The Various Chronic Mental Illnesses - Essay Example

Treatment in secure settings There are several people in this world suffering from various chronic mental illnesses. Sometimes people suffering from such mental disorders pose threat to the entire society. In such cases, patients are treated in a secure setting were they are unable to interact with anyone in the community. Although it is quite traumatic for the patient, however it becomes imperative to treat them in such an ambience due to the probable threat that they can cause to other human beings in the society. There are various strategies implemented in treating such patients that includes treatment, pharmacological and multidisciplinary interventions. Certain risk factors are also associated with treating them in secure setting hence risk assessment and management is imperative to ensure there well-being. The Mental health act has laid down certain rules for detaining patients in secure settings. What is secure setting There are certain individuals suffering from severe mental disorder and highly vulnerable. Such individuals get violent at times and harm themselves and others in the society. Patients with severe mental disorders are locked up either in a hospital unit, social service units, secure hospitals and other locked settings. [Working party on psychiatric treatment within secure settings, n. d]. This is termed as secure setting. In such isolated ambience, patients are treated for their mental disorders with the help of various personnel. This kind of set up helps the patients in their recovery and reduces the risk of harming people in the community. There are countries were national homicide rate from mentally ill patients and the violence caused by them is depreciating due to the existence of secure settings. [Working party on psychiatric treatment within secure settings, n. d]. These settings vary from "high security hospitals, to intensive care units, challenging behaviour units and other settings were there are light physical security and short lengths of stay." [Working party on psychiatric treatment within secure settings, n. d]. Why is a secure setting required There are various reasons that has attributed to the development of security settings for those people who can harm themselves and others in the community. The primary reason for the emergence of security setting is the potential harm that such people can cause to themselves and the community. It also improves the mental health status of individuals through various rehabilitation programs and medicines so that they return back to the community and live the life of a normal human being. The requirements of such patients are identified and appropriate treatment and care are provided to them under such set up. There are people specialised in this area of care to ensure the rehabilitation of such individuals, which may otherwise not be possible. This kind of treatment is involuntary since such patients are treated without their consent. The existence of such setting also reduces the rate of violence and homicide caused by such individuals in the community. This kind of setting ensures safety and privacy to the patients. [Safety, privacy and dignity in mental health units, n .d]. Ethical principles This kind of involuntary treatment in a security setting is considered ethical by certain individuals while others consider it be unethical. The security setting makes an effort towards the rehabilitation of an individual suffering from mental ailments so that they can lead a better life after recovery. These individuals are not independent therefore, in the best interest of such individuals and the community these treatments are considered ethical. [Milone, n. d].While others consider it unethical because such kind of treatment is against the principles of autonomy and libertarianism. According to these principles, people have the right to lead their life without any control by others. Certain others think that since such treatments are imposed on individuals it is ineffective in their rehabilitation. [Milone, n. d]. There are conditions laid down for detaining a person in security settings. If a person suffering from severe mental disorder has the potential to harm oneself and others, their detention in security setting is allowed. There should be scope for rehabilitation of such patients. Involuntary treatment should only be enforced if the patients refuses to seek treatment voluntarily and lacks capacity to make decisions about treatments for their metal ailments. [Proposed changes to APA guidelines -Principles of ethics and professionalism in psychiatry, n. d]. Millan's ten principles During 1999, a committee chaired by Rt Hon Bruce Millan reviewed the mental health act of 1984. [Scottish executive health, n. d]. They laid down ten principles called Millan's ten principles with an intention to provide clear policies for the elucidation of the legislature laid down by the Mental Act. [Renewing mental health law, 2005]. It is imperative to have a holistic understanding of these principles in order to decide the ethics of treating patients under secure setting. According to Bertin [2002], the ten principles laid down by the Millan's committee are as follows. 1. Non-discrimination A patient with mental ailments should not be discriminated from patients suffering from other ailments. 2. Equality The laws laid down by the mental health act should offer equality to the patients and they should not be discriminated based on physical disability, age, gender, sexual orientation, race, colour, language, religion, national, ethnic, or social origin. 3. Respect for diversity The care, treatment and support should be offered in such a manner that it respects the individual qualities, abilities and diverse backgrounds and properly takes into account their age, gender, sexual orientation, ethnic group, social, cultural and religious background. 