Mental Illness

The ability for patients to access mental health services these days are more wide ranging than ever before. This is in part due to the fact that the realm of mental health, once simply governed by physicians, is now peopled by staff of all different types and disciplines. In addition, many mental health professionals are now multiply credentialed, so it is not impossible to see a mental health professional who is all at once a family and marital therapist, a chemical dependency practitioner and a social worker.

All these elements only serve to improve the ability of patients/clients to receive quality mental health services, whether it be in a large institutional setting, a community mental health center or in a private clinical office. But what are the different types of mental health professionals who are trained in the identification and treatment of patients with mental health issues? There are many, but for the matter of clarity and brevity, we will focus on just three. Licensed clinical social workers are one type of mental health professional who may be assigned a clinical case.

These are individuals who have received graduate level training in the assessment and management of patients with mental illness. They may choose to specialize in a certain type of therapy, such as marital or family therapy or they may provide a more general practice. Clinical social workers are also found in the hospital setting, whether for psychiatric patients or medical patients and are experts in arranging for social services and referral to assisted living facilities, nursing homes, and other post hospitalization care.

Advanced registry nurse practitioners are one of the newer types of clinicians in the mental health field. These are nurses who have taken graduate level education which allows them to perform diagnosis and treatment for patients. Many nurse practitioners (also called ARNPs) can prescribe medications for their patients, depending on the laws of the states where they live. ARNPs are also unique in that they can open up clinical practices of their own without having to work under the auspices or licensure of a practicing physician.

ARNPs provide medication and counseling services, as well as crisis intervention services. ARNPs are also found frequently in both the inpatient and outpatient settings. Another type of professional who may diagnose and treat a patient with mental health issues is a clinical psychologist. These are men and women who receive post-graduate education and receive a doctorate in psychology. Psychologists are often called “doctor” but the difference is that they are not allowed to prescribe medications.

Psychologists are multifaceted, and are able to diagnose and treat patients with mental health issues, as well as perform and interpret psychological testing to held aid in the diagnosis of patients with personality or learning disorders. Psychologists are usually utilized in the outpatient setting, but it is not unheard of for them to work on an inpatient mental health unit as well. While all these different clinical backgrounds are able to assess patients for the presence of mental illness, the issues which they must consider are the same from patient to patient.

Whether the patient is a self-referral, court mandated or identified by a family member, before a true clinical diagnosis can be made, a thorough mental health assessment must be made. This mental health assessment includes several key issues which must be answered. First, the clinician must know what the problem is which brought the patient in for evaluation in the first place. Does the patient feel sad, or depressed, or anxious? To what degree does the mood problem affect the patient”s day to day life?

Are they able to go on about their daily business, or are they incapable of holding a job or caring for themselves or their families, because of the severity of the illness. Does the patient actually perceive there is a problem, or has the patient been referred by a medical provider, family member, or friend? The high coincidence of mental health problems and substance abuse makes it necessary for the mental health professional to assess if there is any drug or alcohol abuse issues here. How long has the patient had these symptoms, and are they getting worse, better, or staying the same.

A family history is also important, especially as it pertains to issues of mental illness within the family, or a history of physical/sexual or emotional abuse. Above all, when any mental health professional is assessing a patient for mental illness, he or she must assess if the patient has any thoughts of hurting himself or anyone else. This is almost the most important question to be asked of any patient who is being assessed for mental health problems, and when answered in the positive, must be dealt with immediately.

As we are discussing suicidal ideation, it is important for any clinician to understand who is at the greatest risk of self harm. There is a disparity in the rates of suicide between men and women, in that it is more likely for a woman to express thoughts of suicide and it is more likely for a man to actually commit suicide. In fact, men over age 45 are more than four times more likely than women to kill themselves as women in the same age (National Patient Safety Agency, 2001). An unemployed man is two to three times more likely to commit suicide.

Suicide is also believed to account for 20 percent of all death in young people aged 15-24 and is second only to accidental death. The prevalence of substance abuse in this age group tends to be a contributing factor to suicide rates. The additional issues of academic pressure and relationship problems, as well as possible history of physical and sexual abuse are other risk factors. Interestingly, research has also shown that youngsters who know someone who commits suicide are more likely to commit suicide (Shaffi, et. al. 1985).

While issues of race and likelihood to commit suicide have been studied, the pattern changes over geographic distribution. A study done in 1993 by Briget seemed to indicate that gay men and lesbians had higher rate of suicide and attempted suicide than the general population. And, as previously mentioned, research has shown that substance abuse is a significant risk factor for suicide and suicide attempts. One study estimated that among people who abuse drugs, the risk of suicide is twenty times greater than that of the general population (Faulkner, 1997)

Any discussion about mental health in the 21st Century is sure to bring some in some element of the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. HIPAA is a federal health benefits law passed in 1996, effective July 1, 1997, which among other things, restricts pre-existing condition exclusion periods to ensure portability of health-care coverage between plans, group and individual; requires guaranteed issue and renewal of insurance coverage; prohibits plans from charging individuals higher premiums, co-payments, and/or deductibles based on health status.

It also places strict limits on the type and amount of information which can be released about patients, and to whom the information can be given, and in what manner. While the privacy of patient care information is important, HIPAA can be a stumbling block to the care of patients. For example, should the patient refuse that any collateral information be obtained about his case from a family member or friend, the mental health professional is prohibited by law from making any contact with this person, even if the collateral information could be of help in the care and diagnosis of the patient.

In addition, it makes it almost impossible for family members to make appointments or even ascertain that patients are getting care. Health care providers are given leeway in one manner, in that should a mental health patient make what is felt to be a credible threat against another person, the healthcare provider is then able to provide information about the threat to the person in the broadest possible terms, known as a “duty to warn”.

