Mental Health Services Delivery vs Organization Management & Risk Mitigation - Literature review Example

Running Head: Mental Health Services Delivery vs. Organization Management & Risk Mitigation Student’s Name: Instructor’s Name: Course Code and Name: University: Date Assignment is due: Mental Health services are delivered in an environment that emphasizes management and mitigation of risk. What dilemmas does this pose for provision of services that are recovery orientated? What implications does this have for social work practice within the mental health context? Introduction This short essay shall focus its discussion on the dynamics of mental health services provision in Australia, as a basis of developing an argument that contemporary mental health service delivery is dominated by the need to manage and mitigate the risks involved. Most environments in which social workers are delivering mental health services have strict protocols in place all directed at managing and mitigating the inbuilt risks. The paper uses this argument, with the support of relevant literature as well as legislative history of Australia in regards to mental health services, to examine the dilemmas that this trend poses to the provision of recovery-orientated mental health services. Further, the paper discusses the possible implications of this trend on social work practice within the mental health context. To deliver on this mandate, the paper begins by exploring the range of definitions associated to mental health, mental illness and mental health services, before discussing the dynamics of delivering mental health services. With this background, the paper then launches a brief examination of the policy trends in Australian mental health services and the basics of the Australian regional and national mental health legislation. On the second segment of the essay’s body, a discussion on management and mitigation of risks in mental health services provision helps to deduce the dilemmas in mitigating risks during recovery-oriented mental health services provision as well as the potent implications of risk managing and mitigating in mental health social work practice at large. Mental Health Services The Australian National mental health Plan 2003 – 2008, understands mental health as a complex domain and not simply the absence of any mental illnesses. To this agency, mental health illnesses and problems denote a wide range of emotional, cognitive and behavioural disorders which develop and interfere with the life and productivity of a person. Australia has numerous adopted definitions of mental illness with almost every region having its own definition. The Queensland’s legislation as denoted in Mental Health Act 2000 (Queensland) mental illness refers any ‘medical condition that’s characterised by significant disturbances of mood, thought, perception and or memory. The same definition is adopted in Victoria while other territories have their own definition of mental health. The Australian Institute of Health and Welfare in its report for National Health Priority Areas on Mental Health aptly defined the concept of mental health as that capacity of people and groups to harmoniously interact with each another and their environment, in such a way that promotes their subjective wellbeing, their optimal development and their use of affective, cognitive and relational human abilities (Mental Health Council of Australia, 2010). Consequently, mental illnesses become any conditions in which people develop behaviours and symptoms that are distress them or others or interfere with their normal social capacity and functioning in daily life (Mental Health Council of Australia, 2010). The Australian Institute of Health and Welfare thus defines mental health services as clinical, psychiatric and other professional assistance aimed at treating, rehabilitating and even hospitalising individuals these behaviours and symptoms until recovery to normalcy is restored (Mental Health Council of Australia, 2010). Delivering Mental Health Services Having understood mental health services as such, it is important to note that for the purposes of this essay, delivering the mental health services shall refer giving service and engaging in beneficial activities that aim at overcoming the negative issues that accrue from emotional disturbance of patients, their maladaptive behaviour which may adversely affect learning, socialization and development, or even cognitive anomalies (Erikson, 1957). Most institutions offering mental health services as part of their social work are either private or public agencies (Delaney et al, 1999). There are two types of mental health institutions namely, non-residential and residential agencies (Delaney et al, 1999). The process of providing mental health services as a primary form of health care begins with diagnosing patients of mental illnesses and conditions (frequently reached after a positive mental health assessment) (Delaney et al, 1999). Once an individual has been assessed and deemed to lack perfect/normal mental health, he or she is then diagnosed for the type of mental illness he or she is suffering from (Suarez et al, 2001). It is from that diagnosis that mental health services ensue, aiming at treating and caring for the patients with respect to the condition they are diagnosed with (Suarez et al, 2001). Contemporary mental health services, especially in national public agencies, also involve putting in place necessary frameworks and strategies that help prevent the emergence and proliferation of mental health disorders (Delaney et al, 1999). Offering mental health services requires the expertise of numerous primary health care personnel (social workers) with key behavioural science and psychosocial skills such as interviewing skills, counselling skills, interpersonal skills and clinical skills (WHO, 1990 in Suarez et al, 2001). This range of skills is employed in a way that seeks to improve the overall mental health outcomes of the patients (WHO, 1990 in Suarez et al, 2001). Most social workers in charge of mental health patients, are usually part of larger organisations, non-residential or residential, and bound not just by the ethical and professional