Community Care for Those with a Mental Health Disability - Essay Example

Community Care for Those with a Mental Health Disability Introduction This essay will discuss the Community Care efforts being made especially focusing endeavors made in United Kingdom. The article starts with historical review of the mentally ill people and the society attitude towards them; and how it evolved over the course of last 200 years. The article will also look at the current issues and controversies with the discussion of the recent legislation and support available to the mentally disabled people. In a majority of societies individuals with a mental illness are associated with shame and disgust and blamed for bringing their illness and bad luck to their families. As a result some families hide their mentally ill people away, imprisoning them in homes in miserable conditions. One major reason for this attitude is the enormous cost associated with the care of such people. It is one of the most devastating afflictions know to mankind. More than 450 million people around the world suffer from some kind of mental or behavioral disorder (Encarta, 2005). Mental illness goes alarmingly undermined, untreated and misunderstood. Difficulties in diagnoses, as well as cultural stigmas contribute to the widening gap between the problem and the resources devoted to it. Researchers who study the Global Burden of Disease (GBD), estimate that mental illness accounts for 11.5 % of the total global burden, and the numbers are growing. (http:/world.org) Thus, making mental disability a serious issue in today’s world. In the 18th century many unique and shocking methods were adopted, such as gyrating chair and collapsing bridges, which would plunge the patient in icy water unexpectedly. The rational behind such methods was that, these frightening experiences would restore their sanity. Other treatments included making mental patient frightened and thereby improving their behaviour through submission, as it was believed it will cure their mental illness. At that time the physicians became interested lunacy portrayed mentally ill individuals as having lost their reason making them lesser kind of human beings. As a result their status was degraded to animal level and doctors at that time were convinced that disabled people are in sensitive to pain and torture. These patients were often cramped and enchained in small cells. In 1808 the County Asylums Act allowed to build asylums for mentally ill people and remove them from prisons and workhouses. Similar kinds of asylums were built in Norwich, Nottingham and Bedfordshire. In 1825, a series of lectures by Alexander Morison were published, which for the first time recognised mental illness as a disease. In the following years, Morison developed an extensive care system for mentally disabled people. In 1832, the Madhouses Act was established, which appointed the Lord Chancellor as custodian of the property of the lunatics. The function of the Lunacy Commission was to construct a network of asylums and monitor and regulate all the relief efforts in such centers. However, the mentally ill people in Scotland were suffering as described by Earl Shaftesbury. As a result the Lunacy and Asylums Bill Scotland was also passed in 1857. However by the end of 19th century, people were convinced that insanity was incurable and a large number of mentally ill people were sent to asylums to protect society from their harm. At the same time, the alternative treatment for mental patients were provided by small religious groups, such as Quakers, who collected funds and donation and formed Mental Retreat, where these patients could be treated in general and kind manner. Rather than considering them beasts and wild, lunatics were considered as confused children who need care and support. It was not until the mid 1960’s that silence broke in the UK, and the Royal Commission in 1957, for the first time, considered mental illness as a “physical illness”. The 1959 Mental Health Act maintained the detention of the mentally disabled people only, if they exhibited “immoral conduct” (The 1959 Mental Health Act). There were also several press and television reports, which discussed these issues, which were earlier considered taboo. In mid 1950s, first anti-psychotic drug came into being, which controlled many symptoms without producing sedative effects. The 1960s shifted from the approach towards mentally ill and who were shifted to community with an assumption that availability of funds for the community will make treatment of these patients easy. It was assumed that community agencies and the psychiatric units in the hospitals should share care equally. During the 1960’s and 1970’s a number of enquiries were carried out with regard to hospital scandals, this involved patients being treated badly by staff who were abusive. During the 1980’s and the 1990’s more inquires raised profound anxiety about the policy and practice of community care. This resulted in the change in mental health treatment and more systematic approach was created. Instead of hospitalization, daycare treatment came into practice and patients were taken care of at homes and health centers. In 1988 came the Report of the Committee of Inquiry into the care and aftercare