Usually now, before a mental health professional takes on a case, he or she will have the patient sign a document explaining the patient”s rights and the clinician”s responsibilities under HIPAA. In this document, the clinician outlines most common reasons for which the clinician may have to release information about the patient”s care, such as coordinating care with another provider or even obtaining coverage information from the insurer. The patient is also generally advised that he or she may revoke all authorization at any time, but in turn the clinician may choose to discontinue treatment.

In this way, both parties are protected. It should be noted, however, that HIPAA restrictions do not apply in cases where abuse is suspected, for clinical health oversight activities, for judicial reasons if evaluations are court ordered, and in cases where the care involves a workman”s compensation issue. The clinician must also provide to the patient a name and number of a person to who concerns about privacy violation may be addressed, and if all else fails, complaints may be made to the Department of Health and Human Services, the federal agency which oversees HIPAA.

But should a mental health professional be incautious about the kind of information he or she chooses to release, then he or she may find that they are subject to high fines, sanctions from federally funded agencies and loss of clinical privilege. To me, HIPAA seems like the extreme end of the pendulum, and does little to take into account common sense. I believe that in the future, different legislation will be made to modify the tone of HIPAA and allow a bit of clinical common sense to be used as well.

Until that time, mental health practitioners will have to tread lightly and practice with care, keeping in mind at all times the needs of the patient and the rule of the law. So in summary, there are many kinds of mental health professionals, of all different backgrounds and disciplines. It would not be difficult to find a therapist or other mental health professional that would be able to help a client with his or her problems. All are highly qualified.

All receive excellent training, and the high degree of diversity allows the mental health patient to almost have a consumer attitude when shopping for mental health care. No matter what kind of practitioner a patient chooses, the patient should be sure that he or she has chosen one who is well versed in the diagnosis and treatment of mental illness. New laws put into affect do much to protect the rights of the patient, but in some ways can tie the hands of the clinical provider. But ultimately, rules are in place to protect both the patient and the practitioner.

The intent of this paper is to look into and place the common factors that influence maternal filicide, and its relationship to mental/psychological upsets within the culprits. Filicide has been defined as the knowing act of a parent/guardian killing her or his ain kid ( Putkonen, Amon, Almiron, Cederwall, Eronen, Klier, Kjelsberg, Weizmann-Henelius, 2009 ) . There are two subcategories that branch from filicide which include infanticide and neonaticide. Infanticide is best described as the slaying of a 1 ‘s ain kid that is younger than one twelvemonth. Whereas, neonaticide is the violent death of a kid that has been born non more than 24 hours earlier ( Putkonen, et Al, 2009 ) . Surprisingly, this act is non uncommon and has been reported to take topographic point all around the universe. Previous surveies have found that filicide has taken topographic point in 3rd universe states such as Bolivia in under developed communities ( Hilari, Condori, Dearden, 2009 ) , and besides in states such as England, China and France ( McKee, 2006 ) . Although this act is practiced around the Earth, there is really small information and research recorded about the subject. Filicide is a really sensitive issue and is hard for most to hold an unfastened treatment about the topic. Past surveies include Putkonen et Al. ( 2009 ) , and their research on filicide in Austria and Finland. The intent of their survey was to analyze the common traits between filicide culprits and if these persons shared any psychological upsets. In order to carry on this survey the research workers had to garner all filicide instances that occur between 1995 and 2005. They examined factors such as motivation, method of offense, relationship between culprit and victim, and mental wellness intervention of the culprit. They besides took into history the poisoning of the executor during the filicide act. Other research in this country included the work by Kauppi, Kumpulainen, Vanamo, Merikanto, and Karkola ( 2007 ) where 10 female parents that committed filicide were examine to see the relationship between filicide and maternal depression. In all instances, female parents showed marks of crossness, shouting for long periods of clip without cause or ground, weariness, anxiousness among other symptoms that are common in depression. The research workers did non interview the adult females nevertheless were able to look into the similarities that lead to the slaying and the common factors after the act was committed. These two research surveies were examined in Finland and Austria. Hilari, Condori, and Dearden ( 2009 ) , besides looked at parents that committed filicide nevertheless examined the pattern in Bolivia. They explored two communities within Bolivia and found that unlike the yesteryear to surveies the grounds for filicide were frequently due to biological defects of the kid or societal factors within the community. Their research looked at how the autochthonal people of Bolivia justified the violent death of kids. Most frequently, the slaying of a kid went unnoticed as the kid life was taken within 24 hours of birth. Oberman andMeyer ( 2009 ) surveies the societal economic well being of adult females that have committed filicide. They interviewed adult females that have been convicted with the offense and found similarities in societal environment, household history, and instruction degree. Their research brings to illume a universe that is unknown to most other persons. The intent of their survey was to take the reader into the heads of these adult females and to see what the rational was when make up one’s minding to perpetrate the act of filicide. Their findings revealed that most adult females that performed filicide are non making it out of hate for the kid ; instead it was due to confusion and a sense of non being able to supply for the kid.

This paper intends to look into each article in farther item and determine if there are commonalties between the topics and their mental province, their socio-economic environment, educational degrees, and household history. This paper will besides propose other patterns and resources that can be attempted by adult females who find themselves in this type of state of affairs as all signifiers of filicide should be avoided.

