Grant Proposal Page

2021 GRANT PROPOSAL

FOR

COMMUNITY MINDSET

PROJECT TITLE

Community Based Approach to Mental Health Care is Better than Medical Care Project

LOCATION OF PROJECT

Pennsylvania

PROJECT DURATION

12 Months

TOTAL FUNDS NEEDED

$300,000

IMPLEMENTING ORGANIZATION

Community Mindset

NAME AND TITLE OF CONTACT PERSON

Robert Hampton

President and Founder

Background

The World Health Organization (WHO) defines inpatient psychiatric care as specialized, hospital-based overnight medical care for people with mental disorders. Community care, by contrast, includes non–hospital-based care, such as community mental health centers, outpatient clinics, day care centers, sheltered workshops, and clubhouses, for people with mental disorders. This latter form of care emerged in the late 20th century, when financial considerations, human rights movements, and the development of antipsychotic medications facilitated the deinstitutionalization of people with psychiatric conditions out of “insane asylums” in affluent countries. Since then, observers in both developed and developing countries have rejected institutional care as an inappropriate, or otherwise antiquated, approach in most instances.

The preference for community care guides much of the research in mental health, although with deficiencies. Longitudinal research has found that deinstitutionalization was associated with lower mortality rates among people with mental disorders, but the concomitant improvement in mortality rate among the general population remains a confounding factor. Similarly, a meta-analysis published in 2014 found that shorter psychiatric hospital stays were associated with higher social functioning, but the analysis included only six studies conducted between 1969 and 1980, when treatment in inpatient wards differed markedly from contemporary practices. Additionally, cross-sectional research has not shown conclusively that people with mental disorders accessing community services fare better than people accessing institutional care. This is because researchers tend to compare study groups to control groups lacking access to either type of care and because the patient populations of institutional and community-oriented services are frequently incomparable.

Community-based mental health programs are emphasized in the World Health Organization’s Mental Health Action Plan, the World Bank’s Disease Control Priorities, and the Action Plan of the World Psychiatric Association. There is increasing evidence for effectiveness of mental health interventions delivered by non-specialists in community platforms.

The incidence, prevalence, and prognosis of mental disorders is strongly linked to community-level factors. The availability and integration of mental health services into communities can promote accessibility, acceptability, affordability, and scalability of services, as well as promote adherence to treatment and increase the likelihood of positive clinical outcomes. Moreover, community services can play a crucial role in promoting mental health awareness, reducing stigma and discrimination, supporting recovery and social inclusion, and preventing mental disorders. It follows that international action plans and guidelines emphasize community mental health care.

The World Health Organization’s (WHO) Mental Health Action Plan for 2013–2020 calls for the provision of comprehensive, integrated mental health and social care including promotion and prevention programs in communities integrating the perspectives and engagement of service users and families. The WHO Quality Rights Toolkit requires the establishment of community-based, recovery-oriented services. Article 19 of United Nations Convention on the Rights of Persons with Disabilities asserts that persons with disabilities, including psychosocial disabilities, should be provided with support to live independently in the community.

The World Psychiatric Association’s (WPA) guidance on community mental health care characterizes community-oriented care as having a population and public health focus, community-based case finding, services available within half a day’s travel, participatory decision making, self-help and peer support for service users, treatment initiation in primary care facilities and communities, stepped care, specialist supervision, collaboration with non-governmental organizations (NGOs), and networks across services, communities, and traditional and religious healers. Similarly, the third edition of the World Bank’s Disease Control Priorities recommends community platforms for the following mental health service components: training gatekeepers for early identification and delivery of low-intensity psychosocial support, establishing peer and family support groups, raising awareness about harmful substance use, implementing workplace stress reduction programs, supporting community-based rehabilitation, and establishing community programs for child and adolescent mental disorders such as parenting programs with special attention to early childhood enrichment and life skills for adolescents.

The importance of community mental health care may have even greater relevance. The gap between the burden of mental disorders and available evidence-based services is staggering. Whereas one out of five persons with depression receive minimally adequate care, only one out of 10 receive care, and one out of 27 in lower-middle income countries. The picture has been equally bleak for severe mental disorders, where it is not uncommon for persons with schizophrenia to spend more than five years with active psychosis before evidence-based treatment is initiated.

About Our Organization

Community Mindset is a new approach to mental health connecting people to their passion. As nonprofit organizations, we play a vital role in building healthy communities by providing critical services that contribute to economic stability and mobility.

Community Mindset also strengthens communities in other important ways. Frequently, nonprofit leaders are the voice of the people they serve. Thanks to the combination of strong community relationships and intimate local knowledge, these organizations often understand better than anyone else their communities’ needs and the best ways to meet them. Strong, well-resourced nonprofits that are connected to the decision-making infrastructure in their communities can catalyze growth and opportunity.

We are trying to build a network of people who are willing to help. So when we find a need in our community, we can email everyone in the network and as a group we can solve the problem and help the person in need.

