The Nature of the Needs Which Face Victims of Enduring Mental Problems - Essay Example

First 30th January A crittique of current research findings and research direction in psyshiatric rehabiliation research I. Statement of problem a. Research topic To better get understand the topic, we will look at the primary definition of psychiatric rehabilitation. According to the World health organization, it is defined as “the application of measures aimed at reducing the impact of disabling and handicapping conditions and enabling disabled people to achieve social integration.” The aim of psychiatric or mental rehabilitation is to help people with diverse and complex mental health needs to recuperate and regain various aspects of life such as skills, family and relationships. This in efffect helps them to achieve the long term goals of integration is into the society as well as live a fulfilling life like any other normal citizen, or with minimal dependency on others. In this paper, I will particularly critique current research findings and research directions in psychiatric rehabilitation with reference to the authors captured above. b. Research problem As the title article suggests, it is important to substantially understand the nature of the needs which face victims of enduring mental problems, whose lives have taken a different course because of such problems. It is clearly outlinesd that “without a good understanding of the special needs required by such people, a there will be gaps in carrying out assesments on them (Pratt Carlos W et al. 158).” As a result, treatment and other health-care services cannot be administered to best suit the needs of such patients. Similar to every profession, psychiatric rehabilitation has a history. The practices can be traced from its early beginnings where it employed trial and error method as a way of seeking treatment to severe mental problems. This has over time caused springing up of many distinct services for the large number of peculiar mental illnesses: some of which yielded positive results while others ended in the death of the patients. Consequently, it necessitated the adoption of a better approach founded on evidence (evidence-based practice approach) in addressing such cases. Specialists in this field have thus engaged in intense research so come up with a more trusted solution. This approach uses controlled clinical trials to point out efficient services that help to determine the crucial factors that yield positive results. It is therefore important to scrutinize the principles, methods and practices that are continously being introduced in psychiatric rehabilitation so as to assess their appropriateness in treating the mentally ill people. This will further help to come up with specialized rehabilitation facilities as well as improve the existing ones. This will be a great leap towards recovery and intergation of victims of mental problems into the society so as to live a normal life. Further, it is noted that those patients in specialized rehabilitation facilities have higher chances of getting well as compared to those in standard health care faciclities by eight times. II. Review of literature With advance in research, knowledge has increasingly grown. In addtion, it has been established that some modern practices and care services are more superior and effective as compared to others when implemented it the treatment of the patient. Pratt Carlos. W et al gives a case study of a patient suffering from schizophrenia – a mental disorder charactirezed by strong delusions /distortion from the reality and withdrawal symptoms (170). A Patient Outcome Research Team (PORT) carried out a study on the effectiveness of the methods used to treat schizophrenia and then made their recommendations. According to PORT findings, it was established that a majority of these patients did not recieve proper treatment and services. Additionally, it was found out by researchers and administrators that there existed a rather wide rift between research findings and the practices used in psychiatric rehabilitation facilities. In 1998, researchers, clinicians, administrators, consumers, and family members whose relatives were victims of mental disorders converged in a forum that was planned and sponsored by the Robert Wood Johnson Foundation. The agenda of the meeting was to fast track process of implementing the superior Evidence Based Approach in psychiatry. The group of specialists was charged with the task of identifying medical procedures that were supported with dependable research results (Pratt Carlos. W et al 178-183). Clearly set out steps were followed in establishing an EBP. In the procedure, a service model was used. It was studied using multiple controlled clinical trials which gave researchers a considerable latitude to draw causal inferences between the variables that were being studied. Thid was achieved by assigning participants to experimental and control groups during the research. For instance, through progressive findings during research, it was possible to determine the educational approach that was most suitable in helping the patients learn about their diseases. Alternatively, it was also easy to establish which medication was most effective in treating a specific class of symptoms. Moreover, controlled clinical trials went a great way to avoding the problem of bias which is often leads to drawing the wrong research findings. Evidence Based Approach model, one of the current research directions, over the time has been found to yield positive results. The effectiveness of the method used is rated using a standard known as the fidelity scale depending on its ability to treat patients suffering from severe mental diseases. Below is a list of six EBP’s which through research have been shown to have a significant impact on the one or more facets of a illness. i. Medication management ii. Assertive community treatment (ACT) iii. Supported employment (SE) iv. Illness management and recovery education v. Family education vi. Integrated treatment for dual disorders According to Pratt et al, the following are among the changes noted amongest patients following controlled multiple trials six EBP,s i. Symptom improvement (especially for positive symptoms) ii. Less hospital utilization iii. Fewer and less severe relapses iv. Higher rates of competitive employment v. Improved quality of life vi. Increased community involvement vii. Better control of substance abuse problems In our review of literature, we also look at mental rehabilitation in Ireland by giving the past practices, the current provisions and the direction of research findings in psychitric rehabilitation (Lavelle Ena et al. 28). This review follows a national survey, the first of its kind to be carried out in Ireland, of psychiatric/mental health rehabilitation services. It was conducted as a part of a research between 2006 and 2010. During the study, is was established that the number of mental rehabilitation facilities which were headed by expert consultants had risen from five to sxiteen. However, this was lower than the recommended number as determined by the Vision for Change strategy. Further, it is worth noting that below the standards by Vision for Change, it was found that ten out of the sixteen specialists were serving more that 100,000 people. Rehabilitation teams which had been dispatched to work in the various communities were found to be ineffective. This was attributed to lack of consensus regarding the role that the