Obeman and Meyer ( 2009 ) wrote a book that discussed maternal filicide and different interviews that were made in prison on female parents who were convicted of this offense. The writers explained how most of these adult females felt uncomfortable and would non desire to discourse it in general. Obeman et Al. ‘s ( 2009 ) conducted face-to-face interviews at the Ohio State Reformatory. They explained how the givens ‘ that were made of these adult females slaying their kids were non ever accurate. Their options based on their societal and familial systems were really restricted and limited. The writers explained how most of these adult females expressed themselves as non holding a topographic point that should experience safe, when it was suppose to experience like place ( Obeman et al. , 2009 ) . Many common factors were attributed to these adult females such as ; fright, economic want, isolation and deficiency of fiscal support. The female parents normally indicated a deficiency of instruction, emotion and really minimum medical support ( Obeman et al. , 2009 ) . Physical, mental, and emotional maltreatment were normally early symptoms that these persons experienced prior and after the filicide were committed. Obeman et Al. ‘s ( 2009 ) identified history of maltreatment in the household that factored these adult females ‘s behavior throughout their lives. The book explained how these adult females struggled against the odds of being good female parents to protect themselves and their kids. In add-on, the female parents normally fought back against the power of maltreatment they were sing with their spouse ( Obeman et al. , 2009 ) . Most of the clip, for some of these adult females they thought that giving up was safer so contending back. The writers identified some external support that came from caring others. This

normally gave them a self-awareness of their ain strength ( Obeman et al. , 2009 ) . The female parents were normally isolated by fright of their ain spouse.

Most of them were besides affected with mental unwellnesss ( Obeman et al. , 2009 ) . The book explains how the U.S justness system purely relies more on requital oppose to rehabilitation. In add-on, there appears to be more of a broad assortment of shelters for animate beings so there is for people ( Obeman et al. , 2009 ) . They explained how these adult females travel on a painful procedure to accept who they are, and what they have done. Many of the issues that the female parents faced was non cognizing where to happen aid, how to entree it, and whom to swear ( Obeman et al. , 2009 ) .

Kauppi, Kumpulainen, Vanamo, Merikanto, Karkola ( 2008 ) besides conducted research on female parents that committed filicide. There were unable to interview the adult females in their survey nevertheless were able to recover informations on their mental wellness after kid birth, and household history which included opprobrious parents being surrounded in an alcoholic environment. They were besides able to obtain information on the kids that were murdered.

Their survey provided information that indicated that none of the births were unwanted. When the babes were born, all showed good wellness and had no marks of upsets or malformations. It was stated that the motivation behind all filicide instances examined were non of selfish nature. Majority of the female parents believed that the universe was a bad topographic point and that it was non the topographic point for a kid to be raised. Six out of the 10 adult females in this survey tried to perpetrate self-destruction after slaying their kid. An of import factor that was discovered in this survey was that in most instances the individual responsible for the decease of the kid had a hard childhood with demanding parents and a deficiency of emotional support ( Kauppi et. Al, 2008 ) . The research workers of this survey besides found that more than 50 % of the adult females were abandoned by their ain female parents during their childhood. In the scrutiny stage, in four instances the female parents were diagnosed with some sort of depression such as ; postpartum depression, major depression and psychotic depression ( Kauppi et. Al, 2008 ) . Keeping in head, none of these adult females were convicted in the tribunal. In most instances, the female parents ne’er wanted to be left entirely with their babes as it would do symptoms to increase in badness. Other symptoms developed when the kid was left entirely with female parent which included but are non limited to hallucinations and anxiousness ( Kauppi et.al, 2008 ) .

Another book reappraisal written by Mckee ( 2006 ) , examined the gender differences within the filicide population. Statisticss showed that within the population forty seven per centum of female parents were the culprit and 50 three per centum of male parents committed the act of filicide. Mckee ( 2006 ) found that kids under 1 twelvemonth old were more vulnerable to filicide than kids over the age of one. In the United Kingdom, future research suggest about 10 to 20 maternal filicide instances will be committed annually ( Mckee, 2006 ) . The United States averages 256 filicide instances per twelvemonth. Reasons for this high sum of filicide instances in developed states include economic want, lower educational degrees and a deficiency of resources that guide and help immature female parents when faced with postpartum depression ( Oberman, Meyer, 2009 ) . Mckee`s ( 2006 ) book discusses prevalence rates and old research completed on maternal filicide. In add-on, hazard appraisals and direction schemes are besides analysed for this peculiar country homicide. Mckee ( 2006 ) discovered five wide classs of maternal filicide. These classs include rejection, mental unwellness, unintended, antisocial, and revenge. By utilizing instance illustrations, Mckee explains his “ Maternal Filicide Risk Matrix “ . This explains the association of the mother`s unprotected cell and protective factors based on two dimensions. These dimensions are known as phase and sphere. This tool must include hazard intercession points for each phase of maternity and gestation. Unfortunately, the appraisal is non through empirical observation validated. The writer besides discusses different rules and their strengths and failing of the “ Maternal Filicide Risk Matrix “ . He besides argues the sum of abandoned kids who are ne’er found and job specifying the cause of decease may be the prevalence of female parent who kills. The last article in this reappraisal, written by Hilari, Condori, Dearden ( 2009 ) took a different attack to look into filicide instances. Their survey took topographic point in Bolivia where they examined the autochthonal people of two countries. The first country is Qaqachaka and had 38 communities participate in the survey. In the 2nd country is Ancoraimes which had 28 communities in the survey. The grounds why these countries were chosen are due to the surveillance systems that have been installed by the authorities to supervise the communities. The intent of their survey was to look into why households partake in filicide Acts of the Apostless. Unlike old literature examined in this reappraisal, the chief causes for filicide are due to biological and societal factors. Examples of biological factors include physical malformations and duplicate ship. In this civilization, when a female parent gives birth to male and female twins, it is seen as evil and is socially accepted to destruct both genders. As for the societal factors, the communities seldom excuse the liquidator ; nevertheless the life of the kid is taken within 24 hours after birth and is ne’er recorded. Often there is no disciplinary action as the slaying has gone unnoticed. Individual interviews and concentrate groups were besides utilized to derive informations. Findingss indicated that female filicide were higher in both countries, for illustration Qaqachaka had 14 deceases in entire, 13 in which were female. Qaqachaka besides recorded 20 times higher than neonatal mortality rate, compared to national rural norm. Some drawbacks to Hilari et Al. ( 2009 ) , research are that the communities surveillance under reported births as camera`s were non set up in individual`s places.

