Mental Health the Medical Perspective: a Case Study

The aim of this assignment is to citic entirelyy examine the medical exam model in simile to a client that I am counterfeiting with, for reasons of confidentiality I congeal down apply a pseudo figure of speech The medical perspectives in cordial Health. Background Alan is a 42 yr old white British male, he was diagnosed with schitzophrenia at the age of 21yrs. He is the eldest of deuce children, his sister resides with her husband and children nearby. Alan resides at place with his p arnts, who are in their early seventies. Alan has always complied with medication, and agreed to hospitalization when necessary, compulsory entrance fee has non been required. Scitzophrenia is a devastating intellectual illneess, and probably the approximately distressing and disabling of the severe intellectual disorders. The first signs of schizophrenic disorder verit fitting(prenominal)ly emerge in adolescence or young adult. The make of the unsoundness are confusing and often shoc king to families and friends. http//www. psychopathology24x7. com. schizophrenia retreived 19/01/06. Alan is seen by his psychiatrist, every six months, unless he is unwell, when he will be seen more frequently. He is reviewed through the Care program approach at hospital show up-patients.His key histrion is a community psychiatrical nurse, (CPN). The psychiatrist plays a central subr let outine in the diagnosis of a mental disorder. Diagnosis is made after(prenominal) a mental wellness examination. The role of the psychiatrist in the mental state examination serves two purposes A detailed history is final paymentn to identify channelize and char cloakeristic clusters indicative of a specific psychiatric disorder. Secondly the psychiatrist has to make a coincidence of change against a diagnostic criteria to establish presence or not of a specific psychiatric disorder. (Holland, 2003, p. 938) After illiminating organic cause, by physical examination, the psychiatrist ma kes a diagnosis by classification of the symptoms. In to solar days psychopathology there are two systems used to more reliably identify a mental disorder. The International Classification of Disease, 10th revision, (ICD10), and the American Classification Diagnostic and Statistical Manual, 4th revision, (DSMIV). European psychiatry are guided by the former. The ICD10 catogarises schizophrenia under, F. 20. using the description of Kurt Schieders first rank symptoms, (1959).These are ranked as A D, former(a) symptoms E-I have also been added. (p. 49, ICD10, WHO 1992,). For a diagnosis of Schitzophrenia the some wizard moldiness show at least hotshot 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 someone or something is responsible for this. (First Rank symptom A). Auditory Hallucinations, he hears a running commentary about him. (First Rank symptom C). These are also h it the sack as the positive symptoms of schitzophrenia.Alan also experiences more than two of the symptoms E I, he has thought disorder, anxiety,depression and poor motivation, referred to as damaging symptoms. (Kingdom, cited Bailey, 2000) The ICD10, goes on to provide subsections for eccentric persons of schizophrena, and notes not everyone agrees with the sub-sections, payable to the overlapping symptoms that can be present from one type to another. According to Alans medical notes and on asking him, he does not appear to have been diagnosed with a specific type of schizophrenia. Given the clusters of symptoms that e has experienced, at various times, it would be difficult to place Alan into one of the sub- sections. The medical model excepts that the schizoprenic brain has extendd ventricles, (spaces in the brain), which leads to an imbalance of chemicals in the brain. Using their main cock pshycopharmoglogy, they prescribe drugs to correct this imbalance. (Leonard,2003). T he pathology of the illness considers that the chemical which is imbalanced is dopamine. Drugs used to treat mental disorders are known as neoroleptics or psychoactives, they target the chemical dopamine by blocking the neuroreceptors.The drugs effect demeanor, mental cognitive function and/or the sensory experience. They also effect other neurotransmitters in the brain, such as serotonan, a chemical associated with affective disorders, therefore, the same drugs are used to treat different diagnosises. (Barry,2002). Alan has been overconfident various psychotropic drugs to try and control the positive and negative symptoms of schizophrenia. His medical notes reason that drugs have been introduced, decreased and increased on a number of occassions, with little effect of relieving the symptoms substancially over a long period of time.Over the age in psychiatry drugs have evolved, Alan has been prescribed some of the older drugs, Chlorpromazine and Haloperidol, these are referred to as typicaldrugs. These drugs cause side- effects such as pseudoparkinsonism, (uncontrolable shaking of limbs), and Akathisia, (an uncomfortable internal restlessness and anxiety). (Barry 2002). Further medication was prescribed to combat these side- effects. Following this Alans psychiatrist changed his medication to the newer uncharacteristicdrugs olanzipane and risperithrough.Alan did not respond to this medication and after a deteration in his mental health he was admitted to hospital and agreed 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 blood cells, if the deficiency becomes to dandy the drug can kill. (Barry 2002). To reduce the possibility of this the white cells are monitered through regular blood testing.The endpoint of the long term effect of these drugs is not yet fully known. (Barry, 2002). Psychiatry does n ot go without critisim, Szass, (1997), scoop 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 destiny any commonality, and that the reason a scitzophrenic patient becomes a patient is because those around him refuses to except a behaviour beyond the norm.Laing, (1985), also supports this theory and informs the reader that psychiatry is the completely medical model that does not have an exact pathology that is proven by labortory testing. Another school of thought suggests individuals are treated for the side-effects of medication moreso than the passkey illness, (Illich, cited in Laing 1985). They can end up fighting side effects One drug to combat another. Prehaps it is the medication that ends up disturbing mental behaviour, warping personalities or or conditions in to larger problem s. ( Hewitt, 2001, p. 72) Alan prosponed the decision to take clorazil payable to the risk of toxicity. Since commencing treatment, the symptoms have reduced but not deminished, he even-tempered 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 society, he would like