Category: Mental health

In 2011, Medi-Cal (California’s version of Medicaid) expanded their mental health services offered under the Mental Health Services Act (MHSA), allowing recipients access to group and individual mental health evaluation and treatment, outpatient services, psychiatric consultations, and psychological testing (“Medi-Cal Expansion”, 2017). Although this would allow for many low-income recipients to finally have access to mental health services, few would be able to do so because of the limited programs that would open to accept Medi-Cal insurance. Therefore, the financial resources are readily available for individuals to receive mental health care, but there are too few programs/ facilities that are willing to offer these benefits to them. Already as of 2014, there was evidence of expanded mental health care coverage penetration into the population.

An example of such penetration can be seen in the figures on emergency and urgent psychiatric care in Los Angeles, California. The data were obtained from two psychiatric emergency care centers. Both of them provide insurance in Los Angeles County. The obtained statistical data demonstrate significant growth in coverage for the medically indigent. For the first three months of 2013, the Psychiatric Emergency Care Patient Insurance Coverage division was as follows. the part of Medi-Cal was 29% compared to 71% of Indigent. A year later, during the first quarter of 2014, the percentage for Medi-Cal and Indigent was 62% and 38% correspondently (Schaper, Murphy, & Wirshing, 2014). It should also be mentioned that in general the change in the distribution of the treatment population, by primary diagnosis, was not so evident. However, coverage for patients with a primary psychotic disorder increased more than two times (Schaper et al., 2014). It proves the positive impact of the Affordable Care Act.

Broader access to mental health care is significant for California. As of 2009, about one in six adult Californians have some kind of a mental health need, and nearly 5% of them have a serious mental disease (California Health Care Foundation, 2013). The situation with children is even worse. One of thirteen minors suffers from a mental disease that not only needs expensive treatment but also changes the life quality. The situation is more serious than it seems. Approximately 50% of adults and more than 30% of teenagers with mental disorders do not get any treatment (California Health Care Foundation, 2013). As of 2009, 7.6% of children in California experience serious emotional disturbance. As for adults, 15.9% have mental disorders and 4.3% of the adult population suffer from serious mental illnesses (California Health Care Foundation, 2013). The importance of available and affordable mental health care is crucial for society. In the example of California, it is obvious that among the adult population with mental disorders 9.3% are individuals below 100% federal poverty level (FPL), and only 2.1% with 300% FPL and above (California Health Care Foundation, 2013). Thus, it is necessary to provide mental health care that can be easily reached by any citizen who needs it. Since the treatment of mental disorders is expensive, low-cost insurance plans can be the way-out.

The count of citizens receiving specialty mental health services is increasing too. Speaking of children and youth, as of the financial year 2011/12 228,815 individuals were receiving SMHS. Already in 2014/15, this figure increased to 266,915 people (California Department of Health Care Services, 2016). This increase is even higher with adults. In the financial year, 2011/12 227,705 citizens were receiving SMHS and 336,619 individuals in the financial year 2014/15 (California Department of Health Care Services, 2016).

The Specialty Mental Health Services program demands substantial financing. As of November 2016 estimated for the financial year 2016/2017, the federal financial participation in the program for children amounted to 1,096,238 dollars and 1,354,300 for adults (Department of Health Care Services, 2016).

Specialty Mental Health Services are available in all the counties of the state. They provide crisis counseling, individual, group, and family therapy, special day programs, etc. (“Guide to Medi-Cal Mental Health Services”, 2013). The majority of programs offered are through hospitals—which seem to have limited programs designated towards their mental health department and revolve around the medical model of psychiatric practice. The San Francisco Behavioral Department of Public Health offers a “full range of specialty behavioral health services provided by a culturally diverse network of community behavioral health programs, clinics and private psychiatrists, psychologists, and therapists” (“Community Behavioral Services”).

Although this department offers some of the same interpersonal psychotherapy treatments as CHFH, they are centered around treatment for the individual—limiting access of the entire family. They also specify that the majority of behavioral therapy services are only needed for a short period—exemplifying the high demand for services and lack of ability to serve the large population of recipients. By indicating that the treatment is a short process, they are assuming that treatment and recovery of all mental illnesses can be done within a limited amount of time. It is fully dependent upon the type and severity of mental illness an individual is experiencing—which does not begin to encompass the various needs of the entire family surrounding the individual with mental illness. Another center that is similar in the treatment services offered is Highland Hospital’s Behavioral Health department. They offer partial hospitalization programs, outpatient programs, and several therapy programs to ensure stabilization and recovery—a few that include Cognitive training, young adult treatment, and multiple family-based programs and therapy options (“Behavioral Therapy”, 2015).

Their treatment services are extensive and extend to ensure the well-being and recovery of the entire family, well-organized, and operated by professional doctors and fully-licensed staff. Although they offer the utmost in treatment, they lack in the provision of holistic health ensuring the overall well-being of the family. The sole focus upon treatment also does not allow them to meet the supplemental needs of the family—communion amongst similar families and access to alternative resources such as dietary classes, and job training. Because their staff is only composed of doctors (psychiatrists and psychologists), they also lack the personalized relationships formed between social workers and their clients, as they follow each family’s case until full recovery is achieved. These doctors would tend to be drawn to the medical model of study (diagnosis through the DSM-V) as opposed to the multiple other fields of therapy and diagnosis that are not being accepted and explored within the field of mental health. The last center that seems to be most similar to CHFH through the array of services offered and wide population served is East Bay Community Recovery Project. This community center is a non-profit organization; therefore, they are not reliant upon Medi-Cal, but instead upon Federal and State funding. They seek to “support the wellbeing of the community by providing comprehensive services for mental health, tobacco, alcohol, and other drug-related health problems” (“FAQs and Testimonies”).

Their services are offered to children, adolescents, women, men, and families, and a wide demographic of the population—with a focus on those that are impoverished, were once incarcerated, and the HIV/Hepatitis infected. They also provide “the tools they need to succeed, including education, adequate housing, health care, nutrition, and support” (“FAQs and Testimonies”). Even though the East Bay Community Recovery Project is currently helping a larger population than CHFH, it seems to direct much of its’ focus towards drug rehabilitation programs, as opposed to individual and family therapy treatments—an idea that falls into the realm of “deservingness”. And although it claims to offer holistic health services, they are steered towards individuals with HIV or Hepatitis, instead of the individual or family experiencing mental health. Their population may encompass a broadened population that is beyond mental health, but in doing so, it does not ensure the same level of recovery and overall well-being like CHFH does in this sector of need. CHFH also offers services, such as child-care and recreational activities to elicit friendships and comradeship to be formed. Each of these programs offers mental-health support to low-income populations, but only CHFH offers a broadened scope of services that extend beyond treatment to the ensure happiness and security of each family that enters our center.

References

California Department of Health Care Services. (2016). Statewide aggregate specialty mental health services performance dashboard. Web.

California Health Care Foundation. (2013). California Health Care Almanac. Mental health care in California: Painting a picture. Web.

Department of Health Care Services. (2016). Medi-Cal specialty mental health services. Web.

Guide to Medi-Cal Mental Health Services. (2013). Web.

Schaper, E.C., Murphy, D.L., & Wirshing, W.C. (2014). Early evidence of the Affordable Care Act’s impact on the medically indigent population consuming emergency mental health care in Los Angeles county. The American Journal of Psychiatry, 171(10), 1117-1117. Web.

Introduction

The current outbreak of a new coronavirus that was first detected to affect humans in Wuhan (China) and, in a short time, spread globally, has an impact on the health of people all over the world. The resources of medical organizations are employed to combat the virus and provide all necessary medication and care to the infected people. However, it might be argued that the problem of mental health of the population and the level in which it was impacted, has not yet received adequate attention. In light of this, an appropriate question for nursing research may be related to the strategies and possible actions of nurses for providing the improvement of the mental health of the people affected (or supposed to be) by a coronavirus. Approach to this problem requires, prior to performing evidence-based practice (qualitative research), the examination of its theoretical and factual basis, which is available up to date. Such a review will be provided in this paper, helping to create the appropriate focus and form the objectives for the following research.

