Defining Mental IIlness: Do Proposed Change Meet Needs - Essay Example

DEFINING MENTAL ILLNESS: DO PROPOSED CHANGES MEET NEEDS Essay Defining Mental Illness: Do Proposed Changes Meet Needs The Law As It Stands The Mental Health Act of 1959 questioned whether a legal order to detain a patient in a hospital against the patient's wishes empowered the hospital to impose medical treatments. It did not, however, set controls on the application of treatment in the event it was determined that admission of such a patient was legal (Roberts, 2005). The 1983 Mental Health Act, which applies to England and Wales, was offered and passed to "govern the admission of people to psychiatric hospital against their will, their rights while detained, discharge from hospital, and aftercare" (Priory Group, par. 1; Turner, 2006). The Act imposed certain legal controls such as the need for an approved social worker (ASW), trained and qualified in mental health, as well as the duty to provide aftercare for mentally disturbed patients leaving the hospital. At the time, the Act was considered a major step forward in the care of the mentally ill. However, the terms "mentally ill" or "mentally disturbed" were not really descriptive of specific mental health problems. What is the difference between mental health and physical health What determines the kind of care needed by someone who is considered mentally unhealthy Rights of the People and Codes of Conduct Over the years, and especially since 1983, the government has made a point of trying to protect the rights of people suffering from different types of mental disorders through Codes of Conduct ("Mental Health," 1999). In 2004 the decision finally was made to update the Mental Health Act of 1983 when it was determined there were a number of areas neglected by researchers, for instance, services to support the carers as well as the patients. In addition, the public had demanded a plan for community care, and it was evident that understaffing and underfinancing were keeping improvements from being put in place (Roberts, 2005). Perhaps the most unforeseen result of the research that was done was discovering the broad range of mental disorders at all levels of need, each with its own definition, making a single definition of the phrase "mental illness" almost impossible. Basic Mental Disorders Only three types of mental disorders are considered here. The first type is categorised as "mentally handicapped." Several levels of capability can be attributed to an individual of legal age with diminished mental capacity, and admission as a mental health patient for such persons usually is considered "informal," with the patient having the same rights as any medical patient. They can refuse treatment and/or admission as long as they can understand what that treatment would be and why it was needed. Because they might not always understand what and why, the less time they have to spend in a hospital setting, the better. Two pilot projects underway to assist the mentally handicapped at all levels are establishment of community care resources and a self-advocacy movement that will enable mentally handicapped adults to formulate their own needs (Roberts, 2005). As noted in the Essex Mental Health Services article ("The Mental Health Act," 1983), the second type of mental disorder is when a patient is diagnosed as "mentally ill," and such patients can be admitted for up to 28 days, with emergency assessment up to 72 hours, and if compulsory admission is approved, the patient can be kept for six months, with admission renewable for another six months, and assessment every 12 months after that. Although these people can volunteer to be admitted if they wish, compulsory admission can be instituted if a patient is considered dangerous to himself or others. Admission must be recommended by an approved social worker and two doctors. One doctor can admit for 72 hours, and police can transport a prospective patient to the hospital. As soon as practicable after admission, such patients must be informed that they are being detained, and they must be made aware of their rights. If they are released because it has been determined that they are no longer dangerous, aftercare must be set in place in order to minimise risk of readmission. On admission, they must be told they have the right to request legal justification for treatment with a tribunal: a lawyer, psychiatrist and lay person ("Mental Health Law," 2005). The problem with this constricted view occurs when a person is considered dangerous to self or others but has never committed any type of discretion. Is it legally permissible to detain someone because of what he or she might do in the future, and how is this determined It is in this instance that the term "personality disorder" comes into play. According to Eldergill (2000), an "anti-social behavior" is not necessarily dangerous, but those with a psychopathic disorder can be considered to have a "dangerous severe personality disorder" (DSPD) (pars. 4-5). Even if this diagnosis is made, in a case where the patient has never been violent in the past, can legal rights be ignored regardless of the patient's condition This is an issue that should be addressed