Abandoning Patients or Clients of Mental Health and Drug Abuse - Essay Example

?INTRODUCTION Up-to research shows that most hospitals are abandoning patients or of mental health and drug abuse. McHugo (et al 2006elaborates how these patients get meager services at the clinical level. These patients who had co co-ccuring mental disorder would not get proper treatment and services. Mostly, in the United States, it was observed that patients with the mental disorders and drug abuse would not get any treatment they would instead bring clients together. This was according toRidgley, Osher, Goldman&Talbott, 1987.However there were some patients who were lucky enough to get treatment but unfortunate for them the results of services given could either be random. A research survey done by Epstein, Barker, Vorburger & Murtha, 2004 showed that about 12%of people with this problem received integrated treatment. The treatment addressed two major concerns which were improving the reach of the clients in the hospitals by ensuring the services for treating the cases are available and two improving individual counseling, group counseling and residential treatment. However there are barriers to the integrated treatment such as lack of training and professionalism, finances issues and the organization itself that challenges the treatment of the substance and mental health. On the other hand Drake et al., Center for Substance Abuse Treatment, 2005, New Freedom Commission on Mental Health, 2003, tend to differ since he has come up with training attempts to overcome these barriers. Since the early 1980s problems of co-occurring mental illness and substance use disorder have gradually been developed and tested.In the research there is a review regarding types of interventions, problems limiting the research and suggestion regarding future directions of the research. Current research shows that at least three types of integrated interventions for drug use disorder are effective with these two groups: counseling contingency management and long term residential patients. The other integrated treatment such as the Group counseling are reliable on factors such as education, skills building and friends and family support while the contingency management integrated treatment check mostly on substance use and do not rely on factors such motivation from others and other processes which involve learning and understanding of things. Other interventions treatments never show effects on drug use but they lead to improvements of the other integrators this is according to Ledger, wood & Petry, (2006). The researchers have drawn positive reasonable conclusions such as in the studies of individual counseling which were based so as to motivate the individual who was being interviewed. Eight studies were identified and then followed experiments which were mainly aimed on the outcome of the drug abuse. Four studies examined individual counseling and other three studies showed that substance abuse repercussions was unpredictable, (Baker et al., 2002a, 2002b; Hulse & Tait, 2002; Swanson, Pantalo, & Cohen, 1999. A single study of nine months was conducted by Barrowclough et al. (2001) and he documented some positive results but most of the experiments he conducted the outcomes of the drug abuse and other outcomes differences on substance use were not constant when the client was at his eighteen month of usage. The most recent studies indicate that group interventions are becoming more definite, standardized, and more effective. Bellack, Bennett, Gearon, Brown, and Yang (2006) came up with evidence that group counseling treatment have positive effects on those using drugs though one challenge they faced is that the patients must be willing to learn. Family intervention was aimed at improving the knowledge of the family members concerning the problems of the client and how they cope when the mental illness or substance abuse re -occur. A study was conducted for this and the results were positive but faded when interventions ended. Case management in this case means concrete work which is in build to improve health and is achieved by dealing with social factors affecting the health of the client, and it usually involves community treatment in that the community is interviewed on the effects of substance use and mental illness. Coinciding with this, eleven studies were undertaken and they involved half experiments and half-quasi-experiments.These studies brought about disagreeing issues on the results, with six studies reporting reduction in substance use and the other studies showed concentration of case management which resulted to weak results. For example the study would have been different if the interviews from the community members were taken a week after there was an education about effects of substance use. Studies on mental illness also showed disagreeing results but there were good outcomes in other areas. Such outcomes included increased engagement in community work, reduction in hospital use and improved living of the patients’ life. Therefore, case management is a good intermediate for treating those patients with mental illness and substance use, but in those that are been treated against substance use it depends on specific treatments within the case management. Systematic reviewing techniques are rapidly developing in the research studies and most depend on factors such as whether the reviews bring meaning and suitability to the study. However the research shows that not all of these reviews have been proven a 100% correct. Other reviews may have or may possess invalid misleading data. To produce the best systematic reviews, good published studies and those that are unpublished are taken its value is checked so as to come up with proper studies which are fair and square. High