The Community Care of Mentally Ill Patients - Research Paper Example

? Introduction Providing mental health care for individuals who have severe mental disorders, is one of the critical challenges for the mental healthcare systems reform over the last decades, for numerous reasons such as perception of the mentally ill patients, weaknesses in the development of an effective system and community and budgetary constraints making it difficult to fund community based services appropriate for mental patients. As far as the definition of community care goes it refers to the participation of external forces to care for the mentally ill and the impact it has on their treatment. These forces can be legal, social, based on the relationship to the mentally ill individual or purely based on providing a professional service to aid in their betterment. The community care of mentally ill patients faces numerous social and legal weaknesses in terms of developing a system which makes treatment for these individuals effective based on a stringent observance of their human rights and overcoming the challenges associated with a community based model of care. Problems associated with providing healthcare to mental patients Although mental disorders are considered to have a low prevalence, the impact that they have on the families and societies is huge. Research shows that out of the many severe mental disorders the one that is considered most critical is that of schizophrenia. This is mostly because of the great impact that the disorder has on the individuals functioning. Its approximate point of prevalence is about 0.4% and the disease poses a lifetime risk of 1%, that is, at least 1 in a 100 individuals will have schizophrenia at a certain point in their lifetime (Goldner et al., 2002, pp.832). Also it is considered in the top ten diseases in terms of the duration lived with disability, and accounts for about 3% of disability caused by all disease. Furthermore for individuals between the ages of 15 to 44, it is rated as the third most critical disease (WHO, 2008). Another critical problem as far as the challenges of the health system reform go is that of the development of a community which provides the appropriate services for these individuals. This is a complex procedure which faces a number of critical barriers. Some of these exist at a mere policy level, and are most likely to occur due to non-existent appropriate mental health policies and legislation, lack of funds or the existence of procedural discrimination taking place with individuals with mental disorders, in case of the presence of limited health insurance. Some other noticeable barriers that are present on the level of the health system comprise of: difficulties in the provision of funding to community-based services for mental patients; an inability to integrate the mental health services with those of the general health system; not integrating mental health with the basic social care systems, especially the existence of weak coordinating efforts with welfare, housing and employment services go; and lastly a lack of appropriate training to stall circulating in the system to provide healthcare to mental patients (WHO, 2001). Over the decades efforts have been made to overcome these barriers and formulate a community based framework that ensures higher standards of health care for individuals who have severe mental disorders. These improvements include better living conditions in psychiatric hospitals, developing superior community services, integrating mental health care with primary care, improving psychosocial care which comprises of housing and extensively trained staff, efforts to enforce protection of human rights of individuals with mental disorders and encouraging families of these individuals to participate in order to improve policies and services (Muijen, 2008, pp. 481). Extensive research has served to be a valuable base in order to develop and provide guidance for the appropriate investment into the mental health care systems. Human Rights and Mental Health Care As far as effectively delivering care to individuals who suffer from mental disorders protecting human rights is a key issue. The principles and standards that have been set by international organizations, such as the United Nations Human Rights System and the European Human Rights System, play an important role in pushing the process of de-instutionalization. The European Human Rights System particularly comprises of elements which focus on issues which are highly relevant for individuals with mental disorders. These include the Convention for the prevention of torture, prevention on inhuman and degrading treatment, non-discrimination etc. From among these the individual’s right to be protected and not discriminated against or treated disrespectfully is the most important dimension which dictates the individuals rights to community service. Some examples of the community care which falls in the dimension of the individual’s right to receive are those which are dictated by the Article 19 of the United Nations Convention. These comprise of the person with mental disabilities to have the right to be a part of the community, be involved in the decision to select residence and have appropriate access to residential as well as domiciliary services. A person, depending on their level of disability, also holds the right to be a part of the community and avail services and facilities like the general population. Even though the right of patients with mental disabilities and their relationship with the community is defined in order to improve the situation for these individuals, conditions in numerous countries still remains highly inadequate (Muijen, 2008, pp.479). The international legal framework as far as the quality of care mental patients receive continues to be instrumental in challenging the abuse and weak implementation of the rights of these individuals. Today, despite numerous improvements in the care individuals with mental disabilities receive there are a great number of people who continue to be ostracized and live in isolation from the community. They are discriminated against, especially in spheres of education, physical health care and employment. Those that undergo treatment in hospitals are subject to improper conditions, like being kept in isolation for extended periods of time with no human contact, being unfairly detained and a general lack of consent for their treatment plans. Many are denied their basic rights and a lack of access to channels which can aid them in protecting these rights. Keeping in mind these issues, a basic identification of shaping the system of care for individuals with mental disorders, aiding their independence in order to facilitate their return to community as early as possible, and a protection of their rights is of great importance. Challenges of the transition to new comprehensive community-based models of care The social sector plays a great role in defining the community care which mental disorder patients receive. The lack of coordination among health services and the services that the other sectors provide is one of the key reasons why mental health service development is frequently insufficient. With the implementation of better coordination, joint funding and