what is community-based mental health?

There is an opportunity to use the tenets of community-based mental health (CBMH).

A common misconception is the meaning of CBMH—that it is about putting mental health care closer to the community. This typically means integrating mental health professionals, such as psychiatrists or psychologists, in the barangay or municipal health office. This might also mean improving access to essential psychiatric medication or therapies. This might also mean outpatient psychiatric treatment instead of institutional care. In the Philippines in particular, this means more substance use treatment or rehabilitation programs in the local community. This is the approach favored by the new law.

This is not community-based mental health. The current law and existing policies and programs aim for ameliorative change. CBMH aims for transformative change.

Ameliorative change is a change in the mental health care system but retains the curative model. This model is borne out of the traditional illness approach where people with mental health problems are seen as “sick,” “less than,” or “vulnerable.” This ameliorative change also retains the power imbalance so endemic in the health care systems of developing countries. Health care workers and other professionals are seen as “experts” and “all-knowing,” relegating consumers and their families as passive individuals. This curative model is very much how the current Philippine mental health care system operates.

Community-based mental health is transformative change. Transformative change is about creating fundamental change in the values and operations of the mental health care system. Where ameliorative change is about “improving” the individual as well as policies and programs, transformative change is rooted in an ecological approach. Here, the problem is not the consumer or their families. The problem is the community. Central to addressing this is shifting the power imbalance back to the consumer so that they are empowered to make decisions about their own lives. In CBMH the consumer is not a passive vessel. She is an empowered, active agent.

The values of CBMH are too numerous for this discussion, but they can be summarized by the following:

  1. People with mental health problems participate in all aspects of their lives and are empowered. Consumers gain mastery over their own lives, such as choice and control over their treatment and support. Professional expertise is valued but so is lay knowledge. Everybody has something to offer in order to improve the recovery of the consumer.

  2. They are supported by the community. Every effort is made to integrate them back to the community. Institutional care is to be avoided whenever possible. CBMH emphasizes peer support, in particular. In CBMH the “experts” are not professionals. Rather, they are fellow consumers because shared or similar experiences of mental health problems can be powerful agents of transformative change.

  3. There is social justice with access to valued resources. In CBMH an individual with mental health problems is no different than anyone else with or without other health problems. Like anyone else who wishes to attend school, to be gainfully employed, or to otherwise fulfill their aspirations, an individual with mental health problems should have access to the same resources and opportunities.

Community-based mental health is an opportunity for growth, reach, and impact.