Mental Illness - Term Paper Example

 «Mental Illness» The entire Johnson family demonstrates signs of illness, anxiety and depression, of which Eustace is the most notable of the lot. He is suffering from grief at his wife’s death and his condition has been deteriorating steadily, while his daughter Mary has also begun to suffer from depression and anxiety. The report provides below provides a brief history of how the laws on mental health have developed and the social and legal context surrounding the treatment and individuals with mental health problems, both by members of society as well as by doctors, nurses and other medical personnel. In describing individual with mental illnesses, Ann Beall offers the following view: “We are truly an outcast people. Anti-stigma work is about rediscovering common ground. Otherwise we’ll always be the ‘other’. We led the parade to the death camps and no one questioned.” (Sayce 2000:78) A definition of mental illness is equivalent to a crisis in meaning and is best handled through crisis intervention and grief counseling as a separate clinical approach. (Roberts, 2000:3-30). There is a difference that exists between crises arising out of mental health problems and those that arise out of natural disasters, since the latter represents a response to an unexpected natural calamity while a mental health crisis represents the sudden deterioration in the mental condition of a person, which can sometimes be instigated by natural disasters. In the case of Eustace and Mary, the mental illnesses in question have been brought about by the death of Susan, Eustace’s wife and the attitude of the other family members. According to the figures given out by the Department of Health (2002), at any given point of time in the U.K, about 1.7 million parents with a mental illness will be in the process of caring for some 2.5 million children. According to Mayberry et al (2005), people who suffer from mental illness as well as their families, form a particularly vulnerable group who may often suffer from social isolation within their communities. Some of the reasons that have been advanced by Mayberry et al (2005) in support of this position include poor ante natal care that such victims of mental health problems may have received, the generally low socio-economic status of these persons which may make it difficult for them to seek medical assistance on a prompt basis, their generally low levels of educational achievement which may hinder their ability to realize that they are sick and seek help and finally the fewer social supports that they may receive. This may also be noted in the case of the Johnson family, their origins from Trinidad may have contributed to the feelings of isolation that Eustace has experienced upon the death of his wife. One of the earliest acts developed was the Lunacy Act of 1890, which brought about laws regulating the operation of asylums and compulsory care.(www.mind.org.uk). This was followed by the Lunacy Act of 1891, which established a rigorous set of criteria so that only the people who had the most severe forms of mental illness were admitted to hospital. In 1930, following a report of the Royal Commission on lunacy and mental disorder, the Mental health treatment Act of 1930 first came into force, which allowed psychiatric admissions to be made and this was further buttressed by subsequent versions of the Mental health Act which further refined the provisions of the Act and brought a wider range of mental illness under the purview of hospitals and care. According to Campbell (1996) civil rights became increasingly prominent in the twentieth century and the modern survivor movement grew out of the enhanced focus on civil rights, which could serve to explain the shift from institutional to community care for mental health patients experiencing a crisis situation. However, as pointed out by Johnson and Thornicroft (1995), the drive towards community care has led to the growth in the number of patients who have severe psychiatric disturbances for long periods, as a result of which higher levels of crises become imminent. The levels of support provided in a community care setting may however be inadequate to deal with the needs of patients who are facing a crisis. As Johnson and Thornicroft (1993) have explained, the Community Mental Health Teams which serve the needs of people with severe and disabling mental disorders, generally operate only through the day and this is a universal arrangement throughout Britain. These CMHTs have improved the level of their services in pre-emoting and responding to emergencies through closer observation and monitoring of their clients. However Individual CMHTs would find it difficult to offer 24 hour crisis handling facilities, because it would require the setting up of separate out of hours teams in safe locations. Therefore, on the whole assertive community treatment has not been successful in dealing effectively with mental health crises in the UK and it may be necessary to examine cultural and social factors in tackling such crises more effectively. The Audit Commission report (1994), which was based upon the consultations carried out with a range of local service user groups in order to determine their priorities, found that alternatives to hospital for treatment of mental crisis situations was sought by most of the respondents. There were requests for 24 hour crisis facilities and crisis centers that were not hospital based. A majority of the respondents who used mental health care services wanted someone to talk to when in a crisis stage, rather than hospitalization. Combs(2007) has