Besides, information gathered from sources could hold been bias as many stated that they did non partake or witness the filicide instead heard about it through word of oral cavity.

Discussion In most instances of filicide, in general frequently occur with immature adult females that come from a deprived childhood and low socio-economic position. Often these adult females lack the instruction to admit the effects of their actions. In most of these instances, there was a limited sum of resources and entree to seek aid. For female parents in these countries, there should be societal workers that are readily accessible to observe and mention early symptoms of postpartum depression and psychological/ behavioral upsets. Many of the restrictions that were common is these surveies were the deficiency of empirical grounds, and how many adult females did non desire to discourse the traumatic event. The fundss to convey psychologists and head-shrinkers into these lower income communities are unluckily non available. Weekly follow ups by the female parent ‘s household doctor would be a positive attack to placing certain behaviors that may take to temper upsets, which may ensue to filicidal Acts of the Apostless. Understanding each phase of the female parent ‘s gestation and parentage, these are the ideal stages to seek of import forms. To reason, this research has been reasonably new and different theories have been developed to better understand the rational of these murderous wrongdoers. Future research should obtain different methods and garner more information from past culprits to analyse and look into and develop proactive steps to forestall the act of maternal filicide.

Jennifer Tozier Compentency Assignment 1, Review #2 Dr. Besthorn 09/15/2012 I chose to write my article review on the article entitled, “How clinical Diagnosis Might Exacerbate the Stigma of Mental Illness. ” It is a not new concept that people are consistently drawn to a labeling others with a stigma, and this article delves into how we as social workers can (unintentionally) either encourage that stigma or hinder it based on the presentation to the client and to the public. A key point to the article talks about three kinds of potential ways stigma hurts a client.

The first was being label avoidance. Many people do not want to admit to a mental illness, let alone get it treated because of how they might be perceived. Those that can admit having a mental illness and seek services may feel a certain stigma that then draws them back, and they avoid treating the problem, after they have confirmed that they, in fact, do suffer from the illness. They are afraid of being labeled in society or among their peers. The second stigma is blocked life goals. When suffering from a mental illness, everyday life can be and often is hard for the client.

Without treatment, the stress of daily life can inhibit the client from seeking opportunities such as work, school, family and friends. Without these life goals being fulfilled, the mental illness takes control of the clients’ life and they are fixed from advancing in the everyday life. The third way a stigma hurts a client is the self-stigma. This is where the client begins to believe what is being said about them and their problem. It further exacerbates the problem because they not only deal with the issue of mental illness but feel judged in every encounter; this changes their behavior and creates a greater issue.

This article also discusses the diagnosis of a mental illness in regards to “groupness” and the “differentness” aspects of how the public distinguishes people with mental issues. This looks into the stereotypes and over generalizations and how it relates with mental illness and the general public. Mental illness while it may be more prevalent in some groups, it is an equal opportunity illness and can affect anyone regardless of age, race, financial status, or occupation. The article does an excellent job of describing how once a person is diagnosed with a mental llness it draws diversity in how they might be labeled and construed in society, similar to how they might be treated if they were a minority group. Research shows that this stigma “groups” individuals once they have been diagnosed with a mental illness, regardless if the client demonstrations any abnormal characteristics. The author did a terrific job of discussing the different stigmas that mental illness produces. It talked about how society or the majority labels a person with mental illness and the way a person can label themselves, both which produce disastrous results.

I can see that this is a relevant article in the field of social work, because social workers can shape the way the client is perceived, both by the majority and the client all in the way they identify the illness. I understand that the article is talking about how the diagnosis can exacerbate the stigma, but I did not get a strong hold on ways to diagnosis it in an improved approach. The paragraph talking about diagnosis as a continuum seems like the closest point of reference for me, as an approach, but as it suggested this dimensional approach is not familiar to most clinicians.

It seems once again there is only so far workers can go, with the limited knowledge we have obtained through research to date. The theory that I associated with the article is social learning theory. I came to that conclusion for several reasons mainly, because social learning theory suggests that human behavior is learned as individuals. The article talks about how people who have been diagnosed at times will not seek treatment solely because of how they will be stigmatized.

The problem behavior will not be treated and will remain a problem because a stigma will be placed on that individual if they admit the problem and get treatment. I think that using the social learning theory as a mode of treatment can be possible if the social worker can convince the client that if they get treatment and function in a “normal” way they will have a better quality of life. The article talked about how the social worker defines the mental illness and relays the information not only to the client, but also to other mental health providers is a determining factor on how it will be perceived.

It is our ethical responsibility treat the client with dignity and respect, therefor when discussing the mental illness we need to be sure to use professional terms and be 100% correct before we unintentionally put a stigma on our client, they may put undue hardship in their life. When engaging with a client with mental illness it is necessary to discuss with them what they can expect, from meeting with the mental health provider all the way through treatment. Also to find out what they expect from the process.

It is vital to let them know that they will have issues to deal with such as social stigma, but a road to treatment will give them a better quality of life. Mental illness affects people every day. Simply because of the stigma attached to it, people do not want to admit they have a problem. This is an implication because if more people could be honest and upfront social workers and policy makers could be given more time, resources, and attention to create policies that would benefit those struggling. The more resources and policies available the better chance that people suffering from mental illness will not have to deal with a stigma.

Johnson KayLa English 100 M W 9:30-11:00 Mental Illness Essay November 19, 2012 November 26, 2012 Everyone once in their life has either thought as themselves or another as crazy. In today’s day and age people find it fun to be called crazy, that was not the case in the past. People in our past who were demined “Insane” were sent away, hidden from society’s eyes and subjected to cruelty and unnecessary torture. America’s health system has changed dramatically for the good and also it recent cases for the bad for some people.

