A look at structure of mental health services
AS we journey through life, we are confronted with adversities that bring distress of different forms and degrees. These either take a lot from us, as losses, or they add a huge burden we may not bear unless we go through informal social support networks, before we access more structured health and social services.
There are a number of issues that we ignore or fail to address, but later become huge challenges, causing a decline in our mental capacity over time. These are then diagnosed as mental illnesses or disorders.
If you take such issues to a medical professional, they will be diagnosed as illnesses that can be treated, but psychologists view them as disorders of the mind, which can be corrected through psychological skills training.
We need to address these issues in time to prevent costly interventions like surgery, life-long medication or rehabilitation with lengthy psychotherapeutic engagements.
We may not understand the cost benefit analysis unless we take a closer look at the situation over a longer period.
For example, well- regulated substance use can enhance life, while chaotic abuse disrupts it, resulting in addictions and compromised functionality.
So, as we fight the scourge of substance abuse, we must remain focused on unresolved issues for which these victims may be trying to “self-medicate”. Anything else may exacerbate the problems.
The ideal reality requires open access community support centres that provide services in the form of practical advice and vocational interventions that motivate, stimulate growth and foster maturity.
These may include public health approaches such as psychoeducation and use of other self-help media like mobile applications, audio-visuals and drama (edutainment) to cater for different learning needs.
Should issues deteriorate beyond what this support mechanism can manage, it can be quickly identified and referred to a more formal and structured services system.
This will start with primary care services of general practitioners — nurses and doctors
— through the support of social workers, who also assess the needs of the individual.
Primary care services involve low-level structured care and support to prevent deterioration. If this intervention is not adequate or the cases are more challenging, this calls for secondary care, which is better equipped to manage higher risk presentations.
Secondary care interventions cater for more complex situations and include collaboration of different disciplines. They involve a multidisciplinary approach.
They include specialised doctors (psychiatrists), specialised nurses, clinical social workers and psychologists. In cases where crimes may have been committed, prison and police services are incorporated.
Such interventions include more secure accommodation to contain risks, in-depth psychotherapies, more complex medication that requires special monitoring, and targeted family and community engagements.
Following the intensive care and support, individuals may need to be referred back to the community service or informal support service providers that maintain the gained skills. Support groups are a case in point.
All these are services needed to curb mental health deterioration. They also stop self-medicating from turning into addictions. We cannot fight addictions without the fundamental and supportive services required. ◆