Mental Health the Medical Perspective: a Case Study

The steer of this assignment is to citically examine the medical toughie in congenator to a client that I am acting with, for reasons of confidentiality I stomach utilize a pseudo name The medical perspectives in amiable Health. screen background Alan is a 42 yr old unobjectionable british male, he was diagnosed with schitzophrenia at the age of 21yrs. He is the eldest of twain children, his sister re offices with her keep up and children nearby. Alan resides at home with his pargonnts, who be in their early seventies. Alan has always complied with music, and agree to infirmaryization when necessary, compulsory ad young womanion has non been required. Scitzophrenia is a devastating psychical untowardneess, and probably the most distressing and disabling of the severe amiable disorders. The start signs of schizophrenia typically emerge in adolescence or young adult. The effect of the illness atomic number 18 conf exploitation and oft shocking to families and fri ends. http//www. psychia effort24x7. com. schizophrenia retreived 19/01/06. Alan is seen by his shrink, every six months, unless he is unwell, when he allow be seen some(prenominal) than frequently. He is reviewed through the guard program speak to at hospital out- patients.His key worker is a community psychiatric nurse, (CPN). The psychiatrist plays a central section in the diagnosis of a psychogenic disorder. Diagnosis is made afterwards a mental wellness examination. The role of the psychiatrist in the mental state examination serves two purposes A detailed history is taken to identify change and characteristic clusters suggestive of a detail psychiatric disorder. Secondly the psychiatrist has to make a comparison of change against a diagnostic criteria to establish presence or non of a specific psychiatric disorder. (Holland, 2003, p. 938) After illiminating organic cause, by physical examination, the psychiatrist makes a diagnosis by classification of the sy mptoms. In to age psychopathology there are two systems utilize to more faithfully identify a mental disorder. The International Classification of Disease, 10th revision, (ICD10), and the American Classification Diagnostic and Statistical Manual, 4th revision, (DSMIV). European mental medicine are guided by the former. The ICD10 catogarises schizophrenia beneath, F. 20. using the description of Kurt Schieders eldest rank symptoms, (1959).These are ranked as A D, an early(a)(prenominal) symptoms E-I realise also been added. (p. 49, ICD10, WHO 1992,). For a diagnosis of Schitzophrenia the psyche must show at to the lowest degree unitary of the first rank symptoms A- D and at least two of the symptoms, E- I. Alan experiences Thought withdrawal, insertion and broadcasting, he beleives that both(prenominal)one or something is prudent for this. (First Rank symptom A). Auditory Hallucinations, he hears a running comment about him. (First Rank symptom C). These are also kn own as the positive symptoms of schitzophrenia.Alan also experiences more than two of the symptoms E I, he has panorama disorder, anxiety,depression and poor motivation, referred to as negative symptoms. (Kingdom, cited Bailey, 2000) The ICD10, goes on to provide subsections for types of schizophrena, and nones not everyone agrees with the sub-sections, collectible to the everywherelapping symptoms that can be present from one type to another. tally to Alans medical notes and on a uncaseg him, he does not seem to be possessed of been diagnosed with a specific type of schizophrenia. Given the clusters of symptoms that e has experienced, at heterogeneous times, it would be difficult to place Alan into one of the sub- sections. The medical model excepts that the schizoprenic brain has increased ventricles, (spaces in the brain), which leads to an imbalance of chemicals in the brain. Using their primary(prenominal) tool pshycopharmoglogy, they prescribe drugs to correct this im balance. (Leonard,2003). The pathology of the illness considers that the chemical which is imbalanced is dopamine. Drugs used to strain mental disorders are known as neoroleptics or psychotropics, they point the chemical dopamine by blocking the neuroreceptors.The drugs effect behaviour, psychological cognitive function and/or the sensory experience. They also effect other neurotransmitters in the brain, such(prenominal) as serotonan, a chemical associated with affective disorders, therefore, the analogous drugs are used to dainty different diagnosises. (Barry,2002). Alan has been prescribed various psychotropic drugs to try and control the positive and negative symptoms of schizophrenia. His medical notes stage that drugs begin been introduced, lessen and increased on a number of occassions, with little effect of relieving the symptoms substancially over a long period of time.Over the years in psychiatry drugs hurt evolved, Alan has been prescribed some of the older drugs , Chlorpromazine and Haloperidol, these are referred to as typicaldrugs. These drugs cause side- effect such as pseudoparkinsonism, (uncontrolable shaking of limbs), and Akathisia, (an uncomfortable congenital restlessness and anxiety). (Barry 2002). Further music was prescribed to combat these side- effects. Following this Alans psychiatrist changed his medication to the newer atypicaldrugs olanzipane and risperidone.Alan did not respond to this medication and after a deteration in his mental health he was admitted to hospital and agree to try another atypical drugclozaril thearapy. Given the toxicity of clozaril it is not used as freely as other psychtropic medication. A complication of clozaril is the effect that it has on the white telephone circuit cells, if the deficiency be get downs to great the drug can kill. (Barry 