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Community Care for Mental Patients

Community care for mental patients, also referred to as community mental health services, refers to the support and treatment accorded to individuals with mental illnesses or problems in a home setting, as opposed to an asylum (John, 2000). The settings of community mental health services vary in different countries, because they depend upon the culture of the people: their attitudes towards people with mental illnesses or problems, as well as the resources available (Sussman, 1997). Nonetheless, the mental patients’ community acts as the primary care provider rather than other specific health care institutions, such as hospitals and asylums. The main goal of community mental health services goes beyond provision of outpatient health services to individuals with mental illnesses or problems. It also entails providing social and spiritual support to the mental patients (John, 2000).

Usually, services that are provided in community mental health services’ facilities include supported houses, general hospitalization facilities, day centers, primary care services, self-help groups, and community mental health care centers. Supported houses are houses with partial or full supervision, meant to accommodate mental patients who may prefer to stay in the community mental health care facility as opposed to their homes. Primary health care services in the community mental health services’ facilities may be provided by governmental organizations, charitable organizations, association of mental health professionals, or non-governmental organizations. In other areas, specialized mental health care teams provide primary health care to mental patients from the community mental health services’ facilities (Sussman, 1997). The benefits of community mental health care services outweigh those reaped from asylums. According to a study conducted by the World Health Organization, community mental health services reduce cases of social segregation and neglect of mental patients by the community members, and violations of human rights, which mental patients encounter in asylums (World Health Organization, 2003). Thus, community mental health services reduce psychiatric rehospitalization and contribute to the social and mental wellbeing of mental patients as opposed to mental hospitals such as asylums (Parsons & Brigham, 1999; Scott & Dixon, 1997).  

According to a study conducted by Johns Hopkins Bloomberg School of Public Health, community mental health facilities that offer around-the-clock health services are capable of reducing the rate of hospitalization of mental patients by 40-50 percent (Parsons & Brigham, 1999). The researchers in this study evaluated the functioning of the community-based mental health care services offering health care services to non-emergency psychiatric cases. These include administering injections, prescribing medication, counseling, rehabilitation among other forms of treatment to the mental patients. The study discovered that those patients who utilized the services of community-based mental health services providers were admitted to hospitals less often than those who did not utilize their services as well as those who were confined in asylums.

Researchers at Johns Hopkins Bloomberg School of Public Health recommend that services of assertive community treatment are suitable for mental patients with severe and persistent psychiatric cases. Assertive community treatment helps patients with severe and persistent mental illnesses/problems to avoid ‘recycling’ in and out of mental hospitals (Parsons & Brigham, 1999). Assertive community treatment enables such patients to stay within her/his community, while receiving appropriate treatment at the same time. According to the research, this reduces the duration of hospital stays  what contribute to quick recovery among mental patients.

In June 1999, Prof. Salkever (a researcher in health policy and management) conducted a study, where he compared assertive community treatment programs and inpatient mental institutions’ treatment methods. In the study, Prof. Salkever discovered that assertive community treatment was not only effective in offering mental treatment, but was also cost effective. The study assumed that a mental patient incurred $19,000 per every hospitalization. One hundred mental patients were put under assertive community-based treatment for a period of 18 months, where they amount of hospital fees had been reduced by $285,000 (Parsons & Brigham, 1999). The reduction in hospitalization fee was because the number of hospital visits was less, when the mental patients were placed under assertive community-based treatment.

In the same study, 144 seriously mental ill patients were put under an assertive community-based treatment program for a period of 18 months. A control group was sent to different mental hospitals. After a period of 18 months, it was discovered that the number of rehospitalization among the patients who were under assertive community-based treatment was less than the number of rehospitalization among the mental patients confined in mental hospitals (Parsons & Brigham, 1999). The results of this study imply that community mental health services reduce rehospitalization relative to mental health institutions such as asylums.

Further studies on community mental health services indicate that they help to increase residential stability among mental patients (Scott & Dixon, 1997). Residential stability is the ability of an individual to stay and maintain a house in its status: conduct routine house maintenance activities such as cleaning. A significant number of patients with severe mental illnesses/problems are able to maintain their housing status, when they attend a community-based mental treatment programs. Patients with severe mental illnesses are able to maintain their housing status, because they have less hospitalization rates and duration. Less rate and duration of hospitalization means longer period between relapses. This implies that community mental health services allow patients to spend longer periods in their homes, when their mental status is relatively stable, and be in a position to familiarize themselves with the home and housing environment, thus maintaining their housing status.

Besides, community mental health services are associated with improved quality of life among mental patients as well as their families (Huxley & Oliver, 2003). Mental patients who seek services of community mental health services have improved social association with their family members, as opposed to those who seek mental health services from mental hospitals such as asylums. In addition, mental patients seeking services of community mental health services have high medication compliance rates than those who seek services of mental hospitals (Huxley & Oliver, 2003). Family members have less difficult times ensuring that the mentally ill member takes his/her medication. This is attributable to the longer period of mental stability, which enables mentally ill patients to function normally and gain their cognitive ability for a long period. Compliance to medication results to improvement of the mental status, thus resulting to less rehospitalization.

