Mental Health Issues in a Care Setting

Introduction

Mental health difficulties are reported globally to affect 1 in 4 individuals (World Health Organisation (WHO), 2013). Figures in Scotland are similar, where 32% of individuals surveyed in 2013 self-reported having one or more mental health conditions (Scottish Government, 2014). Scotland currently has a wide range of policies and legislation in place to protect those with mental health difficulties, extending from policies designed to reduce stigma and discrimination, to policies designed to support those who are at the risk of suicide.

This assignment will discuss the ramifications of living with schizophrenia and cannabis dependency in an individual called Stuart. There will also be a discussion on the legislative and policy framework in Scotland within which support for people with mental health needs is set.

Case
Study

This case
study will focus on an individual, who will referred to as Stuart. This is not
the service users  real name, but this
paper will follow the Nursing and Midwifery Council’s (NMC) Code of Conduct,
5.1 (2015), stating that a patient’s right to privacy and confidentiality must
be upheld at all times Stuart is a 50- year-old divorcee .He is an electrician
by trade. Currently unemployed. He has three children and an ex-wife.

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Stuart has a
diagnosis of schizophrenia. Schizophrenia is a long-term and debilitating
condition which is characterised by symptoms such as delusions, hallucinations,
low affect, and cognitive difficulties (American Psychological Association
(APA), 2013). It is diagnosed using the DSM-5 diagnostic criteria, which
include delusions, hallucinations, negative symptoms, disorganised/catatonic
behaviour, and disorganised speech (APA, 2013).

The
experience of voice hearing should not be confused with the normal inner voice
that we all have in our minds when we are in good health. Voices caused by
psychosis are profoundly different. They are as real as hearing a person in the
same room speaking ( and indeed research carried out by scientists has shown
that the parts of the brain that are activated by hearing real speech, i.e. for
detecting speech and generating language, are also active when voice hearers
hear the voices coming from inside their heads( Reveley, 2006).

In addition
to schizophrenia, he struggles with substance dependency and has been smoking
cannabis since he was 9 years old. Cannabis is the most widely used psychoactive
substance in the world (United Nations Office on Drugs and Crime, 2016). It is
estimated that 10% of cannabis users develop a cannabis use disorder. This can
be diagnosed when a person’s cannabis use impairs their functioning in everyday
activities, such as driving, over a year long period (APA, 2013). Cannabis use has
high morbidity with disorders such as schizophrenia, and some experts believe
that there is a casual link between early cannabis use and schizophrenia (Hartz
et al.,2014).

History

Stuart was
raised in dysfunctional family. He rarely saw his father who had been physically
abusive towards Stuart’s mother. He was also an alcoholic. Stuart’s father died
at the age of 42 from liver disease. Stuart’s relationship with his mother is
strained. He blames her for allowing him to witness the domestic violence as a
child.

When you
grow up in a dysfunctional family, you experience trauma and pain from your
parent’s actions, words, and attitudes (Boyd, 1992).Because of this trauma you
experienced, you grew up changed, different from other children, missing
important parts of necessary parenting that prepare you for adulthood, missing
parts of your childhood when you were forced into unnatural roles within your
family  (Boyd, 1992).

Impact of
Conditions

Cannabis use
is associated with lower educational attainment and the increased use of other
drugs (MacLeod et al., 2004). There is mixed evidence for the link between
cannabis and impaired neurological functioning. There is some suggestion that
any impairment in function is not permanent and resolves when use is stopped
(Schreiner and Dunn, 2012).

Schizophrenia
impacts negatively on both physical and psychological health. Research suggests
that patients with schizophrenia often have health problems due to low levels
of exercise, poor diets, and other drug use (McNamee et al., 2013). The social
effects are also considerable. Individuals typically avoid social interactions
and become isolated as their relationship with family and friends disintegrate
(Castle and Buckley, 2015). In addition, they can experience significant
developmental difficulties, with their ability to work impaired as a result
(Lauriello and Palanti, 2012).

 When Stuart’s delusions are most extreme,
Stuart finds that he cannot leave the house, which is difficult for his children
to cope with. This is likely to negatively impact on his chances of recovery as
family support is important for recovery (Mueser and Gingerich, 2006).

There
continues to be a stigma around mental illness (Thompson, 2007). This is
particularly true in Scotland where stigma and discrimination have been
identified as a widespread concern (The Mental Health Foundation, 2016).

Stuart was
fired from his workplace for his number of absences. He believes the real
reason was that he had mental health problems. This negatively impacted on his
emotional wellbeing at the time, and he began to experience self-stigma and low
mood. He experienced discrimination when he went to the job centre to seek
employment. He revealed that he was a regular cannabis user and felt that his
case worker judged him, and did not offer him any viable training or employment
offers as a result.

Two
Contrasting Approaches

Two
approaches to mental health which have widely influenced perceptions have been
the biomedical model and the anti-psychiatry model. The biomedical model views
illness as an aberration to be treated (Thompson, 2007). Mental illnesses are
diagnosed based on observable behaviours. This is also known as the labelling
theory (Thompson, 2007). The biomedical view continues to be the prevailing
view of mental illness in the Western world. An opposing view of mental illness
comes from the anti-psychiatry movement. This movement has maintained a stance
that mental illness should be viewed as a sane reaction to the insanity of the
modern world (Thompson, 2007).