before the draft of the next Mental Health Care Act is finalized. Is Dementia a Mental Illness The question here is addressing the care of elderly persons suffering from dementia or depression. These are the people who are falling through the cracks, and they need legislature to protect their rights. If there were no other reason for the new Mental Health Care Act to be instituted, this is enough. The Royal College of Psychiatrists considers dementia to be a mental illness, and this is confirmed in Changing Minds: Our Lives and Mental Illness (2002), edited by Rosalind Ramsey and others, where the following mental illnesses are listed: depression, anxiety, dementia, schizophrenia, alcohol dependence, drug addictions and eating disorders. The elderly might be diagnosed with dementia, or they could also have a long-term psychiatric illness like schizophrenia or manic-depression. Alcohol dependence also makes them vulnerable. If their illness is dementia, however, and it has progressed to a point where they are no longer able to make decisions and care for themselves, a guardian should be appointed for them if they do not have family. Guardianship has in the past usually has been applied to the mentally handicapped under 16 years of age, but it is equally applicable for the elderly with dementia. In Between Self-Care and Loss of Independence There is a time, unfortunately, when a person with dementia is still capable of self-care to a degree, but it could be possible they don't have enough to eat and can no longer take care of financial affairs. In a case like this, social workers, who are overworked and underpaid, are apt to hold off on any specific action, giving the person the benefit of independent capabilities, when he or she can no longer take responsibility. In a case where there are family members to care for an elderly person, should social workers feel responsible for checking up on their elderly clients, or is it invasion of privacy How often are the elderly made victims of abuse, and is this a concern for mental health workers Since these people are categorised as suffering from a mental illness, the new Mental Health Care Act should address the problem of dementia. In December 1998, intention to propose a new legal framework for mental health in England and Wales was made, with proposals scheduled for 2002. The 2002 document was found to be controversial in one respect because it recommended detention of patients with DSPD whether or not they had ever committed a dangerous act. Here again, elderly persons would be at risk because dementia as it progresses can cause a person to exhibit violent tendencies. Also, can persons with dementia be considered a danger to themselves because they have forgotten how to care for themselves The proposals also recommended increased after-care treatment in the community, but this has met with lack of community support. In addition, the unwillingness of some people with psychopathic illnesses to take their medications can make them dangerous. If it has been found they're not taking their medications, they then can be re-admitted, but the chances are greatly increased that they might commit a dangerous act before the discovery is made. The major deterrents to the 2002 proposals are the two areas discussed above--lack of legal definition for a person considered to have a dangerous severe personality disorder, and lack of clear-cut methods of caring for patients released into the community. The Mental Health Alliance, comprising approximately 50 organizations, made it clear they opposed the 2002 proposals and called for further study. ("Draft Mental Health Bill," 2005) These areas have been addressed in the 2005 draft of the Mental Health Care Bill, but a final solution actually might require redefining what constitutes a mental disorder. The present definition as reprinted below from the Essex Mental Health Services site offers no protection to someone suffering from dementia, and in fact allows such a person to be categorized as a DSPD. It also offers little protection for someone considered mentally handicapped. Each paragraph of the definition requires careful attention to make sure the proper diagnosis is initially made and allows for legal recourse. Section 1 DEFINITION OF MENTAL DISORDER Mental disorder: means mental illness, arrested or incomplete development of mind, psychopathic disorder or any other disorder or disability of mind. Severe mental impairment: means a state of arrested or incomplete development of mind which includes severe impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. Mental impairment: means a state of arrested or incomplete development of mind (not amounting to severe mental impairment) which includes significant impairment of intelligence and social functioning and is associated with abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. Psychopathic disorder: means a persistent disorder or disability of mind (whether or not including significant impairment of intelligence) which results in abnormally aggressive or seriously irresponsible conduct on the part of the person concerned. A person may not be regarded as suffering from mental disorder by reason only of promiscuity