Psychiatric Care: The Relevance of Mental Health Policy - Research Paper Example

Psychiatric Care: The Relevance of Mental Health Policy Introduction In the United s, mental illnesses have been traditionally perceived as distinct forms of illnesses from the conventional perception of other physical illnesses as in general medical conditions. It is evident that until recently, there had been unfair discrimination against the mentally ill. Kermis (1987) indicated that the need for services across populations, especially the elderly will remain unmet in the foreseeable future, and many mental health programs consistently remain underfunded. This leads to a situation where deliver of psychiatric care to the population happens in less appropriate and more restrictive settings in reality. The inpatient model of psychiatric care delivery has long been proved to be inadequate, and inadequate funding in programs has limited access to care for the prospective population through the outpatient and community approach. This calls for a mental health policy that would attempt to solve these problems in care delivery, ultimately with the objective of improvement of mental health care quality and mental health status of the population in general (Kermis, 1987). Most countries have currently mental health policies of their own. The basic drivers of these mental health policies are the need to have a preventative mental health service that can reach the prospective clients in the community. This is in contrast to previous approach of curative mental health center based psychiatric care that deploys care to the psychiatrically ill patients. Apart from stigmatization, this approach draws upon the fact that a patient with psychiatric illness will never be normal. However, with improvement of knowledge about factors leading to mental illnesses, it is increasingly clear that these patients can be intervened more successfully with a changed approach and many of them can lead a very successful and productive life (Mechanic, 2002). Therefore, it remains to be examined whether really mental health policies have driven these changes in care forms. There is indeed a need for systems, processes, and services which are able to promote mental health, diagnose mental problems early, assume approaches that are preventive, and foster access to services in terms of psychiatric health. According to current statistics unfortunately, about two-thirds of the affected population fails to access services. Moreover, there are disparities in service utilization rates between people of ethnic and linguistically diverse backgrounds. These discrepancies as has been indicated by studies may be eliminated by policy directives for psychiatric service delivery. Given the volume of literature, a literature review and critical analysis of current knowledge in this area is mandated in order to establish the relevant knowledge. Aim This study aims to examine the current psychiatric care and its relevance to mental health policies. Hypothesis Better understanding of mental illnesses has made it possible to identify factors which have shaped the current mental health policy. Research Questions 1. What are the main features of current mental health policy a. What are the approaches for established psychiatric illnesses b. Are there any known risk factors which can indicate future mental illnesses c. How the current psychiatric management approaches conform to mental health policies in these areas 2. Are there systems, processes, and services within the realm of mental health policies that can adequately cover the psychiatric illnesses a. Are there any access issues for the affected population b. What are the responses of the states and territories to mental health policies c. Are the policies and services adequately responsive to the special needs of the communities 3. Are there any discrepancies in service delivery in psychiatric illnesses a. Are there any identifiable barriers in service utilization and realization b. Are there any perceived benefits of implementation of mental health policies in the communities c. Are all at risk population being covered in preventative mental health care Methodology Research literature in mental health policies and psychiatric health services will be examined and critically reviewed to select relevant articles. Initially key word based search will be performed which will deliver studies encompassing these topics. These studies will be categorized and the review would deliver the answers to the questions above. Review of Literature Thornicroft & Tansella (2003) indicated that some mental illnesses are fairly common, and psychiatric illnesses such as anxiety disorders and depression are largely preventable if the at risk individuals are identified and intervened fairly early. Currently available data for prevalence indicate that the disease burden relevant to these mental illnesses continue to increase within the current framework. Thus specific mental health policies directed toward these problems are therefore necessary. Moreover reported results of recent investigations indicate the need for integrative care involving primary care systems since many at-risk or affected individuals with other general illnesses may have diagnosable mental illnesses which need care but often go unattended due to paucity of access or lack of