management between health and social care services coping with new challenges in the mental health system could be made a lot easier. These challenges occur from the rapid changes in the social and economic structures occurring in most countries as well as the changing characteristics of individuals with severe mental disorders (Fioritti, 2010). Societies have been restructured due to urbanization and changes in demographics which lead to increases in geographical distance among generations and changes between the traditional family ties and the mechanisms in place in a community. This makes it a lot more difficult for families to undertake informal care of members who have mental disabilities. So the burden then transfers onto the community, health and social services; A situation which is made far worse due to unemployment and substance abuse, which increases the social exclusion of these individuals and poses additional challenges to social services (Boardman et al, 2010). It is critical to note here that separating the health and social care needs of an individual with mental health problems does not necessarily reflect their real life situation. For example, a man with schizophrenia who lives with his aged mother, who has cared and supported him throughout his adult life but is now unable to due to cognitive problems. Another example could be that of a young woman with schizophrenia made redundant from work as she has the tendency to become despondent and relapse. Both examples reflect social and health problems that require a cohesive response from a complex but functional network of community services that the public sector provides. Recent model of healthcare for mental patients Adhering to the standards set by the International Center for Clubhouse Development, one of the recent approaches to provide care for mental health patients is the clubhouse model. It was found that through the effective use of this model there was significant improvement viewed in the patient’s recovery leading to a lesser need for hospitalization and the individual being provided with a sense of belonging. The basic formulation of the clubhouse model is on the notion that recovering from a mental illness requires an approach based on community and culture sensitivity. With addition to benefiting patients with ideal treatment these clubhouses also prove to be cost saving. Furthermore the treatment is based on the patients’ needs being kept in mind as a key part of the recovery. The club also provides the individuals with a sense of community by giving them temporary employment. The adaptation of these transitional roles aids club members to develop skills as well as confidence necessary to slowly become independent by the use of community based approach. It is through this community based approach that these mentally ill patients are provided not only with social support but also enables them to be productive and healthy in terms of contributions to the society and a place to belong; Also by being referred to as ‘club members’ instead of ‘patients’ gives these individuals a sense of dignity, belonging and value (Tiwari, 2012). Research done by Latimer, 2005, suggests how a dependency on inpatient psychiatric care has been diminished through the adaptation of a wide scope of community supports. This has been done by distinct institutional and legal features serving as examples of shaping these community supports. The highly successful practices are those of assertive community treatment, providing these individuals with employment, and an integrated treatment for extreme mental disorders. Furthermore the research suggests that in order to improve the system it was important to introduce an integrated evidence based program which would aid in improving the current health care system. Alem et. Al, 2008, based on his research is in accordance with the notion that mental health services and primary health care should be combined. The development of a model on this notion would be highly effective. However issues that can be perceived are those that have to do with appropriate supervision and training of the care workers. Health care for the mentally ill patients is a critical issue vastly due to the forces which impact the community care given to these individuals. These forces have to do with the lack of integration of social care systems, weak coordinating efforts as far as housing, employment and welfare of these patients goes. Enforcement of weak relationships and appropriate training for the care workers who deal with these mentally ill individuals and a general knowledge of the rights of these individuals which do not alter simply based on their mental status. Basic improvements in the healthcare of these individuals based on the impact that social and legal forces have on the community require the participation of families of these individuals to actively take part in the course of their treatment and make suggestions to improve policies and services. Despite all the prevalent barriers and the complications which prevent the development of a health care structure that caters effectively to the needs of the mentally ill there exists the clubhouse model which proves to be successful in observing the social, legal and medically relevant forces and creating a community in which the mental patients feel safe, comfortable and independent. Research also reinforces the critical part the community plays in facilitating the treatment and providing the right kind of help by the creation of a community based support for mentally ill individuals. References Alem, A., Jacobsson, L., and Hanlon, C. (2008). Community based healthcare of mentally ill patients. World Psychiatry. 7, 54–57. Boardman, J., Currie, A., Killaspy, H., and Mezey G. (2010). Social Inclusion and Mental Health. RCPsych. London. Fioritti A, Russo L, Melega V. (1997). Reform said or done? The case of Emilia-Romagna within context. Amer. J. Psych. 154, 83-98. Goldner M., Waraich, P., and Somers, M. (2002). Prevalence and incidence studies of schizophrenia: a systematic review of the literature. Can.J. Psychiatry, 47, 831-843. Latimer, M. (2005). Community-based care for people with severe mental illness. Douglas Hospital Research Centre, Montreal, Canada. Retrieved on 10th April from: http://www.sciencedirect.com/science/article/pii/S0160252705000981 Muijen, M. (2008). Mental Health Services in Europe: An Overview. Psychiatr Serv. 57, 479-482. Tiwari, S. (2012). Community based care model offers mental health patients sense of belonging and recovery. Web. Retrieved on 10th April 2012 from: http://www.advisory.com/Research/Technology-Insights/The-Pipeline/2012/01/Community-based-care-model-offers-mental-health-patients-with-sense-of-belonging-and-recovery United Nations Convention. Article 19. Web. Retrieved on 10th April 2012 from: http://www.un.org/disabilities/default.asp?id=279 WHO. World Health Report 2001. Mental Health: New Understanding, New Hope. Geneva, World Health Organization. Retrieved on 12th April from: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html WHO. (2008). The global burden of disease: 2004 update. Geneva, World Health Organization. Retrieved on 10th April from: http://www.who.int/healthinfo/global_burden_disease/2008_report_update/en/index.html Read More