Providing Mental Health Services - Research Proposal Example

?Research Proposal Psychology Affiliation with more information about affiliation, research grants, conflict of interest and how to contact Introduction: Now the main issue that is faced by the US government is in providing mental health services. The government has made the frame work in such a manner that there is sufficient provision for various mental health programs. But the issue that is being troubling the concerned is the inability to implement various ideas. Many ideas are being developed in this section and many programs are organized in this subject, considering various problems faced by the local people and the immigrants in the country, but none of them has achieved the expected success in this matter. The major concern is in the suburban areas of the country, as the policies are not reaching the destination it is expecting. People in this area do understand the programs to act accordingly. But the most important factor that is faced by the state to implement the mental service is the increasing immigrants in the country. The number of immigrants is increasing at a steady rate and the various policies are not on the right way to act efficiently to an effect in the immigrant population. A large bulk of this population is from the rural areas in Southeast Asia and the Middle East, so they are not in touch with various services on this section and they don’t understand the programs on the mental health. The service does not reach these people effectively. The problem is not confined to people only, the department also various issue in providing the services. Department does not understand the section which require this services so they are unable provide them. By the time when the department identify the problem and provide the service, the condition would have become worse. Department identifies need for various services when there is a crisis. As the major section who requires the mental health services are immigrants as they will have to face many mental problems due to various reasons including change in the living condition, cultural changes, social factors, and many physiological interactions and interferences. But at the present condition department is able to provide the services only the time when there is crisis. This situation is to be sorted out with immediate effect in order to maintain mental level at standard level. Various surveys conducted all over the world have also shown the serious inability in the implementation of mental health services, of which US has a main contribution. The World Health Report 2001 clearly shows that mental and neurological conditions cause a serious amount of morbidity all over the world. It is estimated that about 10 million people in United States are affected by mental, neurological and substance-abuse disorders. Due to the immigration effects there are many people migrating to the state. Survey shows that a large proportion of the people live in countries, including the WHO South-East Asia Region are the people suffering from these problems. It is estimated that the burden of disease from neuropsychiatric conditions measured by DALY’s will increase from 9% of the total disease burden in 1990 to 14% in 2020. It is also known that a substantial proportion of people with neuropsychiatric conditions, do not get appropriate treatment. This is known as the mental-health gap or treatment gap for mental health. It is known above 85% of the people are not getting the services they are in need of. Neurological and psychiatric services have been mainly concentrated in tertiary-care hospitals. As such, large segments of the population, particularly those who live in rural and remote areas, have been deprived of such services. This is despite the fact that both neurological and psychiatric conditions are common in these communities Mental health care programs should include all mental health and well-being needs of the community and it should utilize all the community resources and the primary health system. It should also include, Improve the well-being and mental health promotion and the stigma removal. Psychological support from all sections of the society Rehabilitation to those people, including intellectually impaired, recovering substance impaired, chronically ill patients, and management of learning and behavioral problems. Treatment of metal diseases using primary health care system. “As a part of the new freedom initiative, the president established the new freedom commission on mental health. The commission’s mission was to study the nation’s mental health system and to offer recommendations to assist adults with serious mental illness and children with serious emotional disturbances to participate fully in their communities” (Goldman et al., 2009). Literature Review: Many organizations are framed with a view to provide service to different sections of the community, of which include Mental health self- help (MHSH) which refers to any mutual support- oriented initiative directed by people with mental illness or their family members. These initiatives become increasingly widespread over the years and today MHSH initiatives could overtake the traditional mental health organization in the United States Louis Brown has illustrated various mental health services and its effect in his book Mental Health Self-Help: Consumer and Family Initiatives. This book mainly focuses on the mainly focuses on the efforts directed by mental health service consumers or their family members. These