or other immoral conduct, sexual deviancy or dependence on alcohol or drugs. [http://www.essex-mh.nhs.uk/pages/mh_act.htm#mhbill] At the present time, there are several "high-impact changes" being considered for the proposed Mental Health Care Act (NIMHE, 2004). However, these suggestions appear to be so generalized that implementation of them would be quite difficult. One such change is to treat home-based care and support as the norm for delivery of mental health services, the next to improve flow of service users and carers by improving access to screening and assessment, and in both these cases, the main question is how to finance these improvements when lack of services and personnel are already a concern. The remaining changes are even more generalized and simply seem to apply to the first two. Two articles appearing in the BBC News make it distressingly clear that psychiatric patients lack proper care and attention. In 1999 an article was printed in which the National Schizophrenia Fellowship (NSF) said that patients claimed to have been refused treatment for their illness, even when they were in crisis. Five years later, in a far more recent article, the Mental Health Act Commission (MHAC) which monitors the implementation of the Mental Health Act said in a report based on visits to detained psychiatric patients that hospitals are overcrowded, with "pressure on beds, understaffing and a lack of basic humane treatment," ("Psychiatric care 'fails patients'," 2006). In 2003, a report ("Improving Mental Health") published in regard to improving mental health services for black and minority ethnic communities in England set out three key objectives for a five-year plan: 1. To reduce and eliminate ethnic inequalities in mental health service experience and outcome. 2. To develop the cultural capability of mental health services. 3. To engage the community and build capacity through community development workers. It is debatable with the current problems facing the Department of Health in the Mental Health area that a new Mental Health Act will be in place any time soon. In the meantime, it might be helpful to go back to the beginning and redefine "mental illness" and to take another look at "human rights." References "The Department of Health's reply to the Parliament's Joint Scrutiny Committee Report on the Draft Mental Health Bill" (2005), Department of Health, retrieved 2-1- 2006, from www.dh.gov.uk/assetRoot/04/11/53/72/04115372.pdf Eldergill, Anselm (2000). "Legislating for Personality Disorder," Journal of Mental Health Law, retrieved 1-30-2006, from http://www.mentalhealthlawyers.com/Articles%20pdf%20web/PD%20and%20legislation.pdf "For people from Black and minority ethnic backgrounds," (2004), Mental Health National Service Framework (NSF), retrieved 2-1-2006, from http://www.nhs.uk/England/AboutTheNhs/Nsf/MentalHealth.cmsx. "The Mental Health Act" (1983), Essex Mental Health Services, retrieved 1-31-2006, from http://www.essex-mh.nhs.uk/pages/mh_act.htm "Mental Health" (1999), Department of Health, retrieved 1-30-2006, from http://www.dh.gov.uk/PolicyAndGuidance/ResearchAndDevelopment/ResearchPriorityAreas/ResearchPriorityAreasArticle/fs/enCONTENT_ID=4016458&chk=z4RswU Mental Health Act 1983, retrieved 1-30-2006, from http://www.mentalhealthguide.stockportmind.org.uk/B5-34.htm#_The_Mental_Health_1. "Mental Health Law" (2005), Social Science Information Gateway, retrieve 1-30-2006, from http://www.sosig.ac.uk/roads/subject-listing/World-cat/mentalhealthlaw.html. "Mentally ill 'denied crisis care'," BBC News, October 13, 1999, retrieved 1-31-2006, from http://news.bbc.co.uk/1/hi/health/320588.stm. NIMHE "10 High Impact Changes for Mental Health" (2004), Modernisation Agency, retrieved 1-31-2006, from http://nimhe.csip.org.uk/10HighImpactChanges. "Part 1, the new legal framework" (2000). Mental Health Law: Reforming the Mental Health Act, retrieved 1-31-2006, from http://www.archive.official-documents.co.uk/document/cm50/5016-i/5016i-03.htm Practice Guide 2: Assessing the Needs of Older People, Sec. 9," Social Care Institute for Excellence, retrieved 1-31-2006, from http://www.scie.org.uk/publications/practiceguides/bpg2/section09/index.asp. "Priory Group," retrieved 1-30-2006, from http://www.prioryhealthcare.co.uk/Our-commitment-to-you/Legislation/Mental-Health-Act-1983. "Psychiatric care 'fails patients'," BBC News, 1-11-2006, retrieved 1-31-2006, from http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/4599218.stm. Ramsey, R., Page, A., Goodman, T., Hart, D., eds. (2002). Changing Minds: Our Lives and Mental Illness. London: The Royal College of Psychiatrists: Gaskell, retrieved 1-31-2006, from http://www.rcpsych.ac.uk/publications/gaskell/88_9.htm. Roberts, Andrew (2005). "Mental Health History Timeline: 1983," Middlesex University, retrieved 1-31-2006, from http://www.mdx.ac.uk/www/study/mhhtim.htm#1983. Turner, Nigel (1996). "HyperGuide: Mental Health Act," retrieved 1-31-2006, from http://www.hyperguide.co.uk/mha/overview.htm. "Draft Mental Health Bill" (2002). Department of Health, retrieved 2-1-2006, from http://www.dh.gov.uk/Consultations/ClosedConsultations/ClosedConsultatio nsArticle/fs/enCONTENT_ID=4016921&chk=RmtxuY. Read More