community ought ot play and inadequate resources. There was need to urgently address the issue so as to bring health services to the mentally ill. At the administration level, the findings revealed that there was a lack of a good approach during implementation so as to develop mental rehabilitation in the community. Further, a sizeable number of the rehabilitation facilities in Ireland also reported the presence of ‘new long-stay’ patients in the local facilities. Besides,there was a cry, in a previous report, by rehabilitation centres for more beds. This shows that the resources were not adequate to provide the basic of the services required by the patients. There has however been progressive changes with continuous research. Continuous formulation and implemantation of policies have seen the situation change for the better. There was a recommendation for the setting up of a mental health services to meet the special needs of patients suffering from enduring mental disorders. The rehabilitation of this group resulted from programmes that supported establishment of community-based accomodation for the long-stay patients. This was after the closure of large psychiatric institutions in Ireland. It was found that the number of inpatients in psychiatric hospitals significantly shot down with a big margin from 19, 801 in 1963 to 3,314 in 2007. Decrease in the number of hospital beds ran parallel to a substantial increase in the number community facilities: a growth from 942 in 1983 to 3,065 in 2004 (Lavelle Ena et al. 10-12). In spite of the decrease and supporting policies, the rehabilitation services in Ireland have just been accessed in few regions. A network of rehabiliation services has not been established to ensure all patients in different areas are accessed. For instance, in urban areas and areas undergoing rapid urbanization, there is hardly any development of these services III. Methods In the meantime, we turn our focus to the methods that were used to collect the data for the research. Pratt C. W et al used qualitative analysis approach. Clinical trials were carried out while close and intent observations were made with respect to the concept under investigation. This was done by various participants and progressive findings were noted. As a result, it was easy to establish which medication was most effective in treating a specific class of symptoms. The use of control experiments was instrumental in eliminationg errors caused by bias in scientific experiments. More specifically, an Evidence Based Approach model was employed. Repetition of procedure and continuous review of the procesure was gave guaranteed that if a particular procedure was proven at this stage, it would reliablly be applied on a human being with similar results.A fidelity scale was drawn to mark the effectiveness of the method used at treating one or more of the symptoms. On the other hand, Lavelle Ena. et al used a case study method with Ireland as the object. In his study, he used questonnaires and interviews to acquire the right information. A twenty three items questionnaire was drafted and delivered to the consultant psychiatrist heading each of the mental rehabilitation services. The aim of the questionnaire was to collect information about the structure of the service/facility, the staffing, the number of cases handled within a specified duration of time, the process used to refer people to other services, remit of the facility and how accessibility of other services by the people. Clear definition was given to sufficiently distinguish between hospital and community-based facilities. The questionnaires were collected at the end of the month and the data analyzed to get the required findings (6-7). In this section, I will discuss the findings made after the data obtained was processed. It was discovered that only fifteen out of the twenty six mental health areas had a mental rehabilitation facility which had met the standards set by the Vision for Change. Furthermore, these areas all had a rehabilitation teams that worked collaboratively. The team was headed by a consultant psychiatrist. It was also observed that one region - Dublin North West – had two specialist rehabilitation teams (Lavnaelle E et al. 19). Conspicuosly, the findings revealed that all the 16 specialist teams responded to questionnaire and interview. Of the remaining eleven mental health areas/regions, only four submitted their filled questionnaires which represented a 73%. response rate. In addition, three out of the four areas considered their services similar rehabilitation services. This was despite the fact that they were not headed by a consultant psychiatrist. According to the report of the survey, this is known as “non-specialist” services. The rest of the service encompassed a general adult service which provided some rehabilitation treatments. As a result of the big variation it had from the normal typical configuration of other rehabilitation facilities, it was omitted from the results (Lavelle Ena et al. 18-26). IV. Results and conclusions Both approaches have results which show a positive trend in the treatment of mental illness as a result of research which brought supportive policies and the development of more mental /psychiatric rehabilitation services. Pratt C. W et al adequately supports his claim through tested method of Evidence Based Approach. This approach gives a good representation of the entire population since it is more problem oriented rather than context /region based. It adopts a qualitative analysis approach which gives a comprehensive coverage, which is the same in all areas, by carrying out clinical trials which is followed by verification of the hypothesis by other participants. On the other hand, Lavelle E et al takes a quantitative analysis approach to the solving the hypothesis (12). He explains at length the the the data collection methods and breaks it down to detail. He however is unable to key out the particular elements of rehabilitative care which are most effective. This is to mean the elements that give the best results when used to treat one or more aspects of the mental illness. In addition, the method used to collect data does not guarantee validity. To start with, the questionnaires may not reflect the genuine opinion of the the interviewees. In an effort to give an ‘appropriate’ picture of the situation on the ground, coupled with bias from the interviewee, result findings end up being erroneous. Finally, the results are not representative of the entire population. Some of the respondents do not give feedback which is crucial in drawing up the right conclusions. To rephrase this, it means that even if they were to fill the questionnaire, they would just take a cursory glance and the important elements would escape their attention. As a result, such findings are likely to give a lopsided conclusion which renders the findinggs unreliable . Works cited Lavelle E., Ijaz Atif.,Killaspy., Holloway., King M,. Keogh F., McDonough C., Spelman L. , Goggins R., Daly I., Murphy K., McCrone., Drake R. Mental Health Rehabilitation and Recovery Services in Ireland: A multicentre study of current service provision, characteristics of service users and outcomes for thsose with and without access to these services.n.d www.dohc.ie/.../college_psychiatry_irelan...‎ Pratt C.W., Gill J. K., Barret M. N. & Roberts M, M. Psychiatric Rehabilitation.2nd ed.Burlington: Elsevier Academic Press, 2007. Electronic cpmcnet.columbia.edu/dept/pi/ppf/Hughes.pd Read More