Mental Health and Code of Ethics for Social Work - Essay Example

My client is a 65 year old man who has been diagnosed with Alzheimer's disease. As his social worker I have a number of objectives which must be met. Before I discuss those it is important for me to know the relevant facts about his disease, to review the models for treatment which may be relevant to his case, and to examine how my values as a social worker will affect my ability to give him professional and at very minimum, competent care. Alzheimer's disease is distinguished by gradual onset and progression. Typically there are three stages; early (mild), middle (moderate) and late (severe). In the In the early stage of disease, an individual or a close companion may notice increased forgetfulness and word-finding difficulties, the tendency to lose or misplace things, repeated questioning, and some disorientation. In the early stage motor skills are still intact, and the individual can easily be cared for at home by family members or a care giver. In the middle stage cognitive functions decline. The memory deteriorates and the ability for self care is gradually lost. Personality changes become apparent, and the patient confuses times and places. They begin to have difficult communicating and recognizing friends or family members. At this stage they also begin to wander, and experience delusions and hallucinations. They also have an increased tendency to fall. Depending on the accompanying behavioral problems it may still be possible for them to remain at home with constant care, or it may become necessary to place them in an institutional setting. In late stage disease the individual may well be bedridden, incontinent and unable to understand or speak. Full time care is now necessary. Typically once the diagnosis of Alzheimer's has been made the patient lives from 7 to 10 years, and on average 5 of those years in spent in some type of care facility. Alzheimer's disease can only be diagnosed with certainty from a brain autopsy after the person has died. Diagnosing Alzheimer's is often difficult, particularly in the early stages, but an assessment will be made based on conversations with the person being diagnosed and those close to them, a physical examination, memory tests and/or brain scans. There is no cure for Alzheimer's though there are a few drugs available to lessen the symptoms and improve the quality of life of the patient. People with Alzheimer's will need to visit their doctor on a regular basis, so that the doctor can check how the disease is progressing and treat any other illnesses that occur. In this particular case the service user is still able to live at home with regular support (four visits a day from one care giver) but he is beginning to lose the ability to sequence tasks, or retain a reasonable perception of danger. This would place him in the first or early stage of the disease. There are two models of care currently in common use which I will discuss as alternatives. The first is the Medical Model which emphasizes the individual as sick, diagnoses the problem, makes a prognosis, and prescribes a cure. In this type of case a psychiatrist is the expert and the patient is the recipient of the expert's definition of the problem. The medical model sees the disabled person as a problem who is to be adapted to fit into the world as it is. If this is not possible, then they are shut away in some specialized institution or isolated at home, where only their most basic needs are met. The emphasis is on dependence, backed up by the stereotypes of disability that call forth pity, fear and patronising attitudes. Usually the impairment is focused on, rather than the needs of the person. The power to change seems to lie within the medical, and associated professions with their talk of cures, normalisation and science. The patient has little input or say. Other people's assessments of the patient, usually by non-disabled professionals, are used to determine where and how the patient is treated, what support they get, and where they live. Thus this model defines recovery in negative terms. Many service users internalize negative views of themselves that create feelings of low self-esteem and achievement, further reinforcing non-disabled people's assessment of their worth. The medical model view creates a cycle of dependency and exclusion, which is difficult to break. Granted an Alzheimer's patient gradually loses the ability to make decisions for themselves and someone else must be assigned that role, but my preference is towards letting family members make those decisions for the service user once their own ability to do so has vanished. To that end, the social model of treatment becomes preferred. This model states that impairment and chronic illness exist and they sometimes pose real difficulties. Regardless of their particular impairment, these individuals are subjected to a common oppression by the non-disabled world. The position of the service user and the discrimination against them is socially created. This has little to do with their impairments. They are often made to feel it's their own fault that they are different. The difference is that some part, or parts, of their body or mind are limited in their functioning. This is an impairment but does not make them any less a human being. The understanding of this process of disablement allows patients with Alzheimer's to feel good about themselves and empowers them, and their care givers the right to fight for their human rights. The service user can then take responsibility for developing coping skills and adapting to help themselves deal with their mental illness, The focus is on strengths rather than weaknesses, and on people rather than illnesses. The difference between the two can be broken down more concisely as follows: Medical Model Social Model Disease/Disorder Problems/Difficulties Diagnosis Assessment Causes/Pathology Response/Learning Symptoms Problems Behaviours Treatment Intervention Cure Reduction of problem Patient Service User Rather than look at the disease as the problem, the social model looks at the problems and difficulties it will create for the patient and society. It creates an assessment rather than a diagnosis, and opportunity to respond and learn as opposed to looking for a cause, thus making it proactive. Rather than simply treating the disease and its progression, this model intervenes into as many facets of the patient's life as needed. Rather than