of Miss Sharon Campbell, who had knifed to death her former social worker, Isabel Schwarz at Bexley Hospital. The Campbell inquiry led to the CPA WHAT IS CPA (Spokes et all., 1988). One of the main reasons for introducing the CPA was to try to improve interprofessional communication and coordination. Inter-professional work was viewed as central to achieving a better service and the CPA was seen as a means of bringing this about. In the 1980’s and 1990’s in UK, there was a change of concept about the community care for mentally disabled people as it no longer meant, the facilities inside hospital, but offering services outside the homes in clinics and daycare care centres. The interest in community care arises for many reasons, such as the old age group are expanding due to better health care system. It is suggested by communitarians that the over emphasis on the individual rights has led to disintegration of the family and social life. In response to such breakdown, the communitarians argue for value of communal life and social relationship and shared values among family and community. There is no universal definition of mental illness as it generally depends on society norms and values. Any one violating these values was considered mentally ill, such as extreme social withdrawal, violence to oneself, hallucination and delusion. In the modern world mental illness is becoming an increasing problem due to two reasons: increase in life expectancy, due to which more people are living into old age and suffering from dementia, the second reason is a higher rate of depression due to economic and political change and social violence. (White, 2001). It is still a debatable issue, if the number of mentally ill people is increasing or decreasing? Even though the 1974 Act provided coverage for risks associated with work. A person with Schizophrenia symptoms, by law, has to be removed from hazardous duties with suitable intervals and regular management, but in reality they are hardly ever practiced. The Parkinson Report of 1979 also reported that government since 1959 has been working hard towards community care, but the problem has been a creation of these services in the community. It also mentioned that the ideals mentioned in the Act are too lofty to achieve, as a result “cradle to the grave care” promise has been broken and no policy for community care have been successfully implanted during the last many decades. The UK government Independent Living Fund (ILF) 1988 advanced the independent living movement. This philosophy is based on assumption that all human beings including disabled people should have choices and should not be barred from involvement in the activities like a normal human being. It is argued that independent living will give greater decision making powers to these people and they will have the freedom to opt for the services, whenever they desire, rather than being taken care of around the clock. This concept portrays disabled people as an oppressed part of the society, who are not given access to the choices, ironically these recommendations are given by the able bodied people, not by the disabled person, who themselves have no experience of disability and its problems. And above all this complex situation has been made too simple and too ideal, suited only for the normal people. Disabled people are not in that fitter condition that they can really take care of themselves 24 hours a day except for the slightly disabled people. The rule of equal choice to sick people is doing more harm than good, and will put old and sick people into more trouble rather than comfort. There is no doubt that disable people need more empowerment, but it can come in the shape of making them part of community, involving social workers and communities with them. The NHS Community care Act 1990 is also aimed at changing community care for the people who need care and support and can still live with dignity. It has four basic aims as described below: Make the best use of public money. Encourage local authorities to set priorities. Ensure that local authorities check on the quality of care, which is being provided. Encourage local authorities to use other organisations to provide services. It is assumed that the 1990 Community Care Act will help to achieve home based services, daycare and provide the carers a break from their constant support to these needy people and with local authority being made responsible for all needs assessment. The UK government thinks that such kind of care will create healthy competition for service providers, while making the local authority responsible for the allocation of funds is a more practical idea and more beneficial to all concerned. However critics argue that the National Health Service has not been practical despite portrayed benefits. There have been several reasons for such failure; it is more to do with being based on marketing rather than providing better and cheap social service. The government was spending huge sums on social services and community care, this change in policy is basically following the plan of marketing, aimed at saving money, rather than providing better community care. Hence this thinking that this “mixed economy of welfare “will lead to better and cheaper