Enhancing Community Integration - Essay Example

135629 To avoid heavy burden on service providers, and to encourage community concern, it is necessary to develop various mental health connected programmes and plans to attract help from community and its representatives. Programmes can include suicide prevention squads with round the clock telephonic advice round the clock, short term therapies, educative activities, entertainment with involvement, training and building Sensitivity Group. Tolerance from the community is absolutely essential in normal social life of the person. After tough and long decades of institutionalising mental patients, all countries have accepted the need of community concern and care. "Nearly 50 years after President John F. Kennedy signed the law requiring states to begin investing in community-based mental health programs rather than funding state institutions for treating individuals with mental illness, the promise remains unfulfilled" http://www.nmha.org/shcr/community_based/index.cfm In the modern times, meaning of community and its involvement is fast thinning. There is no doubt that we live in a deprived sense of 'loss of community'. Sociologists have untiringly pointed out this bereavement of modern times. "Maurice Stein's 1960 review of major sociological and anthropological community studies concludes with the central finding of a disappearance of the sense of community among residents of the towns studies (Stein 1960)," Rossi (2001, p.32). Even though olden days had their share of mental ill health, modern times of stress and strain have thrown up a plethora of mental health problems for people of all ages, especially for the elderly. Mental health problems could be very difficult for the afflicted person and for his family. As it is mostly a life span problem, with certain relief combined with cure, or sometimes simply progressive, the problem has to be faced for years and decades. Mental health problems cannot be faced in isolation. It needs help from family, school, and more importantly from community and society. Journal of the American Academy, Child and Adolescent Psychiatry, 35(7):889-897, July 1996, article by Leaf et al has shown the conclusion that community help is necessary for an effective treatment of mental problems. Practically speaking mental health is not a sickness of isolation. It is not an individual problem either. It is the problem of community and society and should be treated so. Community has to take fair share of its responsibility because a person going through a mental sickness, or being cured and coming out of it, has a right to expect better and more considerate treatment from community around him. Treatment meted out to him by the community will be taken as standard measurement of his achievement in being cured, or the lack of it. Reaction of the community and people around him could send an individual reeling back into serious and more difficult mental problems, or can encourage him to come out of it. Afflicted person in his hopelessness of future and helplessness will be very watchful and wary of people around him. He would clutch at any kindness, but could turn violent or morose at the very hint of discrimination or ridicule. Mary and Andrew are mother and son, and the son is afflicted by the unfortunate Schizophrenia. We learn from his own words that Andrew treats his mental inadequacies as a form of education and a boon. He feels that he would never come out of his childhood, and experiences the complete happiness of childhood any time again, will never ask for better things and get disillusioned. He has his hobbies, his pets, his ideas and in his small world he is happy. Community around him had been understanding and cooperative and there lies the real root of Andrew's fulfilment. Is Andrew deceiving himself or taking a brighter view of his very difficult-to-cure mental problem It could be anything. But the fact remains that Andrew is happy in the small community, in their house along with his mother Mary. He could be blocking out the difficulties of the disease. But one must acknowledge that he is happy and is coping very well, and that is what matters in his life. Mary, his elderly mother does not have any complaints in sharing her life with the afflicted son. She is pleased that they are contented in each other's company and are living in companionable bliss. Most of their lives is made out of innocence, happiness and small blessings, which an unaffected person might forget to feel or count. They get adequate help from people around them and Andrew does not need an institution to take care of him. This case showcases the importance of a family member and an understanding community in facing a mental problem. A person taken out of family and community surroundings will immediately feel isolated, targeted and excluded and for a mentally unhealthy person, these feelings are difficult to cope with. He would either be drawn further into his shell or would react violently and both could be equally disastrous. He would never look at social