Mental Health: A UK Health Promotion on Targeting Mental Health - Essay Example

Mental Health – A UK Health Promotion Paper on Targeting Mental Health: The study of mental health is highly significant because it has a direct bearing on the life and functions of an individual since mental health could be of direct consequence in the performance of day-to day activities and also his ability to cope with stress both intrinsic and extrinsic. A mentally healthy person is able to perform his functions more efficiently, effectively and completely compared to a person whose mental health is deficient. More over the ability to combat and conquer negative factors like high stress and depression and other adverse factors is more pronounced in a mentally sound person. The mental health can be defined as “the successful performance of mental function, resulting in productive activities, fulfilling relationships with other people and the ability to adapt to change and cope with adversity; from early childhood until late life, mental health is the springboard of thinking and communications skills, learning, emotional growth, resilience and self-esteem. (www.fountainhouse.org/moxie/resources/resources_glossary/index.shtml) “Merriam-Webster defines mental health as "A state of emotional and psychological well-being in which an individual is able to use his or her cognitive and emotional capabilities, function in society, and meet the ordinary demands of everyday life” (http://en.wikipedia.org/wiki/Mental_health). The developmental stages in an individual’s life determine his or her mental health. Thus childhood plays a pivotal role in the healthy development of one’s mind. Therefore, it is necessary that we give priority to the area of child mental health so that our children can develop properly and grow up as responsible individuals. Therefore children in the age group of 5-16 years have been taken as the target group. BBC says “one in five young people under 20 are estimated to have a mental health problem ranging from anxiety to major psychotic disorders”. (http://news.bbc.co.uk/2/hi/health/375586.stm) Moreover, during the transition to adolescence, teenagers are under real pressure due to sexual awareness, changes in physical appearances, social status, acceptance in peer groups and expectations from parents and elders. They may undergo an identity crisis arising from the newly found independence from parental control. During this period they may question the parameters of ‘normal behaviour’ and challenge authority. Some adolescents may also develop aggressive characteristics which, if left untreated, could lead to juvenile delinquency. Depression and schizophrenia are two of the major mental disorders suffered by young people in the European region and in most of cases they remain untreated. It is believed 4% of teenagers in the 12 to 17 age group and 9% of 18 years olds suffer from depression. (http://www.euro.who.int/document/MNH/ebrief14.pdf) Some two million young people in the European Region of the World Health Organization (WHO) suffer from mental disorders ranging from depression to schizophrenia, and many of them receive no care or treatment. High rates of destructive and self destructive behaviours are regular features in most countries of Eastern Europe. Sizeable proportions of teenagers live in state institution and thus are deprived of love and care available in community living. Because of this, the teenagers grow up in an unhealthy environment which reflects in their personality development. Crime and anti-social activities along with substance intake endanger their health and also become a threat to society. It is high time the concerned authorities joined together to eliminate this social malady in order to provide a safer and healthy world order for teenagers. Studies have shown that suicide among the adolescents in Western Europe increasing (2 to 44 in every 100000 population). http://www.euro.who.int/document/mediacentre/fs0605e.pdf A survey conducted by office for national statistics on behalf of department of health of UK shows that boys were more prone to have mental disorders than girls. In the age group between 5 to10, 5 per cent of girls and 10 per cent of boys suffers from mental disorder. In the higher age group (11 to 16 olds), 13 per cent of boys and 10 per cent of girls suffered from mental disorder. The prevalence of mental disorders was greater among single parent children (16%) compared with both parents (8%). Again in reconstituted families the rate of mental disorder was 14% compared with non reconstitute families (9%). Further, the prevalence of mental disorder is greater among children whose interviewed parents were uneducated (17%) compared with those who were degree holders (4%). In addition, in families where both parents worked, the rate of mental disorder was 8% compared to 20 % in families where both parents were non working. In gross weekly household income group of £600 or more, mental disorder rate was 5% compared to 16% in the case of families whose gross weekly household income was less than £100. In households where a member received disability benefit, the prevalence of mental disorder was 24% while it was only 8% in families where no member received any disability benefit. In households with reference person being a professional the mental illness rate was only 4% compared to 