Why Has Mental Health Policy Been Neglected - Case Study Example

The Mentally Ill Mentally ill people are being neglected by a report in the Lancet (BBC News, 2007). The statistics show a 14 % incidence in mental illness, more than that for cancer or heart disease which are however life threatening. 800000 people commit suicide in poorer countries especially. In spite of the increased incidence, the care accorded to these people is limited (BBC News, 2007). This amounts to sheer neglect on the part of authorities and policy makers. War, poverty and disease can by themselves lead to mental illness. The mentally ill especially in the economically handicapped countries would rise to problematic proportions if measures are not adopted to give ample attention to these ill people and treat them too. If the Government is deaf and blind to the needs of the mentally ill, the chances are that the problem is going to be blown out of proportions. The mentally ill are looked after by relatives who can ill-afford the cost of treatment apart from arranging the care. Mental ill health also has an impact on the other physical illnesses that a human can have (BBC News, 2007). This finally will result in a situation where medical help, social support and therapy do not reach the ill person for want of resources. There is an opinion saying that if basic mental health services could be provided with general health care, it would be cheap and affordable. Social health, physical and mental health are all interwoven and interdependent (Tabish, 2005, p. 34). The well being of a person is dependent on all the three together but the crucial component is undoubtedly mental health. Mental well-being includes the behaviours which provide an atmosphere of confidence and satisfaction. This person with good mental health would exhibit enhanced self efficacy, autonomy, general competence, intergenerational dependence and emotional intelligence. Like any physiological illness, mental ill-health is the consequence of the interaction between the biological, psychological and social factors (Tabish, 2005, p. 34). Neuroendocrine and immune functioning act through one pathway and health behaviour as a second pathway contribute to mental health. Social factors like uncontrolled urbanization, poverty and rapid technological innovation are significantly bothering mental health. The Burden Mental ill health is seen in about 25% of people at some time in their lives. The illness affects all types of people in all countries, men and women, and children, the rich and the poor, urban and rural alike. This universal nature causes a heavy economic impact on societies. 20% of patients in the primary health centre are coming under the umbrella of mental illness with one or more mental illnesses (Tabish, 2005, p. 34). Four families would have at least one mentally ill person. The rest of the family would be providing physical and moral support as well as suffer social discrimination and the stigma associated. In 2000, an estimate concluded that 12 % of total Disability Adjusted Life Years (DALYS) was attributed to this illness. The DALY is a health gap measure which gives information on premature death, disability and non fatal health outcomes. One DALY is the loss of one potential year of healthy life. The years lost due to disability is known as YLD and due to premature mortality as YLL. The possible factors that are associated are poverty, gender, age, conflicts, disasters, physical illness, family and social environment. Among the mental illnesses affecting 450 million people, depression would emerge as the second cause of the global burden of disease. Global statistics show that 70 million people suffer from alcohol dependence, 50 million from epilepsy, 24 million with schizophrenia and another 20 million attempting suicide. The magnitude of the problem is therefore not disputed (Tabish, 2005, p. 35). The distressing symptoms of the disorder have an impact on the sufferers, family and community. Part of the suffering is due to the inability to work or participate in leisure activities with others due to discrimination. The difficulty in shouldering responsibilities and the knowledge that they are a burden to others is another aspect. The presence of an ill member leads the others including children to make adjustments which prevent them from attaining their full potential in all their activities. A portion of their time is set aside for the sake of the ill person. Social and economic deprivation is the result (Tabish, 2005, p. 35). The massive disruption that affects the sufferers and the families is measured using the quality of life instruments. The quality of life has been found to be poor during illness and after recovery due to the continued stigma attached and the unmet basic needs and the functioning needs. Those people who did not complete high school had a greater chance (1.8 times) of having psychiatric illness than those who went to college (Yu and Williams, 1999, p.155). Why Health Care facilities are deemed inadequate. Though mental illness contributes to 12 % of diseases globally, the budget that most nations set aside for tackling the problems of mental illness constitutes just 1 % of the total health expenditures (Tabish, 2005, p. 35). There is an obvious disproportion. Surprisingly 40 countries do not even have a mental health programme. Even stranger is that 90% of countries do not have an adequate policy for children and adolescents. Moreover health plans do not cover mental and behavioural disorders as well as for other physiological illnesses. Patients and