Main body

First, the analysis of the factors within the pandemic situation, which may affect public mental health, should be undertaken. The first group of such determinants that cause stress and anxiety among the people includes direct, or objective, factors. They include influence on daily behaviors and disturbance of the routine; impact on the economy, including people’s personal income in the quarantine situation; cutting access to the medical, educational, and other social institutes (Torales et al., 2020). The second group may be called indirect, or subjective, determinants, which include people’s perception of the situation. The level of fear, anxiety, panic is usually evaluated as unreasonably excessive, inappropriate to the actual condition. Thus, Shigemura et al. (2020), describing the situation in Japan, state: “as of 3 February 2020, no one had died directly from coronavirus infection… However, a government worker who had been in charge of isolated returnees died from apparent suicide” (p. 281). One of the reasons for such cases is the lack of distributed information or its credibility. Meanwhile, people tend to imagine the real situation more seriously than it is, and such “fear of the unknown” leads to higher anxiety (Torales et al., 2020, p. 3). Besides, the result of it may be the weakening of immunity, which, in turn, raises the chance to get infected.

Second, the focus groups, i.e., the most vulnerable categories of people, have to be identified. Those are, as recognized by previous research, “individuals with prior psychiatric diagnose,” as well as people with “underlying diseases including diabetes, hypertension and cardiovascular disease” (Torales et al., 2020, p. 2). These people need to be addressed with the special attention of nurses, and sometimes of professional mental specialists.

Third, the particular symptoms of the affected mental health should be considered. As previous research demonstrated, the outbreak is leading to “additional health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger, and fear globally” (Torales et al., 2020, p. 1). It may also be accompanied by social distancing, as well as stigma and misperception towards the infected people.

Fourth, the theoretical basis for the research might be found by investigating the previous cases of global pandemics. Torales et al. (2020) point out that the earlier pandemics of coronaviruses MERS and SARS-CoV may serve, to some extent, as a parallel to the current situation, and, thus, a source for possible solutions at present.

Conclusion

In summary, there are several aspects of the specified research question which need prior factual and theoretical education of the nurses before performing evidence-based practice. They are the factors affecting mental health, focus groups of the most vulnerable people, particular symptoms of distracted mental health, and possible solutions derived from the previous pandemic situations. These factors may help to interpret evidence received during the research, as well as analyze them and choose the proper strategies of nursing practices.

References

Shigemura, J., Ursano, R. J., Morganstein, J. C., Kurosava, M., & Benedek, D. M. (2020). Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: Mental health consequences and target populations. Psychiatry and Clinical Neurosciences,74(4), 281-282. Web.

Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry. Web.

Executive summary

In this report, the findings of a literature review about the growing prevalence of dementia are analyzed as a public health issue in the United Kingdom (UK). Dementia is associated with degenerative cognitive functioning, which often manifests as anxiety, depression, and memory loss among its victims. Statistics relating to dementia, as a mental health issue, suggest that there will be an increase in the number of patients diagnosed with the disease as more people seek help for their mental health issues and the population of elderly people continues to rise. Despite the importance of understanding the impact of dementia on society, gaps are reported in the process of formulating effective health promotion campaigns.

In this report, the health belief model is evaluated as a practical theory for use in health promotion. The model’s focus on people’s beliefs and values suggest that future health interventions should exploit the same constructs to develop effective health program. However, the need to adopt sound ethical practices when doing so is critical because people’s values and beliefs need to be synchronized to develop effective health campaigns about mental health. In this regard, in this report, it is proposed that future health promotion campaigns should use information from national data to develop effective campaigns and convey vital information to the public in a way that does not oppose their beliefs about the disease. These recommendations are particularly designed for application in the UK where the population is relatively aware of the disease.

Introduction

It is sad for a parent to lose the memory of their children or fail to recognize them at all because of dementia. Such is the effect of the disease because it has a degenerative effect on people’s feelings, thoughts, and responses (Alzheimer’s Society, 2020a). Dementia is a group of neurological diseases affecting the brain (NHS, 2020; Bhugra, 2019). This organ is usually made up of many nerves, most of which communicate well with each other. Dementia affects its neurological transmission pathways and, by extension, brain functioning. In advanced cases, the condition impedes cognitive functioning. Although dementia affects people from different parts of the world, most cases are concentrated in wealthy countries that have a high population of elderly people. Therefore, one of the most common risk factors for this disease is old age.

It is estimated that there are more than 200 types of dementia but Alzheimer’s, mixed and vascular dementias are the most commonly known. This report examines the literature relating to the disease because of the growing number of elderly people in the UK who are vulnerable to it. Particularly, the rise in the number of elderly people from World War II and baby boomer generations has increased the susceptibility of local communities to this disease because these demographics form a significant percentage of the total populace. Dementia is also studied in this report because it is poorly diagnosed and may affect more people than has been previously thought. Increased cases of mental health issues within the society further necessitate a review of literature on this disease. Overall, this report aims to critically evaluate facts about the disease, as a public health issue. To achieve this goal, a critical appraisal of the concepts of mental health and their effects on vulnerable communities in the UK will be done. The main sections of this report will also detail how to use local and national data to formulate public health policies relating to the disease.

Concepts of mental health

Mental health conditions refer to a broad set of diseases that affect a person’s cognitive abilities. Some of its symptoms include personality, eating, depressions, anxiety, and post-traumatic stress disorders (PTSD) (Mental Health UK, 2020). It is estimated that about one in four people in the UK suffers from one type of mental disorder per year (MIND, 2020). In England, it is reported that one in six people experience some type of mental disorder per week (Evans et al., 2019). There is no major difference in the prevalence of mental disorders today compared to the past. However, modern life pressures, including financial stresses, unemployment, and expanded work roles may cause an increase in prevalence numbers (Mental Health UK, 2020). The rising incidences of mental health cases in the UK highlight the need to better understand dementia and come up with practical solutions for minimizing its impact, based on communities.

Dementia shares a close relationship with mental health. Regan (2016) says that dementia has a complex relationship with the latter concept because both of them share similar causes and effects. For example, depression is normally reported among patients suffering from dementia and poor mental health (Callaghan and Gamble, 2015; Brown, Stoffel and Munoz, 2019). Therefore, it is increasingly difficult to differentiate patients who suffer from both conditions. In this regard, patients who suffer from dementia have traditionally received the same type of treatment as mental health patients because the diseases have similar effects on the brain.

Statistics

As mentioned in this report, dementia mostly affects the elderly. It is estimated that 850,000 people in the UK suffer from the disease (Dementia UK, 2020). Out of this population, about 42,000 patients experience early-onset dementia, which is commonly diagnosed among patients who are younger than 65 years of age (Dementia UK, 2020). The prevalence of the disease within this age group is estimated at 7% (Dementia UK, 2020). In 2021, the number of patients suffering from it in the UK is expected to rise to more than 1 million and in 2051 it is further expected to double (Alzheimer’s Society, 2020b). These figures show that there could be a public health crisis in the offing that needs to be addressed. Economically, dementia has a total estimated cost of £26.3 billion (Alzheimer’s Society, 2020b). About two-thirds of this cost is paid by patients and their families, while the rest is channeled to private health facilities. These statistics could inform future policy initiatives aimed at addressing the problem.

