Stakeholders in Mental Health Policy - Essay Example

Role of Stakeholders in the Implementation of Mental Health Policy Stakeholders in mental health policy are different groups of people who havean interest in the definition and response to mental ill health (Munro, 2010). According to Williamson (Munro, 2010), "interests are to do with advantage and detriment to individuals and groups. Interests…are something in which a stake is held; a personal or group resource to protect or enhance power. Everyone has interests in resources like influence, power, time, money, knowledge, the way situations involving themselves are defined." In this essay, the role of stakeholders in the development and implementation of Mental Health Policy will be discussed. In any health care, stake holders are different social groups with different sets of interests. Similarly, even in mental health care, there are stake holders who contribute to the development of policies due to their vested interests. The stakeholders in mental health care can be broadly classified into mental health specialists, paraprofessionals and lay persons. Mental health specialists are those who provide care to the mental health patients by virtue of their professional competence. Psychiatrists, psychologists, psychiatric nurses, psychiatric social workers, psychoanalysis, psychotherapists and counsellors fall into this category. The uptake of mental health services depends on the knowledge, quality, training and competence of this group of people. This group is often referred to as “carers” who deliver care to the “users”. Involvement of carers and users in the development of health policies is a much debated topic. While some experts argue that involvement of carers and users benefits them both personally and practically, others feel that their involvement is intrinsically worthwhile. Personal benefits can be through increase in social contacts and empowerment and practical benefits can be like learning new skills and enabling earning money (Simpson and House, 2003). There are many challenges encountered by the health professionals in the mental health and drug-abuse management faculty (Jones, 2003). One important stress factor is inadequate practical experience. Though the nurses are trained academically, they may not have real-life experience, making them more vulnerable to stress. Also, many de-addiction centers and mental health services do not have adequate staff because working in these units is highly demanding with fewer pay packets. Added to this, most of these services rendered are through government or non-profit making organizations and hence may not be funded appropriately. Also, of concern is the patient behavior. The kind patients who come to these units have a wide range of mental problems and hence their behavior will be abnormal. Some may turn violent and others may use abusive language (Room, 2005). Another issue faced by the nurses is lack of resources (Annette, 2004). This is usually a problem in remote and rural areas. Due to the high stressful conditions which drains the nurses physically and mentally, the nurses themselves may go in for alcohol, anti-anxiety medications, etc. Some may develop depression. As such the staff themselves may require counseling and help (Happell, 1999). Such and many other challenges encountered by carers affect the care delivered to the users and indirectly influence the mental health poicy. When users and carers are involved, the services can be improved and better relationships can exist between the users and carers, thus increasing job satisfaction. Also when services are targeted to the needs of the user, it is possible to improve the cost effectiveness of the services (Simpson and House, 2003). There are more than one ways as to how users and carers can influence health services. The consumers can influence the service provision through excise of choice. This is known as consumerism. When politicians apply external pressure and argue for legislative change, it is known as political activism (Simpson and House, 2003). The most crucial element in the improvement and development of mental health services is the social and health care workforce. Despite adequate levels of resources, good, robust and well-thought-out policies and effective service models, lack of opportunity for learning and development of workforce makes the policies futile (Parliamentary, 2000). The National Mental Health Development Unit or the NMHDU is a central organization which consists of a core team and a set of programmes aimed "to provide national support for implementing mental health policy by advising on national and international best practice to improve mental health and mental health services" (NMHDU, 2010). The unit is launched and funded by the National Health Service and the Department of Health. The NMHDU functions by providing specialist expertise on certain priority areas of the mental health policy and policy delivery, by transferring effective research knowledge for evidence based good practice, by translation of various national policies into deliverables that are practical and can achieve targeted outcomes and by coordination of various national activities through local and regional implementation (NMHDU, 2009). Professionals who come in contact with individuals with mental health problems, are in a position to recognise changes in their mental health and have a role in offering support and advice to the individuals are known as paraprofessionals. This group of people refer the individuals to appropriate health care professionals and create an atmosphere where there is decrease in stress. Police, probation officers, general practitioners, teachers, politicians, civil servants, pensions, inland revenue, department of social security, service managers and clergy fall into this category. For any health care service like the mental health care, the carers and users see the workforce which is situated at the front end. Lack of appropriate learning and development of the workforce contributes to inappropriate level of care, support and management contributing to lack of confident of the service users which further leads to decrease in the use of services, increased rates of morbidity and mortality, decreased morale of the workforce and increase in complaints and dissatisfaction for both users and carers. This in turn reflects politically up to the ministers level (Simpson and House, 2003). The Mental health Act of 1983 was reviewed in 1999 after an Expert Committee appointed by the then Secretary of State for health, Frank Dobson determined to review the existing mental health policy and aimed to break "the current link between hospital detention and compulsory treatment." In July, 1999, the expert committee presented a report for the ministers as the Green report. Professor Bingley, one of the members of the Expert Committee summarized the policy change as (NHS, 2007) "You can ask the law in this general area to do probably three things: First of all, provide a basis for the provision of services, and maybe a bit of an entitlement. Secondly, I think you can ask it to set out when you can use compulsion and the sort of safeguards, and in essence I suppose what the 1983 Act did was preserve more or less intact the sort of paternalism of the 1959 Act but add some important additional safeguards, mostly by way of forms of independent audit of the decisions of professionals. Thirdly, I think you can ask the law