Emergency Mental Health - Essay Example

?Running head: EMERGENCY MENTAL HEALTH Emergency Mental Health (school) Emergency Mental Health Mental illnesses are a of incapacity where an individual’s normal physiological and psychological processes are disturbed or damaged (Lasser, et.al., 2000). In the current state of mental health care however, mental health services are inadequate and are not properly made available to the mentally ill – the most vulnerable members of society (Saxena, et.al., 2007). This raises the need for mental health policies to be changed for the benefit of the mentally ill. The disenfranchised and the marginalized people in society, according to Dr. Paul Linde (2011) are those who walk into mental health institutions with serious mental health afflictions like schizophrenia, major depressive disorder, bipolar disorder, and similar other mental health diseases. A serious mental health illness is that which “substantially interferes with one's life activities and ability to function” (Wang, et.al., 2002, p. 93). Those who are mentally ill are often disenfranchised because of their mental condition. Consequently, they do not vote, nor do they advocate for themselves, making it easy and convenient for politicians to refuse them mental health services. Linde (2011) unforgivably and irreverently defines these acts as acts of stinginess, which translates to the deliberate refusal of politicians to spend for their care. Admittedly, those with severe mental illness suffer from mental illnesses which often incapacitate them to a degree where they are unable to care for themselves, making them a danger to other people, even themselves (Kessler, et.al., 1998). The stigma against the mentally ill still exists in this current day and age. Even as the prejudice against the mentally ill has already gone beyond name-calling and misnomers, the general stigma against mental illness makes the situation of the mentally ill even more untenable (Corrigan, 2004). Moreover, referring to the homeless as mentally ill and vice versa is still a common mistake for many people. For which reason, it is very much common to see the disenfranchised people put in the same category as the mentally ill, the homeless, or in some instances, those who voluntarily choose to live their life in the streets (Linde, 2011). Linde (2011) points out that the sickest of the sick are not receiving adequate help. Instead, they are put in jails, in prison, in homeless shelters; in short they are put in what he terms as “ghettos.” He also points out that some imprisoned individuals actually have serious mental illnesses; yet, they are not given access to adequate and appropriate mental health services in the prison systems. Linde (2011) discusses how it is possible to bring the mental health services into the 21st century by using contemporary tools in addressing mental health issues. The tools to do so are within the grasp of the health professionals, the problem is that the mental health system is financially limited to bring about these improvements. Another issue in mental health care as discussed by Linde (2011) is the fact that the mantra taken on by health professionals for people who have mental illness is “if you want to stay, you have to go.” This is based on patient perspective. In effect, patients who want to stay, have to be discharged. This is basically the way the laws are written in the US. Another problem seen in the management of mental health care, relates to the second mantra or rule of mental health workers, and it basically states, “if you want to go, you have to stay” (Linde, 2011) This is often applicable to patients who are manic, who insist that there is nothing wrong with them. It also applies to the disenfranchised individuals mentioned earlier, the ones who wear multiple layers of clothing, those who want to go, who refuse to stay in the hospital. The principle of “if you want to go, you have to stay” does seem to apply to these individuals, however, based on how the laws are written, the state does not seem to want to pay for their care because they do not seem to be dangerous. The health officials believe that there is nothing psychiatric about their condition. But they are actually very much mentally ill. Some of them have schizophrenia and are unable to care for themselves. Although they are not dangerous, they pose a danger to themselves, and under psychotic breaks they pose a danger to others. In effect, the government is saying that it would not spend money to care for persons who do not present a danger to public safety. Linde (2011) also discusses that the above situation creates a dilemma for health workers who are pressured to make the assessment of patients and the dangers they pose, and to decide eventually who gets to be admitted. These health workers have to face the reality that the patients admitted would soon be discharged after being stabilized. This creates a revolving door phenomenon, with mentally ill patients being admitted, then released, and then admitted again, and so on and so forth for mental health issues. In relation to cases in the Australian setting, various incidents and cases can be linked with the Linde discussion. Linde speaks of the disenfranchised, and Sue Bowen speaks of the forgotten people, and they basically refer to the same people – those who are mentally ill. Bowen mentions how the government seems to have forgotten about the mentally ill. This is an unfortunate circumstance because according to Bowen, it is possible to manage their illnesses, by talking to them once they have calmed down and by treating them like human beings. The case of Brett, a schizophrenic, highlights the importance of continued mental care for the mentally ill. Brett was released 20 years ago from an asylum after the government decided to close these asylums and care for the mentally ill in community settings. This community care setting never materialized and now Brett has been receiving limited mental health care. He was homeless for 10 years, but through the Matthew Talbot Hostel, which provides emergency accommodations for the mentally ill, he was able to improve his life, join a band, and manage his symptoms. And yet, Brett is still experiencing difficulties in improving his life. He still cannot get a job, his pension can barely pay for the housing, and he is still in danger of psychotic breaks. Along with other mentally ill patients in Australia, he has been forgotten by the government. In a similar case, Sid was also diagnosed as schizophrenic. However, unlike Brett, Sid refused medications and any other form of mental assistance. He left his wife and children and was living as a homeless man with some imagined people for company. He, among hundreds of other mentally ill people are living in the streets, looking filthy, and unable to care for themselves. Twenty years ago, the Australian government introduced deinstitutionalization. It was a means of making the mentally ill more productive members of