to engage in use, paid or unpaid, even in his current frame of mind this is not a possibility.Labour force 1995, reported that employment figures in mental health patients are much lower than any other disabled group. scarcely 21% of spate 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, alcohol should not be taken with a lot of psyhcotropic medication. All of these restrictions impact upon Alans aptitude to function in society. Secondry to this, Alan has to cope with the stigma attached to mental health disorders.There is a binaural typical societal perception that individuals with mental health issues are more dangerous than others, regardless of explore suggesting the opposite Philo et al, (1993), published look into to demonstrate that there is no evidence to suggest that a person with mental health issues is any more likely to harm than anyone else. Figures over the last 20 yrs demonstrate that there has been no increase in murder 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 stop with the lay person.White, western people have better experience of the service than other ethnic groups. (Haddad & knapp, 2000). The Sainsbury Cenre for amiable Health, (SCMH), (2002), in its aim to influenc e 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 treatment, reponses therefore confide 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 Race and Equality, (2003), set out to provide an action plan over 7yrs to improve mental health services for ethnic minority groups. The focus is on raising professional awarness around culture, ethnicity and racism. As the western world progresses towards a multi-cultural society, it is infallible that more people from ethinic minorities w ill come in contact with mental health services.Fernando, (1991), considers this to be of a special concern and warns that The white mastery of black people promotes, and often imposes a cultural domination so that ways of thinking, family animateness patterns of mental health and mental health care that are determine as Europeanin tradition whiteby racial origin, are seen as best to others. (p. 198) Fernando, goes on to highlight the fact that many forms of human 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.Therefore suggesting that individual diagnosis can depend upon where you reside in the world. Rack, (1982), notes that western psychiatry has an important role in social control, whilst Asian psychiatry is largely 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. According 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), bear witness that only 33% of individuals diagnosed with schizoprenia in western soceity were successfully treated by drugs. A further cowcatcher 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 advised that they would get better rather than bein g told there future(a) 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 support 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 advertise 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 w as that this was a funding 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 soundless strong. (p. 121. Baruch&tr separatelyer,1978, Roman,1985, Bushfield 1986, cited Pilgrim&Rogers, 1987).Alan has spoke with me regarding the conscequences of stopping 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 tend to be concerned only with the effectiveness of the drugs in symptom reduction (assessed by them, not the pa tients 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 collision 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, th ey 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 query 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 whi ch 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 trespassing(a) treatment such as ECT, which Alan is oppossed to. I am therefore proposing Alan prepares an advanced directive, which will be incarnate 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 proportion of community care is carried out by unpaid family members, who often miss out on employment and become isloated. (W ebb&Tossell, 1999). To ensure that Mrs A, is able to continue in her role, her needs also must be met. I have therefore bespeak an updated assessment under The Carers (recognition and service) Act 1995. Mrs. As wellbeing is paramount in preventing deteriation of the infrastructure situation which would inevitabley impact upon Alans mental health. Mrs.A recognises the signs and symptoms when Alans mental health starts to deteriate, which in turn has historially prevented admission to hospital. Research from All Saints Hospital Birmingham evidenced that 59% of relatives recognise early warning signs one month before lose and 75% two weeks before relapse. (cited Howe, 1998). Mrs. A feels that she is coping at present with the financial aid of her support worker she is able to off load. She feeleres carers groups which she finds helpful. If the situation becomes to much the family have agreed to glide slope further support for Mr. A. nder The Community Care and National Health Se rvice Act 1990. Alan receives support from the day centre where he is involved with Art therapy and other activities. He attends the Fountain club, (a mind project), where he has access to support through group therapy, and attends respite two days a month. Alan finds these resourses useful in percentage 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 project regarding accomodation because I feel that Alan has enough going on in his life at present, in coming to t erms 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 evolution 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 improved with medication. However in my view this should be minimal to releive distress and enhanced with other socia logical and pyshcological intervention. Although relapse cannot be illiminated, research and literature referenced throughout this assignment suggests that there is a high colleration amongst 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 terminus ad quem of resourses and the cost to them, which is not measurable 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, even so no realistic alternative is provided.In my view the way forw ard is through raising mankind and professional awareness and de-stigmatising mental disorder. Word count 3297 References Barry, P. (2003). Mental Health and Mental Illness. (7th ed). Philidelphia.. Lippincott. Colman, R. (2004). Recovery an unknown quantity 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 kitchen-gardening.London. Mind publications in association with Macmillon. Hewitt, P. (2001). So You look Your Mad, 7 Practical Steps to Mental Health. Ppppppppppp Handsell Publishing. Howe, G. (1998). 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