Mental health articles

OF mental health care and mentally ill

Health of the individual versus the community

Whether the main emphasis of mental health promotion should be on the health of the individual or that of the community can be debated. Within the WHO documents outlined earlier there is strong support for community level approaches and for measuring the success of actions in terms of community rather than individual level indicators. Working at the community level, using participatory approaches is designed to enhance empowerment of the community and the individuals who are part of it. Working with communities, it would be argued, creates greater potential for health creation than working simply with individuals.

Where work meets the criteria for being described as community development its activities are geared not only to the immediate health of communities but to enabling those communities to take action to get changes of upstream factors which may improve local determinants of mental health and even impact more widely. For example, a community action to secure a local Home Zone might lead to a city wide decision to create such Zones benefiting the whole population. To focus on community also fits in better with many cultures which have a communitarian rather than a strong individualist focus. Raeburn (2001), for example, with reference to Maori culture makes a strong case for a community-based approach. Maori ideas place family and community and their relationship to resources and the environment as the core of good mental health. Despite the importance that is given to working with communities in health promotion a considerable proportion of the work does not fully involve communities or fit wholly within a philosophy of empowerment. Communities are often used as locations of activities with participation consisting of little more than compliance in programmes designed by others.

While work may be carried out with groups outcomes are measured solely with reference to individuals. Communities addressed will often be more disadvantaged or excluded ones. The current attention to developing social capital relates to the question of individual versus community as focus for action. Social capital is generally analysed at the community rather than the individual level although it has been debated whether it should be considered solely as a property of groups or also of individuals. According to Da Silva et al. this continues to be an unresolved issue and researchers have measured social capital ecologically and individually. The decision about focus for action is also partly related to the ideology held of health promotion and the type of practice. Youth workers, play workers, community workers involved in mental health promotion will prefer community level action nurses, community health workers, patient educators at the individual level whether on a one to one or a group basis.

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