This chapter begins Part 3 of the book, which outlines the strategies for health promotion in the community or in populations. We begin with mental health, which becomes increasingly salient as a concern of communities as they gain greater control over threats to physical health. Mental health, expressed in community terms, reflects and influences social health. The economic stability and social supports of a community influence the stress and coping balance of individuals and families. Community health professionals and institutions can help adjust this balance when the levels of stress exceed the coping resources of individuals and families. The overall objective of this chapter is to provide you with concepts and methods useful in analyzing community mental and social health needs and in planning programs to strengthen the capacity of individuals, families and communities to prevent and treat mental health problems.

The epidemiology of mental illness, stress, and social pathology is presented in the initial sections, followed by the identification of specific community interventions to prevent or reduce the causes of mental health problems, suicide, and violent behavior. Some of these issues will be taken up again in the chapters on health promotion, community recreation and fitness, and injury control. The community mental health approach to these problems builds institutional resources to help people cope with their problems, to provide treatment facilities for those who cannot afford private psychiatric care, and to provide rehabilitation resources for those released from state mental care institutions. Primary prevention has consisted largely of public and school mental health education, but current approaches also include increasing emphasis on maternal bonding, parenting, day care facilities for the children of working women, and support groups for people facing or coping with life transitions such as divorce, unemployment and retirement. Employee Assistance Programs, once concerned primarily with alcohol and drug misuse, increasingly seek to help employees cope with family, economic and emotional problems.

City Workers Feeling the Blues Can Call Up a "Mood Meter," An Automated Phone System That Screens For Depression. BOSTON (AP, Feb. 3, 1999) They just can't expect to talk to a live person. Callers listen to recorded descriptions of how they feel and are asked how often they feel that way. Descriptions range from "I get tired for no reason" to "I feel others would be better off if I were dead." Callers punch the digits and hear a recorded diagnosis that urges severe cases to get counseling. Officials said the hotline is valuable for the city's 18,000 workers, who are often blamed for the city's maladies.

U.S. Mental Health System in "State of Third World Collapse" Weston Got Gun Permit Despite Mental Illness. (Washington Post, July 28, 1998)

Abuse Drove Boy to Suicide. (Vancouver Sun February 13, 1997)Golden Gate Bridge to Institute Suicide Patrols. (New York Times February 25, 1996)

Indulge Yourself – But Don’t Feel Guilty, Experts Say. (Reuter November 7, 1996. July 28, 1998)

Suicide Rates to 2003. MMWR 2005: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5415a1.htm.

Steele, Ric G.; Roberts, Michael C. (2005). Handbook of Mental Health Services for Children, Adolescents, and Families. New York: Springer. 

Allen, D. (1999). Success And Failure In Community Placements For People With Learning Disabilities And Challenging Behaviour: An Analysis Of Key Variables. JOURNAL OF MENTAL HEALTH 8(3): 307, June.

Bartlett, C. J., & Coles, E. C.   (1998).  Psychological Health And Well-Being: Why And How Should Public Health Specialists Measure It? Part 1: Rationale And Methods Of The Investigation, And Review Of Psychiatric Epidemiology. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 281-287.

Bartlett, C. J., & Coles, E. C.   (1998).  Psychological Health And Well-Being: Why And How Should Public Health Specialists Measure It? Part 2: Stress, Subjective Well-Being And Overall Conclusions. THE JOURNAL OF PUBLIC HEALTH MEDICINE 20 (3): 288-294.

Bellamy, C. D., & Mowbray, C T. (1998).  Supported Education as an Empowerment Intervention for People with Mental Illness.   JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5): 401-414.

Black, M. M. (1999). Commentary: Feeding Problems: An Ecological Perspective. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 217-219, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

Brown, J. S. L., & Cochrane, R. (1999). A Comparison Of People Who Are Referred To A Psychology Service And Those Who Self-Refer To Large-Scale Stress Workshops Open To The General Public. JOURNAL OF MENTAL HEALTH 8(3): 297-306, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax.09638237/v8n3/contp1-1.htm.

Chaney, J. M., Mullins, L. L., Uretsky, D. L., Pace, T. M., Werden, D, & Hartman, V. L. (1999). An Experimental Examination Of Learned Helplessness In Older Adolescents And Young Adults With Long-Standing Asthma. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 259-270, June.
    For this issue of the Journal, go to: http://jpepsy.oupjournals.org/cgi/content/abstract/24/3/259.

Craft, B. J. , Johnson, D. R., & Ortega, S. T.   (1998). Rural-Urban Women's Experience of Symptoms of Depression Related to Economic Hardship.  JOURNAL OF WOMEN & AGING 10 (3): 3.

Cuijpers, P. (1999). The Effects Of Family Interventions On Relatives' Burden: A Meta-Analysis. JOURNAL OF MENTAL HEALTH 8(3): 275-286, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Jelalian, E., & Saelens, B. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Pediatric Obesity. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 223-248, June.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

Kerwin, M. L. E. (1999). Empirically Supported Treatments In Pediatric Psychology: Severe Feeding Problems. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 193-214, June.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

Kilmer, R. P., Cowen, E. L., Magnus, K. B. (1998).   Differences in Stressors Experienced by Urban African American, White, and Hispanic Children. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5): 415-428.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

McBride, T. D., Calsyn, R. J., & Allen, G. A.  (1998).  Duration of Homeless Spells Among Severely Mentally Ill Individuals: A Survival Analysis. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):473-490.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

Neugebauer, R., Wasserman, G.A., Fisher, P.W., Kline, J., Geller, P.A., & Miller, L.S. (1999). Darryl, A Cartoon-Based Measure Of Cardinal Posttraumatic Stress Symptoms In School-Age Children. AMERICAN JOURNAL OF PUBLIC HEALTH 89 (5): 758-761.
    ABSTRACT: Objectives. This report examines the reliability and validity of Darryl, a cartoon-based measure of the cardinal symptoms of posttraumatic stress disorder (PTSD). Methods. We measured exposure to community violence through the reports of children and their parents and then administered Darryl to a sample of 110 children aged 7 to 9 residing in urban neighborhoods with high crime rates. Results. Darryl's reliability is excellent overall and is acceptable for the re-experiencing, avoidance, and arousal subscales, considered separately. Child reports of exposure to community violence were significantly associated with child reports of PTSD symptoms. Conclusions. Darryl possesses acceptable psychometric properties in a sample of children with frequent exposure to community violence.