2002). To reduce the possibility of this the white cells are monitered through regular blood testing.The outcome of the long call effect of these drugs is not yet fully known. (Barry, 2002). Psychiatry does not go without critisim, Szass, (1997), best known as an anti psychiatrist, challenges the concept of mental health as an illness. For an illness to be an illness it has to be classified as having three commonalities, cause progression and outcome. He argues that schizophrenia does not piece of ground any commonality, and that the reason a scitzophrenic patient becomes a patient is because those round him refuses to except a behaviour beyond the norm.Laing, (1985), also supports this theory and informs the indorser that psychiatry is the only medical model that does not have an submit pathology that is proven by labortory testing. Another school of thought suggests individuals are hardened for the side-effects of medication moreso than the original illness, (Illich, cited in Laing 1985). They can end up battle side effects One drug to combat another. Prehaps it is the medication that ends up disturbing mental behaviour, wa rping personalities or or conditions in to bigger problems. ( Hewitt, 2001, p. 72) Alan prosponed the decision to take clorazil due to the risk of toxicity. Since commencing interposition, the symptoms have rock-bottom but not deminished, he still takes medication for side-effects, anxiety and depression. He continues to struggle with daily living. His anxiety levels are so intense, that this condition has preceeded the effects of schizophrenia, which has led to further isolation from community, he would like to engage in employment, paid or unpaid, however in his current frame of thinker this is not a possibility.Labour force 1995, reported that employment figures in mental health patients are much lower than any other disabled group. Only 21% of mountain with mental health problems are working or actively seeking work. (Webb&Tossell, 1999). Warnings on some medication advise that machinery must not be used, vechiles must not be driven, due to side-effects of drowsiness, alcoh ol should not be taken with a luck of psyhcotropic medication. All of these restrictions bushel upon Alans ability to function in society. Secondry to this, Alan has to distribute with the stigma attached to mental health disorders.There is a stereophony typical fond perception that individuals with mental health subject fields are more dangerous than others, regardless of research suggesting the opposite Philo et al, (1993), published research to demonstrate that there is no separate to suggest that a person with mental health issues is any more likely to harm than anyone else. Figures over the lead 20 yrs demonstrate that there has been no increase in slaughter caused by someone with mental health problems,whilst the increase amongt the general polulation has more than doubled. Research shows that this discrimination within mental health does not full stop with the lay person.White, horse opera good deal have better experience of the supporter than other ethnic grou ps. (Haddad & knapp, 2000). The Sainsbury Cenre for noetic Health, (SCMH), (2002), in its aim to cultivate national policy high lighted the inequalities experinced by Black and African Carribean communities. SCMHs findings suggest that professional have a fear of some ethnic minority groups, due to individual size or skin colour. It is these stereotypical beliefs, cultural ignorance and racist views, that prejudice assessments and influences preaching, reponses therefore rely on heavy medication and restriction.The consequences of which can be dentrimental, and have resulted in death, for people like David Bennett. In response to high profile cases, the Governement have produced various documentation to address issues of inequality. Delivering hurry and Equality, (2003), set out to provide an act plan over 7yrs to improve mental health go for ethnic minority groups. The focus is on raising professional awarness around culture, ethnicity and racism. As the western world progres ses towards a multi-cultural society, it is inescapable that more people from ethinic minorities will come in contact with mental health services.Fernando, (1991), considers this to be of a special concern and warns that The white domination of black people promotes, and often imposes a cultural domination so that ways of thinking, family life patterns of mental health and mental health care that are identified as Europeanin tradition whiteby racial origin, are seen as superior to others. (p. 198) Fernando, goes on to highlight the fact that many forms of kind-hearted distress medicalised by western society are not medicalised by other societies, and notes that political forces dominates what is an illness and gives ultimate power to the psychiatry to treat. wherefore suggesting that individual diagnosis can regard upon where you reside in the world. Rack, (1982), notes that western psychiatry has an all important(predicate) role in affable control, whilst Asian psychiatry is l argely concerned with spiritual development. Fenando states medicine too is part of a culture and not a system with a life of its own outside the culture in which it lives. (P. 197) He advises that a reliable diagnosis is unlikely, unless the individual is interwiewed in their own language, as only a person with the same language knows what to look for.If Racks theory is correct then services have a lot to achieve to gain full equality. gibe to research it is not only the diagnosis in mental health that globally differs, it is also the recovery rate. Research under taken by WHO, (1938, 1958, 1988, 1998), evidenced that only 33% of individuals diagnosed with schizoprenia in western