to protect or enhance the civil social status of those who are described as mentally disordered. If you are looking at the overall mental health legislation, I think you would want to see that there is the right balance between all three of those." Like other health reforms, mental health is also associated with the way health system works. This includes rules of governments, health professionals and the lay public. Frankish et al (2002) studied the effects of political factors on health reforms in British Columbia, Canada. They opined that the qualifications, representation and selection of the health board members influence health reforms. Also, relationship and addressing the concerns of the stake holders has an influence on the implementation of health reforms. There is a disparity in state and federal programs with many areas underserved (Community Alliance, Mental disabilities). In some countries, there are no Mental Health Hospitals. The patients are admitted in general hospitals. There are also severely mentally disabled persons who are homeless and not taken care of, living on the streets, surviving from garbage can to garbage can (Community Alliance, Mental disabilities). Political factors have a major role in the mental health of refugees. This vulnerable group is also subjected to the influences of social and cultural factors. Refugees are displaced from their homes due to political violence, wars or related threats. Thereby they have restricted economic opportunity. In their own country they may be displaced internally or they may have to abide by the rules of the country they have sought shelter in. In a study by LeMoult (2005), he reported that refugees who were women, older, more educated and higher socioeconomic status prior to displacement had worse mental health outcomes. Also, those who were from rural residence or those supported in institutional accommodation suffered the worst. The impact of political violence on collective health and populations is well known. Political violence includes armed conflict and guerrilla warfare, combat, imprisonment, torture, rape and other war atrocities. Pedersen (2006) studied the effects of political violence in the Latin American and Caribbean region on mental health of the individuals. He reported that political violence lead to increased interpersonal violence like child abuse, homicide and women abuse, substance abuse, suicidal tendencies, anxiety, depression, acute stress disorder and posttraumatic stress disorder. Many benefits either financially or resources are provided for the health professionals dealing with physical ailments. Such encouragement is not seen much in mental health care services. Increased financial support in the form of increased ancillary staff salary, post-graduate allowance for general practitioners and medical reimbursement can enhance participation of health professionals in mental health services and increase quality of mental health services. In the long term, such changes can benefit mental health arena even among those currently not interested in mental health work. Preventive services in mental health can be enhanced by more collaborative work practices, decisions on priorities for the team, close monitoring of the health and health needs of the client group and measures of their effectiveness (Newton 1994). Lay persons who can contribute to the mental health policy making are Jurors, media, charitable institutions and non-charity pressure groups. MIND is a private organization that lobbies for "the right support for people to take control of the services they use." According to MIND, despite the introduction of individual budgets and direct payments for users of support services, the positive impact on mental health users is very low because they are often left out. MIND argues that many mental health patients do not receive appropriate social services they need. MIND works with government agencies to bring change in the policies and reforms and is currently trying for social care reforms like implementation of personal budgets which promote independent living of mental health patients. MIND also strived for changes in mental health policy where in remedies to health inequalities experienced by the Black and minority groups are practiced. MIND thus works to improve legislation and services by influences members of the Parliament, ministers of the government, service providers and opinion formers (MIND, 2010). Thus, stakeholders have a role to play in the development and implementation of mental health policy. Involvement or carers and users in the development of mental health policies allows identification of areas of requirement, deficiencies and amendments. Feedbacks from these groups helps the government frame policies. Non-government organizations and other lay people influence the government in making policies through their understanding of interests of different groups of people. References Annette, M., Nkowane, R.N., & Saxena, S. 2004. Opportunities for an improved role for nurses in psychoactive substance use: Review of the literature. International Journal of Nursing Practice, 10 (3), p.102–110. Community Alliance. Mental disabilities. Retrieved on March 27th 2010 from http://medicine.creighton.edu/IDC242/2005/Group7/links.htm Department of Health. (2001). The Mental Health Implementation Guide. Retrieved on March 27th 2010 from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4009350 Frankish, C.J., Kwan, B., Ratner, P.A., Higgins, J.W., Larsen, C., 2002. Social and political factors influencing the functioning of regional health boards in British Columbia (Canada). Health Policy, 61(2), p.125-151. Happell, B, & Taylor, C. 1999. We may be different, but we are still nurses – an exploratory study of drug and alcohol in nurses in Australia. Issues in Mental Health Nursing, 20(1), p. 19-32. Jones, R.N., & Cheek, J. March 2003. The Scope of Nursing in Australia: A Snapshot of the Challenges and Skills Needed. Journal of Nursing Management, 11(2), p. 121- 129. LeMoult, C., 2005. Refugee mental health influenced by social and political factors. The Journal of American Medical Association, 294, p. 602-612. Pederson, D., 2006. Reframing political violence and mental health outcomes: outlining a research and action agenda for Latin America and the Caribbean region. Ciênc. saúde coletiva, 11(2). Retrieved on March 27th 2010 from http://www.scielo.br/scielo.php?pid=S1413-81232006000200008&script=sci_arttext Room, R., Babor, T., & Rehm, J. (2005). Alcohol and public health. Lancet, 365, p. 519-530. Simpson, E.L., and House, A.O. (2003). User and carer involvement in mental health services: from rhetoric to science. British Journal of Psychiatry, 183, 89-91. MIND. (2010). Policy and Issues. Retrieved on March 27th 2010 fromhttp://www.mind.org.uk/policy Munro, M. (2010). Mental Health and Social Work. The Open Learning Foundation. Retrieved on March 27th 2010 from http://www.olf.ac.uk/samples/mhsw/ Newton, J., 1994. Preventing Mental Illness in Practice. London: Routledge NHS. (2007). Mental Health Policy Implementation Guide. Retrieved on March 27th 2010 from http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_073681.pdf NMHDU. (2009). Home. Retrieved on March 27th 2010 fromhttp://www.nmhdu.org.uk/ Parliamentary. (2000). Provision of the NHS Mental Health Services. Retrieved on March 27th 2010 from http://www.parliament.the-stationery-office.co.uk/pa/cm199900/cmselect/cmhealth/373/37311.htm#a16 Read More