The urgency of addressing mental health with a nursing and community perspective
Summary
In this article, the president of the Spanish Association of Community Nursing reflects on the pending issues in community mental health care.
Three decades after the reform of the General Health Law, which established the community approach to people with mental health disorders, putting an end to the old "asylums", the objective of integrating the community model of mental health care with health promotion as a central axis has not been achieved, according to the author.
José Ramón Martínez Riera highlights the importance of incorporating nurses specializing in mental health and specialists in family and community nursing to achieve comprehensive and continuous care in addressing community mental health.
35 years ago, the General Health Law proposed a reform in psychiatry to care for people with mental disorders in a community setting and not isolate them in a hospital; therefore, it urged the closure of "asylums" and the promotion of mental health units in the community.
Coinciding with this legislation, Spain began implementing what came to be known as the new model of Primary Health Care (PHC). Among its distinguishing features were:
- Longitudinality, that is, the long-term relationship established between the healthcare professional and the person receiving care.
- Accessibility
- Comprehensive care, focused on the health of individuals, families and the community.
The new health law and the new primary care model allowed us to look forward with optimism to mental health care from a community perspective that would eliminate clichés, stereotypes and stigmas that had been suffered for so long not only by people with mental health problems, but also by their families and the environments in which they lived and coexisted.
The Mental Health Units (MHUs) created for this purpose constituted a link between Primary Health Care, in which they were integrated and on which they depended, and hospital care, which favored continuity of care in the best therapeutic environment for the person: their home.
Focus on health, not illness
However, this approach soon shifted towards a purely clinical approach as a result of the influence of the prevailing model in the National Health System (NHS) based on medicalization, patriarchal welfare, paternalism and hospital-centrism, which ended up absorbing the USM in most of the Spanish state, which then became dependent on hospitals.
Therefore, we can say that for 35 years there have been no "asylums" as infrastructures, but the powerful centripetal inertia towards medicalization and hospital-centrism has not allowed the essence of the community care model to be developed, so unfortunately the stigmas resurfaced strongly and with them the systematic rejection towards these people and their families.
After many years of drift, the Ministry of Health, Consumer Affairs and Social Welfare promoted a change that sought to update Primary and Community Health Care, in which Mental Health is integrated.
However, despite the positive reception of the measures, there is still strong resistance to the inclusion of community-based approaches in mental health and to the implementation of comprehensive and integrated care that focuses on health rather than disease.
All of this leads to the fragmentation of care, focusing more on pathologies and their diagnoses than on health problems in a comprehensive way, both towards the person who suffers them and the family and environment of which they are a part.
Given this scenario , it is urgent to integrate the community model of mental health care in such a way as to ensure the implementation of comprehensive and integrated care that moves away from clinical-assistance and paternalistic behaviors and has as its backbone the promotion of health and community intervention from which to develop strategies based on community services that provide effective and efficient responses.
Care that not only focuses on illness, but also promotes healthy environments through community interventions (schools, senior residences, workplaces, etc.) that foster mental health throughout the community, enabling healthy people to maintain their well-being. This also includes providing, when necessary, accessible, inclusive, and compassionate care that integrates both healthcare system and community resources to deliver effective and efficient responses to the needs of individuals, their families, and the community as a whole.
Beyond investments, which are undoubtedly necessary, the real priority is to carry out adequate planning that reorganizes and rationalizes both existing community resources and the health professionals involved.
Special significance and attention should be given to the incorporation of specialist mental health nurses and family and community nursing in primary health care in order to carry out comprehensive, integrated, integrative and continuous care in the approach to community mental health, in which the active participation of people and families in decision-making is fundamental.
After 35 years, community mental health care remains a health and social challenge.
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