Theories and ethical principles of health promotion

Health promotion involves pursuing a set of actions aimed at improving people’s health and wellbeing. The process involves making judgment calls about the meaning of health promotion programs to patients and identifying relevant techniques to develop effective campaigns (Kemm, 2015). Consequently, theories and principles of health promotion govern this area of decision-making. The health belief model is one of the most commonly used frameworks for formulating health promotion programs (Hadler, Sutton and Osterberg, 2020; Hayden, 2017). It is relevant to this review because of its focus on people’s social and psychological behaviors, which are related to their cognitive processes and mental health.

As its name suggests, the health belief model predicts people’s likelihood to adopt positive health behaviors based on their beliefs about a disease and the efficacy of preventive methods. The health belief model borrows from psychological and behavioral theories, which operate on two basic assumptions. The first one is that people will do what is necessary to avoid getting a disease and the second one is that they will pursue a set of actions that will contribute to their recovery if they get ill (Staddon, 2015; Bailey, Tarbuck, and Chitsabesan, 2017). This theory of public health promotion portends significant implications to the development of health interventions for addressing mental health issues in the UK because it explains how to create policies that take into account people’s behavioral characteristics and attitudes towards treatment (Glanz, Rimer, and Viswanath, 2015). The focus on people’s belief systems is more relevant to the management of dementia as a public health crisis in the UK based on how people perceive its role and impact on patients and their families.

The health belief model may have significant repercussions on the efficacy of health programs targeting patients with dementia but the adoption of its evidence-based practices is as important as the need to do so ethically. Ethics is notably relevant to this analysis because it focuses on people’s values and such ideals are closely intertwined with people’s beliefs, as explained in the health belief model (Barrett et al., 2016; Mastroianni, Kahn and Kass, 2019). Globally, it is understood that the commonly held ethical values and beliefs of justice, peace, and equity are the prerequisites of good health and, as such, should underlie the development of mainstream health promotion campaigns targeting the management of dementia. Accepting these values in health promotion means it is a moral duty to increase public awareness concerning the disease.

Conclusion and recommendations

This report aimed to evaluate the findings from existing works of literature concerning dementia, as a public health issue in the UK. The condition has been linked to a rise in the elderly population in society. Statistics relating to dementia, as a mental health issue, suggest that there will be an increase in the number of patients suffering from the disease as more diagnoses are made and the population of elderly patients surges. Despite the need to understand the impact of this disease on elderly people, there are gaps in the formulation of effective health promotion campaigns. To fill them, the health belief model is reviewed as a reliable and relevant framework for formulating health interventions aimed at sensitizing people about mental health and dementia in the UK.

Its focus on people’s beliefs shows that future health interventions in this area of disease management should exploit existing community beliefs about the disease and its treatment to realize the best possible outcomes. Such initiatives should be undertaken ethically because there needs to be an asynchrony of people’s values and beliefs in developing the most effective health promotion programs. Relative to this claim, future health promotion campaigns should use national health data to develop effective campaigns and convey them to the public in a way that complements their beliefs about them. Particularly, this approach should be adopted in the UK to increase people’s awareness of mental health and dementia.

Reference List

1. Alzheimer’s Society (2020a) The psychological and emotional impact of dementia. Web.
2. Alzheimer’s Society (2020b) Dementia UK report. Web.
3. Bailey, S., Tarbuck, P. and Chitsabesan, P. (eds.) (2017) Forensic child and adolescent mental health. Cambridge: Cambridge University Press.
4. Barrett, D. H. et al. (2016) Public health ethics: cases spanning the globe. London: Springer.
5. Bhugra, D. (2019) Urban mental health. Oxford: Oxford University Press.
6. Brown, C., Stoffel, V. C. and Munoz, J. (2019) Occupational therapy in mental health: a vision for participation. London: F.A. Davis.
7. Callaghan, P. and Gamble, C. (2015) Oxford handbook of mental health nursing. Oxford: Oxford University Press.
8. Dementia UK (2020) Understanding dementia. Web.
9. Evans, K. et al. (eds.) (2019) Psychiatric and mental health nursing in the UK. London: Elsevier Health Sciences.
10. Glanz, K. Rimer, B. K. and Viswanath, K. (eds.) (2015) Health behavior: theory, research, and practice. 5th edn. London: John Wiley and Sons.
11. Hadler, A., Sutton, S. and Osterberg, L. (eds.) (2020) The Wiley handbook of healthcare treatment engagement: theory, research, and clinical practice. London: John Wiley and Sons.
12. Hayden, L. (2017) Introduction to health behavior theory. London: Jones and Bartlett Learning.
13. Kemm, J. K. (2015) Health promotion: ideology, discipline, and specialism. Oxford: Oxford University Press.
14. Mastroianni, A. C., Kahn, J. P. and Kass, N. E. (2019) The Oxford handbook of public health ethics. Oxford: Oxford University Press.
15. Mental Health UK (2020) Mental health conditions. Web.
16. MIND (2020) Mental health facts and statistics.
17. NHS (2020) Dementia. Web.
18. Regan, M. (2016) The interface between dementia and mental health: an evidence review. London: Mental Health Foundation.
19. Staddon, P. (2015) Mental health service users in research: critical sociological perspectives. London: Policy Press.

Introduction

The mental health of individuals is one of the major concerns of the modern healthcare sector. The increased complexity of the contemporary world and the high speed of all processes also promotes higher levels of stress among people and the development of undesired symptoms. In severe cases, individuals might acquire a mental disease that will deteriorate the quality of their lives and prevent them from successful socialisation. For this reason, the problem of mental health recovery holds the top priority for specialists working in the healthcare sector. Today, the traditional biomedical models of care are often supported with personal recovery approaches as they might demonstrate improved outcomes due to the focus on specific needs of patients and their current status. Michael’s case study revolves around this issue as it outlines the mental health problem and the use of different approaches to treat it.

Michael’s central problem was the emergence of compulsive thoughts, hallucinations, and aggressive behaviours triggered by the belief that his peers stole his ideas from his brain and used it to achieve success. After the outburst of emotions and violent inclinations, Michael was hospitalised and provided with a standard treatment that presupposed the use of antipsychotics to mitigate his state and ensure that no new relapses would emerge. However, during the next several years, Michael had to go to the psychiatric department again because of the low effectiveness of prescribed treatment. He still suffered from hallucinations and psychosis. The positive outcome and improvement were achieved only by the change of the team working with Michael and alteration of the approach. The implementation of the personal recovery model contributed to the resocialisation of the patient, his ability to cope with symptoms, avoid addictive behaviours, and start living a full life.

Differences Between Recovery Models

First of all, the case demonstrates the critical importance of the personalised approach and the need to look for recovery models that will meet clients’ needs as a traditional biomedical model can be not effective in different situations. The given approach presupposes that mental disorders are specific brain diseases that are triggered by deviations in the work of this body (Deacon, 2013). The inappropriate functioning of some of its parts might precondition the emergence and development of symptoms dangerous for a patient and the people who surround him/her. Under these conditions, it is critically important to restore, or at least try to restore, the normal functioning of the brain and its chemistry by using a pharmacological treatment that is prescribed to target the presumed biological abnormalities and regulate the behaviour of a patient at the physiological level (Yuen et al., 2019). However, today, the effectiveness of this model is doubted because of its outdated nature and reduced efficiency in multiple cases.

As it comes from Michael’s example, the use of antipsychotics was not the best option to deal with his mental problems as there were multiple new cases. It means that the biomedical cannot be considered a universal approach that can be employed while working with all patients, regardless of their unique characteristics and demands. The mental health recovery model becomes a potent alternative to the traditional approach. In accordance with this framework, mental illnesses and distresses can be effectively managed by developing a new vision of the problem and future (“Principles of recovery-oriented mental health practice,” n.d.). It aims at helping people to look beyond survival and existence; also, it encourages them to move forward by achieving new goals and building relationships that will give them a new meaning (Ash et al., 2015). Motivating people to engage in the change process, specialists modify their behaviours and motivations, which is critically important for the functioning of the brain and the ability to manage symptoms or threatening signs. Additionally, the given approach promotes patients’ participation in decisions about the provided care and cultivates improved self-management of behaviours that deteriorate the quality of their lives (Rethink Mental Illness, n.d.). Due to the given peculiarities, the discussed approach becomes advantageous in situations when only pharmaceutical treatment fails to reduce problems and risks of relapses.

