Family and community responses to mental illness.

Cultural groups respond differently to mental illness depending on the explanations of the cause, attitudes in the community toward mental illness and its treatment, and the social and community resources available to patients and their families. Our column last month explored these explanations and attitudes. This column focuses on family and community treatment of mental illness and the care of the mentally ill, especially those with severe mental illness. In Western and developed countries, mental illness treatment may be highly organized and provided by mental health institutions and professionals. Ideally, supportive community resources, together with family and friend networks, facilitate effective coping with mental illness (US Department of Health and Human Services [USDHHS], 2001). Often, however, this ideal is not achieved in practice. For example, in Italy there is a general belief and acceptance of biomedical explanations, the use of psychotropic medications, and a community psychiatric treatment model accompanied, nevertheless, by a belief that those with severe mental illness should not have children (Magliano et al., 2004). In developed and resource-rich societies such as the US, social stigma, shame, and embarrassment associated with mental illness, distrust of the health care system, and fear of psychotropic drugs still exist and may lead to denial and a failure to seek treatment (Matthews et al., 2006). Some modern societies embrace both biomedical and traditional treatments — psychiatrists and psychopharmacologic medications coexisting with holy men, religious rituals, and pilgrimages to shrines in