In order to trace the complexities facing ‘community mental health’, one must acknowledge limitations of the term ‘community’ itself. Traditional social science debates about the concept cut across multiple fields: making the term inherently plural, fluid, and malleable, with practical, symbolic, and rhetorical weight (Howarth et al. 2015).
Community typically conjures the image of a coherent (and often positive) grouping of individuals, united by a common factor that shapes the identity of each member in some way. The term describes groups of individuals united by characteristics such as location, shared practices and values (i.e. a profession), common experiences (racism/exclusion), interest (i.e. a hobby), culture, religion, or physical characteristics, such as a health diagnosis (Howarth 2001). These categories can be organised into two broad camps—communities linked to tangible structures, such as spatial dimensions, and those linked to ‘symbolic’ and intangible dimensions, such as identity or cultural norms.
Community ultimately gains meaning through the value the categorical label holds to someone’s everyday survival (Cohen 1985). In this sense, structural dimensions of community, such as areas of space, are equally important as symbolic dimensions and are often inseparable. For example, participation in cultural celebrations, such as birth celebrations, cannot be divorced from the structural dimensions of spatial communities where a cultural practice is lived. The availability of services, quality of housing, and economic opportunities available within a community exert forces on the ability to participate in a cultural celebration, with meaningful impacts on one’s life.
Individuals often hold memberships to multiple ‘communities’ at any given time and can accept or reject membership based on the importance of a community identity (Howarth 2001; Jovchelovitch 2007). Thus, we could better think of people as ‘living’ community—through their actions, relationships, and other forms of social participation—a perspective that is often absent from community health approaches. In fact, it is perhaps more useful to view any single community as an interactive space—one where the realities of any one community blend into and influence the reality and outcomes of others (Burgess 2013b).
However, the fluidity of the term also makes it open to co-option, particularly among political platforms, who invoke the term to serve different and sometimes contradictory ideals. For example, successive British governments’ use of the concept anchors to the belief that ‘communities’ are self-sustaining, able to improve themselves in spaces outside of state support (Fremeaux 2005). Conversely, the term is also linked to highlighting the plight of ‘at- risk’ and ‘excluded’ communities who must be targeted for special support and resources in order to tackle inequality (Allen et al. 2014).
In light of such controversies, engagement with community will involve attention to the making and shaping of meaning, which is in turn influenced by social forces and power relations between groups. What are the implications of this ‘plurality’ for community interventions that seek to address mental ill health?