Community Mental Health

and Traditional Medicine

Health (WHO)?

Mental health ?
The capacity in an individual to form harmonious relations with others, and to participate in, or contribute constructively to, changes in his social & physical envi-

ronment.
Community mental health ?

Community Mental Health:

* considerable changes in the delivery

of mental health occurred in the past three decades. - psychiatric ttt is now provided by several small general hospital psychi-

atric units instead of remotely situated hospitals.

- psychiatry was integrated in the prim-

ary health care (PHC).

- due emphasis was given to the prevetive aspects & to promotion of mental health besides treatment. - health workers were trained, family

members were involved in ttt & the

community participation was ensured.

* Community care denotes a method

of organizing services with four aims:

1. to treat patients outside whenever feasible; 2. to provide service close to pts homes. 3. to prevent the occurrence & recurrehospitals

nce of mental disorders;

4. to involve family & voluntary organizations in planning & provision of care.

Treatment outside hospital:

* is mainly concerned with avoiding

unnecessary admission to hospital. * hospital is provided for the needs of patients with chronic disorders. * unnecessary admission can be avoid-

ed by giving out-pt ttt and providing

day care avoid institutionalization.

Prevention:

1. primary prevention:
* operates on a community basis : - improving the social environment, - promotion of the social, emotional & physical well-being of all people.

- prevent disease transmission (AIDS,

rubella by immunization of women ).

* Strategies of primary prevention:

- mental health education programs.

- use social support systems to reduce stress on those at risk. - crisis interventions after stressful life events (bereavement, divorce).

- prenatal & perinatal care reduces

mental retardation.

2. Secondary prevention:

- early detection & prompt treatment

of mental disorders ( reduce prevalence by reducing duration of illness). - emergency services. - outpatient clinics.

- day treatment programs.

- community-based inpatient units.

3. Tertiary prevention ( rehabilitation ): - aim is to reduce the prevalence of the residual defects or disabilities due to illness or disorder. - the disabilities associated with chronic mental illness represent major social, economic and public health problems. - rehabilitative efforts to help people to reach their highest level of functioning. ( living skills, social support & ttt )

* Six elements are required if long-term

care in hospital is to be replaced

successfully by community care: 1. well-supported carers. 2. suitable accommodation. 3. appropriate occupation.

4. ensure pts collaboration.

5. regular reassessment. 6. effective collaboration of those involved in care.

Traditional Medicine ( TM ) :

Definition:
TM refers to heath practices, approaches, knowledge and beliefs incorporating plant, animal & mineral based medicines, spiritual therapies, manual techniques, applied

singularly or in combination to treat, diagnose & prevent illnesses or maintain wellbeing.

* countries in Africa, Asia & Latin Amer-

ica use TM to help meet some of their

primary health care needs. * in Africa, up to 80% of the population uses TM for primary health care. * in industrialized countr., adaptation

of TM is termed Complementary
or Alternative medicine - CAM.

Increasing use and popularity:

* TM has maintained its popularity in all

regions of the developing world & its use is rapidly spreading in industrialized countries. * in China traditional herbal preparations

account for 30 - 50% of the total medicinal consumption.

* in Ghana, Mali, Nigeria & Zambia, the

first line of ttt of 60% of children with

high fever resulting from malaria is the use of herbal medicines at home. * WHO estimates that in several African countries traditional birth attendants

(TBAs) assist in the majority of births.

* in industrialized Cs > 50% of the population have used CAM medicine.

Safety and efficacy of TM :

* scientific evidence from randomized

clinical trials (RCT) is only strong for many uses of acupuncture, some herbal medicines & for some of the manual therapies.

* unregulated or inappropriate use of

TM & practices can have negative or dangerous effects.

Tried & tested methods & products:

* 25% of modern medicines are made

from plants first used traditionally. * Acupuncture has been proven effective in relieving postoperative pain, nausea during pregnancy, anxiety,

panic disorder and insomnia.

* Yoga can reduce attacks of asthma.

* TM can have impact on infectious

diseases, e.g. the Chinese herbal

remedy Artemisia annua, used in China for almost 2000 years has been found to be effective against resistant malaria. This can prevent

one million deaths annually, most of

them children, from severe malaria.

WHO efforts in promoting safe,

effective & affordable TM/CAM: * WHO launched its strategy in 2002. * it was designed to assist countries to: - develop national polices on the eval-

uation and regulation of TM / CAM

practices.

- create a stronger evidence base on

the safety, efficacy and quality of the

TM / CAM products & practices.

- ensure availability and affordability of

TM/CAM including essential herbal

medicines.
- promote therapeutically sound use of TM/CAM by providers & consumers.

- document traditional medicines and

remedies.
Why promoting the use of TM ? * over one-third of the population in developing countries lack access to essential medicines.

* China, both Koreas & Vietnam have

fully integrated TM into their health care systems with good results.