Community-based mental health care encompasses a wide variety of programs and services designed to meet local needs. These programs are delivered primarily by community agencies and sometimes through hospitals or health clinics. The majority of programs provided by community-based agencies are designed to serve the most vulnerable and most severely mentally ill.
Often, people that receive community mental health services have a diagnosis of schizophrenia, chronic depression, bipolar disorder or borderline personality disorder. Most have been ill for a lengthy period of time. And have suffered from a series of complex life problems such as poverty, homelessness, involvement in violent relationships, a history of child abuse, incidents of victimization through sexual or physical assault in adulthood, multiple periods of institutionalization, physical illness, and, sometimes, trouble with the law.
To meet the needs of people experiencing homelessness that also experience mental health problems a number of community mental health services are required:
Different types of subsidized and supported housing such as group homes, shared accommodation and apartments. Housing workers visit sites regularly offering counseling and holding tenants' meetings. Some agencies work with individuals to find appropriate housing in the private sector. Some agencies provide 'safe houses,' which provide short-term accommodation for people in crisis, designed to prevent hospitalization.
Case managers work one-on-one with individuals, often several times a week, in the setting of the client's choice (apartment, coffee shop). They help people find the services they need, access medical care, acquire new skills, find jobs and make friends. Certain case managers also provide counseling or help in overcoming addictions and work to prevent hospitalization.
Psychiatric treatment for mental illness may be offered in hospitals and includes assessment, diagnosis, the prescription and monitoring of medication, electro-convulsive therapy and interpersonal or cognitive therapy (individual, group or family). In the community, multi-disciplinary teams that include psychiatrists, social workers, nurses and case managers provide treatment to clients in their homes and in their communities so that hospitalization can be prevented.
Peer support and self-help programs:
These groups bring together people with similar circumstances or illnesses to share experiences, challenges and coping strategies. Family members also have their own support groups.
Community mental health agencies respond to people who are in a crisis situation by assessing their immediate circumstances, providing short-term counseling, getting prescriptions for medication or assisting with hospitalization if it is required.
Mobile crisis services:
These services operate 24 hours a day and provide immediate care where and when they are needed.
Court diversion programs:
People with a mental illness who have committed a minor offense need not go to jail. Instead, court diversion programs work to get them the help that they need outside of the judicial system. Court division programs reduce court costs and meet people's mental health needs in a more effective manner than the corrections system.
These programs provide a place for people to go to five days a week. Members participate in the running of the club but they also can receive training for work and support while in job placements.
Agencies partner with local businesses to find jobs for people with a mental illness. Staff may also provide skills teaching and job coaching.
Community mental health services are developed with the particular needs of the community in mind. Some agencies provide warming rooms for those experiencing homelessness in the winter where people can take a shower, eat and have a good night's sleep. Other examples of programs include support groups for the newly bereaved, or people who are divorcing, clothing or food banks, and education programs on mental illness for high school students.