In many countries, mental health services are often hidden or fragmented. People living with serious mental illnesses need effective treatment and recovery supports, integrated within general primary care.
They also need to address the underlying determinants of mental, neurological and behavioral disorders, working with partners in education, labour, transport, housing, justice, food and other sectors.
Prevention
Mental health professionals must be aware that people need to have access to resources before they become ill. This includes self-help support groups like Alcoholics Anonymous and Al-Anon for family members of people who are addicted to drugs, overeater’s and bulimia support groups, and mental health peer recovery programs that connect recovering patients with each other.
Prevention of mental illness is difficult to achieve, as the disease process has many influencing factors that are not under direct control of public health agencies. For example, exposure to violence and social isolation may contribute to mental dysfunction. Poverty remains a major risk factor for the development of mental disorders, as well as other conditions such as chronic physical illnesses.
Preventive interventions may be geared to the general population (universal), aimed at populations that carry potential risk indicators of mental disorders (selective), or directed at individuals who have early signs and symptoms of a mental disorder (indicated). There is modest evidence on the effectiveness of universal, selective and indicated preventive programs for various mental illnesses.
Diagnosis
Just like with diabetes or cancer, a health care professional must do an evaluation before a person can receive a diagnosis of a mental illness. A mental health evaluation includes a complete health exam and often long term monitoring to check for any medical conditions that may be contributing to or complicating the symptoms of a mental illness (such as a thyroid condition).
Once a person has received a diagnosis, there are many steps that can be taken toward coping with and recovery from a mental health condition. Most important is a treatment plan developed by the individual and their health care provider. This usually includes psychotherapy (talk therapy) and medication.
The goal is to reduce symptoms and improve functioning. This is best accomplished through a combination of therapies and medications, as well as self-help strategies and support services. Psychotherapy is delivered by trained health care professionals such as psychologists, social workers and psychiatrists, or sometimes by primary care clinicians who have had specialized training in psychiatry.
Treatment
Treatment options include medications, psychotherapy (also called talk therapy), and support groups. Psychiatric medications work to restore proper chemical balance to the brain, and they can help control symptoms such as anxiety and depression. Psychotherapy, or talk therapy, includes a range of techniques from learning relaxation skills to intensively reworking thinking patterns. Support groups can provide friendships and tips on living with a mental health condition.
Advances in drug therapy and concerns about the negative impact of long-term institutionalization have prompted changes in mental health services to focus on community orientation and linkage with primary care. Community-oriented models provide outreach, home service, and patient and family counseling, with back-up from general hospital psychiatric units and specialty clinics. A community-oriented approach may also require changes to funding mechanisms, with primary care physicians and managed care programs assuming some responsibility for screening for mental health problems. This could involve training for primary care physicians in basic psychiatric knowledge and providing them with resources.
Recovery
Recovery is a journey that may involve setbacks and successes. It is a personal process that requires individual responsibility and choice.
It involves an active partnership between people with mental health problems and professionals. It is a partnership that encompasses mutual support, respect, and an emphasis on self-worth, coping skills, and social participation. It also encompasses education, employment, housing, transportation, leisure activities, spirituality and a sense of belonging and purpose.
A recovery-oriented approach is an integral component of community mental health services. This includes a range of programs, including supportive communities, family supports, peer support, rehabilitation and vocational services, and residential treatment.
Recovery-oriented practice is a shift from traditional medical models of care that focus on symptom reduction to a consumer-driven perspective that promotes hope. In order to implement a recovery-oriented mental health service, training needs to be provided for both professional staff and consumers. This training should be co-produced by staff and consumers to ensure that it is authentic and meaningful for all involved.