15%, where the reference person was in a routine occupational group. The prevalence of mental disorder was lower (7%) where families lived in own accommodation compared to 17% where families lived in rented houses. Families who lived in poor areas registered a mental disorder rate of 15% compare to 6-7% in wealthy area. Children with emotional disorders were more likely to be girls than boys (54 per cent compared with 49 per cent) and to be in the older age group, 11-16 (62 per cent compared with 46 per cent)One in five of the children with a disorder were diagnosed with multiple disorders (emotional, conduct, hyperkinetic or less common disorders). This figure represents 1.9 per cent of all children. The most common combinations were conduct and emotional disorder and conduct and hyperkinetic disorder (0.7 per cent in each case) http://www.ic.nhs.uk/pubs/mentalhealth04/04118339.pdf/file (http://www.ic.nhs.uk/pubs/mentalhealth04/04118339.pdf/file) Child and Adolescent Mental Health Services (CAMHS) It “is a comprehensive range of services available within local communities, towns or cities, which provide help and treatment to children and young people who are experiencing emotional or behavioural difficulties, or mental health problems, disorders and illnesses. Some of these services are based in National Health Service (NHS) settings such as Child and Family Consultation Services, in-patient and outpatient departments of hospitals, in GP Surgeries and health centres and in private health care. Others are based in educational settings such as schools, colleges and universities or in youth centres, walk-in centres for young people and counselling services”. (http://www.youngminds.org.uk/camhs/) Health Sound health is very important for human happiness and well-being. It is also one of the important factors for progress as healthy people live longer and will be more productive. It can be defined in the following manner “The overall condition of an organism at a given time in regard to soundness of body or mind and freedom from disease or abnormality.” www.adipex-phentermine-diet-pills.com/diet-pills-glossary.asp or “a state of complete physical, mental, and social well-being and not just the absence of disease or infirmity” (www.jhsph.edu/publichealthexperts/Glossary.htm) Health Promotion to solve Health Care issues: Though the term ‘health promotion’ is well known to all sections of people, when it comes to a standard definition, there is not a single one that encompasses the scope of the term in its entirety. Authors have given a wide variety of definitions to this concept. “In many cases health promotion seems to have become an all-inclusive term under which any health service may find coverage. Perhaps the most popular of these is Greens definition of health promotion as, any combination of educational, organizational, economic and environmental supports for behaviour conducive to health.” http:www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=retrieve&dopt=abstractplus&list_uids=10276152). Green’s definition is all inclusive and it is not specific regarding what is actually meant by health promotion. However, it could be utilized as a broad spectrum definition. Joseph E Zins and others have defined health promotion as “a term that is increasingly being utilized by educators and related professionals, including special service providers. Health promotion can be considered a reflecting approach intended to facilitate physical and emotional well being of individuals and groups. In schools and related educational settings, health promotion approach may include a range of physical and mental health programmes and practices to target to educational goals such as improved cardiovascular fitness, non-utilization of potentially hazardous chemical substances, social skills proficiency, affective development, and enhanced motoric functioning. [Zins et al (1985)] This definition excludes the sociological and psychological aspects of health promotion. There are other definitions to health promotion like: “Health promotion can be defined as any combination of educational, organisational, economic and environmental supports for conditions of living and behaviour of individuals, groups or communities conducive to health. Definitions of public health and health promotion activities vary, but at their broadest both refer to improving health through a broad combination of policies and interventions. (http://www.hta.nhsweb.nhs.uk/panels/Current/dp_details.htm). In order to devise and implement a proper action plan for improving mental health, I will consider the Tannahill Model of health promotion as the platform. The London Borough of Richmond upon Thames is my chosen area. They show a clear partnership and collaboration with its Primary Health Care Agencies and other local target groups and sectors, in the tackling of mental health in respect of the age group 5-16. The Tannahill Model will be considered against the background of literature on health promotion models and the specific target group will be children and teenagers in the age group of 5 and 16 years. The debate currently ongoing in literature with some reference to the demographic, sociological and physiological trends will be evaluated. The study will also consider the current and planned documented work of the chosen borough with reference to its activities; partnerships