Public Psychiatry

Refers to treating mentally ill people in the community, where all aspects of care, from hospitalization, case management, and crisis intervention to day treatment and supportive living arrangements, fall under the public umbrella and are sponsored by the government.

One unfortunate result of this approach is the numerous homeless, mentally ill people who would once have lived in state institutions but are now left to the understaffed, financially limited, often grossly inadequate public health services.

Community Mental Health Center FactorsCommitmentCommitment to a populations health care implies a responsibility for planning.Suggests that the plan should identify all the mental health needs of the population, inventory the resources available to meet these needs, and organize a system of care;That citizens and political figures should be involved in the planning process;

That prevention is at least as important as direct treatment;And that all the population, including children, older people, minorities, people who are chronically and acutely ill, and those who live in geographically remote areas, should receive care.The federal requirement that mental health services be located close to peoples residences or workplaces is meant to make it easy for people to get treatment and to identify illness early so that hospitalization, when required, is likely brief.

ServicesPublic mental health to be effective, services must be integrated and balanced, so that appropriate treatment modalities are available to fit patients needs.A lack of services in one are (such as community placements) can delay other services ( such as hospital discharges) and can lead to lack of services for some patients ( for example, those who cannot gain admission to overcrowded hospitals).

Mental health teamPsychiatristsClinical psychologistsPsychiatric social workersPsychiatric nursesAdministrative and clerical staff membersOccupational and recreational therapists for inpatient and partial hospitalization programsLinks to welfare workers, the clergy, family agencies, schools, and other human services groups are also maintained.

Long-term CarePublic mental health programs must encourage continuity of care.Continuity of care enables a single clinician to follow a patient through emergency services, hospitalization, partial hospitalization as a transition to the community, and outpatient treatment as follow-up.

Continuity also provides an exchange of information and team responsibility for the patient when various therapists, for reasons of convenience or economy, treat the patient in several settings.

Case ManagementIntensive case managers are clinicians who can provide continuity of care by following patients through all the phases of treatment while helping them negotiate a complex and fragmented system.Intensive case managers provide support, advocacy, and systems management.

They engage patients in treatment through outreach in single-room-occupancy residences and shelters;They ensure continuing treatment by initiating contact during hospitalization and continuing support through aftercare;They serve as liaisons between patients and other mental health providers and between the providers themselves.Ideally, intensive care managers should have small caseloads that allow for intensive contact with their patients.

Community ParticipationCommunities should participate in decisions about their mental health care needs and programs instead of having them defined solely by professionals.Mental health services are sensitive to the needs of those served when the public is actively involved.National Mental Health Association (NMHA) and the National Alliance for the Mentally Ill (NAMI) are two lay advocacy groups working at local, state, and national levels to improve care for people who are mentally ill.

Consultation Range from attention to or treatment of a persons emotional problems to using knowledge about human behavior to help organizations achieve their professional goals with their programs and patients.Consultants offer assistance to mental health professionals who work in outpatient centers or agencies and also provide direct educational activities.

Evaluation and ResearchEvaluation is the process of obtaining information about a total community mental health program and its effects on people, institutions, and communities.Program evaluation should also provide feedback to planners and decision makers, so that operating programs can be modified and new ones planned.Research may focus specifically on key issues rather than on a total program and may address a particular disorder or a treatment method.

PREVENTIONPreventive psychiatry is part of public psychiatry.The goal is to decrease the onset (incidence), duration (prevalence), and residual disability of mental disorders.The prevention of mental disorders is based on public health principles and is divided into primary, secondary, and tertiary prevention.

Primary PreventionThe goal is to prevent the onset of a disease or disorder and thereby reduce its incidence (the ratio of new cases to the population in a specific period).This goal is reached by eliminating causative agents, reducing risk factors, enhancing host resistance, and interfering with disease transmission.

Examples:Help people cope with life include mental health education programs (such as parent training in child development and alcohol and drug education programs)Efforts at competence buildingDevelopment and use of social support systems to reduce the effects of stress on those at high riskAnticipatory guidance programs to assist people to prepare for expected stressful situationsCrisis intervention after stressful life events

Primary prevention also aim at eradicating stressful agents and reducing stress.

Secondary PreventionDefined as the early identification and prompt treatment of an illness or disorder, with the goal of reducing the prevalence (the proportion of existing cases in the population at risk at a specified time) of the condition by shortening its duration.Crisis intervention and public education are components of secondary prevention.In psychiatry, secondary prevention targets children who are emotionally ill for early intervention.NIMH Child and Adolescent Services System identifies and treats these children to support their family structures and prevent or reduce later disability.

Tertiary PreventionThe goal of tertiary prevention is to reduce the prevalence of residual defects and disabilities caused by an illness or a disorder.In the case of mental disorders, tertiary prevention enables those with chronic mental illnesses to reach the highest feasible level of functioning.

DeinstitutionalizationProcess by which large numbers of patients are discharged from public psychiatric hospitals back into the community to receive outpatient care.

Transinstitutionalization is the transfer of state hospital patients to other facilities.Deinstitutionalized patients need extensive social support such as vocational and recreational counseling, comprehensive psychiatric treatment, paying jobs, and affordable housing. Homeless mentally ill peopleOutreach programs