looking for a cure, it seeks to reduce the problem. And finally, the term patient is abandoned and replaced by service user. Since Alzheimer's has no cure, this is the best model to use in devising a plan for their future care. Medication, psychotherapy and case management can all be successfully adapted to the social model and indeed are all necessary in reducing the advance of the disease. Prescription of medications becomes a process of education, consultation and collaboration. Psychotherapy will offer a variety of treatments suited to the individual in more natural settings and within more adult-to-adult relationships. Case management becomes a personal service plan which sets goals, offers support and facilitates solutions to problems as they arise. The definition of the social work profession given by the BASW is "the social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work" (Bolton) As a member of the social work profession my role as social worker is based upon my personal ethics, values, education and experience. The values that I have used to form my ethical and moral treatment of my service users are in part those recommended by the BASW including my devotion to individual human dignity and worth, my belief in social justice, a desire to be of service to humanity, and my personal integrity and competence in achieving my goals. More specifically my beliefs are that every human being has intrinsic value. All persons have a right to well-being, to self-fulfillment and to as much control over their own lives as is consistent with the rights of others. It is my intent to respect basic human rights, to show respect for all persons, and respect service users' beliefs, values, culture, goals, needs, preferences, relationships and affiliations, to safeguard and promote service users' dignity, individuality, rights, responsibilities and identity, foster an individual's sense of well-being and autonomy, subject to due respect for the rights of others, respect service users' rights to make informed decisions, and ensure that service users and peers participate in decision-making processes, and to ensure the protection of service users, which may include setting appropriate limits and exercising authority, with the objective of safeguarding them and others. The service user in this case history is an older gentleman who is facing a future that promises a decrease in both mobility and mental capacity due to the nature of his disease. The situation can be frightening for those faced with it, as everything they once knew becomes strange as their memory fails. Depression is a common side affect of Alzheimer's and can mimic and intensive the symptoms of the causative disease. In addition his family and care givers will be placed under increasing strain as the disease takes its course. Added to the physical and monetary burdens the disease places on a family are the emotional issues of watching someone you love deteriorate to a point where they can no longer recognize you or take care of their own basic bodily functions. Under the social care model and using my values as additional guidelines I have a number of responsibilities. I must first be sure to evaluate my service user's capabilities at regular intervals, and then explain to him and his caregivers what steps we should be taking to optimize the functions he still has, and to minimize progression of the disease. This does include regular visits to the physician and compliance with medications the physician might order. Because the service user's memory is likely to make taking medication risky at best, I must make sure that someone else is designated to dispense medications at the required times. Since arrangements have already been made to have one caregiver make four visits a week, we will have to evaluate his medication regimen and determine how the other three days will be managed. An evaluation of my service user's residence must also be made to determine safety factors, and risks that may be overlooked by the care giver. As his condition worsens he will become more prone to falling, and it may be necessary to arrange furniture to an arrangement less confining. Because his ability to recognize potential dangers is deteriorating it might be a good time to somehow block access to stoves and heating devices requiring the use of gas in particular. He is still cognizant of most things happening around him, so I must be sure to involve him in the decisions to do these things, and the manner in which these tasks will be completed. Personally I feel it would also be a good time to contact any neighbors he is friendly with (with him in attendance of course) and explain what he is facing, and ask if they would be so good as to keep an eye on him and offer assistance if they see it is necessary. At the same time I could leave my business card so the neighbors could contact me if they see any behavior out of the ordinary. Because at some time or level he is likely to feel some of the stigma of mental illness being applied to him, this might be a perfect opportunity to educate his neighbors and allow them to react with compassion as opposed to discriminating against him. With his primary care giver present I will discuss with him the possibility of his getting lost in the future. He scoffs at the idea at present, as he feels he is more than familiar with the area, but we will recommend that he begin carrying a card with his name and address, and the diagnosis of his disease, so that should he be discovered wandering the police will understand the cause. His caregiver's phone, as well as mine, is listed on the card. In the near future it will become necessary for travel arrangements to be made for him to all of necessary appointments, as public modes of transportation may become too confusing. And of course at some time it may become necessary to have his driver's license revoked, not in an effort to restrain or restrict him, but because it is necessary for the safety of others. Since cooking can become dangerous for Alzheimer's patients due to a risk of fire or burns in the future we will have to examine alternatives and either have meals brought in to him, or have him walk to a nearby pub for meals. He needs to have some choice in this matter as well, and companionship at meals would be good for him. As someone not living with the disease as he is, it is sometimes difficult for me to appreciate everything that he must be feeling. Not so long ago he was a