Social Policy and Mental Health Practice - Essay Example

SOCIAL POLICY AND MENTAL HEALTH PRACTICE STUDY The role of the Approved Social Worker is broad. Within the ambit of mental health, the ASW is to prevent the necessary compulsory admission to care. Current legislation requires that two doctors, one of which must be a psychiatric consultant, and an Approved Social Worker must all be in agreement before a patient/service user can be detained via compulsory admission policies (Unison 2005). It is imperative that the ASW is placed in a position that he/she is able to work without institutional pressures when making decisions. Without this independent status, the holistic and non-medical perspective would not be a part of such a potentially life changing decision and or event (Mind Information 2005). Parliamentary mental health policy initiatives and the mental health act of 1983 spell out the specific role of the ASW within the compulsory admissions framework (White 2001). The role of the ASW is one that is meant to safeguard the rights of individuals and ensure customized health care for each patient. The ASW can work independently in diagnosing treatment for a service-user and/or work alongside the other medical practitioners that may be involved in the service user's care. In general, the Approved Social Worker is to provide a check and balance system between the medical staff and the patient. Every attempt should be made to provide for a 'neutral' environment for the potential patient/service-user. Psychiatric studies have shown that most patients that have to utilize hospital facilities, whether they are voluntary or compulsory, when their lives outside of the hospital are addressed before, during and after the stay that they are more successful in the long term (Project Cork 2004). This may mean looking for alternatives to a hospital facility, if and when appropriate. This is what the ASW should attempt to provide each patient. Attached is a practice study that illustrates the role that the ASW takes in the development of mental health care programmes and compulsory admissions. This practice study is based upon a service user and my involvement with her during my placement in the CMHT and later with the PCMHT. I took the lead role in the mental health act assessment of 'Susan' while being observed by the ASW on the duty rota. Susan's case involved a compulsory admission to the hospital. For the purpose of this assignment, the names of the service user and relatives that got involved in her case have been changed and their permission obtained prior to including them in my studies. This was done to protect their identity and to respect their confidentiality rights. Susan Susan is a thirty-four year old white British, unemployed, working class female, that lives with her husband and three children in Local Authority accommodation. She has a thirteen-year history of admissions under the MHA 1983. This assessment was a 'lead role.' Susan had been admitted voluntarily two days earlier after a suicide attempt. At the time of this assessment, she was being held on a 5(4) nurses holding power because she attempted to leave the ward. The decision to compulsorily admit Susan under section MHA 1983 was felt to be the only option available. This decision was based on Susan's history and recent incidents of attempted suicide. The most recent attempt was the reason for her informal admission. Her attempts to leave the hospital resulted in the sec 5(4) MHA 1983. Nurses holding power lasts for up to six hours. Admission under section 3 was considered "necessary for the health or safety of the patient or for the protection of others" (MHA sec 3(2) (c), Jones 2003. Medical recommendations were from the psychiatric consultant and Susan's GP, whom both knew her well. The ASW working independently of the Local Authority is accountable for her/his own decision-making. It is very important that the ASW adequately assess the service user's mental needs. It has to be determined whether or not the patient can continue treatment from their residency or will have to be admitted. This calls for a careful assessment of the level of risk that the patient presents to herself and/or those around her. The ASW also has to consider the needs of the persons that the service user resides with along with the needs of the service user before, during and after treatment (Mind Information 2005). It is imperative that the needs of the family unit are met once the patient re-joins their family after hospitalisation. The family needs to be informed on how to properly assist the patient in dealing with their health and taught to be aware of any signs that the patient may need some additional assistance in the future. Of course, the patient/service-user needs to be educated on these same issues simultaneously, therefore treating any problems related to the mental health issues as a family-oriented case. This allows the problems to be addressed holistically. It also may prove to assist in eliminating or reducing any stress that the children or spouses may feel individually when dealing with such a crisis. Ensuring that the family is educated on all alternatives involving treatment and on