In some cases, mentally ill individuals engage in activities, which lead to their imprisonment. Some of them may engage in criminal activities, such as robbery, assault, or drug abuse due to the inability to recognize what is wrong and what is right. Available evidence suggests that community mental health services are associated with reduced imprisonment among mentally ill persons (Scott & Dixon, 1997). This has been attributed to the social impact that community mental health services have mentally ill individuals. Although the aforementioned impacts of community mental health services are achieved slowly, they are apparent over the years, and mental patients can achieve them, if they maintain consistent in seeking mental care from community-based treatment programs (Scott & Dixon, 1997).

Given the numerous benefits of community mental health services, there are different forms of community-based treatments that mental patients can seek. A community mental health care team (CMHTs) is one of the community-based mental treatment programs. CMHTs entail provision of non-specialized mental health care to mental patients (Page et al., 2009). The teams are located in different, but defined geographical areas. They provide a wide range of interventions, but individuals with severe mental cases have priority over the rest. Some of the benefits of CMHTs include greater user satisfaction, promotion of engagement with mental health services, and increased fulfillment of patients’ needs. CMHTs allow mental patients to benefit from increased continuity of mental care as well as flexibility.

A mental patient can utilize the services of the same staff member over a long period of time. This assists in early diagnosis of relapses or occurrence of other mental-related illnesses (Page et al., 2009). When this occurs, appropriate medication is administered to the patient, thus reducing the rate and duration of rehospitalization among mental patients. Besides, the mobile ability of CMHTs enables them to respond to crises. Furthermore, their mobile ability enables them to operate from different locations, such as homes, schools, and churches, as well as neutral places, such as cafes. This enables one CMHT’s staff to access as many mental patients as possible over a wide geographical area. However, CMHTs do not produce significant improvement in social functioning of the mental patients (Page et al., 2009).

Another source of community mental health services is specialized community mental health care teams. They provide specialized mental health care as opposed to non-specialized care, provided by the CMHTs. Specialized CMHTs are categorized into early intervention and assertive community treatment (ACT) teams. Early intervention teams are concerned with identification and treatment of early psychiatric episodes (Page et al., 2009). Staff members of early intervention teams, deal with first time cases of psychiatric illnesses: patients who exhibit symptoms of psychiatric problems for the first time. Their main role is to diagnose the symptoms exhibited by potential mental patients, and administer the appropriate treatment to their illnesses. Recently, interest for early intervention teams has increased as psychiatrists discover that longer periods of untreated psychiatric psychosis (the period between an individual experiences the first symptom of psychiatric disorder and when the individual receives the first treatment) contribute to worsening of psychosis. Therefore, early intervention teams play a great role in reducing occurrence of serious cases of mental illnesses by offering treatment to early victims of mental disorders (Page et al., 2009).

On the other hand, ACT provides both mobile and immobile treatment to patients with severe mental illnesses. Their defining features include 24/7 operations, 80 percent community coverage, small caseloads (ten core staff for every 100 patients), and daily delivery of medication to the patients (Page et al., 2009). Members of ACT assume a team approach, when delivering treatment to the mental patients. A team of ACT members is usually made of psychiatrists, nurses, nutritionist, and other professionals including financial managers. Financial managers are usually included in the ACT teams, because they do not only provide medical care, but also oversee management/arrangement of the patients’ finances. As earlier mentioned, ACT reduced the rate and duration of rehospitalization among mental patients, increases patients’ satisfaction, and results into improved housing status. However, use of ACT is only possible in high-resource countries, because it requires quite a large number of high-valued resources.

Long-term community-based residential care is also another source of community mental health services. This usually serves mental patients with acute and permanent mental disorders, as well as those patients whose mental conditions have rendered them physically disabled (Pugsley, 1997). Instead of having such patients receive mental health care from mental institutions such as asylums, they are transferred to long-term community-based residential care facilities. However, transfer of severely mentally ill individuals from a mental institution to a community-based care facility requires careful planning and management.

A long-term community-based residential care should have auxiliary services, such as dispensaries for offering primary care to the patients, mental patients’ emergency wards, counseling facilities, among others. These services are necessary, because the patients are meant to stay in the facilities for the rest of their lives, thus the need to not only look after their mental health, but also their general health. Although long-term community-based residential care does not result into cost saving (given the fact that patients require almost the same services as provided in mental institutions), it is considered economical, because it results into improvement of the patients’ quality of life as opposed to mental institutions (Pugsley, 1997).

Community health care for mental patients refers to provision of medical care to individuals with mental illnesses/problems from a home setting as opposed to institutional settings such as those available in asylums. Community mental health care has numerous advantages than mental hospitals. They help in reduction of the rate and duration of rehospitalization of mental patients, improvement of the patients’ social wellbeing, and improvement of the patients’ quality of life. In addition, many of the community mental health care facilities are more cost effective than conventional mental institutions. Some of the sources of community mental health care services include CMHTs, specialized CMHTs: early intervention teams and ATC teams, and long-term community-based residential care.

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