capable, responsible member of society, and now we sit and discuss things he took for granted as do we all. I can already see the frustration on his face as he struggles to remember things that he knows he should know. Perhaps it is fortunate for him that he doesn't know graphically how much further the deterioration will be. At the present time, in his case, I have informed him; as did his physician that the symptoms will increase, though medical treatment will quite possibly slow the progression of the disease. At the present time, he is likely to be able to handle most tasks if he has lists to help him remember what must be done. His care giver will bear a lot of the responsibility for recognizing the level of progression in his case, because he/she will be in attendance four days a week. I have provided her with a specific list of symptoms or problems to watch for, and that I should be contacted if they appear. They include severe memory loss, particularly for recent events. A sufferer may often remember long-ago events while being unable to remember a television show they just viewed. In this stage, disorientation usually begins, dysphasia (inability to find the right word) may occur, and mood changes happen that can be unpredictable and sudden. Depression is always a concern, and personal and household hygiene may deteriorate as they forget to complete tasks. Many people diagnosed with Alzheimer's also have sleep problems or insomnia. The way in which Alzheimer's disease affects sleep patterns physiologically is difficult to understand but has been documented. It will be necessary to discuss my service user behaviours which he can use to help control any potential sleep problems. They will include creating a schedule that reinforces a calming demeanor in the evening hours, and a recommendation to avoid daytime naps. Sleep deprivation can lead to an increase in behavioural problems and depression, and can hopefully be avoided. Hygiene, both personal and housekeeping are other areas which will deteriorate with the service user's condition. While his personal hygiene will be of less and less importance to him, it will be a determent in how society views him. For now, a list of tasks that we will discuss for both daily and weekly performance will be used as reminders. A calendar will be strategically placed for his use. The more he can do for himself, and do without intervention by anyone else, the higher his self esteem will be maintained. As his condition progresses I must remember the following priorities: the importance of my service user's understanding, my belief in what he says, that I determine his wants not just his needs as I interpret them, that the personal strengths he retains are explored and utilized, that those strengths are recognized as multi-dimensional, that I continue to acknowledge the uniqueness of this man as an individual, that we reach mutual agreement on issues regarding his care, that I use client-friendly language, that we conduct assessments of his condition and needs as a joint activity, that blame is avoided, that singular cause and effect is avoided, and that the intention is always to assess need, NOT to diagnose any deficits. Above all it's very important to remember that the patient neither intends to nor can control this behavior. In working with this man I must first and always remember that he is a person and not just another file in my case load. This means some personal knowledge and involvement in his life history. Once I get a feel for who he is, I can help him and involve him in decisions which must be made for his future care and well being. Because I know better than he that his condition will deteriorate, and the stages at which that likely to occur, I can anticipate many needs he will have in the future. While he still retains cognitive awareness and some decision making abilities I can investigate his preferences now, in a subtle manner so as not to alarm him. One of the contingencies which must be planned for is his eventual placement in a facility, unless his primary caregiver can change status and become fulltime, and in-home. I know that many of the questions I will be asking my service user will seem intrusive, and they must be presented in a simple manner that he can understand, especially as his condition worsens. One of the areas of perhaps greatest sensitivity will be a discussion of his finances, which will have a greater bearing on his case as the disease progresses and he reaches the late stage and requires full time assistance or hospitalization. Paranoia is frequently a problem in the late stages of the disease and no wonder. Suddenly, or so it must seem to these individuals, they live in a world where nothing is familiar. As much as anyone else can, it is my responsibility to ease this gentleman's transition into a world he does not know and provide him with as much as dignity as is possible. Society still discriminates against mental illnesses, in large part because they do not understand the processes of the human mind. Many people, including caregivers think that the dementia associated with Alzheimer's is a normal part of aging, but it is not. Unfortunately with no cure in sight for Alzheimer's this service user's destiny is foreordained. For his sake, and for society's sake, my role is to anticipate and coordinate all phases of his care, and ensure that he retains his dignity and rights as a human being. That includes his physician, psychological care as needed, medications, nutrition and exercise, housing, safety, and his caregiver. My final role will be to assist in arranging for full time care as determined by his financial status and availability, according to his wishes. Bibliography ABOUT, 2005, What is Alzheimer's, http://alzheimers.about.com/cs/diagnosisissues/a/what_alzheimers.htmJuly 3, 2005 Bolton, Jon, 2003, Code of Ethics for Social Work, BASW, http://www.basw.co.uk/articles.phparticleId=2&page=2, July 3, 2005 Hanley, Fiona, 2003, BASW, Using Advocacy in Social Work, http://www.basw.co.uk/articles.phparticleId=75&page=3, July 3, 2005 Medical Model/Social Model, 2005, http://www.diseed.org.uk/Medical_Social_Model.htm, July. 2, 2005 Ragins, Mark, 2004, The Journal, Volume 5, Issue 3, Recovery: Changing From A Medical Model To A Psychosocial Rehabilitation Mode, July 3, 2005 Social Guardian.co.uk, 2005, Are social work values under threat, http://society.guardian.co.uk/healthandsocialcarebill/story/0,7991,472484,00.html, July 2, 2005 Read More