In such a way, from the definitions provided above, it is possible to outline several basic differences between the traditional biomedical model and mental health recovery. First of all, there is a discrepancy in the perspectives on how undesired behaviours can be treated. The conventional approach recognises the high potential of pharmaceutical treatment and the use of antipsychotics which are expected to affect the brain’s functioning of biochemical level and depress processes that can be related to the development of the disease (Becket, 2017). The recovery model also acknowledges the power of medication; however, it promotes the idea of patient involvement’s importance for positive outcomes (Lim et al., 2017). This difference can also be seen in the fact that the biomedical model focuses on the achievement of outcomes without clients’ participation or recognition of the problem, while for recovery it is fundamental to motivate a person to move forward, establish new goals, and learn how to manage actions combining medicines and other approaches (Mericle et al., 2015). For this reason, today, there is a shift of priorities presupposing the extensive use of the newest model of care.

Differences Between Personal and Clinical Recovery

The case also outlines Michael’s experiences regarding personal and clinical recovery and helps to conclude about their effectiveness. After the emergence of the first symptoms, the development of hallucinations, and aggressive behaviours, the patient was provided with the traditional biomedical treatment presupposing the use of antipsychotics to mitigate his state and achieve desired levels of socialisation. However, according to the client’s words and experiences, he did not feel significant improvement. The treatment took several years and included new hospitalisations because of the aggravation of the situation, deterioration of symptoms, progression of hallucinations, and the need for stronger interventions (Wade & Halligan, 2017). Michael was not able to socialise and enjoy the high quality of his life, which also preconditioned the emergence of addictive behaviours, such as the use of alcohol.

From the case, one can see that the treatment scheme selected by the psychiatrists was not sufficient, and the selected medication was not able to improve the patient’s state. On the contrary, the absence of progress and the inability to recover and socialise hurt Michael and served as demotivating factors (Wade & Halligan, 2017). Because of the absence of clear goals and his inability to contribute to his own recovery, the patient started to drink, or engage in self-destructing behaviours as the only way to avoid suffering. For this reason, the clinical recovery that was not supported by the focus on Michael’s unique aspect failed to contribute to the significant improvement. On the contrary, it preconditioned the deterioration of the situation and the constant re-emergence of symptoms.

The change in the team working with the patient and the employment of the personal approach became an essential factor in Michael’s case. The central difference was in the attitude to the client and the utilisation of the individualised method to treat his disease. As against the clinical approach presupposing standard schemes and prescription of drugs that are known for their effectiveness in mitigating certain symptoms, the personal care model selected by a new psychiatrist acknowledged the uniqueness of the case and the significance of opportunities and choices available for a client to live a meaningful life (Wade & Halligan, 2017). Michael outlines that shift in priorities and his out positive attitude to it. The patient’s involvement became the central component that differentiated the two discussed models. The new team provided him with real choices and goals regarding his future life and the ability to struggle with the disease, which is one of the fundamental aspects of recovery focused care (Nicholas-Holley, 2016). The paradigm change helped the client to socialise, continue his studying and stop drinking.

In such a way, the major difference between Michael’s personal and clinical recovery is in their focus and the ability to promote desired outcomes. The adherence to standardised treatment schemes and medication did not result in the desired outcome because of the lack of flexibility. At the same time, the personal recovery presupposed the focused on the current needs of the patient and contributed to the achievement of positive dynamics and the decreased number of replaces or aggressive behaviours.

Recovery Focused Care for Nurses

Nurses working with mental health patients often face a high risk of being attacked or aggressive behaviours. The acute setting presupposes clients with complex conditions, hallucinations, obsessive thoughts, and dangerous decisions. For this reason, mental health nurses should possess a set of interventions and strategies that might help to reduce aggression levels and avoid being attacked or hurt by patients (Sellin et al., 2019). The modern approach to the delivery of care presupposes that collaboration and development of trustful relations with consumers is one of the most effective ways to remain safe and, at the same time, provide patients with care in the most effective ways (Nicholas-Holley, 2016). Under these conditions, the recovery-focused models acquire the top priority as they acknowledge the increased importance of factors mentioned above and their vital role in treating mental health patients.

One of the basic assumptions of the given paradigm is the uniqueness of individuals and consideration of their current states and needs. The existing body of evidence shows that the employment of recovery-focused care when working with this category of patients reduces risks and contributes to better outcomes (Sellin et al., 2019). For this reason, the improved knowledge of this approach becomes critically important for health workers who remain in direct contact with patients who might have aggressive behaviours. Another important aspect is the focus on a client, not just on his/her undesired signs or health issues (Saraf & Newton,2017). In accordance with clients’ feedback, the given attitude helps them to realise the fact that they are viewed not as patients, but as individuals with their peculiarities and unique features, which is vital for the development of trustful relations and positive outcomes.

The use of recovery model can also help to improve goal-setting and select the appropriate approach to every case. The need to consider the existing requirements of a client is central to the modern healthcare sector, and this idea can also be applied to working with mental diseases. The combined effort of care providers and patients guarantees the creation of relevant goals and the provision of choices for clients. It serves as a factor needed to facilitate the recovery or reduce the frequency and severity of attacks (Rosén et al., 2017). Finally, the recovery focused care provides patients with an opportunity to manage their cases on their own, which is also important for motivation and the emergence of the desire to change life and achieve success (Owen et al., 2019). Using only medications, clients might feel helpless and unable to control their own lives, which also increases the risk of the development of addictive behaviours.

The given factors demonstrate that nurses who have an improved understanding of the recovery-focused model hold an advantageous position when working with mental health patients. They benefit from the reduced risks of being attacked or harmed by aggressive inclinations. At the same time, they can deliver care more effectively and ensure that patients will be able to control their emotions by using the basics of the paradigm, which is also vital for outcomes.

Conclusion

Altogether, the analysis of the case shows that today there is a need for new, more effective approaches to treating mental health patients than the traditional one. The use of medications without any additional measures cannot be effective if it is not supported by the in-depth assessment of patients’ current needs. They should serve as the basis for goal-setting, and a client should be an active participant in the recovery process. It will motivate him/her and guarantee that the motivation levels will increase and better outcomes will be attained.

References

Ash, D., Suetani, S., Nair, J., & Halpin, M. (2015). Recovery-based services in a psychiatric intensive care unit – the consumer perspective.Australasian Psychiatry, 23(5), 524–527.

Becket, J. (2017). Evaluating some of the approaches: Biomedical versus alternative perspectives in understanding mental health. Journal of Psychiatry and Psychiatric Disorders, 1(2), 103-107.

Deacon B. J. (2013). The biomedical model of mental disorder: a critical analysis of its validity, utility, and effects on psychotherapy research. Clinical Psychology Review, 33(7), 846–861.

Lim, E., Wynaden, D., & Heslop, K. (2017). Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. International Journal of Mental Health Nursing, 26(5), 445-460.

Mericle, A. A., Miles, J., & Way, F. (2015). Recovery residences and providing safe and supportive housing for individuals overcoming addiction. Journal of Drug Issues, 45(4), 368–384.

Nicholas-Holley, J. (2016). Auditing the needs of recovery room staff providing care for the child in an acute hospital. Journal of Perioperative Practice, 26(5), 102–105.

