the focus to the situation of the individual in isolation, it tries to study the broader milieu.


In the context of mental health and psychological well-being, community plays an imperative role. Knowledge base of the community has a significant impact on the attitude, seeking of help, reduction of stigma and prevention of discrimination against patients with mental health problems. Hence, the incidence, prevalence, and prediction of mental disorders has strong links to factors at the community level. 


Research has provided evidence of the bleak picture for people with severe mental disorders; for instance, it is not uncommon for patients of schizophrenia to spend more than five years with active psychosis before evidence-based treatment is commenced. In community platforms, such as homes, prayer camps, traditional healing centers, and religious institutions, they may be chained or kept in forced seclusion and suffer sexual abuse and other forms of exploitation. Besides, patients of severe mental disorders die earlier than people of the same age - largely because of social determinants of mental health that undermine health and wellness. Few of these  social determinants include poverty, lack of access to quality healthcare, stigma surrounding mental illness and its treatment, discrimination and high rates of smoking, and alcohol and drug use. People of color have an especially hard time accessing care which is culturally sensitive in nature.


Strategies need to be formulated to overcome these barriers to health. These could include medical practices that decrease side effects of psychiatric treatments, psycho-educating people, instrumental and interpersonal support that assists people to navigate their community, along with shared decision-making that assures individuals have ultimate control over their health and wellness plan. The World Psychiatric Association’s (WPA) guidance on community mental healthcare characterizes community-oriented care as “having a population and public health focus, community-based case finding, services available within half a day’s travel, participatory decision making, self-help and peer support for service users, treatment initiation in primary care facilities and communities, stepped care, specialist supervision, collaboration with non-governmental organizations (NGOs),  networks across services, communities, and traditional and religious healers.” These methods are referred to as community interventions - strategies outside of the clinical setting that foster change in attitude of the public to reduce stigma and discrimination for better social inclusion, improve knowledge, prevent illness, and promote access and adherence to treatment and recovery. The availability and integration of mental health services into communities can promote accessibility, acceptability, affordability, and scalability of services, increasing the likelihood of positive clinical outcomes. 


Research is essential for the development and evaluation of these community interventions to address social determinants of mental health. Community-based participatory research (CBPR) is one of the first principles - research meant to test concepts and interventions relating to a specific community is impregnated with that community. Traditional research methods do not meaningfully engage community members in the research process. CBPR, a collaborative process between community-based organizations and academic investigators, lets them work as partners to define hypotheses, methods, analyses, and summaries of the research and development effort; it fuses the cultural and social dynamics that are crucial to successful research and implementation. It utilizes community dialogue to build trust, bridge socio-cultural differences between partners, and brings multiple perspectives in examining an issue. It has the potential to make research more responsive to existing needs and to enhance a community’s ability to address important issues, with the goal of development of effective interventions that can be maintained over time. 


Active community participation in research is being recognized as essential to improving health outcomes in diverse populations. Patients of mental illness are a community worthy of CBPR and there is an undeniable need to make them vital members in participatory decision-making. Community-based participatory research holds promise towards reducing mental health disparities. Unfortunately, people with serious mental illness, particularly members of racial and ethnic minority groups, are rarely included in prioritizing research topics or developing tools and measures important for improving their care. Although conceptual and empirical work from psychiatry, public health, and preventive psychology are great examples of ways in which community interventions in mental health have expanded and shown great promise for the future, partnerships among academic researchers, clinicians, and communities that include members of underrepresented minority groups can improve understanding of patients’ healthcare preferences. This would in turn promote engagement of mental health patients in the treatment process and in behavioral health services research.





References:


  1. https://www.nami.org/Blogs/NAMI-Blog/November-2019/The-Importance-of-Community-and-Mental-Health

  2. https://sci-hub.se/10.3390/ijerph15061279

  3. Trickett, E. (2001). Mental Health: Community Interventions. International Encyclopedia of the Social & Behavioral Sciences. 9645-9648. https://doi.org/10.1016/B0-08-043076-7/01368-1

  4. https://psychnews.psychiatryonline.org/doi/full/10.1176/appi.pn.2022.2.32

  5. https://unsplash.com/photos/Zyx1bK9mqmA



About The Author:

Sehej Kaur

Member, PsyCreative Column,

Psychology Committee NMIMS


Sehej Kaur is a first-year student, currently pursuing B.Sc. Applied Psychology from NMIMS, Mumbai. All that is needed to impress her is to have a similar spectrum of music taste as hers and a collection of serene sky and moon pictures. She has a passionate eye for beauty in the little things of life and loves capturing the subtleness of everyday moments. She likes to pen down her thoughts as it helps her gain mental clarity. She is really meticulous in her work. For her, self-development is not a destination, but a journey.


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