awareness about existing services (Thornicroft & Tansella, 2003). Studies have indicated the need for increasing emphasis on preventive psychiatric practice that can identify patients with mental health risk factors. The behavioural risks are best diagnosed in the community, and this can be achieved through community contacts with the prospective patients who are increasingly being exposed to psychosocial risk factors. This needs supports from the mental health policies and pioneering steps from the authorities and psychiatric practitioners who can decentralize care systems that can outreach the people. A supportive care policy would eventually attempt to generate productive lives out of those who are affected and can deploy measures for those who are at risk. There are barriers to these, and these barriers can be overcome through increasing access. Increased access is possible through care delivery by paraprofessionals trained to deliver care, which is a possibility within the supportive mental health care policy framework. Factors inherent in such care systems are identifiable through research, and this research throws light into it, so further research can be conducted to inform policies (Happell & Roper, 2009). Mechanic (2002) indicated that population has well known psychiatric morbidity, but there is lack in provision of appropriate care. This has been recognized to be a major public health issue, and the policy on mental health care is increasingly being designed to understand and ameliorate the barriers of care. Information sharing is a potent tool to eliminate these barriers of care, since only with exchange of information, the people will be knowledgeable about the available care. In many cases, the primary care access these patients, and if mental health policies involve early diagnosis and treatment of these conditions at the primary care level, early intervention and access issues may be solved in one go (Mechanic, 2002). Hannigan (1998) indicated that community-focused care for people with mental illnesses is multifactorial. The dominant factor out of them is establishment of comprehensive community alternatives to the orthodox inpatient psychiatric care. This is more so for people with severe and chronic mental ill health with need of ongoing and enduring care. It is very evident that only policy changes would not be able to accomplish this objective, the associated social processes relevant to psychiatric illnesses also play a major role in the implementations of these policy changes. Social perceptions about deviant behavior and community attitudes toward mental ill health and the very real social stigmatization, all play important roles. From the prevalent care scenarios, it seems that there is a need for critical review of the mental health policies in the sense that most such policies fail to recognize the reality and gaps in the requirement of care. It has also been noted that the policy directives indicate an approach toward preventive mental health. In the community and at the level of the mental health professionals, there has been an observed ignorance toward consumer involvement in the care. Although the mental health polices direct decentralization of care, in practice healthcare for the psychiatrically ill is still medicalized with promotion of institutionalized care when the care delivery is concerned. Therefore, the policy must be aligned to care in such a manner that, the policy of promotion, prevention, and early intervention should be practiced, which is only possible through participation, collaboration, and community based care (Hannigan, Fragmentation or integration, 1998). Many mental health policies have recommended a community-based, recovery-focused mental health system which will have ingrained elements of mental health promotion, prevention of mental illnesses, and services directed towards early intervention. This dictates the need for reexamination of the actions, since some authors expressed the need for expansion of preventive and early interventional cares. Even then, in suicide attempts in regional areas, where responses are poor and there is inappropriate hospital-based acute care provision, the care remains inadequate. In such situations, there is potentially harmful premature discharge from the hospitals. Herman and Jan-Llopis (2005) indicated that the concepts of promotion, prevention, and early intervention as a policy build on the idea that the at-risk people will be actively involved in the care delivery system. A policy of collaboration and partnership is therefore the need. With the goal of reducing prevalence and severity of mental ill health, the mental health promotion should be the prime intent with the main theme of the approach being preventive. This is indeed a drift from the medical approach of mental health, and biological causes of mental illnesses are, so to say ignored in policy frameworks (Jan-Llopis & Barry, 2005). Mental health policy initiatives have promoted care program approach. In general this is now considered to be the cornerstones of mental health policies. Most policies now highlight partnerships with the service users through the use of specific charters. It is significant to note that gradually the nonpsychiatric mental health professionals are given increasing importance in care delivery. It has been contemplated that this