Today healthcare is easy to come by but with so many faults it’s hard to know which ones are good and will do better by the person and their family’s health needs. There are many types of health care, that all offer different things. Have different coverage’s and pay for different things. Asking several different people what they think is wrong with America’s health care system Coming to a list of conclusions of our health system. When asked “How do you feel about the health care plan you have? ” people generally answered its okay, better than none.

A generally flat answers right? Well when asked “What do you think your plan can improve on? ” they began to list things like pay for more test pay for more medication that’s needed and the most common answer was to allow them to pick their own doctors and not having to wait months for one appointment. As an eighteen year old college student there was no clue about healthcare and its faults and didn’t know it was so hard to get good healthcare. Also finding out that it may be hard now but it was not as nearly as hard as it was before in America.

Treating public illness has long been a process of trial and error guided by public attitudes and medical theory (Kimberly Leupo). This quote makes so much sense because as a society were so concerned about what people will think we just want to get rid of the problem, even if it’s your son with autism or a daughter with down syndrome etc. There has always been those who’s suffered from mental illness, as far back as the Egyptian or even the second millennium before Christ. They were often killed or locked away and that had little change in our history.

In early America the colonist refereed to those with mental illness ass “lunatics” all because they believed a person was crazy when they were born on the night of a full moon or sleeping under the light of a full moon, who’s crazy here? They declared these people possessed by the devil (no exaggerating on their behalf), and were removed and locked away from society. These lunatics were put under 1 of 2 labels which were: Mania and Melancholy. Mania was mental illness marked by periods of great excitement, euphoria, delusions and overactivity. Melancholy was a feeling of pensive sadness, typically with no obvious cause.

They believed to cure an individual they had to catalyze crisis or expel crisis from the indiviual. For this they had several procedures including: 1. Submerging patients in ice baths until they lost consciousness 2. Executing a massive shock to the brain 3. Induced and forced vomiting 4. The notorious “bleeding” practice, The bleeding practice entailed draining the bad blood from the individual, unfortunately this inhumane practice normally resulted in death or the need for lifelong care; at best the odds were one in three that this procedure would actually lead to an improvement in the patient’s health(Kimberly Leupo).

The colonial era’s methods of handling the mentally ill and medical procedures are considered arguably barbaric vs. todays means of the treatment of the mentally ill. In that time it worked fine because they were hidden from society’s harsh and judgmental eyes. Around the 19th century the Europeans showed us a new to treat the mentally ill called “Moral Management. ” This was based on that the environment played a vital role in treatment of the mental ill.

In this process you had to create a more domestic feel to the patients living conditions, thus, replacing shackles, chains and cement cells with the little things like pictures and a bed. Recover was more likely to occur if they felt more like they were at home. Treatment also went under construction Phrenology was introduced, studying the shape of the brain to explain illnesses and render diagnosis. Also since the patients were no longer restrained all day they became unruly and basically bored so they had to come up activates for them to do to occupy their time.

A very important point in the history of how we treat our mentally ill was the civil war. After the Civil War in America a great number of servicemen suffered from postwar trauma; war wounds that were emotionally and mentally ingrained as opposed to physical injuries. These inflicted persons were passed on to state mental hospitals and asylums, where the public displayed much interest in their care and treatment. Although, the public eye watched very closely how their ‘war boys’ were treated, institutions had no choice but to reinstate old procedures due to the serious issue of overcrowding.

Restraints and shock therapy were reintroduced, along with new drug treatments such as opium. With that came the need to find more room for mental ill, thus, Asylums began to open up across the country to give those people help. Thomas Story Kirkbride was the designer of asylums at the time, and became well- known for his popular architectural ideas. He took great care and thought in constructing asylums taking in consideration of the patients and workers who would be in the asylums. For example in 1874 “Athens Asylum for the Insane. ” Was open for the public.

It was the most attractive asylum in its day built to please the public’s eye but also to withstand the harshest conditions from within. The original 544- room construction had two staggered wings branching out from a central building. The building had an exit and entrance only from the center building and the design was ideal for cross- ventilation and patient control. The design called for the least disturbed patients to be placed closer to the center building to encourage interaction with the staff, and as the patients’ conditions worsened their placement would extend respectively throughout each wing toward the back of the structure.

The establishment community housing farms, a dairy barn, greenhouses, a transportation system, graveyards, etc. the patients had much to do while being treated. With the increasing great news of the asylums their population grew in shocking numbers. However some people took advantage of this. It was common for homeless people, tramps and hobos to become ‘patients’ of the asylums seasonally for shelter and food, and then “elope,” or slip away when the good weather returned.

Families would leave the elderly people at these places because of lack of time or resources to “deal” with them properly. The community found that these institutions were an easy means to remove unwanted people from society. As a result of asylums not having a mean of rejecting patients the people who were truly mentally ill and needed treatment suffered as a result. The now revised and human care of mental patient began to slip back to their old ways because of overcrowding. Now instead of single bedrooms to one’s self patients had to sleep in wooden crib like beds three stacked.

Water baths and shock therapy had made an unjust comeback, and now the in the early 1930s the notorious lobotomy was introduced into American medical culture. The original lobotomy is a medical procedure where the neural passages from the front of the brain are surgically separated from those in the back of the brain, the most common result of this procedure was the patient would their depressing or discouraging feelings or tendencies. This was a very delicate and time consuming process it required great skill and training from great surgeons.

In result of the great outcome of this great time was invested into this. Walter J. Freeman developed the trans- orbital lobotomy. The procedure was performed as follows: -To induce sedation, inflict two quick shocks to the head. -Roll back one of the patients’ eyelids. -Insert a device, 2/3 the size of a pencil, through the upper eyelid into the patients’ head. -Guided by the markings indicating depth, tap the device with a hammer into the patients’ head/ frontal lobe. -After the appropriate depth is achieved, manipulate the device back and forth in a swiping motion within the patient’s head.