and strategies implemented and being planned. “Mental health of children and adolescents is a serious problem with profound health and social consequences. It has received substantial media attention recently due partly to the rapid increase in prevalence across the UK as well as internationally. Current statistics suggest the prevalence of mental illness in adolescents is much higher today than it was 30 years ago. Therefore, this is a serious menace that needs immediate attention and concerned efforts for preventive action. The data available from a wealth of literature indicates that mental illness is pandemic problem in the UK. This has been the subject of Government intervention, as result of which it has announced incentives and programmes. There are a number of models that support the theoretical study of health promotion; each has its worth and standing in literature but the Tannahill model of health promotion, which is described below, seems to be the most appropriate method for this study: The Tannahill model of health promotion: Tannahil’s Model of health promotion is concerned with three main areas: Health Education, Disease Prevention and Health Protection. (http://www.sunderland.ac.uk/~hs0bgr/lectures/lec3.htm). This theoretical process focuses on enhancing health and reducing risk of mental ill health through the overlapping spheres of health education, health protection, and disease prevention. To control mental illness we will have to work on preventing rather than treating it. Therefore, the Tannahill model which aims at prevention through observation, counselling and education is best suited for this study. Health Education that informs on the need for counselling and knowledge about illness is helpful in reducing mental illness. Adolescents with emotional and behavioural difficulties can get a significant level of support through counselling. Some of the issues which can lead to deterioration in an adolescent’s mental health and behaviour are bereavement, anxiety bullying, loss and relationship difficulties. An emotional upset often causes behavioural changes in children and adolescents. In such situations, counselling is an effective strategy to tackle it. It is also an effective method for an early intervention and preventive strategy in the management of stress levels of adolescents with emotional and behavioural problems. Moreover, it enables adolescents to gain a better understanding of themselves and situations. “Counselling can be of benefit for adolescents who: have a dramatic drop in their standard of work are subdued or over-excited, have marked mood swings, or behave out of character have school refusal difficulties bully others, or are a victim of bullying behaviour are known to be, or suspected of being, sexually, physically or emotionally abused have difficulties due to family breakdown have peer group difficulties have been bereaved, suffered loss or separation or experienced trauma in their lives have low self-esteem self harm, e.g. cutting and drugs” (http://www.bacp.co.uk/emotional/advice.html) Mental Health Knowledge: Knowledge about mental health and disorder are essential to prevent its occurrence among adolescents. Though adolescents are conscious about physical illness, their knowledge about mental health is too inadequate. They are not able to recognize specific disorders or different types of psychological distress. They have little knowledge about the causes of mental disorders and how to treat them effectively. Sometimes, due to psychological reasons, they have wrong attitude in seeking medical help. Moreover, much of the mental health information which is available to adolescents is misleading. So, the most important thing to be done to create full awareness in the children about mental health and to improve their mental health literacy. The aspect of disease prevention could be studied by using of the following preventive measures. Primary method of health promotion is through change in the risk behaviour of the people. The public are informed about medical aspects of preservation of health and also warned about the consequences of mental ill health. Some schools of thought negate this method by advocating that it is a ploy of medical professionals to retain their importance since the healthier population would mean a fall in the volume of practice of medical practitioners. Secondary method of health prevention is to raise awareness in society regarding the ‘socio-economic and environmental causes of mental ill health and inequalities in the distribution of health resource. Health professionals would assume the role of political lobbyist to clamour for more effective legislation against substances which can cause mental ill health Tertiary prevention involves the use of control measures of more advanced mental diseases to reduce the harmful effects In Health protection, with the intervention of government, the quality of mental health services is improved. Ottawa Charter The first international conference for health promotion was held in Ottawa, Canada in 1986. The meeting was basically a response to growing expectations for a new public health movement around the world. The discussions in the conference primarily focussed on the needs in developed countries, but it also included the similar concerns by other regions of the world. The main aim of the Ottawa charter to