and increasing involvement of mental health nurses in community mental health care delivery have made it possible to involve the service users in collaborative care. In some cases, the policy reviews have indicated that nonphysician mental health care professionals, especially the nurses should examine the mental health polices to align their practices to the needs of the service users. In the current policies, the care planning thus takes the center stage, so the discharge from the psychiatric facility is based on clinical guidelines since many people will need supervision within the community. The policy implies that people with severe mental illnesses would need work for aftercare, and the care must be facilitated through interagency collaboration even including social care. Mental health policy initiatives have known to create specific expectations for all mental health professionals so each of them may set a priority to deliver care to the severely mentally ill. This model would obviously need collaborative, interagency, and multiprofessional integrative care (Hannigan, 1999). Donovan et al. (2007) indicated the role of involvement of the community in successful case management and policy implementation. Therefore people's perception has important bearing in outcomes. People's perception about mental health has three recognized parameters. These are, having an environment of free social interactions. These enable people to express their problems, keep their minds active, and confer ability to be in control of one's own life. People are known to have negative connotations regarding mental illness. Most perceive mental illness to be maximally contributed to by three factors, crises of life and consequent mental traumas, absence of a support network or friends precluding sharing of thoughts, and drug or alcohol abuse, the social scene of which are set up by families, communities, and associations. This study basically indicated that communication in mental health promotion interventions is relevant and necessary as an important part of policy implementation. It has been further suggested in it that in these policies, there is an element of social inclusion that reduces stigmatization automatically. Reduction of social stigmatization may reduce the impact of predisposing environment for the mentally ill or people who might have, otherwise, been exposed to such perilous risk factors. A policy that fosters a community based approach may create conditions where people can be reached within the community to prevent or lessen the severity of the disease through their participation in care delivery. This indicates a need for understanding the contexts of the affected and at risk people. The youth mental health is such an area of practice, where preventative approach and mental health promotion can be very effective, especially when substance abuse is involved. In this jurisdiction, promotion, prevention, and early intervention may play very significant roles in reducing the mental health burden considerably (Donovan, Henley, Jalleh, Silburn, Zubrick, & Williams, 2007). According to Anteghini et al. (2001) using community perspectives in policy implementation would need suitable models for actions, and these should be guided by appropriate strategies leading to desired outcomes. The policy should also make provisions for extensive participation of all stakeholders, namely, citizens, other community groups, target groups, governmental agencies, mental health professionals, and nongovernmental organisations. Obviously this could be accomplished through partnership and collaborative work. It is expected that intersectoral interactions are significant components in fulfilling these policy needs. It has been found that community based mental health promotion comprises of activities relevant to promotion of mental wellbeing. This study demonstrated the key patterns of activities for mental health promotion. These are provisions of support and services, sharing of information, activities promoting mental wellbeing, and advocacy. It is important to note that policy implementation should have an in-built process of systemic evaluation of long-term outcomes following policy implementations in care. This study particularly is important from the point of view that it suggested about the importance of education and training of care delivery professionals emerged as a prominent need for implementation (Anteghini, Fonseca, Ireland, & Blum, 2001). Friedli (2002) reported a lack in collaborative approach where adequate intersectoral communication may play very important roles in care delivery for the psychiatric illnesses. He also indicated mental health promotion programmes and interventions and their effectiveness emanate from a better understanding about respective roles played by these factors at the level of individual mental well being. Unfortunately, although a comprehensive health promotion-public health approach is necessary still intersectoral strategies from the perspective of mental health is lacking (Friedli 2002). This implies that if a mental health policy needs to be implemented effectively, there must be provisions for promotional interventions within the service system provided. This could also be the avenue for articulation of mental health promotion and prevention into the wider planning of the health services