This week’s blog is a little different to the usual. Having recently completed my HNC in Social Care I was looking back over assignments I had written. I was tasked with writing an essay about ‘mental health in a care setting’, which I very much enjoyed doing. I found the assignment very insightful and thought you might too. I’ve attached my references at the bottom also for further reading if it takes your interest. Please bear in mind that I had to hit certain knowledge points and so it at time lacks the direction I might put into a blog.
This assignment was to also include a case study of a person I have previously supported but I’ve gone through and anonymised this person for this blog. I considered removing this part of the essay but I now find reading it that it brings the human experience into it. I hope you find this aspect useful in understanding those affected by mental health problems.
I don’t expect many to read this but i thought some might find it interesting. If you find this helpful please share for the benefit of others. If you have some feedback please leave a comment or contact me directly.
Mental Health in a Care Setting
by Ryan Warren
Due to the breadth of factors that contribute to mental health a ‘succinct, universally applicable definition of Mental health has long been elusive’ (Elder, Evans and Nizette, 2008). World Health Organisation (www.who.int: 2014) offers the definition that mental health is ‘a state of well-being in which every individual realizes their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community’. This definition is like that of Kittleson (1989) who states that positive mental health is the presence of high self-esteem, effective decision making, value awareness and expressive communication skills. Thus, mental health is a complex concept that is defined differently depending upon the whether it is in a positive or negative state.
Many factors affect the perceptions of mental health issues such as personal experience, relationships with someone with mental illness, the portrayal of mental illness in the media and the culture or society that person identifies with. The media has great power in the way that people understand mental illness. Stigma is commonly attached to those with low mental health by the media. The symptoms may take the form of challenging behaviours that those without mental health problems also display. Thus, making it hard to distinguish a person with mental problems and one without. This can include socially unaccepted behaviours such as violence towards others or themselves and being verbally disruptive or abusive. This stigma can lead to an individual feeling victimised, marginalised and isolated from society as they may not be able to control such behaviours. This was certainly the case for Mark who has self-harmed for several years.
Four main theories exist regarding the development of mental illness. The medical model proposes that imbalances in the physiological, biochemical or genetic foundation of an individual are to blame. This model can offer structured methods of treatment such as drug therapy; which relies on trial and error to determine the most effective drug, electro-convulsive therapy; which attempts to interrupt the brain chemistry but is widely condemned and psycho-surgery; which involves surgically breaking the brains nerve connections and is a last resort. The main weaknesses of this model is that treatments address the symptoms rather than provide a cure and the side effects to each treatment can be more impacting than the illness itself. Mark has struggled through the years to find a sufficient medication that does not make him feel physically ill in order to combat the mental illness.
The psycho-dynamic model proposes that mental illness is caused by psychological trauma and remains in the unconscious. Treatments for this model revolve around counselling and seek to enable an individual to resolve unconscious conflict. These treatments can take a long time to be effective and rely on the individual being able to recognise the unconscious trauma as well as being responsible for resolving said trauma. Whereby the medical model proposes that the individual has no control over the symptoms of mental illness the psycho-dynamic model places all responsibility upon that person. Each model has its benefits and its weaknesses but in some circumstances the combination of treatments can have significant impact on individuals. Mark, having experienced trauma at an early age has engaged in counselling which has failed to provide Mark with a ‘cure’ or ‘fix’ for his problems which he had been hoping for. This approach has however given Mark a continuous framework to monitor and maintain his mental health which he has found useful.
The moral model asserts that an individual must develop such characteristics as compassion and grace, courage and fortitude, honesty and integrity and failing to do so would render them mentally ill. This model treats those afflicted through various types of therapy including: social therapy, occupational therapy and individual therapy. The core principles of which include viewing the individual as being subject to the illness and not responsible for it, open discussion and encouraging purposeful activity.
The Social model suggests that those deemed mentally ill are not in fact ill but are just different from others in society. Based on the three core principles: no behaviour is abnormal or deviant but just different to what society has deemed acceptable, what is deemed a delusion by some may in fact be true and therefore not a symptom and that the challenging behaviour presented by an individual is the result of societal pressures. This model is treated similarly to that of the moral model which also shares the stance that the medical and psychodynamic models impact the individual by labelling them or their behaviours therefore stigmatising said individual and potentially furthering their condition. Both the moral model and the social model approaches have helped reduce the stigma that Mark has felt about his illness. Considering these approaches Mark no longer feels responsible for his low mental health.
Mental health problems can impact on a person’s physical capabilities and can hinder their ability to work and they may be viewed as leech on society. Those with mental health problems who present challenging behaviour that involves persistent law breaking can find themselves ostracised by the community or blamed for the behaviour that they may not be able to control. Individuals that have low mental health and feel powerless to the symptoms can feel isolated or victimised.
There are many factors that are intrinsic to mental health problems. Socioeconomic factors such as poverty, low levels of educational attainment and unemployment are all considered to have contributed to the deterioration of Mark’s mental health. Poverty is considered one of the most important of these factors as the lack of sufficient finances has had many knock-on effects to Mark’s mental and physical state. Without sufficient funds Mark is unable to feed himself with healthy food to nourish him. This in turn has an impact upon his physical health which reduces his ability to work. Time spent away from work has then further impacted upon that Mark’s financial situation making things worse. In this cycle Mark has experienced anxiety and stress related to getting out of his predicament. With poverty also comes the lack of opportunity of higher educational attainment. Mark’s poverty has left him feeling trapped, hopeless and powerless which has had a significant impact on his mental health.