Psychiatrists
such as Laing contended that psychotic episodes were instead expressions of
extreme stress on the part of the individual in response to societal
expectations (Thompson, 2007).

Precipitating
Factors

Stuart has
recently heard that his ex-wife is moving away with their children. This has
been a huge setback for Stuart, who is likely to feel even more isolated than before.

Legislative
and Policy Framework

Scotland has
a strong legislative and policy framework in place to support people with
mental health needs. The Mental Health (Care and Treatment) (Scotland) Act 2003
provides the backdrop to policies such as Delivering for Mental Health
(Scottish Government, 2006), Towards a Mentally Flourishing Scotland (Scottish
Government, 2009 b), and Mental Health Strategy for Scotland: 2012-2015
(Scottish Government, 2012). In addition to these, there have been accompanying
developments such as the See Me programme which aimed to reduce stigma around
mental health (Scottish Executive, 2002), and the Suicide Prevention Strategy
(2013-16) which was developed to target suicide rates (Scottish Government,
2013). The Mental Health Division was set up in 2003 by the Scottish Executive
and has been responsible for some of the above policies (The Mental Health
Foundation, 2016). The impact of the Division and the Mental Health (Care and
Treatment) (Scotland) Act 2003 will be discussed here, and their relevance to
the care that can be provided for Stuart explored.

The
Mental Health (Care and Treatment) (Scotland) Act 2003

The Mental
Health (Care and Treatment ) (Scotland) Act 2003 set out provision as to how
and where individuals could receive treatment, and how they could be treated
without their consent should that be necessary. It also set out the rights of
individuals when receiving treatment. The background to this legislation was
the growing awareness in Scotland in the 1990’s that the previous legislation,
the 1984 Mental Health (Scotland) Act, was outdated. New legislation was
required that reflected the changing landscape of mental health, with its
greater focus on human rights and on supporting individuals in community, as
opposed to hospital-based care (The Mental Health Foundation, 2016). The Act
was an ambitious piece of legislation, and was recognised as one of the most
forward-looking pieces of legislation in the world at the time. Of particular
importance was its emphasis on the human rights of those with mental health
illnesses. It was informed by the Millan Principles (Millan, 2001). These
included an emphasis on participation and non-discrimination. Advance
statements relate to the principle of participation and mean that an individual
can produce a written statement when they are well which specifies how they
would want to be treated when they are unwell from mental health perspective,
and are unable to make decisions for themselves, Stuart has produced an advance
statement which specifies that he is to be administered anti-psychotic
medication If he is too unwell to make that decision for himself. Advance
statements are useful in forming a therapeutic alliance between the
practitioner and the patient (Mental Welfare Commission for Scotland, 2014).

The McManus Review
(Scottish Government, 2009 a) assessed the Act’s progress and found that the
implementation of the Act was proceeding well, but that areas for improvement
remained. The review highlighted areas such as the limited use of advance
statements, and take up of independent advocacy services.

Mental
Health Division

The second
important development that I will discuss is the Mental Health Division and the
policies that this body has been responsible for. The Mental Health Division
was established by the Scottish Executive in 2003, and its aim was to improve
the quality of mental health provision in Scotland. It has been responsible for
policies such as Delivering for Mental Health (Scottish Government, 2006),
Towards a Mentally Flourishing Scotland: Policy and Action Plan (2009-2011)
(Scottish Government 2009b), and the Mental Health Strategy for Scotland : 2012-2015
(Scottish Government,2012). The Delivering for Mental Health policy set out
health improvement, efficiency, access and treatment (HEAT) targets which were
to be achieved within a certain timeframe. The HEAT targets relevant to mental
health included decreasing the number of antidepressants the population was
taking, reducing psychiatric readmissions, and decreasing suicide rates.

Of relevance
to the present case study is the publication of the Mental Health Strategy for
Scotland: 2012-2015. This policy aimed to improve the treatment options
available for people with mental health needs and their carers. The Mental
Health Strategy however, has been criticised by professionals and service users
like, for trying to address too many areas for placing less emphasis on health
promotion and prevention than previous (The Mental Health Foundation, 2016).

Gaps in
Service Provision

An area
where there are some gaps in service provision is in the provision of crisis
support for individuals with mental health difficulties. Crisis provision is
‘’designed to provide support to individuals with or without prior diagnoses of
mental health conditions in instances of acute distress as an alternative to
hospitalisation ‘’ (The Mental Health Foundation, 2016, p.88).

Another area
where further funding is required is around the evaluation of policies (The
Mental Health Foundation, 2016). Most mental health evaluation focuses on
measuring ‘hard outcomes’ such as patient waiting times, the number of
psychiatric admissions, and the take up of services (The Scottish Government,
2006b).

Conclusions

In Scotland,
there is a strong legislative framework to support individuals with mental health
concerns. However there continues to be gaps in service provision with respect
to measuring progress, and the delivery of crisis services. In this way,
Scotland is not unlike other developed countries, however greater efforts must
be made to address these gaps. In addition, service users such as Stuart
continue to experience stigma and discrimination in daily life and this does
not appear to have lessened greatly in Scotland since the publication of the
Sandra Grant Report (Scottish Executive, 2004)

References

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