The social aspect of disorder is also understood and treated at the community level. Community mental health services are psychological treatments and interventions that are distributed at the community level. Community mental health services are provided by nurses, psychologists, social workers, and other professionals in sites such as schools, hospitals, police stations, drug treatment clinics, and residential homes. The goal is to establish programs that will help people get the mental health services that they need (Gonzales, Kelly, Mowbray, Hays, & Snowden, 1991). 1
Unlike traditional therapy, the primary goal of community mental health services is prevention. Just as widespread vaccination of children has eliminated diseases such as polio and smallpox, mental health services are designed to prevent psychological disorder (Institute of Medicine, 1994). 2 Community prevention can be focused on one more of three levels: primary prevention, secondary prevention, and tertiary prevention.
Primary prevention is prevention in which all members of the community receive the treatment. Examples of primary prevention are programs designed to encourage all pregnant women to avoid cigarettes and alcohol because of the risk of health problems for the fetus, and programs designed to remove dangerous lead paint from homes.
Secondary prevention is more limited and focuses on people who are most likely to need it— those who display riskfactors for a given disorder.Risk factors are the social, environmental, and economic vulnerabilities that makeit more likely than average that a given individual will develop a disorder (Werner & Smith, 1992). 3 The following presents a list of potential risk factors for psychological disorders.
Some Risk Factors for Psychological Disorders
Community mental health workers practicing secondary prevention will focus on youths with these markers of future problems.
- Academic difficulties
- Attention-deficit/hyperactivity disorder (ADHD)
- Child abuse and neglect
- Developmental disorders
- Drug and alcohol abuse
- Dysfunctional family
- Early pregnancy
- Emotional immaturity
- Learning disorder
- Low birth weight
- Parental mental illness
- Poor nutrition
Finally, tertiary prevention is treatment, such as psychotherapy or biomedical therapy, that focuses on people who are already diagnosed with disorder.
Community prevention programs are designed to provide support during childhood or early adolescence with the hope that the interventions will prevent disorders from appearing or will keep existing disorders from expanding. Interventions include such things as help with housing, counseling, group therapy, emotional regulation, job and skills training, literacy training, social responsibility training, exercise, stress management, rehabilitation, family therapy, or removing a child from a stressful or dangerous home situation.
The goal of community interventions is to make it easier for individuals to continue to live a normal life in the face of their problems. Community mental health services are designed to make it less likely that vulnerable populations will end up in institutions or on the streets. In summary, their goal is to allow at-risk individuals to continue to participate in community life by assisting them within their own communities.
Research Focus: The Implicit Association Test as a Behavioral Marker for Suicide
Secondary prevention focuses on people who are at risk fo r disorder or for harmful behaviors. Suicide is a leading cause of death worldwide, and prevention efforts can help people consider other alternatives, particularly if it can be determined who is most at risk. Determining whether a person is at risk of suicide is difficult, however, because people are motivated to deny or conceal such thoughts to avoid intervention o r hospitalization. One recent study found that 78% of patients who die by suicide explicitly deny suicidal thoughts in their last verbal communications before killing themselves (Busch, Fawcett, & Jacobs, 2003). 4
Nock e t al. (2010) 5 tested the possibility that implicit measures of the association between the self-concept and death might provide a more direct behavioral marker of suicide risk that would allow professionals to more accurately determine whether a person is likely to commit suicide in comparison to existing self-report measures. They measured implicit associations about death and suicide in 157 people seeking treatment at a psychiatric emergency department.
The participants all completed a version of the Implicit Association Test (IAT), which was designed to assess the strength of a person’s mental associations between death and the self (Greenwald, McGhee, & Schwartz, 1998). 6 Using a notebook computer, participants classified stimuli representing the constructs of “death” (i.e., die, dead, deceased, lifeless, and suicide) and “life” (i.e., alive, survive, live, thrive, and breathing) and the attributes of “me” (i.e., I, myself, my, mine, and self) and “not me” (i.e., they, them, their, theirs, and other). Response latencies for all trials were recorded and analyzed, and the strength of each participant’s association between “death” and “me” was calculated.
The researchers then followed participants over the next 6 months to test whether the measured implicit association of death with self could be used to predict future suicide attempts. The authors also tested whether scores on the IAT would add to prediction of risk above and beyond other measures of risk, including questionnaire and interview measures of suicide risk. Scores on the IAT predicted suicide attempts in the next 6 months above all the other risk factors that were collected by the hospital staff, including past history of suicide attempts. These results suggest thatmeasures of implicit cognition may be useful for determining risk factors for clinical behaviors such as suicide.
- Group therapy is psychotherapy in which clients receive psychological treatment together with others. A professionally trained therapist guides the group. Types of group therapy include couples therapy and family therapy.
- Self-help groups have been used to help individuals cope with many types of disorder.
- The goal of community health service programs is to act during childhood or early adolescence with the hope that interventions might prevent disorders from appearing or keep existing disorders from expanding. The prevention provided can be primary, secondary, or tertiary.
EXERCISE AND CRITICAL THINKING
- Imagine the impact of a natural disaster like Hurricane Katrina on the population of the city of New Orleans. How would you expect such an event to affect the prevalence of psychological disorders in the community? What recommendations would you make in terms of setting up community support centers to help the people in the city?