society – treating their mental illness and reintroducing them into the community setting. A plan of community-based care was set. However, hardly any funds were allocated to materialize such a plan. As a result, hundreds of mentally ill individuals have been released into the community with hardly any medical care, and worse, with hardly any viable means of financial support. They are now in homeless shelters. Some unfortunately have paid the ultimate price and have succumbed to their mental anguish. This has been apparent in the case of Ian Skelter, who died six days after being discharged from a mental hospital. Ian was admitted to the hospital and assessed to be suicidal. But no care was given to him while in the hospital. He was inexplicably deemed mentally fit after 24 hours in the hospital, despite express statements on his plans to kill himself. This is similar to the case of Karen Willard, a gifted research scientist, who walked out of a mental hospital and later succeeded in killing herself. She was left without proper supervision despite the fact that she was suicidal. She was even actually deemed not suicidal by the hospital and classified with the lowest level of care. Such low level of care implied no need for supervision. These two cases relate to one of the mantras discussed by Linde which says, “if you want to stay, you have to go.” If the patients want to stay in the mental health setting, as in the case of Ian and Karen, then they must be let go. Unfortunately, this seemingly illogical mantra has endangered the lives of the mentally ill, even at their own hands. The contrast seen in the provision of adequate mental care can be seen in the case of Kate O’Connor, who was diagnosed with bipolar disorder. She was able to receive adequate mental health care and in the process has shown significant improvements in her health and her reintroduction into society. She represents rule two of Linde’s discussion which states that “if you want to go, you have to stay”. Karen wanted to leave mental health care because she was in denial about her health, but she was prompted to stay in mental care and consequently was able to avoid another Ian and Karen situation. The implications of Linde's key issues for clinical practice of Australian mental health workers and paramedics relate to the need for the Australian government to deliver its promise twenty years ago on the establishment and on the provision of funding for community-based mental health care services (Oliver, et.al., 1996). The Housing and Accommodation Support Initiative, or HASI is one of these programs which are actually working well in the management of mental health care. This is community-based mental health care, and very much a reflection of its actual community-based plan set twenty years ago. Hence, if the government would really deliver on its original plan to implement community-based mental health care, instead of asylum-based care, then it is possible to adequately manage the issues of mental health services in Australia (Hickie and McGory, 2007). Community-based care for the mentally imply that for paramedics responding to mentally ill individuals, there are other possible decisions they can make on the patient’s care. One of these decisions is on where to bring these patients. They can either be brought to the emergency mental health care settings, and possibly to the community-based setting for the more manageable cases of mental illness. These are decisions which must be based on patient’s condition and his needs, with the presence of immediate care implying the need for admission to emergency mental health care. The above issues illustrated by Linde (2011) and as illustrated in the various cases exemplify how mental health workers have their jobs cut out for them. For one, many mental health workers seem to be performing such roles without having the right training or background. This was seen in the managers of housing systems catering to the mentally ill. These people are managers of boarding houses, and yet they are performing mental health services to their mentally ill neighbours. The police officers are also forced to perform mental health worker roles as they often arrest and take into custody mentally ill patients who are disturbing the peace. These officers are often the bottomline solutions to the mental health problem (Green, 2000). There is a need for mental health workers to establish adequate assessment skills in order to ensure adequate qualification of a patient’s symptoms. Qualifying a severely mentally ill patient to be admitted for medical care must not be overlooked because these individuals really need mental health care (Goldney, et.al., 2001). Sue Bowen said it best when she said that there is a need to treat these patients like human beings. Such advice is crucial for mental health workers because it would dictate the quality of care and services which the patient would receive under their care. Based on the readings above, mental health care administered by the mental health workers must not be based on financial considerations, but on human considerations. There is enough of accounting costs on the part of politicians, and this attitude must be avoided at all costs by mental health workers. Reference Corrigan, P. (2004). How Stigma Interferes With Mental Health Care. American Psychologist, volume 59(7), pp. 614-625. Green, T. (1997). Police as Frontline Mental Health Workers: The Decision to Arrest or Refer to Mental Health Agencies. International Journal of Law and Psychiatry, volume 20(4), pp. 469-486 Goldney, R., Fisher, L., Wilson, D., & Cheok, F. (2001). Suicidal ideation and healthrelated quality of life in the community. Med J Aust, volume 175: pp. 546-549. Hickie, I. & McGorry, P. (2007). Increased access to evidence-based primary mental health care: will the implementation match the rhetoric? MJA, volume 187: pp. 100–103 Kessler, R., Berglund, P., & Walters, E. (1998). A methodology for estimating the 12-month prevalence of serious mental illness. In: Manderscheid RW, Henderson RW, eds. Mental Health, United States 1998. Washington, DC: US Government Printing Office, pp. 99–109. Lasser, K., Woolhander, B., Himmelstein, D., McCormic, D., & Bor, D. (2008). Smoking and mental illness: a population based prevalence study. JAMA, volume 208, pp. 2606-2610 Linde, P. (2011). Emergency Mental Health. ABC Radio National 'Background Briefing. Oliver, J., Huxley, P., Priebe, S., & Kaiser, W. (1996). Measuring the quality of life of severely mentally ill people using the Lancashire Quality of Life Profile. Social Psychiatry and Psychiatric Epidemiology, volume 32(2), pp. 76-83 Saxena, S., Thornicroft, G., Knapp, M., & Whiteford, H. (2007). Global Mental Health Resources for mental health: scarcity, inequity, and inefficiency. Lancet, volume 370: pp. 878–89 Wang, P., Demler, O., & Kessler, R. (2002). Adequacy of Treatment for Serious Mental Illness in the United States. Am J Public Health., volume 92(1): pp. 92-8. Read More