achieve health for all through health promotion by the year 2000. According to the Ottawa charter, the health promotion includes: Building healthy public policy Creating supportive environments Strengthening community action Developing personal skills Reorienting health services Building healthy public policy It puts the onus of health promotion on policy makers. They need to understand the significance of children in making up the better future for the tomorrow’s nation. Only mentally fit youth can grow up as responsible individual and build a better nation and thereby better world. Therefore, the policymakers should be aware of the health consequences of their actions and should put health on the agenda of policy makers in all sectors and at all levels. Health promotion policy includes diverse approaches like legislation, fiscal measures, taxation and organizational change. They should give priority in terms of making necessary resources in terms of funding, infrastructure and manpower to take the mental health issues. Creation of a Supportive Environment: The relationship between people and environment can not be separated so creation of a supportive environment is must for health promotion. The guiding principle should be welfare of each other. Factors like changing patterns of life, leisure and work have a tremendous impact on health. Health promotion includes living and working condition which is safe, enjoyable and satisfying. At the same time it should it should also include protection of natural environment and natural resources. Strengthening Community Action It also intends to increase community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health. Developing Personal Skills It increases personal development through providing information, education for health and improving life and skills. This has to be given in home, school, work and community settings. Reorienting Health Services Individuals, community groups, health professionals, governments, health service institutions are responsible for health promotion. They must work together for health promotion. The role of health service must go beyond clinical and curative services. It should cover the cultural needs of people. World Health Organization (WHO) The rate of mental health problems among children increases as reach adolescents. It can be seen that the mental health problems are more prevalent among boys than girls. World Health Organization (WHO): World Health Organization has taken several steps to promote mental health. According to WHO, the rates of mental health problem among children in the age group 5-15 increases as they approach adolescence. It can be seen that mental health disorders occur more in boys than in girls. A tabular representation is provided below; GENDER AGE BETWEEN 5 – 10 YEARS AGE BETWEEN 11- 15 YEARS BOYS 10.4 % 12.8% GIRLS 5.9% 9.65% UK Government Policies to Enhance Mental Health The mental health service in UK consisted of a number of organisations. Most important organization is National Institute for Mental Health in England (NIMHE) which is responsible for developing centres, putting policy into practice, providing learning, and resolving local challenges .Mental Health Trusts are engaged in improving services for people with mental health problems and providing local specialist mental health services. Generally, the first point will be primary care services or social services. Some of the important steps are: The Mental Health Act of 1983 “This Act sets out the criteria which must be met if mentally disordered individuals are to be detained for assessment and/or treatment, and includes a number of safeguards for detained individuals, including their right of access to reviews by hospital managers and Mental Health Review Tribunals, and the powers of the Mental Health Act Commission to visit them and check their welfare”. (http://www.parliament.the-stationery-office.co.uk/pa/cm199900/cmselect/cmhealth/373/37307.htm#a2) 1990 community care It set up a system for assessing individual’s need by assigning a care worker, regular review of progress and an agreed plan of care. Mental Health Act 1995 This Act amended the 1983 Act to create a new power of aftercare under supervision The improvement plan, 2004 “It set out the next stage of the Governments plans for the modernisation of the health service. It signalled three big shifts: putting patients and service users first through more personalised care; a focus on the whole of health and well-being, not only illness; and further devolution of decision-making to local organisations.” http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/ChildrenServices/ChildrenServicesInformation/ChildrenServicesInformationArticle/fs/en?CONTENT_ID=4112068&chk=RnMktQ The national service framework for children, 2004 The national service framework for children, young people and maternity services provides National Health Services (NHS) with measures, through which they can judge the quality of service provided for children and mothers. It also emphasises that NHS in partnership with education and social services can only provide the services needs of children. Through national service framework the holistic needs of the children and young people can be met. (http://www.bmj.com/cgi/content/full/329/7468/693) Some of the other important measures are discussed below Crisis resolution team: It