initiatives are aimed to have an effect in the community as whole which include both locals and immigrants and it typically target mental health promotion goals such as enhanced coping and progress toward recovery. The extension to which mental health professionals influence organizational decision making varies substantially. Here it is important to analyze the strengths and weakness of the weakness of the organizational structure of the mental health service organization. As the as these services grow, they will face pressure from different sections, which include the opposition from different organization, different communities and so on. As such is the case there should be sufficient measures counter these. At the present stage these organization lack the personalized interactions, ability to influence and no strength to encourage the people. Also these organizations lack the support from different sections and community which includes the immigrants. As such is the case these organizations require sufficient restructuring in order to remove various inabilities. Of which the main thing is the extraction of support from other organizations and also from people. The Southeast Asian communities are in health risks as they have suffered a lot during the refugee experience. Vietnam War and its aftermath also lead to the trials and tribulations of the Southeast Asian immigrants. According to Barbara W K Yee Southeast Asians are at the risk of high blood pressure, high cholesterol and obesity. “Overall 61% were at moderate to high risk in at least one category” (Barbara, n.d).There was many people among these refugees who experienced a high degree of pain and trauma in the refugee camps. Most of them repressed these thoughts into the sub strata of the mind which resulted in the mental disorders of many of the immigrants. Dr. Morton Beiser, University of Toronto points out that there is a need for the understanding of the mental health of these immigrants. He spoke about his Refugee Resettlement Project from 1981 to 1991 in which he “studied the resettlement of over 1300 southeast Asian refugee adults who settled in Vancouver, British Colombia, Canada” (Beiser, 2011). The immigrants from the Middle East increased over the past years in US and these immigrants’ forms an important part of the population of interest in public health. Middle East includes Afghan, Arab, and Iranian and so on. These people have to face many barriers in the United States. These populations are not getting access to any of the human services just because they are immigrants from the Middle East. It is found out that though outreach services are available to the general public or to the minority groups, “outreach to the Middle Eastern population by the vocational services delivery system is generally not employed” (Yerakaka, 1994). Louis G Pol and Richard k Thomas observe Southeast Asian immigrants as “new” (Pol & Thomas, 2001). as they are not educated and include a large number of refugees from the wars of Southeast Asia. They points out that these immigrants come only with their clothes on their back. They come from counties were health care system is poorly developed and they also introduce new health problems in the community. This calls for attention of such problems with additional programs like distance counseling and new therapies for the improvement of the condition of such immigrants from Southeast Asia and the Middle East. According to Sylvia Reitmanova and Diana L. Gustafon those people who are immigrants are more accustomed to mental illness because of the problems related to the immigration. They also find it difficult to adjust with the new environment and have social stress. This as pointed by the writer’s may be due to the: “- social isolation cultural conflicts, role changes and identity crisis poor social integration and assimilation low socioeconomic status racial and religious discrimination Organizational, communication and financial barriers to utilizing mental health services” (Reitmanova & Gustafson, 2007). Method section: Thesis Statement: The present study investigates further on the distance counseling and therapy as an alternative to the mental health services rendered to the immigrants from rural areas in Southeast Asia and the Middle East. Preliminary studies have focused on the methods of delivering mental services by the department. The present study extends this line of research by focusing on the growing issues of the department. Research questions: The research questions answered in this research are: What are the major mental problems faced by immigrants Which mental health issues are potential concerns during crisis How much the immigrants are aware about the available services Research Method: The current study is centered in a suburban area of United States. The study focuses on the outpatient program of mental health. To develop a suitable strategy for new treatment method a study of previous experience is conducted. “Mental Health Outpatient Programs (MHOP) provides comprehensive, specialized, clinical treatment for individuals with a serious and persistent mental illness, whose needs are best met with services available from a broad range of clinical disciplines” (Mental Health Outpatient Programs, 2011). Research methodology is a step by step process to recognize specific task or purpose. The methods used for the research are principally secondary and primary methods. The secondary method consists of gathering of information already published or written by others. Primary method