Clinical Review

ABC of mental health: Community mental health services

BMJ 1997; 314 doi: http://dx.doi.org/10.1136/bmj.314.7097.1817 (Published 21 June 1997) Cite this as: BMJ 1997;314:1817
  1. Karen White,
  2. David Roy,
  3. Ian Hamilton

    Introduction

    Community mental health centres should be located in the locality that they serve and provide the base from which multidisciplinary teams deliver the bulk of mental health services for a particular community. A multidisciplinary team may include psychiatrists, nurses, occupational therapists, psychologists, social workers, and counsellors supported by an administrative team. The psychiatrist is the bridge between inpatient and community teams and maintains close links with general practitioners, social services, and voluntary organisations.

    Every person with a mental illness shall have the right to live and work, as far as is possible, in the community United Nations (1990)

    Community mental health centre in a suburban street (Lewin Road, Streatham)

    Who to refer?

    When a referral is considered it is important to remember that mental health services are required to focus on the needs of those with serious mental health problems.

    Differing characteristics of minor and severe mental disorders

    Minor mental health problems
    • Brief, time limited, event related

    • Sufferers seek help and advice

    • May improve with time

    • Best dealt with in person's home and family

    • Specialist treatment rarely necessary

    • Medication usually contraindicated

    Severe mental disorders
    • Chronic (may be life long) and disabling

    • Sufferers often avoid medical contact

    • Deteriorate with time if not treated

    • Specialist supervision and treatment required

    • Medication usually necessary

    These represent the extreme poles of a continuum: in the middle are disorders that may be managed by a combination of available resources. When this involves several agencies, the responsibilities of each agency should drawn up clearly in the care plan.

    Those in distress in the absence of a mental disorder may be helped in one of several other ways: consultation with their general practitioner is all that is necessary for many people with distressing but brief emotional upsets. Assessment and treatment of mild to moderate depressive disorder should also be undertaken by general practitioners. Other patients may be given advice on self help techniques (such as commercially …

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