provides prompt and effective treatment including medication in order to avoid hospitalization. It also gives intensive care at their home. Early intervention teams Individuals who experience a first onset of psychosis are given care and assessment by early intervention teams. Assertive outreach teams It provides intensive support for severely mentally ill people. Support and necessary care are given either at patient’s house or at community setting. Graduate workers They are trained in brief therapy techniques and supposed to treat common mental health problems of all age groups. Gateway worker A gateway worker is an experienced mental health clinician who is employed with local clinical health service and provides assessment and medication for people suffering from mental illness. They are also responsible for enhancing accessibility of specialist services. Care support workers They look after the needs of carers. Criticism of mental health policy Mental health service system in UK has been subjected to lot of criticism in the recent times. Critics say that mental health services in UK have not been adequately funded. Other serious shortages mental health services are excessive pre-occupation with risks, shortages of services for less severe mental illnesses and the limited therapeutic involvement of consultants. http://www.uea.ac.uk/~wp276/burns.htm Appraisal Current Health Strategy and Literature The introduction of Mental Health Bill 2006 seeks to replace the Mental Health Act 2003.Also certain new measures like Bournewood safeguards introduces for the first time to amend Mental Capacity Act 2005 . The Mental Health Bill, 2006 The Mental Health Bill 2006 has been legislated primarily for the protection of public and patients as flagship legislation. The bill for the first time introduces supervised treatment in communities to ensure that patients comply with treatment when discharged from health care centres in order to avoid relapse. This would ensure safety to patients and also public at large. The mental health bill also sets out the circumstances in which a patient can be treated for medical diseases without their consent. The evidence of effectiveness lies in the fact that it is primarily meant to protect the patient and the general public from harm. It also seeks to promote the rights of patients and support technological development in the field of mental ailments. Most patients forget about post-discharge treatment and stay on presumption that their disease is cured. A relapse could be fatal. This is precisely why the Bill seeks to ensure that the patient complies with post-discharge medication .Another effective measure would be that treating patients in community settings would reduce risk of social exclusion due to long stay in hospitals. Coming to the question of ethnicity it is widely believed that Black and Ethnic Minorities including children and adolescents are especially vulnerable in the case of access to mental health treatment, since, in certain cases, they are poor and underprivileged. Effective implementation of available legislation is thus necessary for their protection and effective treatment. http://www.dh.gov.uk/PolicyAndGuidance/HealthAndSocialCareTopics/MentalHealth/MentalHealthArticle/fs/en?CONTENT_ID=4084650&chk=70b0fU Targeting a Life Style That Affects Mental Health: We shall consider a typical case of Master X, aged 14Years, studying in a neighbourhood school. His lifestyle is that he is a smoker, drinker and spends his weekly pocket money of £10 on chips, Coke and hamburgers. The extra calories due to fast food are not burned away, since X takes no exercises and leads a sedentary life throughout the day. Later on, this lifestyle would lead to severe mental and physical illnesses, like depression, obesity, hypertension etc. In this case the Tannahil3 Model needs to be applied in the following manner. Primary Prevention: He should visit nearest health care centre. Master X needs to be put into an Exercise program in order to attain a level of fitness and reduce weight; otherwise he would be a sure candidate for hypertension, diabetes, depression etc. in later life. His diet needs to be changed into one containing fresh fruits and vegetables and should cut down on all junk food. Moreover, he should go for, at least, 1 hour of vigorous exercise daily, like swimming, cycling etc. Secondary Prevention A smoking Cessation Program needs to be administered in order to control his smoking habits. Screening to be done for substance abuse i.e. Smoking, alcohol addiction and if found positive, he should undergo counselling with child therapist Tertiary Prevention In this stage, with the recommendations of the attending health professional, he should undergo medication. At a macro level, The Health Protection measures introduced by the Tannahil 3 Model is about the use of Legislation in Substance abuse, alcohol and drugs and fiscal Measures including introduction of cigarette tax to discourage smoking. These models can create awareness among youngsters and adolescents regarding the long term ill effects of their lifestyle on their health, and of their immediate families, and their susceptibility to mental ill health like depression, schizophrenia, etc., caused by unhealthy lifestyle. The mental health of a person is largely dependent on his physical well being, and vice versa. The Richmond upon