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Introduction

Mental health conditions have become common and affect the experiences and medical outcomes of the affected patients. These disorders are known to affect a person’s behaviour, thinking pattern, and mood. Physicians should conduct proper diagnoses to provide the best treatment procedures depending on the targeted illness. This paper provides a detailed analysis and description of the most appropriate medication regimes for the following mental health diseases: depression, schizophrenia, and dementia.

Treatment for Mental Illnesses

Medical experts prescribe the best treatment plans depending on the targeted conditions. A proper diagnosis process is essential since it makes it easier for the physician to identify the disease and its possible implications. The consideration of a patient’s specific conditions and symptoms will guide the medical practitioner to make the best decision. Altamura et al. (2015) indicate that mental illnesses require proper management if the targeted individuals are to record positive health outcomes. Some of the identifiable methods for meeting the demands of patients with depression, dementia, and schizophrenia are described below.

Depression

Medications form the primary method for treating depression and ensuring that the patient records positive health outcomes. Although such drugs might not cure the targeted condition, they tend to manage the symptoms and make it possible for the individual to complete their daily chores. The available medicines are grouped into various classes that doctors can prescribe to promote the recovery process. First, antidepressants will support the management of depression by reducing sadness, increasing energy, and maximising the person’s concentration. The leading ones include Sertraline, Paroxetine, and Fluvoxamine (McLafferty et al., 2017). Second, mood stabilisers are capable of addressing the challenges associated with depression and mania episodes. Some of the common ones include Lithium, Lamictal, Divalproex sodium, and Carbamazepine (Onyike, 2016). The prescription of these drugs will make it possible for the user to lead a better life.

Psychotherapy is a form of treatment that can work efficiently in patients with depression. The health professional will design a personalised model depending on the recorded moods, feelings, behaviours, and thoughts (McLafferty et al., 2017). The ultimate aim is to guide the beneficiary to manage stress and learn how to cope. The use of brain stimulation will guide depressed people to re-pattern their experiences and eventually record positive improvements. Some of the leading ones include deep brain stimulation and electroconvulsive therapy (McLafferty et al., 2017). Medical experts should offer the relevant guidelines and information to their patients to understand some of the possible benefits and risks.

Schizophrenia

Unlike depression, schizophrenia is a complex mental condition that requires lifelong patient support and treatment. The available regimes need to be continued even after the patients’ symptoms disappear. In most the cases, medications will form the primary basis to ensure that the individuals can cope and address their negative thoughts and hallucinations. Antipsychotic drugs are preferable when focusing on this condition since they will manage symptoms successfully. They act by influencing the normal functioning of dopamine, a brain neurotransmitter (Altamura et al., 2015). The provision of a small dose will ensure that the patient does not exhibit symptoms or signs. Physicians will calculate the best quantity to deliver desirable results.

Doctors can consider the use of injections when the targeted patients are unwilling to take tablets. Second-generation antipsychotics have become preferable since they present fewer side effects. The common ones today include Asenapine, Brexpiprazole, Aripiprazole, and Iloperidone (Altamura et al., 2015). Psychologists will identify the signs of the patient to determine the most appropriate drug. The ultimate objective should be to provide the best support and care to the selected patient.

Medical experts have gone further to support the use of psychosocial therapy since it has the potential to meet the health needs of more patients. For example, vocational rehabilitation is a practice that allows most affected individuals to learn ways of completing their tasks in the workplace. Social skills training will equip more patients with the relevant competencies for interacting and communicating with others. Such gains will guide them to participate in a wide range of activities (Onyike, 2016). Individual therapy is another treatment method whereby individuals learn how to re-pattern their thought systems, cope with depression or stress, and pursue their goals in life.

Schizophrenic individuals should have access to daily support due to the signs associated with it. However, the combination of most of the identified regimes will make it possible for more people to manage the condition more efficiently. Altamura et al. (2015) indicate that electroconvulsive therapy is another useful method that can meet the health demands of patients who do not respond effectively to the available drugs. The approach will help minimise cases of depression and guide the targeted beneficiary to lead a better life.

Dementia

Dementia is another common mental illness affecting many patients in different parts of the world. Onyike (2016) reveals that some types of this disease are incurable. However, physicians will use various drugs and procedures to support most of the affected patients and ensure that they lead contented lives. Medications have the potential to manage some of the common symptoms associated with this condition. For example, cholinesterase inhibitors are capable of boosting a person’s ability to make logical judgments. Some of them include Donepezil, Galantamine, and Rivastigmine (Onyike, 2016). Unfortunately, these drugs will trigger some side effects that could lead to additional problems, such as sleep disorders, slowed heartbeat rates, and fainting. Doctors also prescribe various drugs that can treat any form of hallucination and depression associated with dementia.

Therapies have become acceptable due to their ability to support the management of dementia. Occupational therapy is essential since it allows individuals to cope and prevent falls. Experts can also consider the patient’s unique attributes to modify the surrounding environment and ensure that the individual is capable of completing various tasks (Onyike, 2016). The simplification of duties at home will allow the patient to progress smoothly, learn more about the condition, and, eventually, lead a better life. Family members or guardians need to be involved throughout the treatment program to minimise some of the dangers associated with this mental illness.

Conclusion

The above discussion has identified mental illnesses as problems affecting many people across the globe. Doctors should analyse the exhibited signs to develop the most appropriate treatment regime. Such professionals can begin by providing the relevant medications to manage some of the recorded symptoms and improve the level of progression. Since most of the diseases are incurable, therapies are appropriate to empower the patient to complete their tasks and cope effectively. These approaches will meet the medical demands of more people with schizophrenia, dementia, or depression.

References

Altamura, A. C., Fagiolini, A., Galderisi, S., Rocca, P., & Rossi, A. (2015). Integrated treatment for schizophrenia. Journal of Psychopathology, 21, 168-193. Web.

McLafferty, M., Lapsley, C. R., Ennis, E., Armour, C., Murphy, S., Bunting, B. P., Bjourson, A. J., Murray, E. K., & O’Neill, S. M. (2017). Mental health, behavioural problems and treatment seeking among students commencing university in Northern Ireland. PLoS ONE, 12(12), e0188785. Web.

Onyike, C. U. (2016). Psychiatric aspects of dementia. Continuum, 22(2), 600-614. Web.

The importance of mental illnesses cannot be underestimated due to the fact that numerous people get exposed to such problems on a daily basis. As the evidence from the article written by Latzman et al. (2019) suggests, at least 20% of the adult population across the globe are adversely affected by mental illnesses of various gravity, and at least 40% of teenagers suffer from milder versions of mental illnesses as well. These statistics provide a multifaceted outlook on why it may be important to increase mental health awareness and research mental health conditions more thoroughly to identify possible links between at least some of these conditions. Within the framework of the current paper, the author addresses such mental health conditions as schizophrenia, depression, and dementia in an attempt to develop a knowledge base for the readers and generate an in-depth review of how these conditions affect the behavioural, emotional, and perceptive aspects of one’s personality. The importance of this review may be supported by the fact that if left untreated, mental health conditions could increase the risk of damage given to the patient and their surroundings.

Schizophrenia

Behaviour

Behavioural influence of schizophrenia can be described as a simultaneous hit affecting several areas of human functioning. One of the first (and most evident) aspects of schizophrenia is that the patient would talk about anything and either make no sense or make up inexistent words that they would believe to be real. As it would be discussed below, patients with schizophrenia rarely show emotions or remain expressively agitated for a long time. Another crucial element that has to be taken into consideration is the lack of ability to keep their place clean and do chores accordingly (Morgades-Bamba et al., 2019). One of the most common things for patients with schizophrenia is to repeat certain behaviours from time to time (for instance, wandering). Even though there is a long-standing myth about the increasing risk of violence in people with schizophrenia, modern research disproves it.