Mission

Community Mindset is poised at making a difference in the community. Studies show that children who feel a sense of identity within a group are the most well-adjusted and successful in school and with their “world view” — that, understands the relationship between self and others. Studies also reveal that some of the most important skills children need for success are social interaction, communication, collaboration and problem solving, all of which a sense of community can foster. How many of you, when you were a child, had someone do or say something to you that made such an impact on you that it shaped the person you are today? I believe that if everyone reading this were to really think back on their childhood, they would remember someone that did just that, someone who helped to shape the person you are.

Vision

To be the trusted partner for supporting healthy lives in our community

Project Goal

To become a major provider of community based mental health care in the community.

Project Objectives

To deliver holistic, high quality and competitive evidence based community based mental health, clinical neuroscience, and psychiatric care; and neuroscience program.
To expand the business by opening new Community based mental health centers in several locations.
To develop the business in supplementary fields.
To introduce more specialized psychiatric services.
To bring high-quality but affordably priced mental health services to the community

Project Description

Community Mindset is a community-level prevention planning and implementation system with primary focus on preventing mental health issues and its attendant effects such as substance use, violence, and delinquency and depression, suicide, and other mental health outcomes.

The Community Mindset approach will involve five phases: identification of community stakeholders, formation of a community coalition, development of a community profile to identify risk and protective factors related to mental health and behavior problems, creation of a community action plan, and implementation and evaluation.

We will work with critical stakeholders in the communities to implement evidence-based programs from the building healthy development registry.

Although we believe medication is needed in severe cases, we believe that most people suffer from depression and anxiety due to a disconnection with their community and we want to take an approach that a person’s environment is what really causes depression and anxiety.

Project Activities

This will include;

To get all necessary licenses to provide community based mental health services in the community
To recruit qualified local and international staff service providers
To cooperate with globally known partners for sharing of knowledge and best practices
To develop the non-clinical programs
To introduce new services
To develop loyalty programs to retain customers
To improve processes continuously
To initiate online and offline marketing campaigns
To outsource non-core activities to avoid unnecessary costs

Expected Outcome

Community Mindset mental health care program will result in improved individual outcomes: reduced substance use, delinquency, and violence; later initiation of alcohol use, tobacco use, and delinquency; and lower prevalence of risky behaviors (past-year delinquency, past 2-week delinquency, and past-month alcohol and tobacco use)

There is evidence for the effectiveness of community interventions for improving mental health and some social outcomes across social-ecological levels. Studies indicate the importance of ongoing resources and training to maintain long-term outcomes, explicit attention to ethics and processes to foster equitable partnerships, and policy reform to support sustainable healthcare-community collaborations.

Problem Statement

Since 1948, health has been defined in the World Health Organization’s (WHO) constitution as: ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’

Globally, hundreds of millions of people are affected by mental illness. An estimated 300 million people are affected by depression, and it is one of the leading causes of disability worldwide according to WHO. Every year, almost 800,000 people die due to suicide, making it the second leading cause of death among 15-29 year-olds globally. For every suicide, there are the countless families, friends and communities who are left behind and who experience long-lasting effects of such a tragedy.

The majority of those living with mental health conditions do not receive the care they need, particularly in low-and middle-income countries (LMICs). The reasons for this are complex but include a global shortage of health workers trained in mental health, a lack of investment in community-based mental health care and deep-rooted stigma and discrimination. In low-income countries overall, the ratio of mental health workers can be as low as 2 per 100,000 population compared with more than 70 in high-income countries.

Community-based services are essential to mental health. For decades, researchers, advocates, and policy makers have presumed that expanding the supply of these services hinges on reducing the supply of hospital-based care. Cross-national data from the World Health Organization call this presumption into question. Community and hospital psychiatry appear to be complements, not substitutes.

The dichotomy between hospital and community psychiatry is a cornerstone of mental health policy in countries around the world. Consider the title of a press release from the Organization for Economic Co-operation and Development: “The Netherlands Has an Innovative Mental Health System, but High Bed Numbers Remain a Concern”

Despite the mental health system’s otherwise admirable performance record, the persistence of inpatient care appears troubling. Assuming a trade-off, many international organizations prefer community care to hospital care, as do many researchers, advocates, and national policy makers. A modern, comprehensive psychiatric system presumably should condense its inpatient bed supply and instead develop the supply of outpatient care programs. This belief, however, relies upon uncorroborated evidence, and cross-national data challenge its validity.

Risk and Mitigation Plan

In community platforms, such as the home, prayer camps, traditional healing centers, and other religious institutions, persons with severe mental illness may be chained, kept in forced seclusion, and suffer sexual abuse and other forms of exploitation]. Therefore, outreach to communities is crucial for human rights protection. Standard facility-based psychiatric services are often inadequate to address negative social determinants of mental health such as economic deprivation, ethnic/racial discrimination, exposure to traumatic events, and violation of human rights. Moreover, the high levels of stigma toward people with mental illness among the general public and health workers is a barrier to seeking specialized mental health services.

Additional constraints include lack of evidence on screening and detection programs to identify persons needing care, lack of transportation infrastructure to reach health facilities, shortage of health personnel trained in mental health care, and lack of psychological treatments at health facilities. Given these challenges, it is vital to determine how to effectively work in communities and with community-based service providers for mental health care delivery in low-resource settings.

