In search of ‘community’: a critical review of community mental health services for women in African settings

Abstract

Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up ‘community’ approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term ‘community’ in relation to women’s mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term’s use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.

Time is on our side: operationalising ‘phase zero’ in coproduction of mental health services for marginalised and underserved populations in London

“…The abovementioned engagement is enabled by a wider definition of 'community' in relation to mental health services than is typically seen in the literature (Elias et al, 2020). TPN and their partners exemplify a community of practice anchored to and representing multiple positionalities, where service user/provider identities are one part of a broader picture.…”

Misunderstood and underappreciated: a critical review of mental health advocacy and activism in low- and middle-income countries

“…The format of this review follows that of a critical review, as outlined by Grant and Booth (2009) . Whilst still an emerging form of reviewing literature, it is growing in use and has recently been employed to critically examine meanings around community in the GMH space ( Elias et al ., 2021 ) One of its strengths lies in the ability to identify and discuss areas that need strengthening in the given field of research ( Paré et al ., 2015 ), which lends itself well to the aim of the review. It provides an opportunity to highlight contradictions, limitations and inconsistencies ( Elias et al ., 2021 ).…”

Community Resilience after Disasters: Exploring Teacher, Caregiver and Student Conceptualisations in Indonesia

“…However, we recognise that communities are dynamic and not necessarily geographically bound [11]. While a community can represent a place (i.e., a geographical location or shared institution), communities can also be systems of practice (i.e., belonging to a shared activity or profession), diagnostic identity (i.e., mental health condition) and other symbolic relationships (i.e., meanings and experiences with shared community life), such as spiritual-/faith-based support [12]. Therefore, disaster survivors can belong to multiple communities (see [11]).…”