This was a much faster and efficient way. In a local newspaper, on November 20, 1953, the headline read “Lobotomies are performed on 31 Athens State Hospital Patients,” and the article boasted that nearly 25 of those who received surgery would be able to go home with their relatives Sunday. Soon this began to stir up controversy and harsh criticism due to the larger number of deaths and complications. It was soon referred to as “psychic mercy killing” and “euthanasia of the mind. ” This was by far and no doubt mental health care’s darkest hour.

Healthcare was in its darkest hour until Psychotropic medication was pioneered. In 1954 the medical community introduced an anti-psychotic drug called Thorazine for the treatment of the mentally ill. In a rapid almost trend like success; other psychotropic medications became available, making it possible to cut greatly the length of time patients stayed in mental institutions. This breakthrough led to a significant decline in asylum populations, and the gradual discontinuation of less humane treatments and procedures.

Unfortunately In 1972, a federal court ruled that patients in mental health facilities could no longer work at these institutions without pay. The result of this ruling further changed the nature of the Mental Healthcare; the dairy farming had to go, as well as the upkeep of much of the grounds. The institutions didn’t have enough money to pay the patients for their contributions and also didn’t have sufficient money/funds or staffing to occupy patients with enough free time.

The costs of housing patients increased dramatically, patients became bored and felt they lacked the purpose they once clung to, and consequently the need to de-institutionalize was more prevalent than ever. During the de-institutionalization process, three out of every four patients were released from the Athens Asylum. The relocating process was greatly aggravating and traumatic for the patients; patients were released to their families, nursing homes, and half- way houses. The homeless population soared, the mentally ill population representing nearly a third.

The state pushed this process along by offering monetary rewards for decreasing the number of in-patients in asylums. Although healthcare is not as good as it should or can be, it has greatly changed for the better. People should be glad because if it were the same maybe they wouldn’t be reading this essay, maybe they would of found a reason to lock an individual away in an insane asylum and been done with them. There is some revision needed to healthcare but instead of just adding a complaint why don’t you do something to help make the change you want to see.

Be the change you want to see in the world. Works Cited cracked. com. N. p. , n. d. google. com. Web. 15 Nov. 2012. <http://www. cracked. com/funny-7539-insane-asylums/>. ? Leupo, Kimberly. toddlertime. com. N. p. , n. d. google. com. Web. 15 Nov. 2012. <http://www. toddlertime. com/advocacy/hospitals/Asylum/history-asylum. htm>. nih. gov. A. D. A. M , 13 Feb. 2012. google. com. Web. 15 Nov. 2012. <http://www. ncbi. nlm. nih. gov/pubmedhealth/PMH0001925/>. Schizophrenia. com. N. p. , n. d. google. com. Web. 15 Nov. 2012. <http://www. schizophrenia. com/history. htm>.

The social construction of mental illness Key Words * Career: The gradual change in people as a response to a label e. g. mental patient. * Learned Helplessness: learning how to be dependent. * Life-course model: suggests that the accumulation of social events experienced over a whole lifetime, not just individual important events, influence people and their mental state. * Presenting culture: a term used by Goffman to refer to how people like to portray themselves to others. * Schizophrenia: a form of mental illness where people are unable to distinguish their own feelings and perceptions from reality. Self-Fulfilling prophecy: predictions about the behaviour of social groups that come true as a result of positive or negative labelling. * Social Capital: refers to a network of social contacts. * Social constructionism: the approach which suggests that mental illness exists because people believe that it does. * Social realism: a sociological approach which suggests that mental illness does really exist. Summary Mental illness is the less fortunate twin to physical illness. The NHS is not funding enough support for mental health patients and the attention paid to it is minimal.

Mental health is a major problem in society with one in seven people claiming to have had mental health problems at some point in their lives. Social Trends 2007 (Self and Zealey 2007) said that about one in six British people aged 16 to 74 reported experiencing a neurotic disorder in the seven days before a national survey on mental health. When looking at which group is most likely to suffer from high rates of mental illness, the poorest and most excluded are majorly overrepresented. Defining mental illness Social Realism: A general term used to describe the approaches of sociologists who accept that there are distinctive sets of abnormal behaviour that cause distress to individuals and those around them. * Pilgrim and Rogers (1999) accept that, at different times and in different cultures, there are variations in what is considered as mental illness. * Although mental illness may have different names and sometimes not be recognized, it does actually exist as a real condition. * Similar to the bio-medical approach which believes that symptoms can be scientifically diagnosed and categorized.

They see treatment as allopathic (cure orientated through the use of drugs, shock treatment and surgery etc. * They recommend that sufferers be isolated from wider society. Social constructionism: * Have been very influential in sociological approaches to mental illness and start from the argument that what is considered as normal varies over time and from society to society. * Greater extremes of behaviour have been seen as normal in some societies and symptoms of madness in others. Labelling perspective: Labelling theory examines how the labelling of mental illness occurs in the first place and what effects it has on those who are labelled. * Thomas Szasz (1973) argues that the label ‘mental illness’ is simply a convenient way to deal with behaviour that people find disruptive. He is particularly critical of psychiatrists for diagnosing children with ADHD and calling it a disease. He says that giving a child a drug for a mythical disease is a form of physical child abuse because the child has no say in the matter. Labelling theory therefore rests firmly upon a social constructionist definition of mental illness. The effects of labelling * Scheff (1966) said that whether someone becomes labelled or not is determined by the benefits those others might gain by labelling the person ‘mentally ill’. So, those who become a nuisance are far more likely to become diagnosed as mentally ill as someone who causes no problems. * Once labelled, there are a number of negative consequences for the person because it is then assumed that all their behaviour is evidence of their mental state. Erving Goffman (1961) followed the careers of people who were genuinely defined as being mentally ill. He suggested that once in an institution people are stripped of their presenting culture. Criticisms of the labelling perspective * Gove (1982) suggests that the vast majority of people who receive treatment for mental illness actually have serious problems before they are treated so the argument that the labels cause the problems is wrong. It may explain the responses of others to the mentally ill, but cannot explain the causes of the illness.