discussed the efficacy of provision of mental health intervention by phone as provided by the Red Cross in the aftermath of the Katrina disaster. In discussing his experiences, the author points out that most of the callers felt stronger and more confident after having someone listen to them. They did not really expect an immediate resolution of their problems; rather they were seeking some time and attention from others during a time when their own worlds were in chaos. One of the significant legislative measures that have been mooted in recent times is the Mental Capacity Act of 2005. Section 2 of the Act states that a person lacks mental capacity if he/she is unable to make decisions; however the Act specifies that it is necessary and essential to act in the person’s best interests in any case. (Irons, 2007) Moreover, acting in the best interests of a mentally incapacitated person is not restricted merely to clinical interests but also to social, moral and ethical factors and may serve to address in some measure the existing prejudices of health care professionals against the mentally disabled. In fact, as reported by the Royal College of Psychiatrists (2001), there is prejudice existing even within the medical community against mental illness. Within the medical profession, when doctors or health care professionals experience mental illness symptoms such as depression, they tend to hide the fact due to the discrimination that they face from the medical community. The Doctors Support Network has been set up to provide help for such victims of mental health disorders.(Miller, 2006). Mental crises are often associated with hallucinatory experiences that appear very real to the person who is suffering. According to Rogers (1980), when there are others available to offer support and understanding during period of mental distress, this helps to facilitate self understanding and thereby leads on to healing. Pembroke (2000) highlights this through the case study of a former mental health patient Louise, who was under psychiatric treatment which was not helpful to her in achieving control over her irrational yet very real fears of snakes attacking her and spirit entities that troubled her regularly in her mind. However, with the help of care and support from her partner, she was able to slowly understand that these troubling mental visions were merely expressions of conflicting aspects within herself and therefore normal to her emotional and make up. In discussing her healing, Louise the former patient offers the view that what was helpful was the fact that someone believed her. Crisis intervention strategies may need to bolster inner resilience and integrate protective factors and solution based techniques to deal with mental health patients, rather than following in the line of traditional methods which are focused only upon dealing with the crisis and resolving it by helping the client to find new or latent coping methods in order to cope with the crisis.(Roberts 2000). The existing stigma against mental health patients would also function as a barrier in ensuring effective healing for such patients, because they are treated with underlying contempt and their rights may not be fully enforced. The Mental health reform Bill of 2005 seeks to provide a greater degree of autonomy in patient decisions so that compulsory treatment is used only as a last resort. This Bill also recognizes the danger that seriously ill patients may pose to the community and the need to protect such people from harming themselves and others.(www.medicalnewstoday.com). This improved legislation helps to ensure that the rights of mentally ill patients are protected, so that only a small minority of them will be forced to accept treatment. The recognition of the rights of mentally ill patients is also an important step forward in addressing those who are victims of mental health crises, since the treatment methods are likely to be focused more from the perspective of providing emotional support. From the views of experts as discussed above, it appears that an institutionalized, contained environment such as that found in a mental health hospital may be suitable only for the most disturbed patients who are likely to be a danger to themselves and others. However, for the majority of crisis victims, their autonomy and decision making cannot be neglected while administering treatment. They may need a supportive and nurturing environment and the opportunity to discuss their inner fears and problems, and may prefer non medical staff for this purpose, since the cause of the crisis is likely to be more in the mind than due to physical causes. The feeling that they are believed and supported is likely to help these patients to find a resolution to their problems quicker. It is also necessary to ensure that crisis support is provided on a 24 hour basis, and the provision of a supportive environment is likely to provide a more effective crisis handling measure than a traditional institutionalized setting. While mental health practice has traditionally been treated in an institutionalized setting, crisis counseling is primarily home and community based. Crisis counseling seeks to restore a person to the pre-disaster condition, while mental health crises require a much deeper, fundamental approach , which focuses on the diagnosis and treatment of the mental illness.