Community Psychology and Mental Health Flashcards
Community mental health
- The broad array of services and programs oriented to supporting people living with serious mental illness in the community
- Community psychology has made significant contributions to the development and study of community mental health
Institutionalization history
- Began in the 1800s
Moral treatment
- Removal of people from risks in increasingly industrialized society
- Moral discipline and instruction
- Overtime people seen as incurable
Social hygiene movement
- Removal of people deemed “defective” from communities
- By 1950s, 66 000 people in institutions
Deinstitutionalization
- The process of relocating people with serious mental illness from institutions to the community
- Institutions became abusive
- Radical decrease in beds; even now people don’t stay for long
Contributors to deinstitutionalization
- Criticism of institutions
- Spiralling costs of institutions
- Rise of outpatient services
- Psychoactive drugs
- Environmental models in vogue
- Legal and legislative forces
Problems with deinstitutionalization
- Insufficient supports and resources in the community
- Reliance on substandard housing
- Increased pressure on families without support
This can lead to
- Negative contact between public and people with serious mental illness
- People falling between cracks
- Revolving door process
- Reliance on acute care services
Objectives for community mental health services
General
- Facilitate and support successful living in the community
Specific
- Community integration with non disabled individuals
-Assume normal roles in the community
- Experience quality of life similar to general population
What did we do when we changed directions in community mental health services
- Downsizing of PPH system
- Reallocation of PPH resources of outpatient and community focused programs
- Increase in funding for community mental health programs
- Implementation of consumer/survivor non-service alternatives
Current mental health system in Ontario is composed of
- General hospital with psych departments
- Psych hospitals/mental health centres
- Community agencies (housing, social rehab, etc.)
- Little coordination between actors
- No comprehensive system mental health
Weaknesses and pressures of the mental health system in Ontario
- Limited integration and coordination
- Significant regional variation in availability of programs/services
- Inappropriate mix of institutional care and community services
- High readmission rates / inappropriate use of services
What are the 3 Ds in serious mental illness
- Diagnosis
- Disability
- Duration
Medical model of mental illness
- Assumption : Dysfunction is primarily die to internal. biological processes
- Focus on illness and defect
- Role of professional: psychiatrist diagnose and prescribes treatment
- Role of individual: Patient who is expected to follow treatment
Rehabilitation model of mental illness
- Assumption: dysfunction is primarily due to inadequate knowledge and skills
- Role of professional: professionals identify deficits and develop programs to address these deficits
- Role of individual: client who is expected to set rehabilitation goals and work with professionals to achieve these goals
Recovery model of mental illness
- Assumption: dysfunction is primarily due to the loss of meaningful social roles
- Role of professional: support individual in working toward personal goals; seek support and resources in community
- Role of individual: person who identifies personal goals and assimed normal roles in community
- Personal, unique process of returning to a satisfying, hopeful, and contributing life even with limitations attributable to mental illness
- Essentially what we follow now
Limitations of the recovery model of mental illness
- Suggests a never ending process
- Focuses on individual goal setting to direct services
- Overly individualistic and personal view
- Ignores how individual and personal struggles are sharped by virtue of group membership
- Leads to individual level programming rather than systems change
- Toward a citizenship and social justice approach
Outcomes of the community mental health movement
- Dramatic reductions in long stays in institutions
- The vast majority of people with serious mental illness living more or less independently in the community
- Programming and services increasingly responsive to individual choice
- Complementarity of pharmaceutical and psychosocial treatments/supports
Limitations of the CMH movement
- Limited interest in policy beyond mental health policy (housing, employment, income)
- No links between mental health strategies and other strategies (housing, poverty reduction)
- Evidence-based interventions are individual focused with limited scalability
- A focus on narrow specialization and professionalization
- Limited cross sectoral collaboration
- Need reorientation to concept of citizenship and a social justice orientation