soceity were successfully do by by drugs. A further pilot study by the same organisation, in the recovery of schizophrenia demonstrated that recovery rates in London and Washington, (33%, 34%), were immensly lower than in IBADIAN AND MAGA PERDESH, (86%,87%).The variable out come appeared to be talking methods and a positve out look from the onset. People were discuss that they would get better rather than existence told there future would depend upon medication. Colman, (2004), suggests Most psychiatic doctors appear to be wedded to the idea that they must treat everyone with medication and that it is only through the use of medication that people recover. The evidence for ths view appears to be based on research carried out using moneys supplied by pharmacutical industry. (p. 4). Colmans view does not stand alone, Klass, (1975), advises that drug treatment is encouraged by the profit they make for their producers, who also provide the drugs to treat the side-effects. Large profits from the industry is used to provide research and labour what they view as successful intervention for mental disorders. (cited Pilgrim&Rogers, 1987). In relation to Alans drug therapy and the side-effects of anxiety, I have spoken to his treatment team regarding alternative therapy such as Anxiety Management.The response was that he had this previously and is unable to sustain self help techniques. My view was that this was a support issue, psychosocial therapy costs more than drug therapy. (Pilgrim&Rogers, 1987). It appears to come secondary to drug therapy in the view of the medical model. Whilst it is generally conceded by most commenters on psychiatry that it is now electic The bias towards physical treatment is still strong. (p. 121. Baruch&treacher,1978, Roman,1985, Bushfield 1986, cited Pilgrim&Rogers, 1987).Alan has spoke with me regarding the conscequences of taenia treatment to combat the side-effects. Pilgrim & Rogers, (1987), amongst others acknowledge that individuals may stop complying with medication if the side effects from the drugs become intolerable and they are not listened to. treating psychiatrists do not take their complaints about side-effects, or their concerns about the debilitating effects of the drugs, seriously. Instead, doctors slant to be c oncerned only with the effectiveness of the drugs in symptom reducing (assessed by them, not the patients themselves). p. 125 ) If Alan chose not to comply to medication, experienced a deteriation in his mental health and refused voluntary admission to hospital he could be detained under the Mental Health Act 1983. (MHA). The mental state examination would be under took by a doctor who was not exculded under s12 of the act (MHA1983,cited Jones, 2004). In good practise Alan should be assessed by his psychiatrist and his own general Practitioner. Thus meeting the requirements of s 12 2, (MHA1983). Both doctors must examine the patient within five days of each other (s12,1,MHA1983).As Alan is known to the clinical team, and has a specific diagnosis, admission for traetment (s3 MHA, 1983, cited Jones 2004), would possibly be the proposed section. (Code of Practise, 1999, ch5). Laing, (1985), Szass, (1997), claims that psychiatry is used to police society and not to treat the individual. Psychiatrists have been given the power to lock people up and treat them against their will, they have more power than a judge, and hospital wards provide a prison for the unconvicted individuals who do not meet societal norms.The approved social worker,(ASW), also has a powerful role under the 1983 Act and does make the ultimate decision as to whether treatment in hospital is the most appropriate form of treatment. (s132,MHA1983). As a social worker under taking the duty of an ASW, (albiet as a shadow), I have been faced with dilemas whereby the role and duty of an ASW conflict with my social work values, instead of promoting rights and autonomy I am restricting them. I am managing this by addressing the issues in debriefing following the ssessments, in supervision, and by challenging other professionals practise when necessary. For example, on one assessment, nursing staff had observed a patient as being withdrawn because he chose not to watch television in the communial lounge. During interview, the patient advised that he was a Johava witness and was oppossed to violence which was all that was on the particular channel viewed in the lounge. On addressing this with staff, it was clear that cultural or religous needs this had not been taken in to consideration.If Alan was formally admitted to hospital his psychiatrist does have the power to treat him against his wish. (part IV, MHA1983). This could include invasive treatment such as ECT, which Alan is oppossed to. I am therefore proposing Alan prepares an advanced directive, which will be incorporated in his careplan. Although, this does not over ride the clinical desicion his treatment team will need to take his views and wishes in to consideraton. MHA Alan is supported by his family they have a good insight in to his illness, his father has belatedly been diagnosed with Alziemens disease.My current concern is that his mother is a carer for two family members. The largest ratio of community care is carri ed out by unpaid family members, who often miss out on employment and become isloated. (Webb&Tossell, 1999). To ensure that Mrs A, is able to continue in her role, her needs also must be met. I have therefore requested an updated assessment under The Carers (recognition and service) Act 1995. Mrs. As wellbeing is paramount in preventing deteriation of the home situation which would inevitabley impact upon Alans mental health. Mrs.A sleep withs the signs and symptoms when Alans mental health starts to deteriate, which