It’s Not Just a ‘You’ Problem, It’s a ‘We’ Problem: Understanding Community Mental Health

Author: Rae Hui-Min

Why does someone struggle with poor mental health?

We often assume that poor mental health is caused by individual factors. For instance, they might not be taking good care of their own health and wellbeing with their poor lifestyle choices and behaviors.

Perhaps, they’re just too sensitive to certain situations. Most individuals wouldn’t react the same way or be as affected if they went through the same situation, right? Maybe they’re just more susceptible to poor mental health or mental health disorder.

When someone struggles with their mental health, we almost immediately start to assume individual factors to be the cause of it. However, with the surge in reports of declining mental health in Malaysia when the pandemic first started, is it still safe to assume that individual factors are solely responsible for this?

Think about it this way:

When a plant is wilted and not growing well, do you assume that its lack of growth is due to the plant itself? Or would you consider its environmental factors such as poor soil quality, lack of sunlight, lack of water and nutrients to play a role instead?

So, is it really just an individual responsibility to maintain one’s mental health?

The Ecological Model: Your Environment Plays a Larger Role than You Think

We can better understand the causes of increased reports of stress, anxiety and depression during the pandemic using the ecological model. The ecological model understands the roots and solutions to issues by looking at the larger picture. This means looking at the problem beyond just on an individual level, but how the individual’s environment (their social circles, what is happening in the world around them, and how they all interact with each other) plays a part in the current issue.

Let’s try looking at the bigger picture through an example together!

First, we all feel the persistent concern for our health and safety as the number of infections continues to grow. These concerns may be particularly higher for those with high risks, or those that have loved ones with high risks. The growing infection rate has also put a huge strain on our healthcare service providers. Hospital beds, doctors, nurses, medical professionals and equipment were scarce, yet the need for these services continue to grow beyond its capacity. This growing burden can also lead to significant strains on the health and well-being of our medical frontliners, and may even limit the availability and capabilities of our already limited healthcare professionals.The lack of access to healthcare led to traumatic experiences for many, be it COVID related issues or non-COVID related medical emergencies. Additionally, it may have left loved ones traumatized by the lack of proper care and support in times of need.

For safety concerns, we had to adapt to drastic lifestyle changes almost immediately, including social distancing, wearing face masks, constant sanitizing, and avoiding crowds. These lifestyle changes can lead to frustrations, and disrupt many different aspects of the community that changes the very way it functions.

For example, social distancing and isolation has disrupted our social relationships. We were no longer able to bond and connect the same way that we used to, leading to deteriorated interpersonal relationships and feelings of loneliness. Some even start feeling disconnected from their communities and may no longer feel supported in times of need. In the initial phases of the pandemic, stay-at-home orders forced many to spend time at home. While some bonded during that period, many also felt overwhelmed by it, which led to more family conflicts. Some even no longer found safety in their homes.

The pandemic has also led to many unemployment and financial distress, some affected more than others. People lost their jobs, businesses and their means of supporting themselves and their families. Many were not able to address the pressures to provide as there was a lack of means to deal with the issue, leading to major distress and anxiety. People were left lost and hopeless, some even taking drastic measures as they no longer see a solution to their situation.

With the evolution of different variants, this seemingly endless cycle is also starting to lead to fatigue and exhaustion. Due to the traumatic experiences from the first year of the pandemic, many are now concerned about reliving those experiences again. Many have yet to get back on their feet, and are now faced with the possibility of a worse scenario.

In conclusion, mental health cannot be understood just on an individual level. Instead, there needs to be consideration for what's going on in our environment, as there is an interdependent relationship between the individual and their environment. In essence, changes in the environment would influence changes in the individual, and vice versa.

This is the ecological model of understanding mental health.

Therefore, if we address these environmental factors and events that are the root causes of declining mental health, we can then support beyond just the individual. Support efforts would be more efficient and sustainable as we also support the larger population affected by the same issues as well.

And that is the approach of community mental health.

Community Mental Health: A multi-level intervention approach to mental health.