on the other hand is the collecting information first hand, that means it is the original information. Data collection is one of the vital components in the design of methodology. The sources of secondary data are mainly online resources, journals and books based on the topic. Primary data are collected mainly through observation method and communication method. Under observation method either natural setting or field experiment is done. The communication method consists of personal interview, telephonic interview, and self administered questionnaire. For the current research we use participant method which is generally a qualitative method comes under communication method. “Participant Observation is a method that attempts to understand the motives and meanings of people's behaviour from the viewpoint of those involved in the behaviour being studied” (Participant Observation, 2003). Participation method has the highest probability of success. Using the participation method answers for the research questions can be found. Participation method contains a variety of methods of data collection like participatory listening and observation, visual tools such as maps, semi structured interviews and focus group discussion. The participatory method helped to analyze the qualitative information about the research. “Qualitative Interviewing is an adventure in learning about teaching in different countries, their cultural views, their problems and solutions, and how their practices are similar and different than our own. The way we interview depends on what we want to know. It is a process of finding out what others feel and think about their worlds” (Rubin & Rubin, 1995). Data collection procedures: Under the participatory method the data is collected using three methods. The first method is transecting walks in which researchers undertake a walk to observe people, surroundings, and resources. This helps to understand the problem of the society and hence of people. The second method is social mapping which is used to present information regarding village layout, infrastructure, demography, ethno linguistic groups, health patterns, wealth and other community issues. The third method is community meeting in which information is obtained in the meetings with the people of the community. Analysis: The analysis of primary and secondary data is done to obtain the result of the research. The analysis of primary data obtained through participatory method is done using content analysis. The results obtained through participatory methods are unstructured in nature. Because of the unstructured nature of the data it is difficult to analyze the qualitative data. The qualitative data are generally analyzed using three approaches- coding, content analysis, and narrative analysis. These approaches are however a rather tentative approaches to interpret the data. The data regarding the outpatient program for mental health is collected using the participatory method and the analysis is done using the content analysis approach. “Content analysis is the coding of documents and transcripts, to obtain counts of words and/or phrases for purposes of statistical analysis. The evaluation team creates a dictionary, which clusters words and phrases into conceptual categories for purposes of counting” (Venne, n.d). Limitations: The major limitation is regarding the availability of data for the analysis. The primary data collected through the participatory method is not as fruitful as the respondents are not ready to agree that they mentally unhealthy. The analysis of data also faced problems as the data collected are qualitative. The content approach is done using certain norms which can be sometimes misleading. Another limitation is in identifying the major mental health problems during crisis as there are a number of symptoms for these deceases which are not identifiable using participatory method. The common mental health issues that are found during crisis are Acute Stress Disorder, Post Traumatic Stress Disorder, Substance Abuse and Addictions, Depression and Anxiety, and Domestic Abuse. Discussion The counseling and therapy has always made an effect on the peoples who were not able to respond to the dreadful situations. Since most of the countries has been the land of cross cultures, there were many immigrant peoples who were coming for there living and has been enjoying the fruitful conditions of the country. Most of the immigrant peoples are from the South East Asia and from Middle East. These newly arrived immigrants may not be conscious of the on hand services or to make use of them until an emergency take places. Immigrants did not find a clear cut distinction between the mental health and illness. They regarded the immigration process as a difficult one which led them to the mental illness. They did not have the social support, employment, physical environment and the mental health services. They did not even find support among the immigrant community. Many of them had limited sources and they experienced loneliness, and isolation. They had to struggle from the internal inequalities and there was no social network to support them. Immigrant women also faced many problems when compared to the immigrant men. If the condition of these immigrants has to be improved there should be consideration for the educational facilities that will be useful for the need of the good health and healthy environment. All the government departments of UK have to collaborate for the development of the health issues of the immigrants from