Emotions

In terms of emotions, patients with schizophrenia are rather limited due to the visible decline in cognitive abilities. Even though they can anticipate certain events to happen in the future and experience softer analogues of excitement and disappointment, their emotional range becomes significantly shorter (Morgades-Bamba et al., 2019). The reason behind these mental health “downgrades” is that imagination and emotional states of individuals with schizophrenia are restricted and cannot help the person in question to maintain an image for a long time. Existing research projects on the link between schizophrenia and emotional transformations suggest that cognition, imagination, and thinking should be integrated with schizophrenia in order to improve the understanding of the possible effects of schizophrenia on the human mind. Thus, there are questions that relate to how one’s emotional range could be improved once they would be diagnosed with schizophrenia.

Perception

One of the biggest issues linked to perception in people with schizophrenia is their abnormal inability to control their mood swings, laughter, or any other displays of emotional approval and condemnation. The growing sense of anxiety also interferes with their perception of the world because they have fewer chances to remain rational and make decisions that are not affected by their overall-depressive state (Morgades-Bamba et al., 2019). The absence of sufficient eating and sleeping patterns may also be seen as the consequence of developing schizophrenia, especially in adults. The ultimate issues with perception begin when the person becomes vulnerable to delusions, disordered thinking, and hallucinations. At this point, it would be rather hard to treat irregular behaviours or any other disorder-related obstacles caused by a damaged perception.

Depression

Behaviour

The most evident change in behaviour that affects depressed individuals is the steadily decreasing level of motivation. Not only do they tend to slow down their daily operations, but they also start moving and speaking slower, mimicking the decline in their inherent cognitive abilities (Panagioti et al., 2016). This resembles the behaviour of a person that carries weights across the room and has no opportunity to show any kind of emotion in order to reduce the strain on their body. As a result, people with depressive disorder might stop gesticulating as much as they did in the past and display less facial expressions that could give away their mood or intentions. In general, depressed individuals choose not to do anything in order not to get even more depressed in the case of failure. Over time, they could start ignoring their washing and eating patterns, which would have an adverse impact on their physical health as well.

Emotions

The primary emotional signs of depression are the loss of interest in life and a gloomy mood. The person gets away from the activities that once seemed pleasurable to them and becomes haunted by the feeling of guilt that eventually comes out of nowhere. People with depression are also prone to seeing themselves as worthless and experiencing the lack of hope even at the times when the situation is not as complex as they see it. This is why it could be crucial to monitor depressive individuals for death and suicidal thoughts in order to prevent any kind of self-harm (Panagioti et al., 2016). On the other hand, there is constant anxiety that averts people with depression from evaluating their life situation in the most appropriate way and making rational decisions that would prevent them from making the matters even worse.

Perception

The problem with the perception that most people with depression experience when under the influence of constant bad mood is the effect of time dilation. Therefore, depressed individuals may be seen as exposing themselves to a kind of a depressive realism where they have to fight against their own wrongful self-conception stating that they are much more depressed than anyone else around them (Panagioti et al., 2016). This suggestion stems from the idea that the human brain tends to compress time when the person is experiencing unpleasant events, which makes the cause of depression and the consequences of depressive behaviours appear closer together than they actually are. The sense of agency in people with depression is damaged to an extent where these individuals start binding cause and effect intentionally. Over time, individuals with depression start losing control over their perception of the world, and it could lead to schizophrenia, as a matter of fact.

Dementia

Behaviour

The behavioural impact of dementia on one’s mental health can be described as multifaceted due to the fact that the majority of dementia cases only occur in adults and elderly adults. The differences in behaviour become evident instantly, providing the ones who care for people with dementia with an opportunity to interfere where necessary. Nevertheless, one of the common transformations that all people with dementia experience is the willingness to repeat a certain activity over and over again (for example, many elderly patients with dementia may be asking the same question even after the answer has been provided and they had approved it) (Miller et al., 2019). On the other hand, such patients become restless and can be either daytime wandering or even walking in their sleep during the night. The ultimate effect of dementia could be the person completely losing their self-assurance, as they would either follow their close ones everywhere or lose interest in any of the activities that appealed to them in the past.

Emotions

One of the sources of impact on emotions in people with dementia is denial. There will be a delay in emotional response to all kinds of situations, even the most moving ones. The person will not be interested in knowing more about their diagnosis, as they would attempt cushioning themselves so as not to confront their inner fears and thoughts. On the other hand, fear is one of the most difficult emotional comebacks for people with dementia because they already feel like they are not in control of their life (Miller et al., 2019). This kind of helplessness is what affects the emotional background of people with dementia the most. Further progression of dementia gives rise to the feeling of guilt as well, making the individuals question each of their decisions. At this point, depressive and suicidal thoughts could take over the person and lead them to irrational decisions linked to vulnerability and self-harm.

Perception

The issues with perception in people diagnosed with dementia mostly revolve around their vision. One of the most common effects is the person becoming able to see from one eye only. The brain merely gives up on processing that much information and closes one of the channels of transmitting information in order to save up space for other procedures. Accordingly, individuals with dementia have a hard time realising how far they are from an object because seeing from one eye blocks the depth of vision to a certain extent (Miller et al., 2019). Overall, any sensory organs could experience a change in perception due to dementia, as the person in question would not be able to evaluate the situation correctly. In some cases, perception disorder could be topped with visual hallucinations.

Discussion

Based on the current review of evidence related to three different mental health conditions, a series of conclusions can be made. First, the risk of dementia may be directly linked to schizophrenia due to the presence of several factors that increase anxiety and fear in patients. The rationale behind this conclusion relies on the evidence from Miller et al. (2019), who suggested that the cognitive decline associated with schizophrenia can cause dementia over time. Nevertheless, there is no clear answer to the question of whether schizophrenia leads to dementia at all times or just during the severest cases. On the other hand, it cannot be ignored that depression is one of the essential risk factors for dementia in people of all ages. Latzman et al. (2019) describe depression as affecting one’s thinking and memory skills to an extent where their other cognitive abilities decline rapidly. Nonetheless, even the evidence presented above does not allow for one-sided conclusions regarding the positive cause-and-effect relationship between dementia, schizophrenia, and depression. Each of these conditions has to be addressed separately anyway if caregivers and patients expect to exert joint efforts in preventing or treating these conditions adequately.

References

Latzman, N. E., Ringeisen, H., Forman–Hoffman, V. L., Munoz, B., Miller, S., & Hedden, S. L. (2019). Trends in mental health service use by age among adults with serious mental illness. Annals of Epidemiology, 30, 71-73.

Miller, L. M., Kaye, J. A., Lyons, K. S., Lee, C. S., Whitlatch, C. J., & Caserta, M. S. (2019). Well-being in dementia: A cross-sectional dyadic study of the impact of multiple dimensions of strain on persons living with dementia and their family care partners. International Psychogeriatrics, 31(5), 617.

Morgades-Bamba, C. I., Fuster-Ruizdeapodaca, M. J., & Molero, F. (2019). Internalized stigma and its impact on schizophrenia quality of life. Psychology, Health & Medicine, 24(8), 992-1004.

Panagioti, M., Bower, P., Kontopantelis, E., Lovell, K., Gilbody, S., Waheed, W.,… & Huffman, J. C. (2016). Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis. JAMA Psychiatry, 73(9), 978-989.

Mental health is a crucial part of Australian citizens’ general well-being and happy life outcomes. The foremost duty of the Australian Department of Health is to develop a better mental health system that helps improve the lives of people with or at risk of mental illnesses. However, such an objective does not seem to be met successfully nowadays (Looi & Kisely, 2019). This paper aims to critically discuss the policy and funding context of mental health service provision in Australia. After carrying out thorough research, I have come to believe that the country’s mental health system urgently needs organizational reformation and restructuring rather than more expenditure.