4. Reciprocity It becomes imperative for the service provider to ensure the well-being of the patients in spite of their discharge in case the treatment is compelled on the patient. 5. Informal care The health authorities must strive to provide treatment to the patients without any kind of compulsion. 6. Participation The patients should be completely involved in their assessment, care, treatment and support. They also have the right to attain any kind of information pertaining to their treatment. 7. Respect for carers It is important to treat the carers of patients with dignity. They should be provided with appropriate information and their opinions should be considered while treating the patients. 8. Least restrictive alternative The patients should receive care and support in the least invasive and restrictive manner and the ambience should ensure the safety of the individuals and others. 9. Benefit In case of any intervention in the new act, it should be for the benefit of the patients, which cannot be attained by any other sources. 10. Child welfare In case of any intervention imposed on a child under the act, prime importance should be laid on the well-being of the child. Therapeutic custody The major dilemma of a therapeutic custody is the need for balancing care and treatment with the security of the patients and others since such individuals are prone to harm themselves and others. [Forensic glossary, n. d]. The main purpose of this therapeutic custody is to ensure safe behavioural control, identify specific risk associated with the patients and provide appropriate services to these patients. [Levels of care and custody, 2003]. There are certain steps taken to ensure the well-being of the patients under such therapeutic custody. There are personnel recruited round the clock. There is stress laid on identifying the needs of the patients rather than confining them to a certain treatment and behaviour management. Counsellors and on-site nursing staffs are present to cater to the requirements of the patients. Patients have to undergo routine health and mental check ups. Role of a nurse in secure setting Nurses play a critical role in treating patients in secure settings. They identify physical and mental health care needs of a patient and provide treatment based on the complexity of the concern. In addition to catering their therapeutic needs, nurses also ensure the security of the patients. In this kind of setting a single nurse is designated to assess, plan, evaluate and provide appropriate treatment to the patient. [Nursing in a secure health setting, 2000]. Strategies of risk assessment in secure settings Since the patients in secure settings have the potential to harm themselves and others there are, several tools developed to assess the risk that these patients can cause to themselves and others. Some of them are HCR-20, sainsbury level 1&2 and suicide assessment tools. The first step utilized to analyse the risk assessment is though HCR20. It assesses the violent behaviour of the patients. HCR20 is a 20-item checklist, which consists of 10 historical Items, 5 clinical items and 5 risk management items. It is created with the help of various literatures and in consultation with forensic clinicians. It helps in attaining relevant information pertaining to a patient's case history. The professional who is conducting the test through HCR 20 must check for the presence or absence of the 20 items present in the checklist. The risk of future violence is done by carefully analysing HCR20. [HCR-20 Assessing risk for violence, 2005] Sainsbury Level1 & 2 is also an assessment tool to analyse the potential harm. It consists of a checklist that analyses the complete details of the patients present and the past details of the risk assessment during the course of the treatment. The information present in it is confidential and is only shared with the professional involved in providing services to the patients. The views of the patients are considered while developing the plan and are only breached in case the individual who has the potential to harm oneself and others. [Carenap, n. d]. Since such patients have the potential to harm oneself there is, a tool developed to analyse their suicidal tendencies. Shea has developed certain interviewing strategies namely "behavioural incident, shame attenuation, symptom amplification, gentle assumption, denial of the specifics and normalization" to assess the suicidal tendencies of such patients. [Knesper, 2003] Risk Management Risk management is the most crucial task in a secure setting. These patients are at high risk and hence appropriate level of security has to be provided to them. The law for the management of the mentally ill has to be balanced with specialized care and treatment. Therefore secure mental health services are provided to such patients, which includes provision of high security psychiatric services, commissioning secure mental health services, review of security at the high security hospitals and re-provision of medium security services. [Managing high-risk individuals service development, 2000]. Treatment interventions The major purpose of retaining mentally ill patients in secure setting is to ensure their rehabilitation. These patients are mainly rehabilitated through several treatment inventions such as Thinking skills: Thinking skills help the patients in analysing, synthesising and evaluating. [Cotton, 1991] Dialectical behaviour therapy (DBT): It consists of weekly psychotherapy sessions, which reflect on the problematic behaviour of the patients during the previous week, and a 2.5-hour group therapy session, which stresses on the "interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, and mindfulness skills." [Dialectical behavioural therapy, n. d] Cognitive Behavioural Therapy (CBT): It is a kind of therapy, which consists of behavioural therapy and cognitive therapy. Behavioural therapy teaches the patients to be relaxed during distressed