Background, target group and rationale
Good mental health is fundamental to the well being of peoples, their families, and virtually to the whole population. Conversely the mental health problems are amongst the greatest cause of disability, diminished quality of life, and reduced productivity.
According to WHO (2004), there are nearly 450 million people are affected by mental, neurological or behavioural problems throughout the world. Nearly 873,000 people die by suicide each year only due to mental health problems. According to WHO (2001) mental illness is common problem to all countries and is creating enormous suffering. People who are affected often subjected to social isolation, poor quality of life and increased mortality. According to WHO (2004) there are 25 percent patient out of 100, who are attending health services are affected by mental health disorders but most pf them are not diagnosed at all.
Andrews, Henderson and Wayne (2001) state that ssituation is also not that good in Australia where it is estimated that nearly one in every five Australians will experience a mental illness in their lives. Episodes of mental illness can wax and wane during course of disease. Some people experience disease only once and then full recover, but currently only half of those are able to get treatment. In Australia about 20 percent of adults affected by mental problems, are mostly due to depression and anxiety.
There is now emerging need of the projects which involve and support mentally ill people in communities. This project will addresses the problems of mental ill health in area health service of south west Sydney where, according to ABS (2004) problems of mental health are more as compared to other areas of NSW. Higher ratio of mental illness is most probably due to less literacy, unemployment, family problems, poverty and other social factors that are responsible for disease.
Target population for this project will be area health service of south west Sydney, which includes, Liverpool, Fairfield, Campbelltown, Bankstown suburbs. People will be between ages of 16 to 64 years who are living in these areas, having psychiatric problems and require assistance.
Need felt for this project can be either comparative need, comparing to other AHS which are having less patients, so need of this type of project is more here then elsewhere (Naiido and Willis, 2000). This can be felt or expressed need as well and government should provide more funding for these areas where there is need of such type of projects.
Rationale of this project is o sustain support and social wellbeing of population from earliest years throughout adult life to old age. It will also support those peoples who are currently well but at risk of developing a mental health problem and those who are experiencing mental illness.
According to Bailey Ricketts Bailey (1998) mental illness is huge problem and nearly one in each family is likely to have a member with mental illness. These families not only provide physical and emotional support but also beer the negative impact of stigma and discriminations.Brundtland (2001) state that in year 2000, mental and neurological disorders accounted for 10 percent of the total disability adjusted life years lost due to burden of disease was estimated. This will rise to 12 percent in 2004, and it is estimated that by the end of 2020 this burden will be around 15 percents if proper interventions are not applied. Common mental disorders which cause severe disability are epilepsy, Alzheimer’s disease, mental retardations and disorders of child hood.
- To improve significantly the health and social well being of mentally ill people.
- Encouraging communities to support mentally ill people.
- Educating the public and community.
- Reducing the impact of mental disorder on individuals, families and communities.
- Addressing the risk factors of development of ill mental health.
- What are the factors causing or contributing to mental illness?
- How can the awareness be raised in community about mental illness and how to educate them to deal will mentally ill people?
- Improving understanding of and responsiveness to people’s mental health needs, include the development of environment which will promote resilience and enhance well being.
- Improving community’s appropriate access to mental health services.
- To increase the capability of welfare services to respond to the need of young people at risk of developing mental health problem.
- Rehabilitation of mentally ill patients.
Participants will be recruited with the help of project partner agencies. Patients with mental illness and their families, who attend general practitioner’s clinic, hospitals or other institutions, will be offered information explaining the project and inviting them to participate. Information regarding the project will also be provided in community health centres. Patients and their partners who take interest in the participation of project will be recruited.
Sample size will depend on number of patients and their families showing their interest, usually maximum number of people will be tried to get advantage. Mostly patients between 16 to 64 years of age will be selected irrespective of gender. The main factor to be measured will be, at which stage is patient currently in. does health health promotion project will be handy to this patient and his/her family or not. Any attributable risk factors that can lead to development or worsening of mental disorder can be identified.
Harnois and Gabriel (2000) states that improvement in mental illness will always depend on how successful intervention strategies are applied during project. Educational campaigns will be launched in all the suburbs of South West Sydney. The project aim will be to reduce barriers to treatment and care by increasing awareness about the frequencies of mental disorders, their treat ability, the recovery process and human rights of people with mental disorders. According to Harnois and Gabriel (2000) the care choice should be available and their benefits should be widely disseminated so that responses from general population, professionals, media, policy makers and politician will be reflect the best available knowledge. People will be informed about risk factors of disease. Mental health policy and legislations will be essential in sustainability of this project. According to Brundtland (2001) Policies which discriminates the people with mental disorders should be avoided. Health insurance schemes which also cover people with mental disorders should be encouraged, and policies should be formulated regarding this.