quality reviews maybe found in journals , electronic sources such as recorders etc. Nevertheless, one should note that not all these published information is correctly detailed thus to ensure good quality, interviews can be conducted using questionnaires or face to face. In-order to better the systematic quality, one should use independent reviewers, have a good topic of which should have patients receiving treatments and outcomes should be well addressed. If the studies do not have a similar effect with the rest then the study was not investigated thoroughly meaning it should be redone again to improve the quality. Other information which could be missing should be assessed to ensure big impact on the findings. If the recommendations are not based firmly on the quality of evidence presented, reviewers can sometimes go beyond the evidence and draw conclusions and making their own recommendations. Systematic reviews are needed if a research plan may seem to have a problem: it maybe unclear or if the study has failed to solve the problem. For example if original studies of the effects of clot busters after heart attacks had been systematically reviewed, the benefits of therapy would have been apparent as early as the mid-1970s, Elliot, Antman, Joseph Lau and colleagues “ two landmark papers”,1992. The functions of the systematic reviews are to know the costs of clinical services and drugs, to know whether an intervention is realistic, if it has got the correct ethics and whether it relates to the evidence provided by the patients, relatives, families or the community. Systemic reviews can also be of use where healthcare professionals or graduates may find a tough issue perhaps wit findings in a study which contradicts with the rest or there are questions which maybe uncertain. It is also a fundamental to the National Institute for Health and Clinical Excellence health technology in that it estimates the process for multiple technologies and also calculates single technology. However, systematic reviews are most needed whenever there is a substantive abuse study case. Limited availability of space and the terms of programs led to participants being reduced from a hundred participants to seventy only. Some sampling biases were used which brought about special concern. While analyzing the samples, self-reported weights were used as they were the only measures available but instead they would have used self-reported weights which are much more accurate. Recorded weights were also used as a follow- up weight which made the case study more sensitive since maybe the samples were not correct or maybe they were biased. There was no significance found between sex and weight loss because studies shows that at the end of the program there was no effect on the patient or even at the end of the year. The secondary analysis compared two programs in the study: Primary care programs and Commercial programs. In the study participants who took part in the primary care programs lost less than the ones in the commercial programs. Those who were in the commercial programs lost 2.3kgs more difference being 1.7kgs. The difference in loss of kilos was accustomed for by age by which young people would lose more since they have more energy; ethnicity and sex did not have significant effects on the study and physical activity which the commercial programs had more vigorous activities than primary care programs. Women were more likely than men to choose one of the commercial providers but there was no statistical data that showed it brought any effect to the study research. Ethics are moral beliefs of what is wrong and what is right. In the research those participants in the commercially run programs had significantly lost greater weight than those in the comparator group and also the attendance rate shown is in the weight watchers and rosemary Conley interventions. This shows an ethical issue as the researcher shows how the primary care programs is hitting lowest level of attendance compared to the other commercial interventions which may ruin the name of the companies. The researcher could have however emphasized on getting the facts of participants than getting the facts of the interventions of the commercial and primary care programs. Search for creative solutions would have been emphasized and encouraged to the interventions. For example the primary care programs would have increased vigorous and physical activities for the groups. The researcher would have recognized that the choices made can be right –right or right-wrong and would have gone ahead and given the ways in which the decisions can be corrected or improved for betterment. The study purpose was to compare individual programs with the comparator group, not to have competition between programs. The limitations came about where they were unable to get an objective weight measurement which led to them asking participants to self-report. The self-report physical activity seems high and was likely to be an over estimate. The costs that was needed for the program was for consultation rates, drugs, the cost of the participants for attending the programs or for purchasing any products from the program. However, as there were base line measures, they were present change in activity, and differences in overestimation between trial arms. Threat to external validity is an explanation of how you might be wrong in making a generalization. For instance in this study ,the researcher says participants chose commercial providers (Weight Watchers 29 (29%), Slimming World 14 (14%), Rosemary Conley 28 (28%)), 16 (16%) chose the Size Down program, 3 (3%) chose general practice, and10 (10%) chose pharmacy provision, whereby women were more likely than men to choose one of the one of the commercial providers. However no statistical