Mental Health Issues in Community Care - Essay Example

Topic: Critical Issues in Community Caring MENTAL HEALTH ISSUES IN COMMUNITY CARE Introduction A third of the British population is estimated to beaffected by mental health problems. It is an extremely common and leading illness to affect most of the world population. Mental health problems have huge social and financial costs, besides the psychological distress that it causes the individual, family, community and society. However, mental health care has undergone a transformation over the last 10 years. The care of mental health patients have been slowly shifted from hospital to home (which ever cases have merited it), with particular stress on early intervention. The investment in mental health care is one of the highest in Britain and this has resulted in tangible benefits with the country having one of the lowest suicide rates in Europe. Definition of Mental Health The World Health Organisation (In the European Commission Green Paper, 2005) defines mental health as, 'A state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.' Mental ill health includes mental health problems and strain, impaired functioning associated with distress, symptoms and diagnosable mental health disorders, such as schizophrenia and depression. Government Programmes for Mental Health Care The government has introduced health action plans in an attempt to reduce some of the health inequalities that people with intellectual disabilities experience (Howells, 1986; van Schrojenstein Lantman de Valk et al., 2000; Elliott et al., 2003; Mencap, 2004). In 2001, the Department of Health also declared that 'the development of health action plans should be supported by primary health care services.' This has led to some primary care trusts in the country to perform annual health checks for people with mental illness. In 2006, The White Paper from the Department of Health outlined a new direction for community services 'Our Health, our care, our say.' The paper emphasised that service users should be put at the centre of service that is services should be tailored and cutomised to fit individual needs. There should be four main goals - prevention and early intervention, more choice and a louder voice, improving access and removing inequality and more support for those with long-term needs to support management outside of hospital. The paper also mentioned that social workers need to work alongside service users to ensure that they become the drivers of service improvement. In December 2009, a cross-government programme 'New Horizons' was launched with the aim to improve the mental health and well-being of the population and improve the quality and accessibility of services for people with poor mental health. This new approach to mental health care combines an improvement in service along with a central and local government partnership. The New Horizon programme has also established a New Horizons Ministerial Advisory Group for inequalities and mental health comprising external stakeholders. Chaired by the Minister of State for Care Services, this body will be advice and monitor the programme. Personalisation of Health Care Personalisation of mental health care is one of the ways in which the community can make sure that all people irrespective of their economic, social, demographic and religious status will have access to health care and service. The government in Britain has made mental health care a priority sector. In 1999, the National Service Framework for Mental Health was created with a National Director at the helm of affairs. This has been backed by an investment that totaled more than 1.5 billion, an almost 50 percent increase. This has boosted mental health care and services in the country. Person-centred care planning forms an integral part of the care planning process (Department of Health, 2001; Thompson and Cobb, 2004). Person-centred planning refers to a philosophy or set of values based on the idea that care planning should begin with the individual (Department of Health, 2001). Care Planning and Delivery The care and service provisions for mental (intellectual) disability can be provided in a various settings that include residential care homes, independent living homes, supported living arrangements and also arrangements for ill people to live on their own in their homes. Much of the care planning and delivery of intellectual nurses now no longer takes place in traditional settings; rather it takes place in within the context of multi-disciplinary and multi-agency settings (Alaszewski et al., 2001). Modern process of mental care includes a system of assessing the needs of individual cases and accordingly a 'package of care' is developed to satisfy those needs. The care managers have an important role in making people lead a fulfilling and valued life. The benefit of this approach is that rather than expecting mentally ill people to fit into the provisions provided by the health care system, the system is fitting itself to the needs of the people. It has been observed that care managers occupy a crucial point which straddles human services and the wider community (Duffy and Sanderson, 2004). Experts have defined the care manager's role in various ways. A really effective care manager is likely to practise in a person-centred way, and probably has some characteristics in common with a 'service broker' (Brandon and Towe, 1989). The care givers, whether nurses or family, has to have specialised training that is based on the principles of personal care. The Approach to Care Programme - Individual Need A Care Programme Approach (CPA) has been described as, 'a framework