(www.mentalhealth.samhsa,gov). It could thus be argued that in Eustace and Mary’s case, the best kind of treatment for them may be available at home and they are most likely to benefit from it but the impatience and anger of the other family members is likely to prove to be deterrent in this case. Scheff (1996) suggests that institutionalized mental health services have a negative effect on the lives of the mentally ill. Byrne(2001) has detailed the stigma that is associated with mental health illness, which creates negative stereotypes about individuals and the development of a prejudiced attitude towards them, both by medical professionals as well as the community. In their study, Ghodse et al (1986) examined the attitudes of physicians and nurses towards mental health patients who suffer crises. The findings in their study pointed towards a predominantly unfavorable attitude in nurses and medical staff towards those patients who reach a crisis stage through dependence on alcohol or drugs which results in overdosing. The limitations of the institutionalized environment in catering to the needs of mental health patients who are in a crisis stage is also illustrated through news articles which point out the dearth of nursing staff and doctors to work in mental health institutions, citing low morale, poor pay and poor working conditions as factors responsible for the staffing shortage.(BBC report, 1999). Recent policy initiatives in the health care setting have become increasingly directed towards bringing about cultural changes in health care organizations. For example, there is a great deal of effort that is being put into redesigning services, facilities, staff and patients in order to ensure that streamlined services and better patient care are provided. (Hyde and Davies, 2004) The prevailing attitude of the public about mentally ill people tends to be one of avoidance due to the prevailing wrong attitudes about them. There is a general trend to the policy of NIMBY – Not in my back yard, whereby the community does not want to be associated with the need to care for mentally ill people, but would rather see them safely locked away in institutions where they would apparently not be a danger to others. This is largely due to the negative images in the media, whereby mentally ill people are perceived as a danger to themselves and to the community they live in. They are therefore perceived to be in need of rigid supervision within an institutionalized environment such as a psychiatric facility. However as Heller et al ( 1996) have pointed out, it is necessary to reverse this impression of “otherness” that is associated with mentally ill people, and to promote understanding within the community for these people, so that they are allow to live and function within the community as members who are well received among their family and friends, rather than being forced to be locked away in an institutionalized environment. Heller et al (1996) have suggested that mentally ill people need to be rehabilitated within the community itself in accordance with the K257 policy, where strategies must be devised in order to take care of these people within the community itself. Where treatment is concerned, the case of Bolam v Friern Hospital Management Committee1 was significant because it laid out the test that a doctor is not guilty of negligence if he has acted in a manner that is proper according to a responsible body of medical opinion, to be in the patient’s best interests. However, as Goldrein (1994) argues, such an interpretation of best interests of the patient may be faulty, especially in the case of mentally ill patients and it may be necessary to evaluate physician negligence as a tortious act, rather than allowing it on the best interests argument.2 The best interests standard allows decisions to be made on the basis of what may be in the patient’s best interests to provide beneficial consequences for the mentally incompetent patient3. As opposed to this, the substituted judgment entails making an effort to arrive at the decision that the person would have made if he/she had been competent to do so, however such decisions may not automatically be those which are in their best interests. Hence, there is a conflict that may arise between the autonomous decision of the patient and the decision in his/her interest. In a survey that was conducted among the parents of eighty eight adults or adolescents with mental retardation, almost all parents supported the sterilization of their children mostly out of fear of the sexual abuse of their children or a pregnancy occurring.4 In the case of Re F5 it was held that sterilization was in the best interests of the patient if a responsible group of medical professionals considered that it was so. Similarly, in the case of Re X (Adult sterilization)6 sterilization was carried out because it was deemed to be in the best interests of the patient. A 19 year old mentally handicapped woman was also sterilized without her consent on the grounds that it was in her best interests.7 In the case of Re B (a Minor) (Wardship sterilization)8 the House of Lords affirmed the decision of a lower court that authorized the sterilization of a 17 year old mentally incompetent girl on the grounds that it was in her best interests for her welfare, since she lacked the mental capacity to handle childbirth. All of these cases have overridden the autonomy of the patient in performing the sterilizations. However, there was also a fundamental principle established by the case of Re F, that every person’s body is inviolate and Lord Goff stated clearly that “the performance of a medical operation upon a person without his or her consent is unlawful, as constituting both the crime of battery and the tort of trespass to the person.”9 The importance of this principle in protecting individual freedom had earlier been spelt