their families in turn suffer from financial problems. It would be more correct to say that the difficulties just continue to grow. Availability of effective interventions and the actual implementation are nowhere near reaching distance. In India, only 20% of schizophrenics and epileptics have treatment when the remaining 80% go without. The situation is different in the West where 80% get treatment (Tabish, 2005, p. 35). The gravity of the situation has to be conveyed to governments and policy makers. These important groups of influential people must be sensitized on the significance of mental well being and the necessity to have a mental health program. Integration of metal health care into the overall primary health care system may help a faster spreading and delivery of the messages and the methods. Community health programs with innovative schemes cater to the genders and culturally diverse populations and thereby are better in that they reach the farthest segments of population (Tabish, 2005, p.35). Community health care must be well organized and reach the psychiatric beds in these centres which must also be increased in number based on demands. Mental health policies must be scrutinized, developed and implemented. The Government must bear the responsibility of this objective and use their machinery of heath staff for this purpose. Strategies must be well organized and integrated into the primary health care or community health care systems. Costly technology is not required. Personnel who have been properly trained in the use of pharmacotherapy and have acquired support skills on an outpatient basis, must be absorbed into the services (Tabish, 2005, p. 36). Community care is the providing of good care to the mentally ill and empowering them. The services that can be provided in this setting must have some of the services provided in an asylum. These protective services should not have any of the services which had negative aspects when served in the asylum. The care provided should be close to home. If admissions were necessary for treatment, this could be done at the community centre or in a hospital. All disabilities must be treated along with the mental illness. Mental health professionals and the community must address the needs of the ill persons (Tabish, 2005, p. 36). Services must be coordinated among the various agencies. Ambulatory rather than static services are better. All these aspects of care must be supported by legislation. It is the absence of these strategies in place that make the program for mental health inadequate. Situation in developing countries Health care programs have a low priority. Only a small number of institutions are available for serving the mentally ill (Tabish, 2005, p. 36). They would usually be understaffed and overcrowded. Inefficient services would be the trend. Very little understanding of the needs of the mentally ill and the range of services available adversely affects the support provided. Adequate psychiatric care would also not be available. The real services may be provided in large institutions which are backed by legislation. Care may look more like punishment than service. Access for family members may be denied. The people who really need the care may be reluctant to approach for care for fear of being discriminated against and because of the stigma. Why has the mental health policy been neglected? The main reason has been that the issue has not been gauged in the right perspective. The global burden of the disease warrants a minimum of 12 % of the health care budget if the figures on incidence are any indication of the seriousness of the proportions of illness. However just 1 % is being spent. Previously the criteria for diagnosis of mental illnesses were not available. Now the criteria are available and appropriate use of these criteria for selecting treatment is possible. One reason for the neglect in having a mental health policy could be attributed to this (Yu and Williams, 1999, p. 153). The poorer countries have not had a mental health policy for want of resources though the chances of having a higher rate of mental illness is possible (Yu and Williams, 1999, p. 158). An inverse relationship has been found between mental illness and socio-economic status (p. 154). Studies have shown that there was a tendency among the mentally ill to become poorer still due to their illness and other problems associated with poverty. The social causation hypothesis says that higher rates of illness are seen in the lower socio-economic status due to other adversities of poverty (Yu and Williams, 1999, p. 158). The social selection theory suggests that the association between mental illness and low socio-economic status is a function of health related downward mobility. Social status also had a bearing on the time selected for treatment. A poor person with an illness like schizophrenia would be slower in taking treatment than a richer person with the same illness (Yu and Williams, 1999, p. 152). This illness with stigma and discrimination discourages people to come forward for treatment, thereby giving the impression that there are not many people with the illness and who want treatment. Family members are equally reluctant to bring them. This being the situation, policy makers have not yet been convinced about the issue by the right people. Researchers and Senior Psychiatrists must meet the policy makers with the right indicators and statistics. Efforts to develop an appropriate policy for mental health is not an easy process and must be taken up earnestly. Organisational problems could