Supported environment will be created for mentally ill patients by involving communities, families and consumers. Charles, Wallace, Tauber, and Wilde (1999) state that Patients who are at risk of developing mental disorder due to certain kind of frustration should be encouraged by providing them job opportunities and enhancing their personal skills by vocational training programs in community. Setting should be done like shifting patients from mental hospitals to community care centres, which are cost effective as well as respect the human rights. according to Charles, Wallace, Tauber, and Wilde (1999) mental health services should be provided in the community with all available resources, their by strengthening the community action as well as reorienting health service for mentally ill patients. This enable the patient to live in normal environment, like Italian city of Trieste has created an impressive network of community based services, protected apartments and co operatives employing mentally ill persons.
By developing personal skill of patients and their families will help them in their ability to make a informed decision about their health, and this will again help in treating the people regarding the nature of disease, treatment available and outcomes.
In this project mostly Beattle’s (1991) model (cited in Naiido and Willis, 2000) is covered, which includes health persuasion, legislative action, personal counselling and community development. This project also covers the traditional perspective of Caplan and Holland (1990) model.
The activities will be evaluated to achieve the desired outcome. Policies will be reviewed twice during the whole project to analyse its effects on mentally ill people, their relatives and general population (which is well supported by Primary Mental Health Care, 2004). The role of community centres and home care visits will also be evaluated. The community centres will be frequently visited to see their efficiency and quality care. Statistically and clinically significant improvements will be recorded. The aim of this evaluation, basically, will be to achieve the desired outcome as mentioned below.
ANTICIPATED OUTCOMES, PLANS FOR SUSTAINABILITY AND DISSEMINATION OF RESULTS
Outcomes that could be anticipated after this project are:
- Increased level of literacy in mental health field in general community and in particular settings, and decreased levels of stigma experienced by people associated with mental illness.
- Increased ability of communities to prevent mental problems, mental illness and suicide, and also identifying and intervening with people at risk.
- Better access to general practitioner and other primary care providers.
- Better access to range of community based alternatives.
- Better access to early intervention services.
- Improved access to service for population group of all ages especially between 16 to 64 years of age with diverse and complex needs.
- Improvement in values, attitudes, knowledge and skills of mental health work force.
Outcome of this project will be disseminated by co ordination of services across lifespan and thus continuity of care can be achieved, which involves specialist mental health sector and primary care.
Sustainability of this project will depend upon:
- Level of acceptance of interventions
This is reflected to the appropriateness of the intervention, and the way interventions are carried out and also to the degree to which people comply with an intervention.
- Resources required for intervention
This mean relative level of resources required (both material and personnel) to carry out an intervention. If the resources required are greater then available then interventions will be non sustainable within community.
- Benefit to the community from intervention
If community realizes the benefit from activities then interventions is more likely to be sustainable.
According to Brundtland (2001) transferability means ability of an intervention that is successful in one community to be applied to other communities. Factors which will affect the transferability will be degree and effectiveness of community and health infrastructure, effectiveness of partnership and inter sectoral collaboration along with the community participation. If interventions non sustainable in one community, it has less likelihood of being transferable to others communities.
Andrews, G. Henderson, S. and Wayne, W.H. (2001). Prevalence, co morbidity, disability and service utilization: overview of the Australian National Mental Health Survey. British Journal of Psychiatry, 178(17), 145–153.
Bailey, E.L. Ricketts, S.K. Becker, D.R, et al. (1998) Do long-term day treatment clients benefit from supported employment? Psychiatric Rehabilitation Journal 22:24-29.
Brundtland, H.G. (2001) Mental Health Around the World: Stop Exclusion: Dare to Care. Retrieved on 18-10-2004 from: WHO
Charles, J. Wallace, J. Tauber, and R. Wilde, J. (1999) Rehab rounds: teaching fundamental workplace skills to persons with serious mental illness. American Psychiatric Association, 50:1147-1153.
Harnois, G. and Gabriel, P. (2000) Mental Health and Work: Impact, Issues and Good Practices. Geneva: World Health Organization and International Labour Office.
Naidoo, J. and Willis, J. (2000) Health Promotion: Foundation for Practice. Edinburgh: Balliere Tindall.
Primary Mental Health Care. (2004) AERF Alcohol and Mental Illness Project: Guide to Evaluation. Retrieved on 16-10-2004 from: http://som.flinders.edu.au/FUSA/PARC/AERF_about_evaluation.htm
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World Health Organization. (2004) Mental Health: The bare facts. Retrieved on 16-10-2004 from:http://www.who.int/mental_health/en/