workers or health providers as family or community members. Being in the community is like telling the individual that his condition is bearable and community has approved him as one of its members. That accords importance, sanity and responsibility and that is exactly how Andrew is coping with his problems. He knows that he is afflicted, but he also knows the support and understanding of family members and community. That makes all the difference. It creates survival instincts and optimism in the face of an uphill task. In Western society, one of the main problems of already afflicted and about to be afflicted individuals is social isolation. Westerners have effectively fought for their individual rights to the extent that they find themselves totally isolated, as other members of the community find it necessary not to encroach into their individual space. Loneliness and isolation have become the bane of modern societies not only in West, but also in East, especially in the cities, although rural areas still live a community life. Suing for flimsiest possible reasons, accusing others of interfering even though done with genuine intentions, fear of being ridiculed etc. drive away people from lending a helping hand and these practices should be relegated in the face of humanitarian approach. Aging with mental problems is another area where community help is needed. Aging with serious mental illness does not mean that there will be a definite problem in functioning. "Indeed, research on people with schizophrenia contradicts the notion of serious mental illness as a lifelong debilitating condition (Harding et al,, 1987), http://by117fd.bay117.hotmail.msn.com/cgi-bin/HoTMaiLcurmbox=00000000%2d0000%2d0000%2d0000%2d000000000001&a=15e9837f13fec6c12bb86690e7a9d4fc586c58479b4a09a4212309472b60fc80 In US it is proved that people, especially elderly, mental health victims receive less care and concern from the carers and community and in certain cases, they are definitely abused by people around them (Ibid). There is a great necessity of overcoming the barriers and seizing every opportunity offered. There is another threat of suicide by mental health patients and this possibility rises with family and community negligence. It is definitely impossible to keep an eye on the victims all the time; but sympathy, kindness and encouragement from people around them would decrease such possibilities and intentions. Isolated people are always vulnerable to attacks, mental trauma, physical ill health, depression and hopelessness. Sometimes poverty, lack of caregivers, minority status where they feel that they are not entitled to a lot or not in a position to ask for more could involve plenty of risk. All these problems could be prevented to a very large extent, by making community a part of the ongoing healing process. Apart from the institutionalised and social care, rehabilitation in the society should take a higher priority. After rehabilitation, constant monitoring of the person from the health providers is absolutely essential. Where victims have to deal with loss, bereavement, reduced coping skills, diminishing functioning, great help can be provided by family, peers, and informal carers, volunteers, apart from formal support groups and health and social services. Clinical depression is persistent with mental health victims and is not easy to tackle. Loss of partner, physical illness, emotional complaints, inability to cope with routine work, difficult medical, psychosocial and environmental factors, can cause serious mental illness that could be progressive. Under such circumstances, premature institutionalisation should be avoided at all costs, because such an eventuality will kill all the initiative of the individual, branding him as a mentally sick person. This means, he would accept his fate and would never fight against it, and will further sink into depression resulting in mental complications and this road only goes downhill. Community health promotion activities could help a lot under the above circumstances. Assuring the person that he is not alone in his battle is very important. Educational programmes, outreach programmes, increasing opportunities of meaningful paid and unpaid work and appreciation at work place, availability of service providers, being one of the self-help groups, and forging ties with other members of community that might lead to social outings where the person is treated equally could all be of enormous help. Remaining segregated in nursing homes, or being kept with patients whose illness is non-reversible, violent and degrading could create a mental tension in the victim, even though his condition could be improved. Such situations can create a terrible mental tension as the patient will see his next fate in the more seriously ill person, and there is no coming back once such hopelessness sets in. Attached stigma of mental care could not be erased either. Lack of knowledge, intimidating mental asylum surroundings, unavailability of home mental service, bias towards mental care as wasting money on