An Introduction to Community and Primary Health Care

Introduction

Mental illness is a leading cause of illness in Australia accounting for 13 per cent of the total disease burden (healthy life years lost) following cancer (16%), musculoskeletal conditions (15%) and cardiovascular disease (14%) (Australian Institute of Health and Welfare [AIHW], 2014). People with mental illness are more likely to die prematurely from physical illness (World Health Organization [WHO], 2013). One in five Australians and one in six New Zealanders will experience a mental illness in any one year (AIHW, 2014; Ministry of Health, 2012). Much of the care provided for individuals and families experiencing mental illness occurs within the community, and nurses are major providers of that care. This chapter focuses on the role of community mental health nurses in providing recoveryorientated care for individuals living with mental illness and their families.

Mental health care

Mental illness has been stigmatised within the community with a detrimental impact on individuals experiencing mental illness or mental health problems and their families. Negative attitudes are often reinforced by media representation of mental illness as something to be feared and individuals with mental illness portrayed as incapable and dangerous, resulting in social isolation, social exclusion and reluctance to seek support (Clement et al., 2015; Kopera et al., 2015). Fear of restrictive treatment in institutional mental health settings can deter individuals from seeking help and following through with treatment. However, increasing awareness of mental health and mental illness in the community through health promotion and education programs by community-based organisations such as beyondblue, the Black Dog Institute and SANE has resulted in changing social values.

Since the 1990s there has been a significant shift away from large psychiatric institutional care to care provided by local hospitals, community mental health services and in people's homes (Ministry of Health, 2012). Community mental health provides comprehensive mental health and psychiatric care where people live and work and, increasingly, policy and funding redirected towards delivering mental health services based on the principles of primary health care and health promotion. This includes flexible and accessible services where people live – not just in hospitals – with a strong emphasis on promoting community engagement and participation, social inclusion and individual rather than health provider choice (Ministry of Health, 2012).

Mental health policies in Australia and New Zealand emphasise prevention, early intervention and a culture of recovery (Department of Health, 2013; Ministry of Health, 2012).