the mental illness affecting the patient is the ASW's role. This role may prove to be important to children involved in such cases, as many times the children of adults that suffer from mental health issues may be more prone to suffer from the same or similar mental health issues (Mind Information 2005). Susan's mental state and hospital admissions may well have, if not already, a detrimental effect on her children and it may be likely that they too will become future users of mental health services, through either genetic pre-disposition and/or inconsistent parenting. Stabilising Susan's mental state would enable her to return home. Her repeated patterns of admission under section 3 MHA 1983 did not usually require the allowed period of six months. In Susan's case, it would be very easy to follow the standard medical practitioner's protocol, which would be to keep her in the hospital for six months. However, this is when it is important for the ASW to realize his/her independent responsibilities from the empowering practice to ensure that both the short and long term health care plan of the service user is taken care of appropriately. The ASW should take this role seriously to ensure that patients like Susan get what they need so that they are in a position to take care of themselves. I took this stance in Susan's case. There are instances where medical professionals seek to bypass the use of the Approved Social Worker by citing the possibility of confidentiality issues. In many cases, staff complains that due to a shortage of available ASWs on staff, that they should be bypassed altogether. This issue is apparent and has been addressed in a recent white paper introduced to the Mental Health Act 1983 by stating that the role of the ASW can be taken on by another "mental health professional" (White 2001). Many ASWs believe this would be an injustice to the service user. As a trainee, I discussed the risk factors involved in Susan's case with the ASW. The risks in Susan's case were initially to herself. Susan was interviewed in a suitable manner (COP 2.12). Multi-disciplinary assessments had been taken, reviewed and accounted for in her case. I did everything possible to make Susan feel comfortable and as if her best interests were in mind. Susan was spoken to in a calm, respectful tone. Susan's assessment was not rushed and prior medical analyses were taken into account (White 2001). The assessment was held in a quiet room and Susan's GP, the ASW and I were present in the interview. Susan protested to our concerns and did not feel as though her situation was as serious as everyone else involved. Susan dealt with the fact that she had just attempted to end her life as an event that was over and would not happen again. After further evaluation, it became apparent that she was acting upon command voices the told her to harm herself in order to "protect her children." Susan did not consider the voices as inappropriate. This was confirming evidence that her case was one that had been a part of her life for a long time; therefore it may be more difficult if not impossible for Susan to differentiate falsehoods from reality. It became clear during the interview that Susan clearly loved her children, which emphasised the extent in which she posed as a potential danger to herself. The fact that Susan obeys the voices that speak to her make her not only a danger to herself but possibly makes her a danger to others. Erratic behaviour associated with patients that suffer from a mental illness such as Susan's is common. Since Susan is the mother of children, it could be possible that she would be left alone with them out of necessity and as an ASW, the safety of the patient's family members must also be considered. Therefore, allowing Susan to leave the hospital was too much of a risk for herself, her family and anyone else that she may come in close contact with. The moment that Susan protested to the staff's concerns regarding her safety provided a great opportunity for the ASW to explain their dual responsibility of both the guardian and advocate for the patient. This could reduce the fears of the service user, if he/she knows that they have someone available to them that will offer any and all available alternatives to them that will solve their immediate and possibly future problems. Part of the ASW's role is to promote advance thinking and to "create a vision and strategy for care" (Flaker 2003/2004). This was done in Susan's case and she was comfortable speaking with us, so that we could adequately access her mental state and life situation. As the lead role in accessing Susan, I provided information regarding my responsibilities to her. I feel that my approach gained her confidence. We did discuss other alternatives to hospitalisation with Susan such as having her live in a crisis house for a while or having her to go home and have an Approved Social Worker come by her home to check on her periodically. Both alternatives based on Susan's high risk factor were unacceptable as it was deemed that she required around the clock care until the ASW and the medical staff felt that Susan had reached a place to where she was stabilised and given the tools to deal with