Norman, J. & Peck, E. (1999). Working Together In Adult Community Mental Health Services: An Inter-Professional Dialogue. JOURNAL OF MENTAL HEALTH 8(3): 217-230, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Onyett, S. (1999). Community Mental Health Team Working As A Socially Valued Enterprise. JOURNAL OF MENTAL HEALTH 8(3): 245-252, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Peck, E. (1999). Introduction To Special Section On Community Mental Health Teams. JOURNAL OF MENTAL HEALTH 8(3): 215-216, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Peck, E. (1999). Tensions In Mental Health Policy? JOURNAL OF MENTAL HEALTH 8(3): 213-214, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Peck, E. & Norman, I.J. (1999). Working together in adult community mental health services: Exploring inter-professional role relations. JOURNAL OF MENTAL HEALTH 8(3): 231-245, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Pilgrim, D. & Bentall, R. (1999). The Medicalisation Of Misery: A Critical Realist Analysis Of The Concept Of Depression. JOURNAL OF MENTAL HEALTH 8(3): 261-274, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Richard, L., Breton, E.R., Lehoux, P., Martin, C., & Roy, D. (1999). How Public Health Professions Perceive Two Dimensions For Promoting Health: Ecological Approach And Participatory Approach. CANADIAN JOURNAL OF PUBLIC HEALTH-REVUE CANADIENNE DE SANTE PUBLIQUE 90 (2): 99-103.
    ABSTRACT: The aim of this paper is to explore public health professionals' perceptions regarding two dimensions of the new health promotion movement; the ecological approach and the principle of community participation. Data were collected by focus-groups of public health professionals (n = 22) in one Public Health Directorate in Quebec. Results indicate a fair degree of integration of these two dimensions into the respondents' professional practice. However, limitations related to the work environment and to the theoretical underpinnings of these two components might impede the respondents' ability to integrate them into their practice.

Riekert, K. A., & Drotar, D. (1999). Who Participates In Research On Adherence To Treatment In Insulin-Dependent Diabetes Mellitus? Implications And Recommendations For Research. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 253-258, June.
   For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

Santos, S. J., Bohon, L. M., Sanchez-Sosa, J. J. (1998).  Childhood Family Relationships, Marital and Work Conflict, and Mental Health Distress in Mexican Immigrants. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):491-.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

Smith, J. A., Hughes, C. T., & Budd, R. J. (1999). Non-Compliance With Anti-Psychotic Depot Medication: Users' Views On Advantages And Disadvantages. JOURNAL OF MENTAL HEALTH 8(3): 287-296, June.
    The Journal’s website is at: http://www.catchword.com/titles/carfax/09638237/v8n3/contp1-1.htm.

Snowden, L. R.  (1998).  Racial Differences in Informal Help Seeking for Mental Health Problems. JOURNAL OF COMMUNITY PSYCHOLOGY 26 (5):429-438.
    The Journal's Home Page is: http://www.oup.org/pubs/jcp.html.

Stark, L. J. (1999). Commentary: beyond feeding problems: the challenge of meeting dietary recommendations in the treatment of chronic diseases in pediatrics. JOURNAL OF PEDIATRIC PSYCHOLOGY 24 (3): 221-222, June.
For this issue of the Journal, go to: http://jpepsy.oupjournals.org/content/vol24/issue3/.

1. Computers and technostress. Computers have become a fact of life for many, but for those with limited technological skills they may arouse feelings of inadequacy, anxiety, and stress. Consider how a community health education program might address this issue. Does the increased pace of work afforded by the efficiencies of computers create more time for reflection and relaxation, or does it merely result in taking on more work? Consider John Naisbitt's, "We are drowning in information but starved for knowledge."

2. Powerlessness and stress. The public's fear of contracting AIDS has reached epidemic proportions in the United States, producing problems for employers, school officials, and government agencies. Some people believe that information in the mass media and on web sites, regarding contagion and prevention, has increased rather than diminished the public's anxiety. Develop a community health strategy that would (1) inform and protect citizens and (2) prevent isolation of the AIDS victim.

3. Self help groups. Attend a meeting of a mutual self-help group in the community (with their permission) and observe the strategies employed to change or reinforce behavior. Again, you can use the PRECEDE model introduced in chapter 4 to explore how these groups predispose, enable and/or reinforce change.

4. Gender and mental health. Women are more likely to discuss their feelings of distress and anxiety than men and are also more likely to be medicated for these complaints. How do social roles affect mental health? How has your community prepared itself to address the mental health needs of men and women?

5. Suicide and youth. While Figure 9-2 shows that some progress is being made on suicide, attempts at suicide among adolescents is moving in the wrong direction. Explore the suicide rates among adolescents and youth for their own community. Then have them identify resources, such as community agencies and hotlines, set up to deal with the issues around youth suicide.