Current trends in Mental health - Assignment Example

?Current trends in Mental Health This paper will seek to present a discussion and a detailed evaluation of a current trend in the Mental Health practice, presenting a rationale for the care or intervention which is based on appropriate evidence and evidence-based research. The author shall also establish the advantages to care management, establishing clear results for clients and practitioners applying the specific intervention. Factors interfering with the implementation will be established, along with significant suggestions which can improve the implementation of interventions. Before a discussion of the current topic can be started, it is important first to adequately define mental illness. Mental illness is defined by the Mental Health Act (2005, p. 1) as a health condition which “changes a person’s thinking, feelings, or behaviour (or all three) and that causes the person distress and difficulty”. It also includes various health conditions which are defined by defects of the individual’s normal cognitive, emotional, and behavioural functions, and caused by social, genetic, and psychological factors, including infection or head trauma. Under the Care Programme Approach, these health conditions have to be adequately evaluated in the patient and a plan of care efficiently established. The current trend chosen by the author is the Care Programme Approach (2011). The Care Programme Approach or the CPA was first established in England for individuals with mental illnesses, referred to psychiatric professionals. This programme requires Health Authorities, in coordination with Social Services Departments, to establish specific arrangements for the care of mentally ill patients in the community setting (CPA, 2011). This programme has four main considerations or aspects: assessment, a care plan, a key worker, and regular review (CPA, 2011). Assessment basically includes the orderly processes implemented in the assessment of the health needs of the individuals admitted with specialist mental health needs; a care plan includes the plan identified in relation to health social considerations; key workers are those who coordinate the plan and delivery of patient care; and finally, standard review is the standard and scheduled evaluation processes, as well as the changes needed in the care plan (CPA, 2011). Changes in the CPA came about in 2008, the CPA established a new approach in mental health care which described the approach used in secondary mental health care in order to assess, plan, and coordinate treatments and support needs for individuals in contact with secondary mental health services who have severe mental health issues (Department of Health, 2008a). It is considered an approach – more than a system – because the manner by which activities are carried out is as crucial as the actual activities themselves. New qualities of those who would need CPA support include those individuals: who require multi-agency support; active engagement, intense intervention; support with dual diagnosis; and those who have a higher risk for acquiring mental health issues (DoH, 2008a). This new trend abolished the two-tier system of Standard or Enhanced CPA and discarded the single-tier system. The main goals of this new trend were to eliminate or minimize bureaucracy by removing from the system those who did not have as many health needs. It also came about because the CPA used to include patients whose needs could be covered under standard care (treatment provided within secondary mental health services, for patients not requiring the support of the CPA). The new trend or provisions of the CPA established that CPA would no longer be used in order “to describe the usual system of provision of mental health services to those with more straightforward needs in secondary mental health services” (DoH, 2008a). In effect, in instances when the service user has specified needs and can contact one agency, then he must be allowed to do so and that agency would be considered responsible for him. No formal paperwork for care planning is needed. However, a statement of care which is signed and established with the service user must be recorded. The rationale of this topic is based on the fact that the present application of the approach has not been adequately evaluated. There is therefore a need to review its current applications, considered atleast one patient who has been under the Enhanced CPA. There is a need to arrange and plan health services in order to establish an efficient allocation and delivery of health resources. In the current state of the global economic crisis, budget cuts on health care are all too common. There is a need therefore for health resources to be efficiently allocated to the people who need it the most. The current trend as seen in the CPA, establishes a refocus of services to those who have severe mental health issues and who need multi-agency or multi-system care. This would eliminate the possibility of redundant health services given to those whose standard care can be handled by other agencies. Moreover, it would ensure that those whose needs are significant would receive the most efficient assessment, diagnosis, and plan of care. This topic was chosen in order to evaluate the amendments to the CPA and to evaluate the implementation and applicability of this trend to those with severe and non-severe mental health needs. There are various benefits seen with the application of the current trends in the CPA. First, there has been an integrated care pathway approach to service delivery (Goodwin and Lawton-Smith, 2010). As a result, the services have been organized and streamlined to benefit those who would need it the most, in this case, those who have severe mental disorders needing multiple mental health services. This means of delivering services is beneficial as it improves patient outcomes for the mentally ill in terms of their ability to function well in society. The potential for the CPA to administer holistic and integrated