services is a mere bureaucratic stunt to save them money as explained by Powel (2001) “Community care was to be used as a vehicle for the marketisation of the public sector”. One inherent flaw in this Act is the inconsistent partnership with private sector; as a result more stress is on the voluntary sector. A critical flaw in the mixed economy of welfare approach has been, that it values community service only in money and this approach has been adopted not for the sake of providing better service, but emphasise more on cutting costs at the expense of giving lesser care to the disabled people. And the reason has been given by Powel (2001) “community care for older people in particular presented itself to government, in both financial and policy terms, as an obvious area of provision into which market principles are introduced and implemented”. Similarly the Mental Capacity Act 2005 has been described to provide more benefits and is in the “best interest” (4,Best Interests, Preliminary, Mental Capacity Act 2005 ) of the disabled people, but it has created a ripple across the society and critics consider it an assault on the constitutional rights. Under the new act the disabled people will not be placed in nursing homes against their wishes, which has been described by the UK government as a radical step to “provide opportunities to the disabled people over the next twenty years”. The proposal includes expanding of the direct payment to the disabled people to purchase their own care within their own budgets. It is assumed that this freedom will give more choice to the disabled people to learn skills and find work and retain jobs, rather than languishing in the care centers. The Mental Capacity Act, like all other acts, is visionary and full of great ideas. The problem has always been the social attitude and the lack of acceptance of such patients in the society. For example by the law, all developers should care for the needs of disabled people but till 2004, developers ignored such instructions. A majority of the gyms have no special sections for such patients, which, in turn, prevents these people from recreation and healthy activities. There may have been some increase in employing disabled people, however it is only vertical acceptance, society at large still consider disabled people as misfits. The Government is ill equipped to meet the requirements of disabled people, even the present railway system lacks full support for disabled people. In a report by Icwales (2004) mentioned that thousands of businesses in Wales are breaking the law and discriminating against the disabled people in access to the services sector. The discussion clearly shows that the government approach is too simplified; society at large is still poised on discrimination against disabled people. The basic need is to take out the disabled people from clinics and hospitals and integrate them in the communities, where they feel themselves part of the society, however not without the constant support of social workers. Simply throwing them out of hospitals and letting them wander in the streets on the pretext of freedom is going back to medieval times. It is essential to generate the feeling, that disable people are part of our society and sooner or later, we will also require help, as no one can escape old age and sickness. If today’s society is unwilling to take any steps to cater for these people, a time will come when a majority of us will be in a similar condition. This initiative can be started with the social workers, volunteers, the network of families and friends and can help in changing this stigma of disability forever. Tina, good points, you have clearly evaluated. However, you have gone off the trail a little when discussing disabled rather then specifically mental health. Your essay at the beginning is just warming up, you need to clearly state what treatment was available in the past using a few acts and discussing if they were good enough to support those with mental health. Then you need to look at the community care, which you have very well. Use some evidence to back up the good points you have raised to show you have read books etc. You could you examples of people not taking medication living in the community to show the gaps in the provision. Bibliography Moore,Stephen (1993) Social Welfare Alive! Nelson Thornes. Russell, Andrew (1998) Anthropology of Community Care Routledge. Sharkey, Peter (2000) Essentials of Community Care Palgrave Publishers. Spokes, J Pare, M & Royle G (1988) The Report of the Committee of Inquiry into the Care and Aftercare of Sharon Campbell London HMSO White, Vicky (2001) Developing Good Practice in Community Care Jessica Kingsley Publishers. Wilmot S (1997) The Ethics of Community Care Cassell. Jason L. Powell (2001). The NHS and Community Care Act in the United Kingdom A Critical Review 2001.Centre for Social Science, Liverpool John Moors University, UK. http://sincronia.cucsh.udg.mx/nhs.htm http://encarta.msn.com Microsoft Encarta Online Encyclopedia. (2005) Mental Illness http://www.scotland.gov.u/k The Role Of The Social Worker In The 21st Century www.opsi.gov.u/acts/acts2005 Mental Capacity Act 2005 http:/hmiworld.org Harvard Medical International 2004 http:/icwales.icnetwork.co.uk Read More