Southeast Asia and the Middle East. The department should try to provide the services of the volunteers to these immigrants for their better living conditions. The problem of unemployment is associated with the health very crucially. This problem may lead to the poverty among the immigrants which is also associated with the lack of nutritional foods for the problem community. Due to unemployment, the people will have to undergo the mental stress which may lead to the mental disorder among many of the immigrants of the community mentioned in the discussion. The mental stress which the people undergo will lead them to undertake many of the unhealthy strategies like drugs, alcohol etc which is also a harm to the good health of the people. Many of these immigrants were suffered major adversities in their own countries as like fighting upset, deficiency and harassment. Some of them have the family problems that make them to escape to the countries like UK. “Resettling in a new country brings a unique set of mental health challenges for immigrants and refugees. Most immigrant parents who arrive in new communities are faced with immediate challenges to their survival – securing a job, finding a place to live, buying food, and enrolling their children in school” (Downs-Karkos, 2004). These immigrants have become an important part of the societies across the countries like USA and United Kingdom. The transformation of these immigrants has created some crisis in the society. There is a momentous quantity of effort that wants to be completed, as alertness of mental health needs is now developing. The mental health of this immigrant population is much important to make a healthy society in the country. The distance counseling and therapy has emerged in order to develop a healthy society. These methods might present an option for providing the services to this immigrant population. Multicultural sensitivity: The various cultures will create the troubles in the country. There are several cultures in the Middle East and South East Asian countries which will makes these people to follow, but the current traditions in the living country enforce them to pursue those cultures also. There have been several problems regarding the cultures for this immigrant population in the country. Some of the immigrant parents have the fear that their children become more attracted to the cultures of that country. There is an innovative set of society prospects concerning the responsibility of parents, together with a huge rank of participation in schools and supporting for kids in getting fundamental services as like mental health care. The kids tend to study the present atmosphere more than the parents and there have been a problem with the parents in understanding those languages. The most important mental torturing for these kids will be from the parent and from school, as they have to keep the culture of their parent country and also have the pressure from school authorities to fit with the culture of the present living country. There will be lot of variations in both cultures which will make these people to be uncomfortable. These stress and strain from the dual cultures have hurting consequences on these people’s mental health and this further leads to the harms as like sadness, violence, family fighting, or dropping out of school. The treatment for this mental healthcare includes counseling and some therapy tactics. Some of the peoples form the south east and middle east Asia consider the discussion of the mental health care issues as prohibited and some are not ready to explain there problems in the society. These immigrants face many obstacles in getting the proper treatment. The mental health care counselors may not have sufficient cultural experiences to really recognize the shades connected to mental healthcare in other backgrounds. Most of them have no training in mental health care and the lack of financial support also creates problems. Implications: Mental health services are there to hold up the plans that deal with psychological strength topics in an ethnically experienced approach. There were several tactics to give them the mental support and increase their efficiency in the country. These services include the straight psychotherapy, public support plans, cultural modification, parenting program and societal tutoring activities. The group considering the needs of these immigrant peoples is only with few properties and has to offer a good quality technological backing. There must be sufficient funds to raise these kinds of organizations that will increase the ethics of mental health care services. These service centers have to be more concerned about the requirements of the immigrants. It is found that the cultural, language and educational difference is the main reason for the decline in the mental services provided to the immigrants. Immigrants face hypertension which leads to the higher dementia rates in these communities. Ethical considerations: There have to be some moral consideration while finding the causes of the immigration and their mental health problems in the host country. “In general, physicians do not ask foreign-born patients about their documentation status; however, social workers or other hospital employees frequently inquire about documentation status to determine the patient's eligibility for health care–related services. When foreign-born persons report being undocumented, they do not likely anticipate that this information will be used to distinguish them from other patients in research