situation. Cognitive therapy provides reasons to the patients about their certain pattern of behaviour. [Bush, 2003] Sex offender treatment: This treatment reduces or eliminates sexual attractions towards minors. [Sex offender treatment, 2003] Anger management: This helps in controlling emotional and psychological emotions that causes anger. [Controlling Anger -- Before It Controls You, 2005] Substance misuse: There are various strategies and treatment developed to pre-empt a person from his dependency on various drugs. [Addictive, n .d] Regular therapeutic community style meetings: During this process, the professional involved in treatment of the patients discuss therapeutic community environments and practices, treatment systems, organizational factors , treating special populations and studying therapeutic community treatment processes. [New Directions in Therapeutic Communities Research: Building a Partnership between Research and Practice, 2005] Life skills: This program teaches individuals to build good relationships with themselves and others in the society. It teaches them to be responsible and wean them away the act of self-destruction. [Tasmania together, 2005] in addition, many more such treatment interventions. Pharmacological interventions The treatment of such patients with the utilization of recommended drugs with the consultation of the professional also becomes mandatory in certain cases. Prior to recommending any kind of drug, therapeutic drug monitoring is conducted to analyse its side effects on the patients. The utilization of certain drugs helps in retaining the normalcy in the behaviour of such individuals. It is imperative that the patients are educated about the kind of medicines that they needs and its appropriate dosage at regular intervals. [Psychiatry, 2005]. Multidisciplinary interventions In addition to several treatment and pharmacological interventions, multidisciplinary interventions help in the rehabilitation of the patients. The constant communication between the team of multidisciplinary professionals helps in designating appropriate treatment to the patients. Tumin Report, the Reed Report, MEL(1999)5 and HDL(2001)9 are the different kinds of multidisciplinary interventions. Tumin report helps in analysing the number of suicidal cases that has occurred while the patients are in the secure settings. [Judgments - Regina v. Her majesty's Coroner for the County of West Yorkshire (Appellant) ex parte Sacker (FC) (Respondent), 2004]. Reed Report helps in analysing the health and social systems of individuals in such settings. [Fryers, Brugha, Grounds and Melzer, 1998].MEL (1999)5 is intended to ensure the safety of the patients. [Chrincton and Clinic, n. d]. HDL (2001)9 ensures that the arrangements made for the patients are in concordance with the designed plan for treatment. [Care Programme Approach (CPA) at the State Hospital, n .d]. What does the Mental Health act say about the secure settings The new mental health act stresses more on the improved conditions for patients under secure settings. In case a person has severe mental disorder then the patient should be shifted to a secure health setting with compulsory treatment. There are huge penalties for offences of neglect of patients, forgery of documents and false statements. [The draft mental health bill September, 2004 problems and solutions, n. d]. The new mental health act has laid down certain laws for emergency detention of patients, Short-term detention and Compulsory Treatment Order (CTO). In emergency detention, a person can be retained in the hospital for about 72 hours in case of a serious concern. Short-term detention allows a person of potential risk to be detained in the hospital for 28 days. CTO requires an approval by the tribunal were the medical officer has to present the proposal of treatment and care to the patients. [New mental health act, n. d]. Future of security setting for the mentally ill Due to the great stress laid on the well-being of the mentally ill patients, there will be better living conditions for people in secure settings. There will be better facilities available to the patients and new strategies will be developed to ensure the rehabilitation of the patients. The primary importance will be given to the patients and their well-being. [Wilson, n. d]. Conclusion Secure setting is an effort to ensure safety for people with mental disorders and other individuals who are at risk of being harmed from such individuals. The perspective of such setting has completely changed since its existence. They offer better treatment and care to individuals rather than traditional methods of controlling behaviour. There are several risk assessment and risk management methods developed in secure settings. Since the primary goal of such setting is to rehabilitate the patients there are treatments, pharmacological and multidisciplinary interventions included in the plan to treat patient. The New Mental Health Act has also laid down certain policies to detain patients in such settings. Due to these tremendous transformations made in secure setting the mental health institution will definitely help in reducing the rate of violence caused by such individual and increase the rate of rehabilitation. References Bertin.[2002]. Engaging people. Retrieved on 22nd Dec 2005.from http://72.14.203.104/searchq=cache:u9oFMJZURFYJ:www.show.scot.nhs.uk/crag/topics/mhealth/opmh.pdf+Millan+Ten+principles&hl=en Cotton.K. 1991. Teaching Thinking Skills. Regional education laboratory. Retrieved on 22nd Dec 2005 from http://www.nwrel.org/scpd/sirs/6/cu11.html#tsr Fryers. T, Brugha. T, Grounds. A and Melzer,D. 1998. Severe mental illness in prisoners. 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Retrieved on 22nd Dec 2005 from http://72.14.203.104/searchq=cache:J0erJ1-JipkJ:www.samh.org.uk/newmentalhealthact/pdfs/mentalhealthactshortintro.pdf+new+mental+health+act+for+security+settings&hl=en . Read More