Despite the lack of conclusive evidence against the effectiveness of contemporary hospital psychiatry, memories of past abuses in mental asylums linger. Many advocates and policy makers presume that rejecting institutional care will foreclose the possibility of additional abuse, even if some forms of outpatient care raise similar possibilities. Many also believe that expanding community care will reduce overall mental health expenditures (by diverting patients away from costly psychiatric hospitals) and destigmatize mental health care (by promoting the social inclusion of those with a mental illness). Although some analysts have suggested that “bringing back the asylum” could correct some of the negative aspects of deinstitutionalization (such as the increased risk of homelessness, neglect, or imprisonment), skeptics of this argument worry that its return could hamper the development of community-oriented services Only by reducing hospital care and expanding community care, it is presumed, can societies optimize the treatment, empowerment, and ultimately, quality of life of people with mental disorders.

Methodology and Scope

Multi-sector and community-based mental healthcare approaches can help address health and social inequities by promoting social well-being and addressing structural determinants of mental health (public policies and other upstream forces that influence the social determinants of mental health).

There is evidence for the effectiveness of community interventions in multiple topic areas and acting at all social-ecological levels. International lay health worker interventions, a parenting intervention to reduce child abuse, a whole-school cognitive behavioral therapy prevention program, adapted community based teams for early psychosis and justice-involved populations, Housing First services, and multi-sector collaborative care and prevention services are examples of effective community interventions.

Studies indicate the importance of ongoing resources and training to maintain long-term outcomes and the need for policy reform to support healthcare-community partnerships.

Ethical considerations are of importance to many community interventions given the focus on marginalized and under-resourced populations. Research on interventions for at-risk individuals with stigmatized conditions (e.g., incarceration, homelessness) would build trust with participants and recognize structural forces that place them at higher risk for these conditions (e.g., discriminatory policing and housing policies), to avoid inadvertently worsening stigma.

Thus, Community Mindset is desirous of involving community stakeholders in equitable arrangements for interventions and research which requires the necessary time and processes to develop effective partnerships.

The expertise of community leaders and other stakeholders will be integrated equitably with that of researchers with trust, respect, and two-way knowledge exchange.

Sustainability

As a way of sustaining the community based mental health care, future research should further define best practices for multi-sector collaborations and partnership structures, identify strategies for sustainable change after the end of research activities, and clarify the types of health and social problems that are best ameliorated through community interventions.

Community Mindset believe that a close and equitable partnerships with communities and policy leaders, future community interventions in mental health should seek to improve mental health and achieve large-scale social outcomes through initiatives that address mental health, structural, and social inequities.

Community-based organizations, social services, and healthcare agencies also have different funding streams and incentives. Efforts to sustain community based interventions should include a focus on funding and other enabling infrastructures (e.g., training, technology) for community groups to participate in intervention-related activities.

Monitoring and Evaluation

Community Mindset, community based interventions for mental health will draw from a larger selection highlight of the successes and promise of several other interventions to promote mental health and broader outcomes at all social-ecological levels: individual, interpersonal/family, organizational/institutional, community, and policy.

Community involvement will be represented in varied ways in the form of individuals (lay health workers), settings (churches, schools), leaders (community-based participatory research), and multi-sector coalitions. Many studies examined the interplay among mental health services, social and structural determinants, and mental health outcomes. Some explicitly assessed social outcomes like intimate partner violence, housing retention, academic performance, parent-child interactions, “societal healing,” and other contributors to mental and social well-being.

The need for actions of community interventions by social-ecological level to promote mental health and social well-being cannot be over emphasized. Hence, most interventions reviewed promoted mental health at the individual level and interventions extend access and increase acceptability of mental health services by leveraging trusted relationships in the community.

Project Plan

S/N	ACTION	TIMEFRAME
1.	Obtain licenses to provide mental health services in community	June 2021 – September 2021
2.	Selection of beneficiaries, community and location	October 2021
3.	Community sensitization	November 2021
4.	Awareness raising / capacity building	December 2021
5.	Implement innovative marketing strategy to attract clients	January 20222
6.	Initiate online and offline marketing campaigns	February 2022
7.	Report writing	March 2022
8.	Research and development	April 2022
9.	Monitoring, evaluation and reporting	May 2022

Governance

The project will be coordinated by the Director of Community Mindset. who through his proven wealth of experience, professionalism, skills and expertise will oversee all project activities in the planning, implementing and reporting of agreed terms of contract.

BUDGET AND ALLOCATIONS

S/N	ACTIVITIES	COST ($)	TOTAL ($)
1.	Community mental health program	55,000	55,000
2.	Personnel Cost	18,000	18,000
3.	Communications (Phone, Website/Internet)	5,000	5,000
4.	Transportation	10,000	10,000
5.	Monitoring and Evaluation (once off payment to consultant)	5,000	5,000
6.	Miscellaneous	7,000	7,000
	TOTAL		$100,000