codes of conduct, but also by the organisational policies, rules and regulations (Suarez et al, 2001). Social workers must in many cases, work in accordance to the goals and structural guidelines provided by the organisations they are part of (Delaney et al, 1999). In this regard, it is the institutional framework that in most cases that have more impact on the processes, practices and outcomes of mental health service provision, more than individual initiative. The nature of policies, rules, regulations, structural guidelines, empowerment, freedom, authority, and protocols that a mental health services institution provides its social workers that can be regarded as the environment of mental health services practice, as determined by its management (Delaney et al, 1999). In many institutions, mental health care services are integrated into primary health care services for all received or admitted patients. Most of the mildly affected patients are simply put on treatment and allowed back into the society at this stage. There are those patients however, whose disorders are either complicated or severe that they need complementary care. This second group of patients are usually referred to specialist care and are frequently hospitalized (Suarez et al, 2001). In most cases, these patients are placed under treatment with the hopes that they would achieve complete recovery and then be released back to the society (recovery oriented) (Suarez et al, 2001). It is often the case that the secondary level patients need other services besides treatment, such as counselling, therapy and socialisation sessions to help them achieve optimal recovery (Erikson, 1957). If the services provided do not help the patient revert to mental health and when such patients continue to exhibit severe signs of illness, then they are classified to the tertiary level (Goffman, 1961). This group of mental health patients are totally dependent on the institutional services and are almost always residentially treated. The tertiary level of patients includes those with chronic disorders that make them unsafe to live in the society, socially dysfunctional and totally dependent on care providers (Frank& Brookmeyer, 1995). Such persons may be detained and restricted in such institutions as asylums, the emphasis being mostly to moderate their conditions more than to treat or cure them (not-recovery oriented) (Goffman, 1961). Policy Trends in Australian Mental Health Services Muir-Cochrane, O’Brien & Wand (2005) believe that contemporary Australian mental health services have been based on the universal concept of human rights, with most national mental health services policies undergoing a progressive since 1990’s in both regional and federal jurisdictions. For instance, in 1992, all Health Ministers in the Australian states supported the National Mental Health Strategy which operationalised the 12 priority areas of the National Mental Health Plan 1992 (NMHP) (Muir-Cochrane, O’Brien & Wand, 2005). The plan called for increased funding of mental health services as well as reforms in the sector towards improving inpatient care in regards to patient isolation, stigma and human rights. This plan was reviewed and published in 1997 and again in 2003, to make it reflect the continued government commitment to developing and maintaining working programs and services promoting prevention, treatment and rehabilitation of the mentally illnesses. According to Muir-Cochrane, O’Brien and Wand (2005), among the key areas addressed by the current Australian national policies on mental health services has prioritized promotion of mental health through prevention strategies, increased service responsiveness, optimization of service quality and increased innovation, research and sustainability of the programs and services. These priorities have tended to amplify the need for better mental health services, the rights of individuals to such services, and the duty of providers to offer the same in their institutions, public or private (Muir-Cochrane, O’Brien & Wand, 2005). From the perspective of service providers, Australian national policies on mental health services is more protective of the patients, more biased to the interests of the patients and very demanding on the service providers. Australian Mental Health Legislation Every state and territory of Australia has a distinct mental health legislation (called mental health Acts). Queensland has the Mental Health Act 2000 while Victoria uses the mental Act 1986. Similarly, the South territory has the Mental Health Act 1993, Tasmania territory has the Mental Health Act 1996, the Australian Capital territory has the Mental Health Treatment and Care Act 1994, the Western territory has the Mental Health Act 1996 and the Northern territory has Mental Health and Related Services Act 1998. These acts define how and when health care services are to be offered such as when to use physical treatments, relevant medical interventions, seclusion practices, detention and involuntary treatments etc. According to Muir-Cochrane, O’Brien & Wand, ‘while these mental health acts vary in regards to requirements placed on psychiatrists and mental health services providers, the core issues of care such as the definition of mental illnesses, the basic admission and detention criteria of both voluntary and involuntary patients, reflect United Nation’s principles of human rights as present in all the state and territorial acts (2005, pp.54). Muir-Cochrane, O’Brien and Wand (2005) also note that besides identifying what mental illnesses and patients constitute, the acts are also very clear on the behaviours and characteristics that do not indicate mental illnesses such as religious and political views and activities, particular philosophies, sexual orientation and preference, being an addict of drugs and alcohols, intellectual disability, being antisocial etc, (See Victorian mental Health Act 1986 as amended in 2003 and Queensland Mental Health Act 2000). Muir-Cochrane, O’Brien & Wand (2005) also note that in recent times, ‘Australian Mental Health Acts amendments ... are progressively embracing the patient’s perspective in care, provision of appropriate and timely responses to