care has been seen from the very beginning, however, various complaints of its failings in this regard have been seen and heard (Goodwin and Lawton-Smith, 2010). Moreover, surveys by Goodwin and Lawton-Smith (2010) indicate that less than half of those under Standard CPA have been given a copy of their care plan and only about 70% of those were given such plan under the Enhanced CPA. The revision and refocus of the CPA has manifested improvements in the care of these patients by redirecting those under Standard Care to the appropriate agencies where they do not have to compete with those needing advanced and multiple care. The current trend has also assisted in the information sharing between the different agencies (National Health Services, 2011). By necessity, these agencies have been prompted to interact with each other in order to establish an effective assessment and plan of care for the patients in need. As a result, these agencies had to share data with each other and exchange crucial information essential for the patient’s effective care (NHS, 2011). In the original CPA, less than half of those needing information from local support groups were able to get the information they needed, the rest could not access data and the lack of access was mostly credited to the lack of information sharing with the other agencies. Improved local shared provider agreements have also been seen with the refocus of the CPA (Goodwin and Lawton-Smith, 2010). This sharing among provider agreements also included improvements in the delivery of services, particularly highlighting the immediate needs of those with severe mental illnesses. The delivery of services have also been improved in terms of the range of these services to meet service users’ and carers’ needs (Department of Health, 2008b). Patients with severe mental disorders often manifest with multiple needs, and the refocused CPA has made available various services which cover not just one, but most of their needs. These services include the assessment of their housing and living needs, specification of plans to meet assessed needs, and among others, contingency plans for crisis situations. These services have been established in order to improve patient’s lives and to help them maintain their daily independent functions. In the original plan of the CPA, many CPA patients have not been able to access such wide range of services because of limited resources (Department of Health, 2008b). However, the refocused CPA was able to provide services which catered to as many of these individual’s needs as possible. Moreover, welfare needs were also secured for many of these patients with mental health disorders. This is a major issue for these mental health patients who often have to give up their jobs because of their illness. Their welfare support has been able to assist them in terms of financial support and health coverage, ensuring that they would be able to access health and social services despite their financial limitations (NHS, 2011). All in all, the refocused CPA has been effective in clearing a wider path for those whose needs are more ominous and numerous, ensuring that health service providers would prioritize them, that these providers would coordinate with each other to provide essential services to these CPA patients, and ensuring that those under standard CPA care would be redirected to the agencies who can also adequately secure their needs through readily available psychiatric and mental health care (DoH, 2008b). This current trend has been able to secure improved patient outcomes for patients with severe mental disorders and in the process has assisted in the reduction of their symptoms, as well as improving the possibility of their reintroduction in society, finding work, supporting themselves and their families, and improving the quality of their lives (Schmidt, et.al., 2008). Within nursing practice, the refocused CPA has been able to provide a more specific target for the delivery of mental health services, especially for those whose needs are more significant. In evaluating the CPA as applied to Claire (not her real name), one of the author’s severely depressed patients, the author was able to note that there are some issues with the system which must be improved by the health authorities (Dunne, 2010). Claire is 32 years old, a divorced, mother of two, and a former school teacher. Claire narrates how she had to go through the process of proving that she was severely depressed by undergoing several tests as prescribed by the CPA before she could be included in the enhanced CPA system. During her initial assessment, she was diagnosed with mild depression and was seen by a psychiatrist who later discharged her to the outpatient care of her GP. Her GP then prescribed her with some appetite enhancers to address her lack of appetite and some vitamins to increase her energy. She was also given the anxiolytic Xanax. She was however still feeling very depressed and at many times had suicidal thoughts. She was later readmitted for attempted suicide after she cut herself with the kitchen knife. She was then reassessed for possible coverage under Enhanced CPA. After a more thorough assessment, she was qualified as a patient with a severe mental illness, therefore, very much qualified to receive Enhanced CPA. After Claire was entered in the Enhanced CPA, her physical and mental health was fully evaluated and her social care needs assessed. A care plan which indicated how each of her needs was to be met was also written and a care coordinator was assigned to her. A regular review of her needs was also carried out when necessary. The needs of her relatives and friends providing support were also considered. Her views and her involvement were also asked at every stage of her care. This case illustrates the dangers which can arise in the system for patients with a less than severe diagnosis and their being denied enhanced CPA. These patients are often given secondary mental health services and continue to receive clinical support. They are