Mental Health Services - Literature review Example

Mental health Services 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. 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) 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) 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. 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. 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 * 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 * “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