which may be dedicated to mental health policy guided care services. Clearly, the prime area that needs to be focused is the service environment. In contrast to the expectation, it appears that services lack planning and management; rather there are signs that most services are developed in an ad hoc manner, which points to new thoughts from the policy making perspectives about examining the readiness and capacity for service provisions. Perhaps so is the case due to the fact that there is considerable inertia on the part of service providers to drift from the orthodox approach focused on services on treatment, where the need of the hour is population focused services. It is expected that the service which had long been oriented to biomedical model of mental illness will have difficulty in reorienting to mental health promotion as the principle strategy where the main problem would be access and deficiency of capacity to handle the actions related to health promotion (Friedli, 2002). Topp and McKetin (2003) suggested that the causal relationship between interventions through policy guidelines and outcomes from care delivery has never been established through research. Therefore, a mental health policy with the agenda to prevent would need comprehensive intervention programmes. In order to bring about a positive change for a diverse range of problems and their social factors, a comprehensive preventive and promotional agenda may be on the cards, which in turn may lead to policy measures for prevention within the context. This fact may also be translated to the need for post policy implementation surveillance, knowledge, participation, and skills, all of which may be cumulatively called capacity building, which has been defined as development of resources, skills, organizational structures, and commitment toward a mental health milieu that can be sustained. This article further suggests that a policy of mental health promotion and prevention would mean greater responsibility of the professionals engaged in such work (Topp and McKetin 2003). Summary of Findings and Conclusion It has been indicated in literature that promotional approaches in mental health care can be designed with a preventive intent. Prevention of mental illnesses in the at risk population can be accomplished best at the level of the community, but for this to be successful, the policy must provide access to the population, training of the staff, and most importantly, there is a need for change of approaches to mental health service provision from biomedical model to psychosocial model. It has also been evident that the maximum benefits from these policy changes are possible only if the mentally ill are provided with the rights of a consumer, where the clients and the care givers may have their say in care delivery. Moreover, mental health has a social component, and in many cases, the mentally unwell due to fear of stigmatization is afraid to seek care when there are implicit or explicit behavioural problems, present late to the clinics. It is where a community based proactive approach may prove to be very suitable, and the policy must allow provisions of care at the primary care level. The social factors in mental illnesses may be cared for by collaborative and interdisciplinary planning of care delivery when such situations may arise in practice. Given the dynamic nature of mental health care policies, literature also indicates that just designing a policy and implementing are not enough; there must be regular and periodic evaluation of the implemented policies to determine future adjustments in policies. Reference List Anteghini, M., Fonseca, H., Ireland, M., & Blum, R. (2001). Health risk behaviors and associated risk and protective factors among Brazilian Adolescents in Santos, Brazil. Journal of Adolescent Health , 4 (28), 295-302. Donovan, R., Henley, N., Jalleh, G., Silburn, S., Zubrick, S., & Williams, A. (2007). People's beliefs about factors contributing to mental health: implications for mental health promotion. Health Promotion Journal of Australia , 1 (18), 50-56. Friedli, L. (2002). ditorial. Journal of Mental Health Promotion , 2 (1). Hannigan, B. (1998). Fragmentation or integration Mental Health Nursing , 1 (18), 4-6. Hannigan, B. (1999). Specialist practice in community mental health nursing. Nurse Education Today (19), 509-516. Happell, B., & Roper, C. (2009). Promoting genuine consumer participation in mental health education: a consumer academic role. Nursing Education Today , 6 (29), 575-579. Jan-Llopis, E., & Barry, M. (2005). What makes mental health promotion effective Promotion & Education , 12, 47-56. Kermis, M. (1987). Equity and Policy Issues in Mental Health Care of the Elderly: Dilemmas, Deinstitutionalization, and DRGs. Journal of Applied Gerontology (6), 268-283. Mechanic, D. (2002). Removing Barriers To Care Among Persons With Psychiatric Symptoms. Health Affairs , 21 (3), 137-148. Thornicroft, G., & Tansella, M. (2003). What are the arguments for community-based mental health care Copenhagen, WHO Regional Office for Europe: Denmark: Health Evidence Network report. Copenhagen: World Health Organization . Topp, L. and McKetin, R., (2003). Supporting evidence-based policy-making: a case study of the Illicit Drug Reporting System in Australia. In Bulletin on Narcotics Volume LV, Nos 1 and 2, 2003. Read More