also reviewed regularly and have to undergo social assessments under the new guidance to local authorities FACS (Fair Access to Care Services) which is available on the Internet (Dunne, 2011). This refocused CPA only provides immediate care for those with severe mental health issues, others with a less severe mental illness would have to prove the severity of their symptoms before they can access the NHS support facilities (Dunne, 2011). While this process is going on for these patients, they are not receiving mental health services. This practice has its inherent dangers because it can push many of these patients to cross the thin line from moderate mental illness to severe. The longer that mental health services are delayed, there is a higher possibility for a patient’s symptoms to become worse or severe (Brunet, et.al., 2007). Some patients are assessed by the CPA care providers as being more deserving in terms of mental health care as compared to other mental health patients. This can create a subjective assessment of patients and cause an unfair delivery of health services, especially for those who are involuntarily committed to mental health treatment. Being voluntarily admitted to mental health institutions does not necessarily negate the serious nature of the patient’s mental disorder. However, voluntary admission may count against a patient being assessed for enhanced CPA care (Dunne, 2011). There also seems to be a contradiction to the consideration for enhanced CPA which covers patients with a current or potential risk. Those with a current or potential risk practically already cover all patients with mental illnesses, whether mild, moderate, or severe (Brunet, et.al., 2007). The CPA does not seem to be clear in specifying who would be considered a current or potential risk, enough to be included under enhanced CPA. In evaluating the actual applications of this enhanced and refocused CPA, which is the current trend in the delivery of mental health services, there seems to be gaps in the policy and the implementation of these policies. First and foremost, according to Dunne (2010), due to inadequate mental health assessment techniques, many patients are forced to endure severe mental health issues which are not assessed as severe or life-threatening (Dunne, 2010). Despite the misdiagnosis of their mental health illnesses, years of medication and from their GPs often help manage their symptoms. However, there are times when their symptoms often become worse and require adjustments in medications or shifts in medical interventions. It is therefore unfortunate for patients to not be qualified for enhanced CPA and to be left to the limited capabilities of their GPs (Dunne, 2011). It does not seem to be appropriate to expect the GP, with limited knowledge in more focused mental health services to care for these patients who need a more informed decision about their mental health care. For the most part, these GPs are only familiar with specific therapies which may not apply appropriately or adequately with the patient’s needs (Dunne, 2010). A review of these policies is therefore necessary. In evaluating the care administered to the author’s patient, there is an apparent limitation in the system, especially as far as those with moderate or mild mental health services are concerned. Since the patient was diagnosed with moderate depression, she was eventually categorized to receive Standard CPA, ending up with the GP who did not have the necessary mental health skills to assess and treat the patient’s symptoms. The impact of the enhanced CPA is most significant on the GPs who are often obliged to treat outpatients with mental health disorders. The patients described under CPA comprise the majority of patients seen in the outpatient departments (Dunne, 2011). And yet, a trend has also been seen in this mental health care where many patients under Standard Care end up being referred to the GPs because they are not care coordinated on enhanced CPA (Dunne, 2011). The current mental health system has also set-up community clinics where most psychiatric issues like depression, schizophrenia, social phobia are dealt with (Dunne, 2010). The traditional outpatient departments are to be abolished (Dunne, 2010). As a result, the burden on family doctors and GPs on caring for mentally ill patients has been increased. In some cases, referrals from GPs are even filtered in order to secure the evaluation only of those cases which are worthy of evaluation (Dunne, 2011). The irony in the midst of this system is that patients with serious mental disorders are those who sometimes do not make undue demands; and those who would make the loudest demands (but may not necessarily have serious mental illnesses) would be the ones covered under enhanced CPA (Dunne, 2010). Inasmuch as various benefits have been seen in the application of the enhanced CPA, there are major gaps in the system which imply a need for health authorities to re-evaluate the system in order to resolve these issues which have surfaced and to ensure that all mental health patients, regardless of the severity of their condition would be able to gain adequate and appropriate mental health services. The refocusing of the CPA requires some teaching and education among nurses and among mental health patients. Health education for both patients and nurses can be empowering, arming both nurses and patients with the correct information about health care and about appropriate interventions (Green and Tones, 2010). In order to refocus the nurse’s knowledge, the author carried out teaching sessions with nurses, mostly providing lectures on the provisions of Enhanced CPA and who can be qualified under Enhanced CPA (Rattehali, et.al., 2009). The author scheduled weekly sessions for the nurses, at two hours per session. These sessions assisted nurses in understanding the requirements of the Enhanced CPA, also helping them to assess patients who should qualify for Enhanced or for Standard CPA. The author also reviewed with the nurses the importance of