patient/family complaints on the care provided, as well as the rights of detained patients’ (pp. 54). For instance, most of the Australian Mental Health Acts provide for voluntary treatment of mentally ill persons if their condition requires approved facilities or if the persons are suffering from an acute mental illness, as long as the patient is involved in all aspects of treatment and care regardless of such person’s status. The acts also provide guidelines for detaining persons and treating them involuntarily such as when the person appears mentally disturbed, immediate care is necessarily from an approved psychiatric institution, when there is a threat of self harm or violence etc (Victorian mental Health Act 1986 as amended in 2003 and Queensland Mental Health Act 2000). In all the states and territories, detention is only validated if it is in the best interest of the patient, especially as regards the risk that such a patient has oh the self and on others (Muir-Cochrane, O’Brien & Wand, 2005). Management and Mitigation of Risks in Mental Health Services Provision As Morgan (1998) as quoted by Muir-Cochrane, O’Brien & Wand notes, ‘the concept of risk in health care management reflects the general public perception that persons with mental illnesses are a danger to others since they have an increased capacity for violence’ (2005, pp. 57). Of special interest in mental health services provision is the need to ensure that patients are kept in the society or in psychiatric institutions depending on the level of risks they pose to themselves and to the society. Risk management and mitigation in mental health services practice only accrues in secondary level patients who are cared for and treated with the goal of helping them recover and rejoin the society as functional members and not for tertiary level patients who have no prognosis of recovery (Delaney et al, 1999). Most social workers have to make decisions of whether to release mental health patients into the society or whether to keep them in detention. This has in recent times introduced a notion of legislative control measures in mental health services practice in a bid to manage risks of having mentally ill patients in the society (Delaney et al, 1999). Mental health institutions in contemporary times have found themselves in great dilemmas when juggling their decisions between the dangerousness of patients and their level of risk to themselves, to the society and to the social workers (Muir-Cochrane, O’Brien & Wand, 2005). Muir-Cochrane, O’Brien & Wand note that, the dilemma accrues from, ‘the notions of dangerousness and risk mitigation/management, both recent concepts of care and treatment of patients in mental health settings, particularly in mental health service delivery’ (2005, pp. 57). Dilemma in Mitigating Risks in Recovery-Oriented Mental Health Services Provision The first dilemma that social workers face today, is that of deciding whether a patient should be detained or released based on their risk levels to themselves and to the society. Not only is it important to determine the risk levels of a mental health patient who is involuntarily admitted and treated, but also that of the voluntary patient. Releasing a patient is and should only be done based on the level of risk that such a patient portends to the society that he or she leaves to join (inclusive of family, community etc) (Findlay, 1999). That is why some voluntary patients may be detained if they are judged to be risky to the community, until such a time when they can recover (recovery-oriented). The second dilemma that contemporary social workers are finding themselves in, is that of determining how best to provide care to the mentally ill without risking their own lives. In some cases, mentally ill persons are deemed as risks to the health professionals administering care in the institutions, such that the social workers are torn between providing care as best as they could, or keeping their distance and reducing the risk of being harmed(Findlay, 1999). If patients are deemed to be risky enough to health professionals, their interaction is reduced with the social workers and they might only be viewed or talked to in cage-like restrictions. In doing that, the risk of such patients attacking the social workers is reduced considerably, but the effectiveness of the services provided is sacrificed largely (Findlay, 1999). In most times, confining ‘risky’ patients completely presents a dilemma for social workers where they either prioritise their personal safety or the effectiveness of their care (Findlay, 1999). Another dilemma is that of secluding the ‘risky’ patient to the extent that they do not have interactions with the people who want and can help them recover, or releasing such patients to the society where their loved ones can help them recover. Such patients may benefit from such interactions and yet, at times, may subject their loved ones to physical harm and violence (Findlay, 1999). Deciding what suits an individual patient is a big dilemma for social workers today, since it is all based on risk management and mitigation. This is more so because choosing to confine ‘risky’ patients completely not only drives them further into illness but also makes them susceptible to self-harm (Findlay, 1999). Implications of Risk Managing and Mitigating in Mental Health Social Work Practice Mental health service providers, the social workers, who are perpetually faced by these dilemmas in every day practice are increasingly finding themselves and their decisions subject to controversy, debate and apathy. While the guidelines, protocols, rules and regulations of risk management and mitigation in health care services are to be found in every institution, which all social work members of the institution must follow, all Australian Mental Health Acts have provisions that facilitate for risk management in detaining and or discharging mentally ill persons to the society (Victorian mental Health Act 1986 as amended in 2003 and Queensland Mental Health Act 2000). However, in most instances, it is the social workers in mental health services environments who are left to make the tough decisions of how to manage and mitigate the