As previously mentioned, mental health can affect the physical health, but where an individual is either born with a physical impairment or develops one in later life their mental health can be negatively impacted. Other physical factors that can alter the state of a person’s mental health include being subject to physical abuse. This was the case for Mark as at a young age he was the victim of domestic violence and emotional abuse. Mark was made to feel responsible for the abuse that he received and has carried this with him. Both his physical and emotional worlds were impacted at an early age which has left him feeling depressed, anxious and isolated.
Having had his physical and mental well-being damaged at an early age and growing up in a state of poverty Mark was not able to achieve much by means of educational attainment. This intellectual factor has impacted his job prospects through the years and has resulted in Mark working low wage and menial jobs that offer him no satisfaction. Mark has felt for a long time that he is unfulfilled and unsatisfied with his life. It is hard for Mark to improve his mental health when he feels so lost with such low educational attainment he has no significant job prospects leaving him hopeless.
Mark has found through all that he’s gone through with his mental health struggles he has lost his identity in society and his culture. Mark identifies as Catholic and the mental health problems that he faces leave him angry and confused as to how he is so afflicted. He believed himself to be a good person yet also feels as though he is being punished by God in the form of his illness. His spirituality has been vastly affected by the mental health problems as he has lost his faith in God and no longer attends the church. Mark has also had to deal with a lot of emotional turmoil throughout his life. All of which have left him both physically and emotionally drained. This has impacted his mental health as he is rarely sure of how to feel and finds himself experiencing periods of heightened emotions at times without the capacity to deal with them appropriately.
Due to the severity of the mental health difficulties that Mark experiences he is vulnerable and at risk of harm. This risk of harm is both from himself and from others, intentionally and unintentionally. Mark could cause harm to himself by forgetting to take his medication which would make him feel unwell and would affect his decision-making ability. Mark’s mental health makes him more susceptible to people who take advantage of vulnerable adults. The Adult Support and Protection (Scotland) Act 2007 (www.legislation.gov.uk: 2007) seeks to protect Mark and ‘adults at risk from all forms of harm. By providing a framework that provides advocacy services and conducting inquiries and investigations the Adult Support and Protection (Scotland) Act 2007 holds people accountable for their interactions with vulnerable adults. This Act can also raise a variety of protection orders that keep the individual safe from harm caused either by themselves or others.
Mark feels that the support he receives is only partially effective as he has been receiving support for many years and doesn’t feel much different from when he started. The Mental Health Strategy 2017-2027 (Scotland) (www.gov.scot: 2017) has provided Mark with some hope as it will be evaluating the effect of the support that is provided to services users and take their feedback in the development of new support structures and therapies.
The Mental Health (Scotland) Act 2015 (www.legislation.ogv.uk: 2015) provides a framework for support practitioners to deliver support that is non-discriminatory, respectful, informal, participatory, equal and reciprocal. These guiding principles ensure that supported individuals like Mark are not given a generic support package based upon their mental health diagnosis but are instead provided with tailored support based on who they are and how they wish to be supported.
Mark receives support from a variety of organisations and services. No one service can support all of Marks needs and as such he interacts with statutory agencies such as the community psychiatric nurse (CPN). As Mark no longer resides in the psychiatric hospital the CPN visits him at his residence to assess his health and liaise with the wider NHS psychiatric team on his behalf.
Mark is visited by a support worker from the national voluntary sector organisation Scottish Association for Mental Health (SAMH) (www.samh.org.uk), who support him in his day to day life. They support Mark to continue to life in the community by promoting his independence and protecting him from harm. This organisation also liaises with the statutory services on Mark’s behalf when he feels he is unable to do so or when the organisation notices his mental health lower. Mark’s mental health has caused him to harm both himself and others in the past and so he is required to engage with both the CPN and SAMH. This is for his protection and for those in the community due the compulsory treatment order that Mark is under.
The organisation Mind (www.mind.org.uk) is an online forum which offers a variety of support resources, all of which Mark engages in voluntarily and independent of the other services he is involved with. Mark has recently used Mind to seek information and legal advice about his care. There are several other services that they provide such as counselling and advocacy that he has yet to engage in but intends to do so. The advocacy service provided will speak on Mark’s behalf to the CPN or SAMH when he feels that there is either something wrong with his support or if he feels he is not being listen to.
Elder, R., Evans, K., Nizette, D., (2008) Psychiatric and Mental Health Nursing: 2nd Edition, Sydney, Elsevier.
Gov.scot. 2017. Mental Health Strategy 2017-2027 (Scotland). [ONLINE] Available at: http://www.gov.scot/Resource/0051/00516047.pdf. [Accessed 1 April 2017].
Kittleson, M., (1989) Mental Health vs Mental Illness: a philosophical discussion, Health Education May :40-2
Legislation.gov.uk. 2007. Adult Support and Protection (Scotland) Act 2007. [ONLINE] Available at: http://www.legislation.gov.uk/asp/2007/10/part/1. [Accessed 1 April 2017].
Legislation.gov.uk. 2015. Mental Health (Scotland) Act 2015. [ONLINE] Available at: http://www.legislation.gov.uk/asp/2015/9/contents/enacted. [Accessed 2 April 2017].NE] Available at: http://www.who.int/features/factfiles/mental_health/en/. [Accessed 1 April 2017].