When addressing mental health, community mental health considers interventions on multiple levels: the individual, their family and close social circles, their neighborhood, their community, and the policies and cultures of the societies they belong to.

Since all these levels play a role in influencing individual mental health, it also follows that something can be done at each level to improve and support the mental health of their community members. By intervening at each level, this empowers the community members with a self-sustainable approach to protect and promote their well-being for the long-term. In sum, it aims to create positive changes in the social and environmental structures to overcome the factors contributing to the community’s declining mental health.

And we all have a role in shaping the structure of our community: through our own actions, our interactions with others in the community, the beliefs and values we hold, and the different roles we play in our community.

So, we all play a role not just in supporting our own mental health, but the mental health of our community as a whole.

With the example of the increased feelings of loneliness in the elderly population during the pandemic, community mental health would approach the issue as follows:

As the elderly are a high risk population and could suffer severe health consequences, the majority of pandemic loneliness in the elderly are rooted in the pandemic restrictions. Therefore, community mental health psychologists would advocate for efforts in reducing pandemic severity. This includes supporting and calling for policies promoting nationwide vaccinations and safety measures that help flatten the curve and reduce community spread. Ideally, this would improve public health safety and allow for the ease of restrictions, and the elderly population would lower risks of falling ill.

Pandemic loneliness can also be attributed to the lack of community cohesion. Community cohesion is the relationship between members of a community, including how connected and supported they feel to their community. Due to the pandemic restrictions, many of our social circles have significantly reduced in size as we no longer actively come into contact with other members of the community. Some may even start to doubt their sense of belonging to their community, especially those who are inactive on social media and are highly dependent on face-to-face interactions, such as the elderly. A good solution to this would be to coordinate inclusive community events that allows the elderly to interact with their community safely. Community mental health psychologists would also recommend facilitating support groups for the elderly to help them feel heard and supported throughout the pandemic.

As the world continues forward at a fast pace, it is common for the elderly to feel left behind, even with family members. This loneliness would be exacerbated by the lack of healthy communication and time spent between families, and families feel like they cannot understand each other. To counter this, community mental health psychologists would encourage active listening skills and effective communication skills to better communicate with each other. They would also be prescribed family bonding activities that includes every family member, allowing them to practice their healthy communication skills and spend quality time. For special occasions such as holidays, anniversaries and birthdays, these family bonding events can also take place in person with controlled visitation procedures: including frequent self-tests, full vaccinations, proper mask wearing and sanitization.

Finally, due to their old age and perhaps even due to feeling left behind, the elderly may subconsciously socially isolate themselves from others, pushing themselves away from their social circles. Perhaps they would be living alone and are forced to self-isolate as the pandemic makes it difficult for them to spend time with others. In these instances, the elderly would be encouraged to pick healthy coping mechanisms to overcome the spiral of loneliness, or even taught social and technological skills, such as learning how to use technology to connect with loved ones or even make new friends).

How Do I Play My Part Today?

With the example given above, it is clear that the responsibility of improving and promoting mental health does not fall on just a single individual, but it is something we can all do, at different levels.

So, here are some actions you can take today to do you part in improving and promoting mental health in Malaysia:

While these steps may seem small and simple, your individual actions can inspire huge changes in others and even create a ripple effect leading to important changes in our community. So, take the step today and play your role, be the change we all need.

“Great things are done by a series of small things brought together.” - Vincent Van Gogh

References:

1. Jamaiyah, H., “Community Mental Health in Malaysia: Marriage of Psychiatry and Public Health”, Buletin Kesihatan Masyarakat Isu Khas 2000

2. Moritsugu, J., Vera, E., Wong F. Y., & Duffy, K. G., “Chapter 1: Introduction to Community Psychology”, Community Psychology (6th Edition)

3. Kendra Cherry, “Community Psychology Explores How Individuals Relate to society”, VeryWellMind

4. Leonard A., Jason, Olya Glantsman et al., “Introduction to Community Psychology: Becoming an Agent of Change”, College of Science and Health Publications