Community‐oriented primary care: a multidisciplinary community‐oriented approach to primary care?

Developing more of a local public health focus, and involving local communities in Great Britain in health care decision‐making, are key aspects of the radically changing face of primary care. Community‐oriented primary care (COPC) is an international model for innovative primary health care delivery historically applied in developing or deprived communities, but increasingly seen as having broader relevance for a wider range of primary care settings. COPC has a long history of development in deprived communities, it is still however seen as innovative. It fits the current requirements of clinical governance and the ‘Modern and Dependable NHS’, but does its long history also provide information about it's pitfalls? COPC is promoted as an approach that is applicable to community mental health problems, community psychologists can provide the expertise to facilitate addressing community mental health in COPC programmes. This paper describes the COPC model and highlights the relevance of the COPC philosophy and the problems of its implementation for community psychologists in primary care. Copyright © 2001 John Wiley & Sons, Ltd.     

The end of mental illness thinking?

Mental health theory and practice are in a state of significant flux. This theoretical article places the position taken by the British Psychological Society Division of Clinical Psychology (DCP) in the context of current practice and seeks to critically examine some of the key factors that are driving these transformations. The impetus for a complete overhaul of existing thinking comes from the manifestly poor performance of mental health services in which those with serious mental health problems have reduced life expectancy. It advocates using the advances in our understanding of the psychological, social and physical mechanisms that underpin psychological wellbeing and mental distress, and rejecting the disease model of mental distress as part of an outdated paradigm. Innovative research in genetics, neuroscience, psychological and social theory provide the platform for changing the way we conceptualise, formulate and respond to psychological distress at both community and individual levels.     

Detecting “cracks” in mental health service systems: Application of network analytic techniques

This paper argued that problems of coordination and integration of community mental health systems are best approached from a network perspective in which all linkages between agencies are considered simultaneously. Structural coordination and integration can be assessed through the analysis of these linkages. The utility of this approach was demonstrated by deriving a typology of system "cracks" from network analytic constructs. A network analysis of a community mental health service network was then generated to illustrate how these cracks can be empirically identified. It is suggested that mental health planners will find both the network analytic approach and the typology of cracks useful for addressing problems of coordination and integration.     

Citizenship and Community Mental Health Care

Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social‐environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.     

Uplifting the Family: African American Parents’ Ideas of How to Integrate Religion into Family Health Programming

Religion has been reported as a strong cultural-historical and protective factor in the African American community, particularly for African American youth regarding risky behavior prevention. Despite the historical and scholarly evidence of its utility, the opportunities for using religion and the Black Church in supporting the mental, emotional, and physical health of Black youth have not been fulfilled. Furthermore, partnering with the community to conduct research and program development increases the likelihood of use and success. The purpose of this study was to partner with the community and learn and conceptualize how to integrate or use religion in a family health program. Seven focus groups were conducted with African American parents/guardians regarding how a family health program could use religion to enhance the mental and physical wellbeing of Black families. A community sample of parents and guardians conveyed religious/spiritual values that a program should adopt and teach to participants (particularly parents) and ways that a program could use religion and the Black Church to function and succeed. These values include respect, love, prayer, fellowship/community, physical health, Scripture, faith, and empathy/understanding. Participants further provided specifics regarding how such programming might be implemented and offered real world implications for the development of religious family health planning. Parents/guardians indicated that religious values and methods should be used together to bolster family health, prevent risky behavior in youth, and support community functioning.     

Inclusivity in the latter-days: Gay Mormons

Individuals who identify as Mormon – adherents to The Church of Jesus Christ of Latter-day Saints (“Church”), a distinct and peculiar form of Christianity – and also identify as gay or lesbian face a unique challenge to their mental health as they wrestle with the integration of their faith and their sexuality. Compounding this matter is the commonly held belief that one cannot authentically be gay and Mormon nor can one be a practising Mormon and gay. As academics and professionals gain a more nuanced understanding of the complexity of (a) those who identify as both Mormon and a sexual/gender minority and (b) of the Church itself, they will begin to deconstruct their own biases and increase their multicultural competence, thus becoming better equipped to address the mental health concerns of this particular sexual minority group.     

Mental health and North American Indian/Native communities: Cultural transactions,education, and regulation

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.     

Poverty and Serious Mental Illness: Toward Action on a Seemingly Intractable Problem

This paper examines the issue of poverty among people with serious mental illness (SMI), positioning it as a key issue to be confronted by community mental health systems and practitioners. The paper reviews three perspectives on poverty, considering how each sheds light on poverty among people with SMI, and their implications for action: (a) monetary resources, (b) basic needs, and (c) capabilities. The paper argues that community mental health programs and systems are currently unable to address poverty as they are overly focused on individual‐level interventions that, on their own, cannot raise people out of poverty. The paper calls for a social justice value, informed by the concept of citizenship, as a necessary complement to the recovery concept that has informed community mental health practice for almost 25 years. Finally, the paper argues that community psychologists, with their concepts, methods, and values, are well positioned to contribute to this important issue. However, it also contends that addressing poverty requires collaboration from community psychologists with researchers and practitioners from other fields and domains of expertise to begin to make progress.     

