Some Implications of a Community Mental Health Model for Developing Countries

Abstract

THE aim of this paper is to call attention to certain problems facing many developing countries which are bound to lead to further difficulties in psycho-social adjustment. Almost all these problems are inherent in the process of socio-economic change, urbanization, and industrialization. These changes may not only lead to an increase in the rate of mental illness, but because of their impact on the basic family structure and living conditions, will result in a reduced tolerance of deviation on the part of the community. Moreover, the spread of public education and mass media is also likely to lead to a change in the expectations and attitudes of developing nations making it no longer possible to endure psychological suffering as part of one's destiny. Even the improvement of public health services leading to reduction of infant mortality and a rise in life expectancy may lead to a gross increase in demands for mental health services by the very young and the aged sections of the population. It is the contention of this paper that a community mental health model, with certain modifications to fit the local culture, will best serve the increasing mental health needs of developing nations. Of particular relevance are such aspects of the model as population and prevention orientation, community involvement, extension of professional resources through consultation, utilization of non-professional man-power, continuity and comprehensiveness of care as well as an open systems conceptualization of the whole process of the organization and delivery of mental health services. The latter approach will help bring about an integration of mental health services within the wider framework of human service agencies, e.g., public health, general and adult education, family planning, and community development. The implications of these new roles and functions for the training of mental health workers will be discussed.

Culture and the Delivery of Psychological Services in Developing Nations

“…Treatment usually follows the classic &dquo;drugs and management&dquo; regimen ; psychotropic medication for acute cases and &dquo;work therapy&dquo; for those with chronic conditions. One-to-one psychotherapy is a luxury in these settings and generally regarded as ineffective (Mehryar and Khajavi 1974;Koptagel 1971;Bohnan 1968). Residential facilities are becoming less favoured, however, as planners recognize their inordinate consumption of personnel and resources and their role in perpetuating patient chronicity (Thong 1976;Baasher 1975;Collomb 1975).…”

“…Argandona and Kiev 1972;Thebaud 1971;Hsu and Lin 1969;Jayasundera 1969). Mehryar and Khajavi (1974) outline key elements in this orientation: emphasis on primary prevention; use of paraprofessionals ; professional resources extended through consultation roles; and mobilization of community resources to avoid hospitalization. To this can be added the current tenet of WHO advisers to encourage integration of psychiatric with primary health delivery (see e.g.…”