for health and social care assessment, including risk assessment, within a comprehensive, person centred, multi-disciplinary care planning process.' (Thiru et al., 2002, p. 11). People in need of and using mental health services need to be assessed, so that the care and support can be planned and coordinated. A care programme is provided usually when a person presents a risk to the community or himself and the case has already been handled by professionals and agencies from the mental health care sector. Such a care programme operates on various models. A standard model would include an annual review, while an enhanced model will necessitate a six-monthly review. Beside this, the individual care provider can also arrange for flexible reviews and a care user can also move between care programme levels, with changing needs. The key elements of a care programme approach are assessment, care co-ordination, care planning, evaluation and review, and if analysed carefully are not exclusive of the requirements of a person-centred care programme. The Approach to Care Programme - Risk Management In case of mental health care the concept of safety becomes even more important, as the issues are challenging and sensitive as the autonomy of the patient has to be considered along with the issue of public safety. The government is updating the Mental Health Act, to introduce enhanced community-based practices. A new initiative - 'supervised community treatment' is being planned; this will take care of high-risk and vulnerable patients after they are discharged from the hospital. An ideal care giving situation is one where objective risk assessment and sympathetic support are judiciously mixed. Risk management requires certain conditions to make it successful. Among other things there should be perfect trust and collaboration among the service user and the carer, the programme should be based on the service user's strength and emphasise on recovery, the strategies adopted should be flexible and should aim at eliminating or minimizing harm and there should be knowledge and understanding of mental health legislation. It is imperative that people involved in risk management should demonstrate sensitivity and competence to include all types of variables such as race, faith, age, gender, disability and sexual orientation. The service user's requirement may change over time and this should be taken care of by the service provider. The staff involved in risk management should be appropriately trained and updated at least every three years. The entire process should operate in a democratic and transparent environment with multidisciplinary and multiagency teams joining in the effort. A risk management is also best employed when its findings are properly communicated. Delivery of Community Care - Paying the Price In May 2008, a year-long study about the cost of mental health care, 'Paying the Price,' was published. The study reported that the cost of mental illness in England was 50 billion in 2007. Half of this money (22.5 billion) was spent on direct NHS and social care services. Over 26.1 billion was in terms of loss of productivity, due to mental illness. The cost of mental health care services is expected to grow from 22.5 billion in 2007 to 47 billion in 2026, due to inflation. The figures also estimated that 1.24 million people suffered from depression in the country in 2007. The total cost of mental health care services for depression was estimated to be 1.7 billion, in 2007. If loss of productivity is added to this the figure, it is a whopping 7.5 billion. By 2026, these figures are projected to be 3 billion and 12.2 billion, respectively. These costs are mostly due to inflation and increasing cost of health care services rather than due to the increase in number of patients suffering. However, there can be service interventions, which will actually reduce the costs. For example, for people suffering from depression and anxiety disorders are not all currently under treatment. If, the number of people currently under treatment can be increased and receiving interventions increases, then though the service costs would increase, there could be savings in total costs, if treatment is effective and results in an increase of employment. Perception of Community Care by Service Users and Carers The census of 2001, identified 6.8 million carers, of whom, 1.5 million provide care for a friend or a relative. The role of the carer is vital for a person with mental illness to live in the community. Carers who look after their family and friends generally feel marginalised by the health and social care professionals and feel that they are kept out of the professional discussions, this despite the government recognising the carers role. Carers are often the first person to notice that the person they are caring for may be going for a relapse. Carers feel that they need to be taken seriously when they convey this type of information to professionals, and want to feel confident that professionals will respond in an appropriate way. A recent survey revealed that professionals often use the excuse of 'confidentiality,' as an excuse for not revealing information, even where the mentally ill person had encouraged them to be involved. The NHS Service Delivery and Organisation Programme did a study to find out the good practices within mental health services. The study carried out by the Health Services Research Department at the Institute of Psychiatry in London, defined a mental health 'carer' as a relative, friend or neighbour who provides practical and emotional support to someone with a mental health problem. A 'service user' is one