Community Mental Health Competencies: A Flexible Framework for Community Mental Health

Recent work by the first author of this chapter (Burgess 2012; Campbell and Burgess 2012; Burgess 2013b; Burgess 2014) articulates the value of critical community psychology frameworks in grappling with the complex nature of community and a wider range of socio-structural determinants of mental health. The community mental health competency framework (Burgess 2012; Campbell and Burgess 2012) begins with a reconceptualization of ‘community’ for mental health. In this framework, mental health services are positioned as the meeting place of multiple communities, which are often linked to varied approaches to mental ill health (Kleinman 1988; Swartz 1998). These symbolic and relational communities are then viewed within the context of a shared community of place, in order to account for the impacts of social and structural factors on service outcomes. This enables tangible impacts of poverty, violence, unemployment, and a range of other social challenges that characterise many communities around the world to be seen as active factors that shape the lived experience and understandings of community members (Summerfield 2008, 2012). This is particularly important given that LMIC settings are often marked by such characteristics.

Another important feature of the community mental health competency approach is the emphasis on partnerships. Bourdieu (1986) argues that attention to different forms of social capital is critical to health, as access to social, cultural, and economic capital may open pathways to resources that may mediate health risk. Partnerships are viewed as routes to increasing access to these forms of capital. Similarly, Putnam (2000) suggests that social capital provides ties within communities that enable access to necessary structural and symbolic resources. Bridging social capital is one example of such partnerships, which build ties to agents outside of a particular community with access to alternative and needed resources. Within the proposed framework, programmes are viewed as opportunities to strengthen existing partnerships, or establish new ones, with communities, with a view to establishing links to resources beyond those that already exist. Partnership building is supported through quality communication between actors in line with Habermas’s (1984) concept of communicative action—where both groups are engaged in a communicative encounter that drives towards both actors being heard. In many instances, promoting such communicative encounters requires attention to the development of safe spaces, where traditionally excluded voices have the opportunity to be heard (Fraser 1990).

In order to continually foreground structural community drivers of distress, the framework suggests that programmes should also seek to foster resources that enable communities to identify and engage with issues they deem problematic, which are often shaped by economic and political processes beyond local control (Campbell et al. 2007). Rooted in Freirean notions of engagement that promote critical awareness of oppressive social relations (Freire 1973), the form of engagement suggested by this approach should occur alongside addressing mental health needs and involve participation by members from various subgroups of a community (i.e. treatment groups, families, members from the wider community, practitioners). All subgroups should be viewed as agents and partners with important knowledge that contributes to the promotion of well-being. By taking these factors into account during initial planning stages, interventions are designed with the foundations for expanding the knowledge of groups and increasing local strength and capacity for change.

Table 11.1 Four community mental health competencies (Burgess 2012, 2013 b; Campbell and Burgess 2012)

Knowledge

  • • Enhances the ability of communities to identify and refer serious cases of mental ill health and respond to others in a culturally appropriate manner
  • • Supports the acceptance of cultural and social narratives among professionals

Recognition of individual- and group-based skills, and solidarity to tackle the issue

  • • Helps communities develop or expand on existing skills that can contribute towards addressing mental ill health
  • • Mutual recognition of the validity of contributions from both professionals and lay individuals

Safe social spaces and dialogue

  • • Promotes dialogue between outside mental health professionals, local mental health service sectors, and target communities
  • • Communities develop better understandings of the links between social environments, symbolic issues, and mental health outcomes (critical consciousness) within safe social spaces

Partnerships for action

  • • Supports opportunities for individuals and groups to exercise agency to improve the conditions that they feel impact their mental health
  • • Promotes linkages to external agents with access to material and symbolic resources where appropriate
  • • Ensures sensitivity to issues of power that influence who acts around mental health

The competencies for community mental health introduced in Table 11.1 emerged through research into community mental health services in South Africa conducted in 2008—2011 by the first author (see Burgess 2012, 2013b). Each of the four principles was identified as psychosocial resources key to the promotion of spaces where mental health issues can be addressed in locally sensitive and relevant ways, alongside efforts to tackle wider determinants of distress.

The remainder of this chapter is organised around two case studies, each exploring how attention to community mental health competencies responds to mental ill health in locally relevant ways. The first case study explores the dimension of partnerships and knowledge through a discussion of the inclusion of traditional healers in mental health services in a rural community mental health setting in South Africa. The second case study explores a partnership around a community mental health programme in western Uttar Pradesh, India, and highlights the influence of key socio-structural challenges on attempts to establish competencies related to knowledge and safe social spaces. Cases draw on data in different ways—the first draws on analysis of a cluster of interviews with traditional healers, and the second on evaluation research and focus groups about the community mental health programme.

 
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