difference in weight loss came about at the end of the program and there was no significance between the program chosen and who choose it. The authors did give a sufficient amount of information concerning the statistical tests .They analyzed data according to intention for the treatment. They however used self-reported weights and they should have used measured weight to give accurate information since the information on the self-reported would have been highly over estimated. There were investigations differences from the study between comparator groups and the interventions. This was due to the interventions used recorded weight as a follow up which could have being wrong data. In an exploratory subgroup analysis, there were examinations weight loss separately in men and women by using a regression model, with the arm to which they were allocated age. In the study, the commercial weight loss was examined to prove whether the effects of the interventions were affected by the sex gender. It showed that the intervention had most clients being women. So it was positive that the effectiveness varied by sex. Studies have shown that receiving the diagnosis of breast cancer is a traumatic experience and may cause various emotional reactions. Most women are reported to have posttraumatic stress disorder symptoms, some even long after treatment. Quantitative design studies have focused on the experiences rather than on the total experiences expressed by the women as the qualitative designs can do. Most qualitative designs studies on pre-surgery and retrospectively. Several studies also show that patients waiting for breast cancer surgery are most stressful the day before the surgery. However, uncertainty remains one of the major stressors that influence women’s experiences during that cancer period. Most patients are afraid of the diseases reoccurrence and have to live with the uncertainty. In the study, descriptive approach was used which analyzed data independently, and the data findings were discussed by the other researchers throughout the process to reach agreement. This principle was convincing and dependent because the interviews conducted were audio-taped and the memos were written during the analysis to ensure ideas were noted down. The researchers may use different kind of approaches in collecting the data for example they could use interviews, group discussions, observations, taking field notes, texts, pictures and other materials. This would have made a large impact on the patients since one would be prepared physically and psychologically. Unlike the descriptive approach qualitative research rely on different methods for gathering information, For example participation observation, Non-participant observation, field notes but the descriptive approach only uses for example participant observation only. The researcher conducted interviews which were analyzed in three steps using the method of qualitative data analysis. Three levels were used: self-understanding, theoretical and common-sense understanding. At the first step the interviews were read to acquire sense .When the interview brought meaning ,self-understanding emerged and the researcher got to feel the women’s personal meaning according to his own understanding. The second step, the interviews were read several times so as to bring about common-sense understanding. The third interview, it was all about getting to the mutual relationship with the patients and the understanding became clearer. These processes were discussed by the nursing theory of ‘Uncertainty in illnesses. The researcher’s findings revealed different emotions such as anxiety, fear and suffering as they waited for surgery which was brought about by uncertainty. Some of the participants anticipated negative thoughts such as negative effects and co-occurrence of the disease while other patients trusted surgery to finish off their suffering. Suffering must be ‘worked through’ for example in the hospitals nurses may support persons going through this experience thus aiding the patient. Patients who lose control over situations tend to be more stressful than those who believe they can overcome the situation. The patients with cancer who tend to lose control have been known to get into a state of depression and self-helplessness. Trust and confidence in credible authorities and expertise decrease uncertainty according to Mishel and Braden (1988). The research shows that patients who were informed about the date of the surgery would prepare themselves both physically and psychologically. The systematic study review that over the years there has been improvements in number of designing future studies. Despite the interventions having a positive impact it has several limitations targeted to families of the patients of those who are affected. However improvements still need to be made regarding effective ways of providing psychosocial support to families. The study gives knowledge of experiences women with breast cancer face and aids in developing ways to help them deal with the anxiety and stress. The research shows that clinical professionals should show compassion and sensitivity to the patients. Also it shows how women deal with stress and uncertainty before surgery. Nevertheless, future studies should show what women undergo through after surgery, how they live with it thereafter and how the community and families cope with it. The findings show that client who enrolled in commercial based programs lost more weight than those who enrolled in the program care. Research studies show how use of substance use and mental health illness continue ravishing in our society. However the research shows interventions that are rapidly growing to ensure positive outcomes at clinical level. 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