who uses or has used the services of the carer. Carers are the one nearest to the service user and such need information to carry out their services effectively. They need to know about changes in medication, or to look out for certain types of behaviour that may indicate that the service user is about to relapse. However, carers also need to preserve their own health and wellbeing. At the same time the service user also has a right to privacy. Mental health care also goes by confidentiality between the service user and the professional. This helps the service user to put his/her trust in the professional and aids in the recovery process. On the other hand, the service user may not always be the best judge to take decisions and this may prove to be unsafe for the individual as well as the public. The British Medical Association and the General Medical Council, have produced clear guidelines saying that medical professionals may disclose information to carers without the service user's consent, if this is clearly in the service user's best interests, and to enable carers to provide care. When doing so, professionals will adhere to the principles and guidance in the Mental Capacity Act 2005. This conflict of interests can be illustrated in an example. When an adult service user is living with the parents and has his mother as carer and is accompanied by her to the professional, then the professional is not in a dilemma to share the information. However, if the carer is a friend or a neighbour, who accompanies the care seeker, then the professional is not sure how much information should be shared. Similarly, if the care giver is living in the same house as the care seeker, then the professional feels a greater responsibility to share information than if the care giver and care seeker are living separately. Anti-oppressive Practices in Community Care The term anti-oppressive practices have been used to indicate an explicit evaluative position that constructs social divisions (especially 'race', class, gender, disability, sexual orientation and age) as matters of broad social structure, at the same time as being personal and organisational issues. It looks at the use and abuse of power not only in relation to individual or organisational behaviour, which may be overtly, covertly or indirectly racist, classist, sexist and so on, but also in relation to broader social structures. (Clifford 1995: 65.) An anti-oppressive approach to ethnic diversity and difference would begin by acknowledging the impact of racism on the experience of both staff and service users. The next step would be to challenge existing structures and practices, for example in relation to employment, training and promotion within services, to ensure they did not discriminate against people from particular backgrounds. In terms of work with service users, an anti-oppressive approach would challenge the ways in which current practices disadvantage, either directly or indirectly, patients or clients from different ethnic groups. This approach would not ignore 'differences' in terms of needs but, rather, would see such differences as the result, at least in part, of existing racist and discriminatory practices. Recommendations for Delivery of Health Care Service The NHS Institute for Innovation and Improvement states that "Innovation is about doing things differently or doing different things to achieve large gains in performance." New ideas for solving current and emerging problems in mental health are vital. Mental health care facilities now have innovative ideas such as text messaging to remind people about appointments and medication, robotics for filling in complicated medication regimes, telepsychiatry for contacting remote areas or reaching in to prisons and physical healthcare consultations in high and medium secure settings. The Department of Health is conducting focused workshops to ensure mental health partner organizations, across agencies, understand and perform better. Conclusion The structural problems of the mental health system in the UK have been analyzed by a number of authors. Hadley and Goldman (1995) suggest that one possible solution to some of these issues may be the creation of a local mental health authority, which would be responsible for all mental health services for a geographic area. Such an authority would consolidate the funding, authority and responsibility in a single entity. The numerous 'reforms' of the health and social service systems were not designed for the care of the mentally ill (Han, 1996). However, the recent policies and reforms have considered the mentally ill and hence better equipped to handle community care. Reference List: 1. BBC News. Mental health: An overview [Internet] (Updated 4 Nov 1999) Available at: http://news.bbc.co.uk/2/hi/health/background_briefings/mental_health/472797.stm [Accessed 26 Dec 2009.] 2. Government launches 10-year mental health strategy. 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Paul McCrone, Sujith Dhanasiri, Anita Patel, Martin Knapp, Simon Lawton-Smith [Internet] (Updated 28 May 2008) Available at: http://www.kingsfund.org.uk/research/publications/paying_the_price.html [Accessed 27 Dec 2009.] 10. Mental illness in England cost 50 billion in 2007. Press release. [Internet] (Updated 28 May 2008) Available at: http://www.kingsfund.org.uk/what_we_do/press/press_releases/mental_illness_in.html [Accessed 27 Dec 2009.] 11. A Partial Solution: a Local Mental Health Authority for the UK. Trevor R. Hadley1* and Howard H. Goldman2. [Internet] (Updated NA) Available at: http://www.icmpe.org/test1/journal/issues/v1i2/v1i2text03.pdf [Accessed 27 Dec 2009.] Read More