lunatics, lack of political will for reform, bureaucratic stumbling blocks, community exclusion are all the reasons why most of the mental health victims do not get cured. In cases like Andrew, he has been shown such kindness that he has identified his sickness as a boon. Unfortunately, most of the patients think of it as a curse and long to perish. This shows how imperative community integration could be under similar circumstances. Even religious and spiritual interventions could provide solace for the believers, if done tactfully. This includes cultural problems, which again, have to be dealt with care. Community integration programme is part of the mental health care today in most of the advanced countries, including New Zealand and it is found to be essential and important. There is an interesting point to note here. In almost all Eastern countries, rural areas live community based life and are never isolated. It is believed that very rarely people become mentally unhealthy under such circumstances, where people share problems, take solutions and earn understanding and sympathy, and the entire process makes the problem look smaller. Mental health victims are rarely marginalised; they could be ridiculed in a kind way, taunted to some extent, but are never feared or isolated and this provides a better atmosphere. Weakening of social influence is considered to be one of the reasons for higher mental problems. Modern ways of living, curbing of impulsivity, and fear of being regarded as 'peculiar', anxiety to be known as 'normal', lack of friendship, responsibility, leadership, love and justice all could be cited as other reasons and the answer lies in community integration programmes. Mental victims have to be encouraged to be normal; make mistakes without fear of being institutionalized, open communication and avoiding covert ridicule all go a long way in curing a victim. Communities have to discard prejudice, discrimination, stigma, being impressed by stereotype media images, labelling etc. Instead they could conduct neighbourhood campaigns, especially anti-stigma campaigns. "Around the world, the stigma associated with schizophrenia is high, though it is less severe in parts of the developing world, where symptoms of psychosis are at times regarded in a more positive light," according to Thornicroft and Szmukler (2000, p.462). Today social context of psychiatric treatment is considered to be important. "This viewpoint developed independently of the pharmacological and biochemical approaches to mental disorder, and was sometimes thought of as an alternatibve to them; in the therapeutic situation, however, these separate approaches have been intertwined to a considerable extent," Rehin and Martin (1968, p.8). Lesser number of people getting cured in institutions also led to the understanding that mental care combined with local health monitoring and community intervention could produce better results and it had its initial set backs in UK. "Early measures associated with community care were reactive to institutional problems and closures and were facilitated by improving drug treatments, but there were few signs of an underlying proactive approach or political leadership at central or local levels," Cherry (2003, p.276). Later with 1963 Health and Welfare measures showed a lot of improvement and today, almost all the countries have realised the importance of community integration. New Zealand is one of those countries who are striving hard to build up a highly positive community integration oriented mental health programme. As sociologists point out, Man is a social animal. No doubt we resent the extreme interference and constant advice from community and its leaders. At the same time it is unnatural to be isolated and segregated and it is unbelievable that a person can live a contented life completely severed from society. Mental patients need community as their approval point and nothing affects a mentally afflicted person than the society persecution and ridicule. So, the community integration programmes and a compassionate society should be answer to this serious problem. BIBLIOGRAPHY: 1. Cherry, Steven (2003), Mental Health Care in Modern England, The Boydell Press, Suffolk. 2. Rehin and Martin (1968), Patterns of Performance in Community Care, Nuffield Provincial Hospitals Trust, London. 3. Thornicroft, Graham and Szmukler, George (2001), Textbook of Community Psychiatry, Oxford University Press. 4. Rossi, Alice S. (2001), Caring and Doing for Others, The University of Chicago Press, Chicago. ONLINE SOURCES: 1. http://www.jaacap.com/pt/re/jaacap/abstract.00004583-199607000-00014.htm;jsessionid=F3pPWYZQcLCBTTynl4Xs94ryrhBNqnhmcr8mBJjyVhGL8SkDrPrZ!1305623180!-949856145!8091!-1 Journal of American Academy, accessed on 19.10.2006. 2. http://by117fd.bay117.hotmail.msn.com/cgi-bin/HoTMaiLcurmbox=00000000%2d0000%2d0000%2d0000%2d000000000001&a=15e9837f13fec6c12bb86690e7a9d4fc586c58479b4a09a4212309472b60fc80 National Mental Health Information centre. 3. http://www.nmha.org/shcr/community_based/index.cfm 4. Read More