studies. These certificates allow the investigator to refuse to disclose identification information in any civil, criminal, administrative, legislative, or other proceeding at the federal, state, or local level” (Achkar, et al, 2011). Migrant relocation must move to immigrant incorporation, supporting both for the immigrant and their getting society to take joint accountability for the adjustment procedures. This mutual development is a representation that many locate good-looking as it does not put the entire trouble on the individual family, but recognize that conventional organizations and society member also have significant responsibilities to take part in. This relationship will centers on serving local societies effort with the conventional associations to sketch for and apply some policies that add to combination as it speak about the mental wellbeing and civilizing alteration of migrants. To offer a high quality mental health services, the services want to develop into culturally susceptible and apt. from the healthcare point of view, the migration will not increase the chance of mental health issues. It is caused or come along with some other reasons as like the fall in communal and financial position after the immigration, incapability to verbalize the language of the host nation, partition from the relations, short of responsive welcome by the host people, lack of ethnical and cultural neighborhood to offer the help, a shocking occurrence previous to immigration, and immigration at the old age, etc. The risks for the mental health problems may be associated with the some additional characteristics. Some of the peoples of immigrants from the Asian region can speak English language well and they do not have the depression for their communication and they have the chance of lower risk of mental health hazards. Nativity was the most constant forecaster of psychological turmoil in Asian women compared to other foreign women. The outline of usage of mental health services are also less in the immigrant population compared to the host countries. Questions for future examination of this issue: “Improving mental health and the outcome of mental health problems and illness will require action across a number of sectors. In order to match the challenge of the census data and literature, private and voluntary sectors as well as a range of public organizations – not just traditional health services – will need to be involved. The need will be to promote strong and healthy communities and build resiliency rather than just to improve services” (McKenzie, et al, 2009). There are some questions to consider in the future for the good mental health services of these immigrants. They have to find the foundations to support the immigrants in their own societies. Another important task is to find their societies’ immigrant clusters. There is a requirement to concentrate on their issues with the migrant based associations and think about spending in intensifying their competence. One of the main important suggestions related with this is the incorporation of the normal institutes as like the health service contributors and schools to comprehend that how they are acting in response to immigrant relatives and what are the problems persisting there. The effective mental health care services will provide the strong, cohesive and vibrant society that will makes a rich country in terms of its resources. Reference List Achkar, J. M., et al. (2011). Ethical Considerations about Reporting Research Results with Potential for Further Stigmatization of Undocumented Immigrants. Oxford journals. Retrieved May 21, 2011, from http://cid.oxfordjournals.org/content/48/9/1250.full Barbara W.K. Y. (n.d.) Health and Health Care of Southeast Asian American Elders: Vietnamese, Cambodian, Hmong and Laotian Elders. Stanford. Retrieved May 21, 2011, from http://www.stanford.edu/group/ethnoger/southeastasian.html Beiser, M. (2011). 54th Annual Meeting of the Canadian Psychiatric Association: Mental Health of Immigrants. Medscape. Retrieved May 21, 2011, from http://www.medscape.com/viewarticle/493073_2 Downs-Karkos, S. (2004). Addressing the Mental Health Needs of Immigrants and Refugees. Grant Makers Health. Retrieved May 21, 2011, from http://www.gih.org/usr_doc/Immigrant_Mental_Health.pdf Goldman, et al. (2009). Transforming Mental Health Services: Implementing the Federal Agenda for Change. American Psychiatric Association. Retrieved May 21, 2011, from http://books.google.co.in/books?id=aA2zkY4RkNsC&printsec=frontcover&dq=mental+health+service+in+US&hl=en&ei=XJbXTY_tBcTsrQfk5c2EBg&sa=X&oi=book_result&ct=result&resnum=8&sqi=2&ved=0CGoQ6AEwBw#v=onepage&q=mental%20health%20service%20in%20US&f=false McKenzie, K., et al. (2009). Improving mental health services for immigrant, refugee, ethno-cultural and racialized groups Issues and options for service improvement. CAMH. 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L. (2007). Concepts and Determinants of St. John’s Immigrants’ Mental Health. Division of Community Health and Humanities. Retrieved May 21, 2011, from http://www.nlcahr.mun.ca/research/reports_search/Immigrant_mental_health_reitmanova.pdf Venne, R. (n.d). Annex II: Participatory methods of data collection. Monitoringris. Retrieved May 21, 2011, from http://www.monitoringris.org/documents/imp_glob/Annex_II_final2.pdf Yerakaka, S. (1994). Middle easterners Underserved. University of Pennsylvania - African Studies Center. Retrieved May 21, 2011, from http://www.africa.upenn.edu/Govern_Political/ME_Under.html Read More