The meaning of ‘community’

Health professionals are familiar with the importance of taking a clinical history so that a detailed appreciation of the past can lead to a richer interpretation of the present. The same ‘historical’ approach used to translate symptoms into diagnoses is applicable to the translation of words into useful concepts. In this manual, before discussing community mental health services we need to address at the outset the question: what is the meaning of ‘that overused word community’(Acheson,1985).

Table 2.1 shows five definitions of ‘community’,selected from the Concise Oxford Dictionary. The first two meanings (‘all the people living in a specific locality’, ‘a specific locality, including its inhabitants’), include both the people in a particular area and that locality itself. These lead us to our view that mental health services are often best organised for defined local areas, for all local residents, and that research upon such services will necessarily include consideration of the size and characteristics of the population at risk (the denominator).We shall return to what has been called ‘the science of the denominator’ when we discuss the ‘local level’ in Chapter 5 (Henderson,1988).

The third definition (‘body of people having a religion, a profession, etc., in common’) is consistent with our argument when we consider disaggregated sub-groups of the total population who may be at higher risk for particular mental disorders, or whose needs for services are distinct. Such groups may include immigrants, people who are homeless or those exposed to particular environmental or biological risk factors such as bereavement or pregnancy.