affect the successful implementation of the mental health policy (Morris, 2006, p. 243). Service settings can be extremely challenging. A considerable level of commitment, firmness of purpose and resourcefulness are of utmost necessity on the part of the administrators and staff to impart self-less service in a hospital setting especially in the face of fiscal restraints. Culture and climate can influence service settings (Morris and Bloom, 2002). . “Climate refers to the specifically psychological or affective impact of the work environment on individuals, and is typically assessed quantitatively” (Morris, 2006, p. 245) while culture is based on normative and behavioural aspects (James & Jones, 1974).Cross cultural sensitization is essential for delivery of continuous, individualized and sensitive care to patients with mental illness. The organization culture should encourage workplace cohesion and morale (Morris, 2006, p. 244). High quality care must be accorded so organizational factors must be a main subject in the researches (Southam-Geow, 2004). The implementation of new treatments in mental health policies, technology transfer, the quality of service and outcomes are based on an organization theory. The organizational culture was developed and linked to “organizational effectiveness, employee work attitudes and productivity, as well as staff turnover” ( Ostroff, Kinicki, & Tamkins, 2003). Behavioural services also involve interpersonal relationships, judgment, discretion, and communication skills all of which are difficult to standardize or to quantify (Schorr, 1997). All quality programs have staff who are discrete, resourceful, innovative, and creative to personalize services. They need to act outside the rigid protocols of the organization to cater to complex consumers (Morris, 2006, p. 244). Behavioural norms and values specific to the intervention and policies are adopted. Development of an appropriate mental health policy. A good and up-to-date mental health policy must be developed keeping the local conditions in mind. The Government policymakers are responsible for the development and establishing of a suitable mental health policy (Tabish, 2005, p. 36). The major issues and objectives must be determined with the coordination of senior psychiatrists and leaders in the community. Financing may be arranged with the private and public sectors. Policy instruments may be drawn up with the associated exchange of ideas between the policy makers and public sector. Organisational arrangements may be made with the public sector to meet the objectives. Capacity building and organizational development must be triggered off. Resource allocation and expenditure prioritization must be well planned. Information about the community, mental health indicators and effective treatments must be collected and discussed. Prevention strategies must be implemented. Promotion of the therapy, services and the mental health resources must be done (Tabashi, 2005, p. 36). The policies must be reviewed frequently and changes made when necessary. The special mental needs of the women, elderly and children must be addressed. Care should include all mental illnesses in the same light and address substance abuse too. The services should work towards keeping the mentally ill within the community and not in institutions. Community mental health services must be developed. Mental health services must be incorporated into the general health care system. All government policies regarding employment, housing, economics, education and social welfare services and criminal justice must work with an eye on mental health. This multilevel approach should be able to gradually overcome stigma and discrimination. The mass media and information services must be stepped up and the whole nation must identify with the mental health policies and objectives. The implementation of a strategic mental health policy is essential to the progressive modern world. References: BBC News, 4/9/2007, Retrieved on 14/3/09, “Mentally ill suffering neglect”. http://news.bbc.co.uk/go/pr/fr/-/2/hi/health/6977262.stm BBC MMIX James, L.A., & Jones, A.P. (1974). Organizational climate: A review of theory and research. Psychological Bulletin, 81, 1096–1112 Morris, A., & Bloom, J. R. (2002). Contextual factors affecting job satisfaction and organizational commitment in Community Mental Health Centers undergoing system changes in the financing of services. Mental Health ServicesResearch, 4, 71–83. Morris, A., Bloom, J.R. and Kang, S. (2006). “Organizational and Individual Factors Affecting Consumer Outcomes of Care in Mental Health Services”. Adm Policy Ment Health & Ment Health Serv Res (2007) 34:243–253 DOI 10.1007/s10488-006-0104-9 Springer Science and Business Media. Ostroff, C, .Kinicki, A. J., & Tamkins, M. M. (2003). Organizational culture and climate. In W. C. Borman, D. R. Ilgen, & R. J. Klimoski, (Eds.), Handbook of Psychology (pp.565– 593). New York: Wiley. Schorr, L. B. (1997). Common purpose. New York: Doubleday. Southam-Geow, M. A. (2004). Some reasons that mental health treatments are not technologies: Toward treatment development and adaptation outside labs. Clinical Psychology: Science and Practice, 11, 186–189. Tabashi, S.A. (2005). “Mental Health : Neglected For Far Too Long”. JK Practitioner, 2005, Vol. 12, No. 1. Pgs 34-38. Yu, Y. and Williams, D.R. (1999). “Socio-economic status and Mental health”. Chapter 8 in (Eds.) Handbook of the Sociology of Mental Health by Carol S. Aneshensel and Jo C. Phelan., Published by Springer Science and Business Media, New York, US. Read More