in cut into has historially prevented admission to hospital. Research from All Saints Hospital Birmingham evidenced that 59% of relatives recognise early warning signs one month before relapse and 75% two weeks before relapse. (cited Howe, 1998). Mrs. A feels that she is coping at present with the care of her support worker she is able to off load. She accesses carers groups which she finds helpful. If the situation becomes to much the family have agreed to access fu rther support for Mr. A. nder The Community Care and National Health Service Act 1990. Alan receives support from the day means where he is involved with Art therapy and other activities. He attends the Fountain club, (a intellect project), where he has access to support through group therapy, and attends respite two days a month. Alan finds these resourses useful in helping him to live with not only schizophrena but also the side-effects of his medication. He is offered support and advise that is not from a medical perspective. The family also consider that alternative therapy is as important to them, as to Alan. Mrs.A considers that Alan and the familys needs have been better met since a holistic approach has been under taken, as social and pshcological factors are adressed, aswell as the pathology of the illness. Howe, ( 1998), acknowleges that this has been a general failure in the medical model. I have not progressed with my original task regarding accomodation because I feel that Alan has enough overtaking on in his life at present, in coming to footing with his fathers illness. Although his CPN, considers that this would be in his best interest, the family do not want it and I am not convinced it is what Alan wants either.Szass, (1997), refers to how the mentally ill pateint is considered to be incompetant where as the medically ill pateint is considered to be competant. If Alan did not have a mental disorder, residing at home would not be an issue for anyone, other than the family. I will continue to project my view wtih the CPN and in supervision. In conclusion to this assignment I would agree that all those who work with in this area have far to go in create services. My role amongst this will be to challenge oppression, by raising awarness as I have done in practise, and to promote an holistic approach towards assessment.I am of the view that medication does help certian individuals, and their life has alter with medication. However in my view this should be minimal to releive distress and enhance with other socialogical and pyshcological intervention. Although relapse cannot be illiminated, research and literature referenced end-to-end this assignment suggests that there is a high colleration surrounded by staying well and receiving a combination of services. Drawing from my previous managerial experience I have know doubt that the constraints on budgets will effect resources, which will inevitable effect the services individauls receive.Pilgrim&Rogers, (1987), acknowledge that the limitation of resourses and the cost to them, which is not measured in comparison to physical treatment has been a factor that has prevented psychological and social models from competeing against the medical model. Undoubtabley this will need to change to allow individuals a successful chance of recovery. Authors referred to who opposs psychiatry and its role do have a fair arguement, in that drug treatment and legislation polices society , however no realistic alternative is provided.In my view the way forward is through raising public and professional awareness and de-stigmatising mental disorder. Word conceive 3297 References Barry, P. (2003). Mental Health and Mental Illness. (7th ed). Philidelphia.. Lippincott. Colman, R. (2004). Recovery an Alien Concept. (2nd Ed). Fife. P. P press. Delivering Race and Equality, (2003) The Sainsbury Centre for Mental Health, breaking the Circles of Fear, breifing 17. A review of the relationship between mental health services and African Caribbean communities. London. Fernando, S. (1991). Menatal Health Race and Culture.London. headway publications in association with Macmillon. Hewitt, P. (2001). So You Think Your Mad, 7 Practical stairs to Mental Health. Ppppppppppp Handsell Publishing. Howe, G. (1998). Getting in to the System, Living with Severe Mental Illness. London. Jessica Kingsley publishers Ltd. Jones, R. (2004). Mental Health Act Mannual. (9th Ed). London. Sweet &M axwell Ltd. Laing, R. D. , (1985). Wisdom, Madness and Folly. Making signified of psychiatry. Basingstoke. Paper Mac. Leonard, B. E. (2003). Fundementals of Psychopharmocology. (3rd ed). Wiley. Pilgrim, D. ,and Rogers, A. (1987). A sociology of Mental Health and Illness. (2nd Ed). Pppppppppppp. Open University Press. Professor, Kingdom, (2000). D. Edited by Bailey D. 2000, At the Core of Mnetal Health. Key issuese for practitioners managers and mental heealth managers, Rack, P. (1982). Race Culture and Mental Disorder. forwarded by G. Morris. London. Routledge. Szass, T. (1997). Insanity. The Idea and its Consequenses. Syrcuse. University Press. WHO, (1992). The ICD10, Classification of Mental and Behavioural Disorders clinical Descriptions and Diagnostic Guid production lines. Geneva.World Health Organisation. Webb. R. , & Tossell, D. , (1999). Social Issues for Carers Towards Posive Practice. (2nd ed) London. Arnold. Haddad, P. , & Knapp, M. , (2000). Health Professionals views o f services for schizophrenia fragmentation and Inequality. Psychiatric Bulletin (24), p 47 50. http//www. psychiatry24x7. com. schizophrenia retreived 19/01/06. NICE, (2003). Recommends newer antipsychotic drugs as one of the first line options for schizophenia. Press release. retrieved 19/01/06. Webb site http//www. nice. org. uk/page. aspx? 0=32928