her issues appropriately. Susan's long history of involvement in psychiatric services indicated a rapid improvement in mental state after administration of appropriate anti-psychotic medication. I consulted her nearest relative (MHA 1983 13 (2), Cop 2.16) in order to gain information. The relative felt that she could not be managed at home; yet also spoke of her pattern of improvement after a period of hospitalisation and medication. After assessment, the relative raised no objections to the application for compulsory admission under section 3 and was advised of his rights under the MHA 1983 sec 23. Section 2 would not have been appropriate as there were no new developments to present. As well as a diagnosis of schizophrenia, Susan had also been labelled with borderline personality disorder. This diagnosis suggests that she may have difficulties with relationships. Susan's husband does not engage in paid employment, as taking care of Susan and the children are a full time job. Living on state benefits places Susan in a position of poverty (Spicker 1993). 'Voices,' relationship breakdown and poverty are all significant factors in suicide. There is also a positive relationship between schizophrenia and suicide (Rethink undated). Again these diagnoses illustrate the risk factor in this case. Susan's case was too high of a risk to use a community alternative treatment plan. Susan made it clear that she would not agree to stay in the hospital; therefore compulsory treatment was the only alternative. As predicted, Susan's mental state improved rapidly and since returning home she has completed an Advanced Directive. Susan suffers from multiple health issues: psychosis, schizophrenia and borderline personality disorder. One is very complicated by itself, but the three combined can cause havoc in one's life, as illustrated in Susan's case. In Susan's case and others similar to hers, the proper medication and the correct dosage will make the difference one's quality of life. Many times, choosing the correct medications and dosages for a particular individual can be trial and error and time consuming in itself. Susan's case was simpler in this regards as she had already had a history with a therapist that was familiar with her situation and she had already been diagnosed with specific illnesses. Also, her family could give detailed accounts of her actions and symptoms; her family members could aware that medication helped her to feel better. One of the issues that needed to be addressed in Susan's case was why she decided not to take her medications when they clearly illustrated a marked improvement in her behaviour. Part of this could be due to the family's financial situation and the other due to a lack of her spouse being accountable for Susan and monitoring her to ensure that she was taking her medication. I addressed both possible reasons for not taking the medications along with its implications with the Susan and her spouse. Due to their grave financial situation, this in itself can make a situation look helpless to a family unit. I advised both Susan and her spouse of the various options that would be available to them with proper medication intake. I suggested to Susan to make it a part of her goals that once she feels better to possibly look into getting a part time job. This may not only assist her socially, but would help the family financially. I asked Susan and her spouse to make a pact to act as partners when it came to her medications, both were accountable and were to make sure that it was taken regularly. Medications were to be placed in a pill box, which cost little or nothing, which would allow weeks worth of medications to be placed in the box by the day of the week. This would make it more difficult to forget when or if the medications had been taken. With this information and her advanced directive completed, Susan has been able to plan for her future care and plan for herself and family should her mental state deteriorate again. As in Susan's case, 'when we enact public mandate, we witness at least two processes of social work: a process on deciding on the intervention and the process of getting to know and creating a working relationship among all participants of the situation' (Flaker 2003/2004). REFERENCE LIST Mind Information, 2005, Getting the best from your Approved Social Worker, viewed 13 June 2005, www.mind.org.uk Unison, January 2005, Draft Mental Health Bill, viewed 12 June 2005, www.unison.org.uk Flaker, Vito, IUC Journal of Social Work Theory and Practice, Journal Issue 7 2003/2004, viewed 11 June 2005, www.bemidji.msus.edu/sw White, Marcia, February 12, 2001, Report raises concerns over compulsory mental health admissions, viewed 12 June 2005, http://society.guardian.co.uk British Association of Social Workers, October 25, 2004, Evidence to Joint Parliamentary Committee, viewed 10 June 2005, www.basw.co.uk Project Cork, March 9, 2004, CORK Bibliography: Compulsory Treatment, viewed 06/10/2005, www.projectcork.org/bibliographies/data/Bibliography_CompulsoryTreatrment.html www.nimhe.org.uk Community Care/Guardian - websites DOH websites www.gov.uk -- reform of mental health act www.markwalton.net www.mind.org.uk Read More