According to statistics, in the years 2017-2018, $9.9 billion was spent on mental health-related services in Australia (Australian Institute of Health and Welfare, 2020). Overall, it increased from $382 per person in 2013-2014 to $400 per person in 2017-208. This shows effective funding of the field, including expenses on initiatives, programs, services, and research necessary to provide the best care for people struggling with mental health issues. Suicide prevention, research on mental health stigmatization, prevention, and recovery have been funded by the Australian, state, and territory governments along with private health insurers and individuals (Batterham et al., 2016). Thus, Australia pays close attention to the mental health of its nation and regularly supports the system with funding and the related expenses. However, the system lacks an organizational structure and often fails to provide the best care to patients with mental health illnesses.

The first crucial organizational issue is that there are not enough mental health services to help patients who need it the most. Thus, the current difficulties with rationing result in a situation where only severely ill people receive professional help, with others failing to be admitted for treatment or being discharged from the facility too early (Uchmanowicz et al., 2020). Another serious issue deals with new mental health policies that make it difficult for patients to access the necessary treatment due to being less restrictive and influenced greatly by the already discusses rationing complications. Moreover, the problem of treating patients with mental health conditions within the general health system – and not by special psychiatric services (Bartram & Stewart, 2019). That is, the unique needs of such people are not fully met and often given only basic attention. Finally, Australia lacks new psychiatrists and psychiatric nurses being trained, with many already existing professionals retiring and leaving the field. Let alone the fact that training opportunities are rather limited in today’s realia.

To conclude, while the Australian mental health system requires funding the necessary scientific research and programs for patients with mental illnesses, it is not a primary objective in the present day. What is more important and demands close attention is better organization of the system. It is necessary to eliminate such issues as rationing difficulties, reconsider the present acts and policies in the field, stop the so-called mainstreaming of mental health services, and introduce more training opportunities for young professionals. This way, when enough expenditure and sufficient organization go hand in hand, the system will work best for patients’ benefit.

References

Australian Institute of Health and Welfare. (2020). Expenditure on mental health-related services. Web.

Bartram, M., & Stewart, J. M. (2019). Income-based inequities in access to psychotherapy and other mental health services in Canada and Australia. Health policy, 123(1), 45-50.

Batterham, P. J., McGrath, J., McGorry, P. D., Kay-Lambkin, F. J., Hickie, I. B., & Christensen, H. (2016). NHMRC funding of mental health research. The Medical Journal of Australia, 205(8), 350-351.

Looi, J. C., & Kisely, S. R. (2019). Potemkin redux: the re-disorganisation of public mental health services in Australia. Australasian Psychiatry, 27(6), 607-610.

Uchmanowicz, I., Witczak, I., Rypicz, Ł., Szczepanowski, R., Panczyk, M., Wiśnicka, A., & Cordeiro, R. (2020). A new approach to the prevention of nursing care rationing: Cross‐sectional study on positive orientation. Journal of Nursing Management.

It is hard to disagree that healthcare is one of the most essential and necessary spheres of life. However, there are certain disadvantages in this system, and a number of severe problems are not entirely addressed or eliminated. Determinants of health, which are rather important conditions, include the range of environmental, economic, social, and personal factors influencing health status (“Determinants of health,” 2020). Among other things, determinants of health explore the ways of creating a society in which all people have a chance to live a long, happy, and healthy life despite their social statuses. Hence, one of the objectives is to eliminate disparities and barriers to receiving proper and effective treatment.

With the help of the Affordable Care Act (ACA), access to mental health care among people with low income and from ethnic and racial minorities was improved significantly. However, there are still certain barriers related to health insurance and the mental health population (Novak et al., 2018). Specific disparities may contribute to the problem of increasing mental diseases and the inability of some people to receive proper care. It should be mentioned that in the U. S. uninsured people with a mental health condition are at a great risk and need to be protected. These individuals are those with low income, of ages from 18-64 years old, and different nationalities.

Patients with mental health diseases tend to lack support and help, as well as have fewer persons who can improve their condition by simply being nearby. Together with this factor, limited access to proper treatment may significantly worsen the mental health population’s problems (Novak et al., 2018). That is why it is of vital importance to make this issue a priority and develop special healthcare programs for all those persons who have troubles with paying for an effective treatment or getting extended insurance (Novak et al., 2018). Population with mental illnesses should not find high-cost barriers to accessing care, and unique health insurance plans covering all or almost all necessary expenses should be created for people with low income. Otherwise, if this problem remains unsolved, the number of patients with mental health diseases of various degrees who have no resources to help themselves will continue growing.

References

Determinants of health. (2020). Healthy People. Web.

Novak, P., Anderson, A. C., & Chen, J. (2018). Changes in health insurance coverage and barriers to health care access among individuals with serious psychological distress following the affordable care act. Administration and Policy in Mental Health, 45(6), 924–932.

Patients with mental illness have been regarded as a vulnerable population in a healthcare setting for a long time. The reason for their inequity is the lack of a legal framework to address the mental health issues, the absence of awareness to treat it, and the financial burden of therapy. However, the recent developments in policymaking have implemented significant changes to improve people’s quality of care in regards to psychiatric illnesses. One of such fundamental changes made to facilitate eliminating barriers to healthcare is the Mental Health Parity Act of 2008. It has been introduced to minimize the distinctions between physical and psychological well-being, as well as enable patients to seek treatment for both aspects of their welfare equally. More specifically, the given regulation obliges insurance to cover behavioral therapy equally to a surgical and physical one. Thus, every insurance coverage enables a person to seek treatment for both psychological and physical issues without any distinction.

This policy has a drastic effect on vulnerable populations and their access to mental health services. According to the research done by Goldberg and Lin (2017), there has been at least a “10% increase in psychiatric therapy prevalence and more than 75% of medication prescription” (p. 35). Furthermore, people seeking psychological treatment have more than tripled since the policy’s implementation, which signifies a need for behavioral health equity. As evident from the statistic given above, the regulation has significantly contributed to improving emotional well-being among patients by enabling them to seek relevant medical care. This policy has also been the first step in battling the stigma surrounding the behavioral illness. As Thalmayer et al. (2017) state, negative stereotypes and stigmatization of people with mental illness have been the primary barrier to change when reducing the financial and social burden of depression. With the introduction of the policy, a major ethical shift in perception has been made in terms of normalizing psychological treatment and therapy, which allowed more people in need to address their problems medically and be able to afford it.

As it concerns the perspective of healthcare providers, the policy has been helpful in terms of enabling workers to provide much-needed psychological help to patients regardless of the patients’ insurance. While this policy has implemented a positive change, it has also uncovered an underlying ethical issue within healthcare. According to Goldberg and Lin (2017), “patient race/ethnicity, practice setting, physician specialty, and primary source of payment were associated with the diverging likelihood of being prescribed depression treatment” (p. 36). This finding indicates that people of particular socioeconomic, racial, and ethnic backgrounds are less likely to receive treatment even if it is covered by their insurance.

Social determinants of health are prevalent in psychiatric treatment, and healthcare professionals should be able to recognize and address hidden biases that are present both within their individual and institutional levels of care. While the Mental Health Parity Act enabled medical professionals to help patients in need, it also highlighted other fundamental ethical issues (Thalmayer et al., 2017). As a measure to address the rising costs of healthcare expenses and the widening gap of health disparities, the Patient Protection and Affordable Care Act supplemented the initial policy in 2010. It reinforced the purpose of the Mental Health Parity Act and ensured that people could seek the treatment they need regardless of costs (Thalmayer et al., 2017). This regulation further helped to contribute to the destruction of mental health stigma and reinforced the ethicality of equal access to care.

References

Goldberg, D., & Lin, H. (2017). Effects of the mental health parity and addictions equality act on depression treatment choice in primary care facilities.The International Journal of Psychiatry in Medicine, 52(1), 34-47. Web.

