What is social psychiatry?

Social psychiatry is a branch of psychiatry that aims to study the impact of social environment factors on mental health. Social psychiatry includes not only an empirical science based on sociology, but also a therapeutic practice that aims to maintain mental health and integrate persons with mental disorders into society.

As formulated by G. Huber (1987), social psychiatry represents various forms and methods of treatment and rehabilitation of persons with mental disorders (day and night clinics, patient clubs, workshops, hostels, etc.). In addition, the author includes in this concept the attitude of society toward the mentally ill.

According to the famous English scientist A. Leigton, the subject of social psychiatry is defined by five basic provisions:

1. Social psychiatry focuses on human communities.
2. It focuses on socio-cultural processes in society and makes constructive use of them in providing care to the mentally ill.
3. It is more responsible to society and its institutions than to the individual patient.
4. It brings clinical knowledge to strategically important structures of the social system of society.
5. It brings to clinical psychiatry the knowledge of the social sciences about human behavior.

The Swiss psychiatrist L. Chompy regards social psychiatry as "part of general psychiatry, which understands and treats the patient within, and together with, his social environment.

One of the leaders of German social psychiatry, K. Dörner (1995), formulated the main basic principles of social psychiatry:

1. Social psychiatry assumes equality of opportunity for all members of society, including those with mental disorders.
2. Psychiatric diagnoses should not be stigmatizing.
3. Social psychiatry should be based on the principles of solidarity with persons suffering from mental disorders.
4. Prevention and rehabilitation should be the psychiatrist's priority.

According to T. B. Dmitrieva, B. S. Polozhy (1994), the tasks of psychiatry are the study of:

1. Links of social environment factors with the prevalence, occurrence, clinical manifestations and dynamics of mental disorders.
2. Possibilities of social influences in therapy, rehabilitation and prevention of mental pathology.

One of the founders of Soviet social psychiatry is Dmitry Yevgenyevich Melekhov.

Social psychiatry as a therapeutic practice (community psychiatry)

In Western countries, the practice of social psychiatry is called community psychiatry. This practice embodies the idea of decentralization of psychiatric care, taking it beyond the boundaries of hospitals to a smaller social setting (to neighborhoods - in the community) with the necessary set of semi-inpatient and outpatient links.

In addition, community psychiatry is the idea of bringing services closer to the client (medical and psychiatric services, rehabilitation, care services, etc.) in order not to remove the client from the natural social environment, but to provide services in the place of residence - where his relatives and close people who can provide support are. Specialists note that the task of better adjusting/adapting people with mental health problems, increasing their level of social functioning is only possible in the person's familiar social environment.

The initial conceptualization of community psychiatry was proposed by G. Caplan in 1961. It regarded the community as the cause that generates stress, which in turn produces mental disorders. Therefore, on the one hand, it is necessary to work with the community to reduce the impact of stressors (primary prevention) and, on the other hand, the community must bear the burden of treating and caring for people with disorders, since it is responsible for the emergence of these disorders.

Thus, community psychiatry is a new organization of medical and rehabilitative care for people suffering from mental disorders, with an emphasis on supporting social functioning instead of a long stay in a psychiatric hospital (isolated from the social environment). In addition to pharmacotherapy, other methods of intervention are widely used: psychotherapy (individual, family, group), psychosocial rehabilitation (social skills training), vocational rehabilitation.

Initially, the person may be offered participation in programs that are a model of flexible out-of-hospital mental health care based on an assessment of need, providing treatment, home care, or community mental health services (located in the community). These programs increase access to mental health services and improve therapy outcomes. If going through these programs does not improve the person with a mental disorder, outpatient clinical services, day treatment are offered, and only when all of these forms of care do not improve is hospitalization offered.