out by Lord Reid in the case of S v McC, W v W 10 in opposing the imposition of medical procedures because “English law goes to great lengths to protect a person of full age and capacity from interference with his personal liberty.” But in the case of Re F, Lord Goff also pointed out that when a patient is unable to give his or her consent for any reason, “there exists in the common law a principle of necessity which may justify action which would otherwise be unlawful.”11 Parens patriae exercised by the Court thus appears to be the guiding principle behind the forced sterilizations of women who are mentally handicapped, on the grounds that it is in their best interests and must be applied on the doctrine of necessity, codified under sections 5 and 6 of the Mental capacity Act of 2005. In the case of Re S12, the Court of Appeal reversed a decision of the High Court allowing the sterilization of a mentally incompetent 29 year old woman. Dame Elizabeth Butler Sloss was of the view that despite the concerns of the mother about her daughter, the surgical procedure could not be forced upon the young woman without her consent13. According to Richard Kramer of Charity Mencamp, the decision of the Court of Appeal was the one truly in the best interests of the young woman because “sterilization cannot be in a person’s best interest if based on social rather than health grounds.”14 Under Section 58 of the Mental Health Act of 1983, ECT and medicines may be given to a mentally incompetent person when there is a concurring opinion from another doctor on the need for such treatment. The Act also allows for the detention and treatment of patients with mental illness without the need to acquire the consent of the patient. However, in the case of St. Georges Health Care Trust v S15 the Court of Appeal stated that the Mental Health Act of 1983 “cannot be deployed to achieve the detention of an individual against her will merely because her thinking process is unusual.”16 Moreover, with the incorporation of the Human Rights Act of 1998 into UK law, any kind of treatment given without the consent of the patient will be lawful only if it is convincingly shown to be medically necessary.17 On this basis therefore, forcible sterilization of female patients on the grounds of mental disability, such as the cases described above may not be lawful and the autonomy of the patient may need to be respected, as demonstrated in the decision on Re S. Such cases demonstrate that the decision to sterilize the women, made on the basis of parental concerns about pregnancies may not be a valid legal position, which respects the autonomy in decision making of these women. The views of Jackson that the interpretation of “best interests” so far has been unfortunate, appears justified, since the real best interests of the person must be determined on health grounds rather than social grounds. A serious and life threatening crisis posed to the patient may provide adequate grounds for forcible sterilization, the desire of parents or doctors to sterilize a mentally incompetent person on the grounds of being unable to handle pregnancy may not. References: * Audit Commission, 1994. “Finding a place: A review of mental health services for adults.” London: HMSO * Byrne, Peter, 2001. “Psychiatric Stigma” The British Journal of Psychiatry, 178: 281-84 * BBC News Report, 1999. “Crisis in Mental health” 13 October, 1999. [online] retrieved September 1, 2007 from: http://bjp.rcpsych.org/cgi/content/full/178/3/281#REF20 * Campbell, P, 1996. “The history of the user movement in the United Kingdom”. IN “Mental Health Matters: A Reader” (eds T. Heller, J. Reynolds, R. Gomm, et al). Basingstoke: Macmillan. * Combs, Don, C, 2007. “Mental Health interventions by telephone with Katrina survivors.” Journal of Health care for the poor and undeserved, 18(2): 271-277 * Crisis counseling and mental health treatment similarities and fifferences.” [online] Retrieved September 1, 2007 from: http://mentalhealth.samhsa.gov/cmhs/EmergencyServices/ccp_pg02.asp * Ghodse, A.H. Ghaffari, K and Bhat. A.V., et al, 1986. “Attitudes of health care professionals towards patients who take overdoses.” International Journal of Social Psychiatry, 32 :58-63 * Hyde, P and Davies, H.T.O., 2004. “Service Design, Culture and Performance: collusion and co-production in health care.” Human relations, 57(1): 1407-1426 * Irons, Ashley, 2007. “Impact of the mental Capacity Act of 2005” The Mental health review, 12(1): 37-41 * Johnson, S and Baderman, H, 1995. “Psychiatric emergency services in the Casualty Department” IN M Phelan, G. Thornicroft and G Strathdee (eds) “Emergency mental Health Services in the Community.” Cambridge: Cambridge University Press * Miller, Liz, 2006. “Doctors’ Support Network.” The Mental Health Review, 11(3): 41-44 * “Next steps for Mental Health Bill, UK” 2005. [online] retrieved September 1, 2007 from: http://www.medicalnewstoday.com/articles/27413.php * Pembroke, L, 2000. “It helped that someone believed me” IN Reads J and Reynolds, J. (eds) “Speaking our minds: An Anthology” Palgrave: Basingstoke * Roberts, A.R., 2000. “An overview of crisis theory and crisis intervention” IN A.R. Roberts (edn) “Crisis intervention handbook: Assessment, treatment and research.”(2nd edn) New York: Oxford University Press. * Rogers, C.R., 1980. “A way of being.” New York: Houghton Mifflin * Sayce, L, 2000. “From Psychiatric Patient to citizen.” London: Macmillan * Scheff, T.J., 1996. “Labelling mental illness.” IN Heller, T, Reynolds, J, Gomm, R. Muston, R and Pattison, S, 1996. “Mental Health Matters” Milton Keynes: Open University Press. Read More