Foucault’s perspective on mental illness: * He explains the growth in the concept of mental illness by placing it in the context if the changing ways of thinking and acting which developed in the early 18th century. * During the enlightenment more traditional ways of thinking were gradually replaced by more rational and disciplined ways of thinking. He argues that as rationality developed into the normal way of thinking, irrationality became to be perceived as deviant. * Having mad people in asylums isolated mad people away from the majority of the population.

They symbolized the fact that madness or irrationality was marked out as behaviour that is no longer acceptable. Structuralist perspectives on mental illness: * Virde (1977) explained the fact that some ethnic minorities are more likely to develop mental health problems by arguing that the sorts of pressures and stresses that can cause people to develop mental illness are more often experienced by people in an ethnic minority. * Nazroo is critical of this approach. He points out that people of the Bangladeshi origin who are victims of racism have lower levels of mental illness than the general population.

He concludes that mental illness cannot just be caused by racism and deprivation. * Brown et al (1995) explained that women are more likely to lead stressful lives because they have the dial burden and triple shift. * Labelling theorists (Chelser 1972), say that women are more likely to be seen as mentally ill because the defining of illness is mainly done by males. * Link and Phelan (1995) reviewed all the evidence and concluded that research pointed out a relationship between low levels of deprivation and mental illness.

Social capital (Putnam 2000) argued that people who have extensive and strong levels of social networks are more likely to be ‘happier’ than those who don’t. Check Your Understanding: 1) The two sociological approaches to explaining mental illness are social realist and social constructionist. 2) Social realist bases itself on the idea that there are distinctive sets of abnormal behaviour that should be treated; they are very similar to the bio-medical approach.

Social constructionist believes that definitions of mental illness can vary over time and in different cultures. 3) Labelling helps us understand that some people may live up to the label they have been given and can strip mental health patients of any self-dignity as they have no say in what happens to them as they have been given the label of someone who is mad. 4) A structural explanation is closely tied to the social realist definition of mental illness; they accept the reality of mental illness and set out to discover what social factors help cause them. ) Busfield says that it is true that some groups are more likely to find their behaviour defined as mental illness, compared to the behaviour of other groups however al of those groups experience higher levels of stress so mental illness would be higher. 6) They are more likely to show cultural characterises that are not seen as normal in a wider society. 7) They use the idea that women have more responsibilities than men and that the defining of mental illness tends to be dominated by male health professionals.

People with mental health problems experience many different types of stigma. This article explores the attitudes and beliefs of the general public towards people with mental illness, and the lived experiences and feelings of service users and their relatives. Keywords: Mental health/Mental illness/Stigma/Discrimination

This article has been double-blind peer reviewed

5 key points

1. Stigma can affect many aspects of people’s lives
2. Self-stigma is the process in which people turn stereotypes towards themselves 3. How the general public perceive people with mental health problems depends on their diagnosis 4. Stigma can be a barrier to seeking early treatment, cause relapse and hinder recovery 5. Future research should investigate the experiences of service users and their families to understand and measure the impact of stigma

Stigma can pervade the lives of people with mental health problems in many different ways. According to Corrigan (2004), it “diminishes self-esteem and robs people of social opportunities”. This can include being denied opportunities such as employment or accommodation because of their illness. Stigma in the form of social distancing has been observed when people are unwilling to associate with a person with mental illness. This might include not allowing the person to provide childcare, or declining the offer of a date (Corrigan et al, 2001).

Self-discrimination or internalised discrimination is the process in which people with mental health problems turn the stereotypes about mental illness adopted by the public, towards themselves. They assume they will be rejected socially and so believe they are not valued (Livingston and Boyd, 2010).

Being discriminated against has a huge impact on self-esteem and confidence. This can increase isolation from society and reinforce feelings of exclusion and social withdrawal. The Queensland Alliance for Mental Health (2010) observed that people with mental health problems are “frequently the object of ridicule or derision and are depicted within the media as being violent, impulsive and incompetent”. It also found that the myth surrounding violence has not been dispelled, despite evidence to the contrary.

In light of this, the Department of Health (2004) funded a programme called Shift, which aimed to reduce the discrimination that those with mental ill health face. The DH (undated) found that “many people with mental health problems say that the biggest barrier to getting back on their feet is not the symptoms of illness, but the attitudes of other people”.

Reviewing the literature

EBSCO was used to access the CINAHL, BNI and MEDLINE databases to search for available literature with the keywords “discrimination” and “mental” in article titles. This produced a total of 428 articles. The search was then limited to narrow down the number of results. Limits were applied as follows: Publication date was set between January 2000 and December 2010; Original research studies and journal articles were specified; The age range was limited to over 17 years old.

The refined search resulted in 155 articles.

In order to assess which articles were relevant, further inclusion and exclusion criteria were set. For example, articles that included the general public’s perception and attitudes towards mental health were included, and only primary research articles were used. Twelve articles matched the criteria.

Findings

The literature reviewed suggested that the way in which the general public perceive people with mental health problems depends on their diagnosis. Those with schizophrenia are seen as dangerous and unpredictable (Crisp et al, 2000).

People with alcohol and drug addictions are not only seen as dangerous, but the public also blame them for their addiction (Crisp et al, 2005). There still seems to be a general consensus that anyone with mental illness is unreliable, especially in terms of looking after children. Many believe having a mental illness reduces intelligence and the ability to make decisions (Angermeyer and Matschinger, 2005).