Thames and Mental Health Support System: The London borough of Richmond upon Thames has an efficient health support system. It has set up a Joint Commissioning Board (JCB) to promote mental health among its inhabitants. It ensures effective mental health services in the London Borough of Richmond upon Thames. JCB is also responsible “for the production of mental health strategies to meet National Services Framework and local requirements in full consultation with service users, carers and voluntary organizations.” http://www.richmond.gov.uk/mental_health_jcb JCB receive reports from mental health services for children. Its responsibility also includes monitoring the services provided by South West London and St. George’s NHS. Trust. The partners in the local health care system of Richmond upon Thames are South West London and St. George’s Mental Health NHS Trust and the Community Mental Health Team. By getting partners like South West London and St. George’s Mental Health NHS Trust, which is a privilege because it is a highly specialized agency, the Borough can tap better resources and make the process of health promotion result oriented. They have adequate trained staff to meet the needs of the borough. They are constantly involved in promoting mental health. Promotion of mental health is different from treatment because it involves everybody. Moreover, they can train the members of the local community team. One of the disadvantages is that the independence of the local borough may be undermined. South West London and St. George’s Mental Health NHS Trust and the Community Mental Health Team contribute health and social care support to patients who require severe or long term mental needs. They promote mental health of patients, staff and people in the local community area. They offer support for people who belong to all age groups and suffering from mental disorder. Here, those who suffer from mental disorder are supposed to visit his doctor or GP. If the GP is not able to offer necessary treatment, they may refer the patient to community mental health team. The members of community mental health team will talk to the patients and undertake an assessment of him. If the patient does not want to visit an official health care centre, she/he may go to Richmond Borough MIND which is the local branch of charity MIND. (http://www.richmond.gov.uk/mental_health_support Richmond upon). The ‘Thames children’s and young people‘s plan 2006-2009’, proposed to setting up a “strategy for baseline indicators on bullying and threatening behaviour” and also to” establish an assessment process for all children and young people excluded from school”. (http://readingroom.lsc.gov.uk/lsc/London/RichmondChildrenandYoungPeoplesPlan2006-09.pdf). It also includes several measures for vulnerable children and young people to promote mental and physical health. Richmond upon Thames also introduced Active Living Scheme to offer more physical activity to its inhabitants and thus promote overall mental and physical health. It is implemented with the help of Richmond and Twickenham Primary Care Trust, Richmond Local Authority, Local Medical Professionals, and Local Leisure Activities. Besides promoting physical health, it is highly helpful in relaxing and coping better with stress and thereby promoting mental health. Conclusion: On the basis of the deliberations made in the preceding pages on the UK Health Promotion for targeting Mental Health in children and teenagers in the age group 5-15 years, it could be said that the integration of children and adolescents mental health must form a significant part of primary health care in the UK. Since a majority of mental ill-health cases remain concealed, due to reasons of stigma, social ostracism, increased cases of partly cured, relapsed and uncured cases, it has become imperative for the concerned policymakers and executors, to first and foremost, take CONCRETE ACTION by a detailed PLAN-OF-ACTION on its pathogenesis, diagnosis, prevention and cure. Since the case relates to children and teenagers, surveys in community centres, schools, crèches and educational institutions would yield results relating to the extent and magnitude of the occurrence of mental ill health on borough basis. All mental ill cases should compulsorily be registered and treated, whether consent of patient is available or not, since Mental ill health is a social disease, and if untreated, could lead to a threat to society. In this regard, the introduction of the Mental Health Bill 2006 is welcomed and, if implemented in exactitude, would curb the occurrences of mental ill health substantially, but the question remains whether the diagnosis, prevention, treatment and cure could keep pace with the spread of the malady among youngsters as, nowadays, one in every 5 person below the age of 20 years is believed to have a mental problem whether treated or not. The effects of Legislation and social reforms for intervention and prevention should percolate down to the level of the patient and attending health care professionals. Only then, it can be rightly said that the health programs have been successfully implemented and the efforts of achieving higher standards of health care and disease prevention been rewarded failing; which, the very purpose of its creation remains an enigma to society. 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