Changes in the Provision of Mental Health Care - Essay Example

Introduction Mental health can be defined as a measure of emotional wellbeing or an absence of dysfunction in the mind. According to the World Health Organization (2005) mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. However, it is worth to note that cultural discrepancies, opposing specialist theories and subjective assessments influence the definition of mental health. All in all, mental health is a global issue and he United Kingdom is not an exception. Mentally ill individuals can be dangerous to themselves as well as other people (National Institute for Mental Health in England 2008; Mullins 2007). Therefore, it is paramount for every nation to make legislation and policies to define the term, as well as to address mentally-ill cases and persons, and more so their treatment. United Kingdom is one country that has crafted policies and legislations meant to address mental health issues. These legislations include the United Kingdom’s Mental Health Act of 1983 which has been widely reviewed in the Mental Health Act of 2007. Therefore, it is the objective in this document to collate qualitative and quantitative information relating to mental health that would be analyzed and discussed to show how policy and legislation has led to key changes in provision in mental health care. Methods The study includes information the United Kingdom, specifically England and Wales that have instituted various mental health legislations, and have available data on both and traditional and modern provision of mental health care. The information collected is mainly secondary from credible sources due to the limited time allocation as well as financial resources. However, the information is sufficient and significant in illustrating the changes in provision of mental health care that has been fuelled with the crafting and adoption of various policies and legislations. Prevalence of mental disorders It common to find in most countries a ratio of one to three as representation of individuals having adequate criteria for a minimum one diagnosis at a particular time in their life before they were evaluated (WHO International Consortium in Psychiatric Epidemiology 2000). It is of significance to note that a fresh worldwide survey by the World Health Organization (WHO) (Gazzaniga & Heatherton 2006) illustrates anxiety disorders and mood disorders as a significantly common mental disorder in most countries, unlike impulse-control disorders and substance disorders that are unswervingly less common. Legislations and Policies Approximately, three quarters of nations around the globe have instituted legislations addressing specifically mental health. Some people propose enforced admission of mentally ill persons into health facilities while some people view that as infringement on human rights. It is with this that nations are compelled to craft laws that address such mental health issues. Sectioning or involuntary commitment, as compulsory admission is technically referred, is viewed in some section as an invasion on the right of choice as well as personal liberty, and it poses the danger of manipulation for social and political reasons. On the other hand, it can contribute significantly in deterring injury to people and self, and could help the mentally ill people in achieving their rights to healthcare, especially in scenarios where they cannot be able to make decision for their own interests (World Health Organization 2005) Mental Health Acts of 1983 and 2007 The Mental Health Act of 1983 is a United Kingdom’s Act of the Parliament that is applicable to only Wales and England (Great Britain 2007). The legislation addresses the admission, treatment and care of persons declared to have a mental disorder, and looks into the management of their affairs including their property. Specifically, this law offer the guideline in which to detain persons with a mental disorder in health facilities, and for these persons to assessed and/or treated in contrast to their wishes. The Health Act Commission (MHAC) is mandated to regulate and review its use. This legislation which as been fundamental is defining mental health provision in both Wales and England has undergone several amendments to produce the Mental Health Act of 2007. It can be said that The Mental Health Act of 2007 is a combination of the amended Mental Health Act of 1983 and Mental Capacity Act of 2005. A large part of the legislation became fully effective on the third day of November 2008 (National Health Service, 2008) after receiving Royal Assent on the nineteenth day of July 2007. This act, which updates the existing legislations on mental health, aims to achieve the following: Make sure that individuals with significant mental disorders can be availed, when it is vital, so as to be treated in order to shield them as well as the public from any harm Align mental health laws with modern provision of services Reinforce patient protection as well as address incompatibilities with human rights The Mental Health Act 2007 stipulates that implementers of the Mental Health Act of 1983 would be guided by the fresh code of practice. Note that this new legislation features seven amendments to the previous Mental Health Act, and only one modification to the Mental Capacity Act of 2005. Mental Capacity Act of 2005 The Mental Capacity Act of 2005, another United Kingdom law, was implemented on April of 2007. The Act relates to all citizens of Wales and England who are over 16 years old. The fundamental objective of this law is offer a legal guideline on which action and decision are made on behalf of persons who do not have the ability to decide on their own. Statutory principles, which are listed in the first Section of the Act, attempts to safeguard persons who lack the ability to decide, but as well to maximize their capacity to decide, or be part of decision-making if they are fit to do that. Therefore, An individual is assumed be mentally fit unless otherwise established. An individual should not be assumed to have no capacity to make decisions unless the steps to assist him make a decision proves futile. An individual should not be assumed to have no capacity to make decisions simply due to have made decisions that are unwise. Any action done, in reference to this Law, for or on behalf of an individual who has no capacity to make decisions must be made in the best interests of the individual. Before any action is done or a decision is made possibilities of effective alternatives that do not limit an individual on his rights must first be explored. Changes in mental health provision The 20th century has seen the “demand for mental health services” intensify considerably in the