Community Engagement

Stigma is a pervasive problem for people with mental illness. Goffman (1963) defined stigma as ‘an attribute that is deeply discrediting ... turning a whole and usual person to a tainted and discounted one. In western societies, the possible or actual presence of a mental illness is generally considered a highly discrediting attribute (Stuart et al., 2014). Additionally, so is the use of health services for such a problem, especially mental health services. Stigma is considered one of the main factors behind the low rates of service engagement for people with mental illness, with surveys regularly showing that approximately 50-60% of people with mental illness do not voluntarily engage with health services (Wang et al., 2007). An active focus on reducing stigma and engaging people in primary care is needed. Routine measurement and feedback from service users and carers about how well care is working for them is essential. Participant-led studies are growing and could provide another model to augment the peer support models of team care currently in place (Pelletier et al., 2015). To achieve this, mechanisms for community engagement are required at a range of levels and across sectors.

Some studies indicate that primary care is a favoured location for services for people with mental illnesses. As discussed, this may be due to various factors, including the familiarity of primary care clinics and clinicians, less association with stigma than secondary and tertiary care, and the possibility to treat multi-morbidity using a multidimensional framework and approach. Because primary care clinics are also located in neighbourhood settings, visits are easier to integrate into everyday routines, and also cheaper as they may not involve long trips across town on public transport. Therefore, identifying ways to implement primary care-led models that are localized and can skilfully provide a range of services is a good use of existing and available resources.