Developing suicide prevention programs for African American youth in African American churches

Suicide prevention programs for African American youth in African American churches may have broad appeal because: (1) the Black Church has a strong history of helping community members, regardless of church membership; (2) African Americans have the highest level of public and private religiousness; and (3) the church can help shape religious and cultural norms about mental health and help-seeking. The proposed gatekeeper model trains lay helpers and clergy to recognize the risk and protective factors for depression and suicide, to make referrals to the appropriate community mental health resources, and to deliver a community education curriculum. Potential barriers and suggestions for how to overcome these barriers are discussed.     

The Multilevel Relationships of HIV‐Related Stigma to Child and Caregiver Mental Health among HIV‐Affected Households in South Africa

HIV/AIDS‐related (HAR) stigma is still a prevalent problem in Sub‐Saharan Africa, and has been found to be related to mental health of HIV‐positive individuals. However, no studies in the Sub‐Saharan African context have yet examined the relationship between HAR stigma and mental health among HIV‐negative, HIV‐affected adults and families; nor have any studies in this context yet examined stigma as an ecological construct predicting mental health outcomes through supra‐individual (setting level) and individual levels of influence. Multilevel modeling was used to examine multilevel, ecological relationships between HAR stigma and mental health among child and caregiver pairs from a systematic, community‐representative sample of 508 HIV‐affected households nested within 24 communities in KwaZulu‐Natal, South Africa. Two distinct dimensions of HAR stigma were measured: individual stigmatizing attitudes, and perceptions of community normative stigma. Findings suggest that individual‐level HAR stigma significantly predicts individual mental health (depression and anxiety) among HIV‐affected adults; and that community‐level HAR stigma significantly predicts both individual‐level mental health outcomes (anxiety) among HIV‐affected adults, and mental health outcomes (PTSD and externalizing behavior scores) among HIV‐affected children. Differentiated patterns of relationships were found using the two different stigma measures. These findings of unique relationships identified when utilizing two conceptually distinct stigma measures, at two levels of analysis (individual and community) suggest that HAR stigma in this context should be conceptualized as a multilevel, multidimensional construct. These findings have important implications both for mental health interventions and for interventions to reduce HAR stigma in this context.     

社区服刑人员心理健康状况调查

以探讨社区服刑人员的心理特点为目的,以康健街道社区服刑人员为范围,采用艾森克人格问卷(EPQ)及SCL-90症状自评量表对社区服刑人员的人格、心理健康方面进行调查。结果发现社区服刑人员在总体上虽基本属于正常人群在其人格特征仍与罪犯人群所特有的特点具有少量共性;其心理健康也普遍存在一定问题;同时,证明了社区服刑人员的人格与心理健康有一定的联系,其结果可以在今后的社区心理矫正工作中加以关注和应用。     

Improving Mental Health Treatment Utilization in Military Veterans: Examining the Effects of Perceived Need for Care and Social Support

Many veterans with mental health problems do not adequately utilize needed care. Research has focused on identifying barriers to mental health care in veterans. The current study adds to existing literature by examining whether perceived need for treatment and social support affect treatment utilization in a national longitudinal survey of Iraq and Afghanistan veterans (n = 1,090). The Health Beliefs Model (HBM) postulates that a key reason why patients fail to obtain needed care is their belief “it’s up to me to handle my own problems.” This view was endorsed by 42% in the current national sample of veterans and was found in multivariate analysis to predict less treatment seeking in the next year. Mediation analysis revealed that veterans with higher ratings of social support were less likely to believe they needed to solve mental health problems on their own, indirectly equating to higher odds of treatment use. Simultaneously, findings indicated that posttraumatic stress disorder (PTSD) had a direct effect on more mental health visits but was also associated with higher endorsement that one needed to handle one’s own problems and thus had an indirect effect of reducing mental health visits. Both social support and PTSD affected veterans’ perceptions of needing to solve one’s own problems, significantly predicted follow-up with mental health care. As a result, the findings indicate that clinicians’ should explore veterans’ belief systems about perceived treatment need as well as investigate the role of social support to improve mental health treatment utilization.     

The Papago Psychology Service: A community mental health program on an American Indian reservation

A community psychology service run by the Papago Indian tribe and staffed largely by Papago Indians who have been trained as mental health workers is described. This service is unique among mental health services for Indians in that the tribe has complete control of the funds for the service and sets its own policies. It was developed for a rather traditional Indian group, and the culture, the traditions, and the wishes of the Papago community were respected. Consultation with medicine men was built into the program from the start, and adaptation of mental health techniques to fit the culture is stressed. Before this clinic was established, few mental health resources were directly available to the reservation. Similar to other Indian tribes, the Papagos are economically disadvantaged, with an unemployment rate of over 50%, low educational attainment, and very high rates of alcoholism, suicide, and vehicular accidents. The topics covered are the tribe's view of health programs for its people, the present Papago community and traditional means of treatment, traditional psychotherapy adapted to Papago culture, the indigenous Papago mental health worker, and the non-Indian professional consultant.     