United Kingdom. The accessibility of treatment for mental disorder has improved, and not only to the detained individuals. These phenomena can be attributed partly to the development of the legislations addressing mental health. The Lunatic Asylums Act of 1845, for instance, obligated every county and borough to offer sufficient “asylum accommodation” to the “pauper lunatic population” at the expense of the tax payers. As a result, there was rapid increase in programmes addressing mental health leading to overcrowding of the asylums. Opponents of the asylum complained for being made less custodial and more therapeutic through the non-certified admission and early intercession, although they lost their case after the adoption of the Lunacy Act of 1890. What is more, the Mental Treatment Act of 1930 led into voluntary admission where applications would be written and presented to the individual accountable of the institution, and as well as sanctioned local authorities to establish outpatient psychiatric clinics in mental and general hospitals, as well. Further, the Mental Health Act of 1959 resulted to informal admission of patients with mental disorder making it the normal way of admission into health facilities and discarded the requirement by the patient to submit a statement indicate his willingness for treatment. Consequently, psychiatric hospitals opened doors to the mental disorder people in the 1950s. Accordingly, the time-honoured asylum turned more and more immaterial to core problems of mental health. More, these traditional health facilities declined drastically after the clearing the way for psychiatric institutions, and alternative health services grew as well as psychiatric divisions in day centres, residential dwelling and general hospitals. Several elderly long stay mental health patients died within the health facilities without many new ones to fill these vacant spaces. In spite of the two-thirds decrease in the bed-space between the year 1950 and 1989, an approximately three-fold rise in the rate of admission to psychiatric health facility was apparent. Nonetheless, the average duration of stay has reduced, despite the fact that a considerable minority even now face protracted admissions to hospital. Fig. 1: a graph show mean daily number of the beds available for mental ill people in England. Note that the elderly and children are not included (http://www.who.int/mental_health/policy/country/en/index.html). Recently, the number of secure beds has risen with the rise in utilization of detention enabled by the Mental Health Act. Significant alterations that compose the Mental Health Acts 2007 The 2007 Act has several changes to prior legislation and that has implication to the provision of mental health services. It offers a single definition to mental disorder and eliminates the use of drugs and alcohol as relating to mental health, but includes “learning disabilities” in cases where it is linked to critically irresponsible or unusually violent behaviour (Mullins 2007). In addition, it stipulates for an “appropriate treatment” assessment that makes it impossible for persons to be detained compulsorily. As well, it would not be possible to continue detaining persons if there is no medical treatment to them. Elsewhere, the new legislation introduces supervised community treatment so that mental patients do not discontinue with their prescriptions even after leaving hospital. In this respect, mental health care will be possible outside the walls of the health facilities. Again, unlike the previous provisions in previous Acts, the 2007 Act enables users of mental health services to appoint a civil servant as their nearest relative. Nonetheless, this should be authorized by the court. Note that under the Act, service user can decline some treatments like electro-convulsive therapy. The order has several other implications for mental health provision. More categories of clinicians can assume the roles once reserved for the Responsible Medical Officer and Approved Social Worker. Managers of health facilities are obligated to make sure that patient below the age of 18 years who are admitted to a mental health facility are kept under a suitable environment in relation to their age. Conclusion The formulation of the Mental Health Act has addressed most of the issues that marred the previous mental health legislations. It means that, under the current legislation, users will be involved more in their treatment. Moreover, the rights of people utilizing mental health services will be safeguard through ethical and fair practices. References Everard, M & World Health Organization 2005, Improving Access and Use of Psychotropic Medicines: Mental Health Policy and Service Guidance Package, World Health Organization. Fagan, J.T & Ax, R.T 2002, Correctional Mental Health Handbook, Sage, UK. Funk, M, Saraceno, B, Lund, C & Ganju, V, World Health Organization 2003, Quality Improvement for Mental Health: Mental health policy and service guidance package, World Health Organization. Gazzaniga, M. S & Heatherton, T. F 2006, Psychological Science, W.W. Norton & Company, Inc, New York. Great Britain 2007, Mental Health Act 2007: Elizabeth II. Chapter 12, Great Britain Staff, Great Britain. Mullins, K 2007, The Mental Health Act 2007 - Amendment to the Mental Health Act 1983 and Mental Capacity Act 2005, Hillingdon Primary Care Trust Board Meeting, Pt.1. National Health Service 2008, Mental Health Act 2007: key documents, viewed December 24, 2008, . National Institute for Mental Health in England 2008, Mental Health Act 2007 New Roles: Guidance for approving authorities and employers on Approved Mental Health Professionals and Approved Clinicians, viewed December 24, 2008, . Norman, I.J & Redfern, J.S 1997, Mental Health Care for Elderly People, Elsevier Health Sciences, UK. Public Guardianship Office, Mental Capacity Act 2005- summary, viewed December 24, 2008, . WHO International Consortium in Psychiatric Epidemiology 2000, Cross-national comparisons of the prevalence and correlates of mental disorders, Bulletin of the World Health Organization, volume 78, no. 4. World Health Organization 2001, World Health Report 2001- Mental Health: New Understanding, New Hope, World Health Organization. World Health Organization 2005, Promoting Mental Health: Concepts, Emerging evidence, Practice: A report of the World Health Organization, World Health Organization, Geneva. World Health Organization 2005, WHO Resource Book on Mental Health: Human rights and legislation World Health Organization, Mental Health Legislation and Human rights, Mental health policy and service guidance package, viewed December 24, 2008, < http://www.who.int/mental_health/resources/en/Legislation.pdf>. Read More