Thalmayer, A., Friedman, S., Azocar, F., Harwood, J., & Ettner, S. (2017). The Mental Health Parity and Addiction Equity Act (MHPAEA) evaluation study: Impact on quantitative treatment limits.Psychiatric Services, 68(5), 435-442. Web.

Introduction

Chen et al (2005) in their paper titled “Prevalence and co-occurrence of psychiatric symptom clusters in the U.S, adolescent population using DISC predictive scales” have estimated the 12-month prevalence and co-occurrence of symptoms of specific mental problems among US adolescents (12–17 years) by age, sex and racial/ethnic subgroups and have concluded that mental health problems among U.S. youth may be far more common than previously believed, although these symptoms have not yet reached the point of clinical impairment. Heller et al (2006) in their study titled “Helping to prioritize interventions for depression and schizophrenia: use of Population Impact Measures” aim to demonstrate how population impact measures may be used to prioritize alternative treatments for psychiatry. Population impact measures refer to the estimation and prioritization of potential benefits of interventions in specific populations. Heller et al (2006) have studied the implementation of best practice recommendations for preventing depression and schizophrenic and conclude that population impact measures can be the key to deciding which intervention works best in a given population. The two studies taken together complement each other.

Summary I

Though adolescents are found to suffer from several kinds of mental disorders, there is very little information regarding the actual prevalence of various psychiatric disorders among adolescents in the general population. Many studies have been conducted in this context such as those of Turner and Gil (2002) and Costello et al. (2003) National surveys also provide some epidemiological information but they have a lot of limitations such as small samples, or samples from clinics or institutions; overly specific research foci; and screening questions either limited in number or not closely aligned with DSM diagnostic criteria. Hence there is no adequately reliable information regarding what are the mental problems that adolescents face and to what extent. Moreover, there is no information regarding ethnic group specificity of mental health needs that would be needed to design subpopulation specific mental health interventions. To overcome such limitations and estimate the prevalence of mental disorders in the general U.S. adolescent population, Chen et al (2005) have found that the best way will be to include in national surveys of the general population structured diagnostic interviews or selected screening items or scales of symptoms of psychiatric problems that have high predictive value for diagnosis. Though this may not lead to actual diagnosis of disorder, it can help to identify those people at high risk and also help in identifying differential patterns in important demographic groups, including age, gender and race/ethnicity. Chen et al (2005) have estimated the prevalence and co-occurrence of specific mental disorders among US adolescents (12-17) years of age, sex and racial/ethnic sub groups. For this estimation the researchers have used data from the 2000 National Household Survey of Drug Abuse (NHSDA) along with the DISC predictive scales. Multiple logistic regressions were applied to study and find the prevalence and co-occurrence of psychiatric problems in adolescents taking into consideration demographics and environmental factors. Chen et al (2005) conclude that mental health problems among U.S. adolescents may be far more common than it is believed to be though these symptoms may not have been serious enough to call for medical attention.

Evaluation I

Kevin W. Chen, Ley A. Killeya-Jones and William A. Vega are professors at the Department of Psychiatry, University of Medicine and Dentistry of New Jersey – Robert Wood Johnson Medical School in New Jersey USA. Ley A. Killeya- Jones is also associated with the Center for Child and Family Policy, Duke University, Durham, North Carolina. The article is very detailed and includes literature review on the subject. The references used are from peer reviewed journals, and publications from the National Institute of Drug Abuse. Hence they are all authentic sources. The artilce has been published in the journal, “Clinical Practice and Epidemiology in Mental Health” 2005. The authors have discussed national surveys such as the Epidemiological Catchment Area Study the National Comorbidity Survey and the National Comorbidity Survey-Replication. The DISC-2.3 is well explained as a highly structured diagnostic instrument used to screen six categories of the most common mental disorders among children and adolescents. The study makes use of the DISC Predictive Scale. The authors make use of tables to analyze the data in the NHSDA, make comparisons and portray visually the prevalence and co-occurrence of psychiatric symptom clusters based on DPS among U.S. adolescents by gender, race/ethnicity and age over a period of twelve months. The conclusions may be easily deduced from the table. The discussion of the results is conducted from various angles and different possible interpretations are discussed. The paper also includes discussion of its limitations and clinical implications making it very valuable for practitioners of psychiatry.

Summary II

There are many kinds of treatment options in psychiatry and the problem lies in deciding which one to prioritize for development and implementation. Number Needed to Treat (NNT) and Quality Adjusted Life Year (QALY) – are some of the measures used so far to make the decision on prioritizing. But the authors Heller et al have developed a new set of Population Impact Measures to describe the population impact of risks and benefits. PIMs are easy to computer and are relevant to the problem of prioritizing psychiatric interventions. For describing the population impact of an intervention, the Number of Events Prevented in a Population (NEPP) is used. It describes the impact of treatment or other interventions and is defined as “the number of events prevented by the intervention in your population over a defined time period”. The NEPP is an extension of the Number Needed to Treat (NNT), and takes into account the extent to which the condition occurs in the population and the proportion of those with the condition who are actually exposed to the intervention. The measure helps policy-makers to identify and prioritize the potential benefits of interventions on their own population. Heller et al derives NEPP for interventions used in two important psychiatric conditions – schizophrenia and depression. They have concluded that there is a great potential for NEPP to help prioritize psychiatric interventions to maximum benefit.

Evaluation II

The researchers, Richard F. Heller, Islay Gemmel and Lesley Patterson are all professors in the School of Epidemiology and Health Sciences, The Medical School, The University of Manchester, UK and this article has been published in the journal “Clinical Practice and Epidemiology in Mental Health”, 2006. Hence the article is peer-reviewed and authentic. The authors have structured this article well and have explained the concept of Population Impact Measures well. They clearly show the advantage of NEPP over other practice guidelines in the UK and UK and say that other practices do not give an idea of the benefit of different interventions to a particular population while NEPP does. They have used tables to illustrate their arguments in a visual manner. It is interesting that they have omitted the cost data that would be needed to make a final prioritization decision, but they have explained it saying that it was deliberately left out so that the outcomes were described in terms in which the data were collected. They recommend that cost calculations might be added in a subsequent step. They have made use of literature based estimates which vary among them considerably and that is the only limitation.

Conclusion – Synthesis of the two papers

The two papers together constitute a group of writing that tells about the application of epidemiology to the identification and implementation of psychiatric interventions. The paper by Heller et al (2006) suggests using NEPP as a measure to prioritize psychiatric interventions as it is a population impact measure and takes into consideration the impact of a particular intervention on the population. Moreover it demonstrates the use of NEPP in the case of schizophrenia and depression. Chen et al (2005) point to the fact that the adolescent population in the United States suffers from mental disorders to a large extent and that is indicated by applying DISC predictor scales (DPS) to existing data from national surveys. Both the papers acknowledge that there is data that can be processed to maximize the efficiency of the interventions, but eliciting them for relevance needs some mathematical processing. While NEPP is used by Heller et al (2006), Chen at al (2005) find application in DISC predictor scales. Chen et al focus on the adolescent age population. There is future scope for research when the two articles are taken together. The NEPP suggested by Heller et al may be used by Chen et al. As it is a population impact measure, the NEPP will show the extent and prevalence of mental disorders among the adolescents in the United States.

References

Chen, W. Kevin; Killeya-Jones, A. Ley and Vega, A. William (2005). Prevalence and co-occurrence of psychiatric symptom clusters in the U.S, adolescent population using DISC predictive scales. Clinical Practice and Epidemiology in Mental Health, 2005, 1 (22), p. 1-12

Heller, F. Richard; Gemmell, Islay and Peterson, Lesley (2006). Helping to prioritize interventions for depression and schizophrenia: Use of Population Impact Measures. Clinical Practice and Epidemiology in Mental Health, 2006, 2 (3), p. 1-7