reviewing instructions with the patients. For example, the author instructed these nurses about what to say to patients under standard care, teaching them what these patients should do next, where they should go, and who they should go see. These teaching sessions were able to instruct the nurses accordingly about Enhanced CPA and about mental health illnesses. It also gave them confidence in their mental health care skills. As for the patients, the author implemented health education practices by sitting down and conversing with them, explaining to them why they would qualify for either enhanced or for standard care or why they would not qualify for CPA at all. After each patient is admitted for a mental illness, the author immediately scheduled these patients for these health education sessions. After explaining to the patients what type of care they qualified for, the author then explained to them what they should do and where they should go next. Through these sessions, the author noticed how the patients became less anxious and less afraid of their disease and the care they would receive. While the author was interacting with the other nurses in the mental health care unit, the teaching sessions on the CPA were discussed and an active interaction became apparent with the nurses during this discussion. Additional learning on the mental health diseases qualifying under Enhanced CPA was gained through books and journals available in the unit and in the hospital. This added knowledge assisted in the learning process of the nurses in the mental health unit. When the author was with the patients, the patient’s learning process on the CPA was implemented through a thorough discussion with the patient, including the patient’s family. Additional leaflets containing essential data on the CPA and its coverage were also handed out to the nurses and the patients The factors which impact on the current development and implementation of the enhanced CPA are within and outside the nursing practice. Firstly, within the nursing community, the author observed that nurses are not sufficiently informed about the different types of mental health illnesses, especially in terms of which diseases qualify under Enhanced or Standard CPA. Based on the author’s observations, these same nurses, often do not make appropriate evaluations for patients in terms of their mental health issues and the mental health services these patients need. Moreover, their attitudes about mental health disorders are sometimes not appropriate because some of them discount mental health symptoms like depression, suicidal thoughts, anxiety, and they do not consider these as mental health issues which deserve mental health care. This perception is echoed in the study of Jones, et.al., (2007), where the authors pointed out how some nurses often believe that their patients may be faking their symptoms or that the symptoms can be managed by the simplest medical care available. Jones and colleagues (2007) further discuss that it also does not do the mental health patients any favours that the rest of society can also be sceptical about their mental health issues. Under these considerations, the author recognized the importance of nurses maintaining their objectivity at all times, and their applying the mental health standards based on DSM-IV. The author also feels that her staff members must improve their knowledge of mental health illnesses in order to help accurately comply with the provisions of the Standard and Enhanced Care Programme Approach. With more assessment, diagnostic, epidemiologic, and treatment information about the illnesses, there may be a healthier and less cynical attitude about mental illnesses (Saxena, et.al., 2007). The author also observed that training must be offered to the mental health care providers in terms of new knowledge, in terms of assessment of mental health patients, in terms of diagnosing mental diseases, and in terms of establishing plans of care (Shapiro, et.al., 2007). Training is an important part of mental health care because it helps ensure that nurses can carry out their functions as mental health care providers and that their interventions are based on the best evidence which are currently available (Shapiro, et.al., 2007). The process of delivering mental health care services calls for the coordinated and multiprofessional working of various health professionals (Zwarenstein, et.al., 2009). It also calls for the utilization of a wide range of services. The author is firm on this belief and feels that in order for mental health care to achieve success and for mental health patients, like Claire to receive adequate care, these services and professionals need to coordinate more with each other; moreover, they also need to share information with each other. The author observed that it is best for mental health professionals to work professionally within their fields of practice, perfecting their craft and ensuring that there are no gaps in the delivery of their services (Zwarenstein, et.al., 2009). More importantly, the author observed that there is a need to coordinate with policy-makers and government officials, through lobbying activities and letter campaigns, for these officials to consider the implementation of further improvements in the CPA, especially in relation to the issues already discussed within this paper. The author feels that her fellow nurses must still work to implement the essential services under the CPA, despite the issues which they would likely encounter in the implementation of the programme. By implementing the essential features of the programme, the best parts of the programme may still achieve much success for patients under its coverage. Reference Belling, R., Whittock, M., McLaren, S., Burns, T., Catty, J., Jones, R., & Rose, D. (2011). Achieving Continuity of Care: Facilitators and Barriers in Community Mental Health Teams. Implementation Science, 6: 23. Brunet, K., Birchwood, M., Lester, H., & Thornhill, K., (2007). 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