Community‐Based Participatory Research With Black Churches

Black Americans are more likely than other racial/ethnic groups to rely on spiritual and religious resources for mental health support. As such, counselors must seek unique ways to reach and understand Black communities. This article provides an overview of Black Americans' help‐seeking behaviors, the significance and culture of the Black Church, and a framework for counselors and counseling researchers to form effective partnerships to conduct community‐based participatory research initiatives that will produce empirical outcomes and promote culturally responsive mental health and wellness programming in Black communities.     

Contextualizing Acculturation: Gender, Family, and Community Reception Influences on Asian Immigrant Mental Health

This article investigates differences in the mental health among male and female immigrants from an ecological perspective, testing the influences of both individual acculturation domains and social contexts. Data from the first nationally representative psychiatric survey of immigrant Asians in the US is used (N = 1,583). These data demonstrate the importance of understanding acculturation domains (e.g., individual differences in English proficiency, ethnic identity, and time in the US), within the social contexts of family, community, and neighborhood. Results demonstrate that among immigrant Asian women, the association between family conflict and mental health problems is stronger for those with higher ethnic identity; among immigrant Asian men, community reception (e.g., everyday discrimination) was more highly associated with increases in mental health symptoms among those with poor English fluency. Findings suggest that both individual domains of acculturation and social context measures contribute to immigrant mental health, and that it is important to consider these relationships within the context of gender.     

Improving Mental Health on College Campuses: Perspectives of Indian College Students

The mental health of college students is increasingly viewed as an important public health priority. However, there has been little attention paid specifically to college students’ perspectives on factors that contribute to mental health challenges or on potential initiatives that could address them. Even less research has focused on students in low- and middle-income countries. In an effort to better understand how to improve mental health and wellness on college campuses, we administered an open-ended survey to 141 Indian college students (M_age = 19.47, 65% female). We asked the students to identify: (a) issues that contribute to mental health problems among college students, (b) potential initiatives or strategies that could be used to improve mental health and wellness, and (c) topics that students would like to learn about in a course about mental health and wellness. Applying thematic analysis, we identified academic stressors (e.g., pressure to succeed, competitiveness) and social stressors (e.g., lack of community, party culture and substance abuse) that students reported as contributors to mental health problems. Students also described mental health promotion strategies that could be implemented by faculty members (e.g., providing academic accommodations for students with mental health concerns), the student body (e.g., establishing peer counseling groups), and individual students (e.g., checking in with others). Finally, they identified topics that they would like to learn about in mental health and wellness courses (e.g., how to identify mental health concerns, how to support friends). By raising several potential targets for mental health and wellness interventions for Indian college students, our study illustrates how open-ended surveys can be a useful and feasible way to solicit input from stakeholders in low- and middle-income countries. Future research will be needed to assess the effectiveness and feasibility of mental health promotion strategies, including those proposed by students.     

Three Ways of Being Church

This article proposes a theological re-appraisal of three images of the Church: institution, servant and community. The defining characteristics of an institution can be applied positively to the Church when it is seen to have been instituted by Jesus Christ. But what is instituted is a continuing relationship grounded in Christ's own presence. The servant Church is characterized by its commitment to the purposes of God in ‘secular’ society and the promise of God's kingdom. The community model of the Church has two common expressions, one emphasizing social relationships, one stressing mystical communion, but these are grounded in the trinitarian community itself. While each model has its own contribution and integrity, taken together they suggest mutual inter-dependence, itself reflecting the divine community and expressed in the mutually affirming virtues of faith, hope and love.     

Developing coordination of services between a mental health center and a public school system

A child-and-family oriented community mental health center of necessity is concerned with the manner in which the school system in its community is providing for the psychological, social, and emotional development of children. Fortunately, over the last decade, the number of school systems that are aware of their responsibility in this regard has greatly increased, and many affluent and enlightened school systems have moved to develop extensive pupil personnel services, functioning in many ways as in-house mental health programs. Where there are mental health providers both within the community and within the school system, however, problems may develop such as professional competition, overlapping functions, and differences with regard to how mental health problems are best dealt with. This paper will examine the relationship of a town-supported mental health program and the town's public school system. Highlighted will be the variety of problems which develop, including those mentioned above, and strategies adopted to resolve the problems.     

Parents as therapeutic agents: The usefulness of filial therapy in a community mental health center

Filial Therapy, a program training parents as play therapists for their own children, has been found an effective part of the functioning of a child unit in a community mental health center. The basic philosophy and principles of Filial Therapy are identified. The use of parents as therapists is viewed as consistent with the growth of the community mental health movement and the concept of treating the context in which the child resides. The structure and flexibility of this model are delineated to provide the reader with a basis to introduce Filial Therapy in his/her own setting.     

Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.