risks. The first implication of this demand has been the need for increased awareness on the part of social workers on the right of individual mental health patients, legal constraints and provisions as well as institutional policies. Such knowledge comes in handy to social workers when they have to make decisions about discharging or detaining patients. Secondly, social workers have to confront an increased emphasis of accurate and regular patient assessments that ever before. The social workers have to accurately assess patients on their recovery progress, risk levels, treatment options and social suitability. Before recommending a course of actions, social workers have to know their patients better and be able to predict not just their status but also their predisposition to social and self harm. Thirdly, social workers have been forced to increase their involvement of patients in care and treatment processes, having to explain and solicit for patient views before making any decisions, and having to include the same in their decision making processes. Social workers can no longer make arbitrary decisions for the patients without involving such patients (Frank & Brookmeyer, 1995). Conclusion The discussion so far has helped establish several pertinent points. First, that mental illnesses are any conditions in which people develop behaviours and symptoms that are distress them or others or interfere with their normal social capacity and functioning in daily life (Mental Health Council of Australia, 2010). Secondly, that mental health services as clinical, psychiatric and other professional assistance aimed at treating, rehabilitating and even hospitalising individuals these behaviours and symptoms until recovery to normalcy is restored (Mental Health Council of Australia, 2010). The discussion has also established that offering mental health services requires the expertise of numerous primary health care personnel (social workers) with key behavioural science and psychosocial skills such as interviewing skills, counselling skills, interpersonal skills and clinical skills (WHO, 1990). Thirdly, the discussion has established that the nature of policies, rules, regulations, structural guidelines, empowerment, freedom, authority, and protocols that a mental health services institution provides its social workers that can be regarded as the environment of mental health services practice. It thus emerged that secondary and tertiary level of patients may be detained in approved institutions to help them recover or moderate their conditions. It also emerged that contemporary Australian mental health services have been based on the universal concept of human rights, with most national mental health services policies undergoing a progressive since 1990’s in both regional and federal jurisdiction. In the reforms priority seems to amplify the need for better mental health services, the rights of individuals to such services, and the duty of providers to offer the same in their institutions, to the extent of being more protective of and biased towards the interests of the patients while being very demanding on the service providers. The discussion has also established that all Australian states and territories, detention is only validated if it is in the best interest of the patient, especially as regards the risk that such a patient has on the self and on others (Muir-Cochrane, O’Brien & Wand, 2005). The essay has also discussed how the foregoing scenario has triggered a need to ensure that patients are kept in the society or in psychiatric institutions depending on the level of risks they pose to themselves and to the society. The need for risk management and mitigation has in turn created dilemmas for social workers, the first being the fact that social workers face today, is that of deciding whether a patient should be detained or released based on their risk levels to themselves and to the society. The second dilemma that contemporary social workers are finding themselves in, is that of determining how best to provide care to the mentally ill without risking their own lives while the third dilemma is that of secluding the ‘risky’ patient to the extent that they do not have interactions with the people who want and can help them recover, or releasing such patients to the society where their loved ones can help them recover. Consequent implications of these dilemmas are that there has been the need for increased awareness on the part of social workers on the right of individual mental health patients, legal constraints and provisions as well as institutional policies. Secondly, social workers have to confront an increased emphasis of accurate and regular patient assessments that ever before. Further, social workers have been forced to increase their involvement of patients in care and treatment processes, having to explain and solicit for patient views before making any decisions, and having to include the same in their decision making processes. References Delaney, K., Chisholm, M., Clement, J. & Merwin, E. (1999). Trends in psychiatric mental health nursing education. Archives of Psychiatric Nursing, Vol. 13 (2). pp. 67-73. Erikson, K. (1957). Patient role and social uncertainty-A dilemma of the mentally ill. Psychiatry, Vol. 20(1). pp. 263-74. Findlay, S. (1999). Managed behavioural health care in 1999: An industry at a crossroads. Health Affairs, Vol. 18 (1). pp. 116-124. Frank, R. & Brookmeyer, R. (1995). Managed mental health care and patterns of inpatient utilization for treatment of affective disorders. Social Psychiatry & Psychiatry Epidemiology, Vol. 30 (1). pp. 220-223. Goffman, E. (1961). Asylums. New York: Doubleday- Anchor. Mental Health Council of Australia (2010). Mental Health Fact Sheet. Retrieved September 11, 2010, from Muir-Cochrane, E., O’Brien, A. & Wand, T. (2005). The Australian and New Zealand Politico-Legal Context. In Elder, R. Evans, K. & Nizette, D. (Eds). Psychiatric and Mental Health Nursing. Second Edition. Melbourne: Elsevier. Suarez, A., Marcus, S., Tanielian, T. & Pincus, H. (2001). Datapoints: Trends in psychiatric practice, 1988-1998: III. Activities and work settings. Psychiatry Services, Vol. 52 (1). pp. 1026. Read More