Discrimination and stimga have been linked to ignorance and studies show the majority of the public have limited knowledge of mental illness, and the knowledge they do have is often factually incorrect. Many still believe schizophrenia means having a split personality. In addition, many do not understand the difference between mental illness and learning disabilities and there is still a common misconception that those with depression can “snap out of it” (Thornicroft, 2006).

Depression and anxiety disorders do not have the same weight attached to them as psychotic illnesses but they are nonetheless stigmatised. People with depression are often seen as lazy and hard to talk to (Thornicroft, 2006). Public opinions seem to be held across the board, with no significant differences in relation to gender, education level and income. However, there were differences between age groups, with those in their teens or early 20s and those over 50 expressing the most negative attitudes (Alonso et al, 2009; Crisp et al, 2005).

Crisp et al (2005) noted those in the 16-19-year age range had the most negative attitudes towards people with mental illness, particularly towards those with alcohol and drug addiction. These results are surprising considering widespread reports of young people’s alcohol and drug use. These findings reflect a “them” and “us” type of thinking and suggest that many of those who use alcohol and drugs do not consider the possibility that they could become addicted themselves.

There were some indications that public opinion had become more positive, suggesting greater tolerance and understanding towards mental illness than in previous years (Angermeyer and Matschinger, 2005). However, these findings should be interpreted with caution; the DH (2001) found huge discrepancies between the views the public expressed in surveys and the actual behaviour as experienced or witnessed by service users and service providers.

The media

The media have often been accused of sensationalism by portraying mental illness inaccurately in their quest to gain higher ratings. However, the media can also play an important role in reaching out to many different audiences to promote mental health literacy. Celebrities such as Stephen Fry (diagnosed with bipolar disorder) have spoken publicly about their illness and this seems to be effective in reducing stigma (Blenkiron, 2009). Chan and Sireling (2010) described a new phenomenon in which patients are presenting to psychiatrists claiming to have and seeking a diagnosis of bipolar disorder.

However, the lived experiences of mental health service users tell a different story to the findings on public attitudes. In the articles reviewed service users said they experienced stigmatising attitudes and behaviours in many aspects of their lives. Common themes emerged across the articles. Many people felt stigmatised as soon as they were diagnosed with a mental illness, and attributed this to the way in which their illness had been portrayed in the media (Dinos et al, 2004). Receiving a stigmatising label has such a negative effect on people that the Japanese Society of Psychiatry and Neurology – at the demand of the patients’ families group – changed the name of schizophrenia from “mind-split-disease” to “integration disorder” (Sato, 2006).

Employment

Many people with mental health problems experienced discrimination when applying for jobs. This included trying to explain gaps in their CV due to episodes of mental ill health. They not only experienced stigma when applying for jobs, but also found that when returning to work colleagues treated them differently, with some experiencing bullying, ridicule and demotion. Service users also faced the dilemma of whether to disclose their illness to friends, family, colleagues or future employers. Many felt they could tell their partner or parents about having a mental illness and still feel supported, but only 12% felt able to tell colleagues (Bos et al, 2009).

Social stigma

Service users reported social discrimination in the community, giving accounts of being physically and verbally attacked by strangers and neighbours, their property being vandalised, or being barred from shops and pubs; those with addictions or psychotic illness tended to experience this more than those with non-psychotic illness. Reports also included examples of being spoken to as if they were stupid or like children, being patronising and, in some instances, having questions addressed to those accompanying them rather than service users themselves (Lyons et al, 2009). Dinos et al (2004) found service users felt a range of emotions surrounding their experiences of discrimination, including anger, depression, fear, anxiety, isolation, guilt, embarrassment and, above all, hurt.

Health and relationships

Service users also encountered discrimination when accessing services such as GPs. They reported professionals as being dismissive or assuming that physical presentations were “all in the mind” (Lyons et al, 2009). This can result in reluctance to return for further visits, which can have a detrimental effect on physical health. This is especially significant, as evidence suggests people with mental illness are at greater risk from physical health problems, including cardiovascular disease, diabetes, obesity and respiratory disease; they also have a higher risk of premature death (Social Exclusion Unit, 2004).

Developing mental illness can also lead to breakdowns in relationships with partners, family and friends. The SEU (2004) reported that a quarter of children had been teased or bullied because of their parents’ mental health problems. Evidence shows rates of comorbidity of drug and alcohol use and psychiatric problems are believed to be rising (SEU, 2004).

Implications for nursing

Stigma can affect many aspects of people’s lives. Even a brief episode of mental illness can have far-reaching effects on wellbeing, disrupting work, families, relationships and social interactions, impacting on the health and wellbeing not just of patients, but also of their families and friends. This can lead to further psychiatric problems such as anxiety and depression.

Stigma can be a barrier to seeking early treatment; often people will not seek professional help until their symptoms have become serious. Others disengage from services or therapeutic interventions or stop taking medication, all of which can cause relapse and hinder recovery.

If mental illness is treated early enough, it can reduce further ill health, and ultimately the risk of suicide. By intervening at the earliest possible opportunity, people may be able to avoid a full episode of mental ill heath, and retain their jobs, relationships or social standing.

The International Council of Nurses (2008) said nurses are fundamental in helping with the “promotion, prevention, care, treatment and rehabilitation of people living with mental health problems and support of their families and communities”. It is therefore imperative to reduce the stigma surrounding mental health and stop these factors impinging on people’s mental wellbeing.

The National Service Framework for Mental Health incorporated standards services must follow to provide consistent quality of care (DH, 1999). These included guidance on “social inclusion, health promotion, tackling stigma and the promotion of opportunities for a normal pattern of daily life”. The DH (2001) concluded that “everyone has mental health needs, whether or not they have a diagnosis of mental illness”. Box 1 features recommendations of ways to help reduce the stigma experienced by mental health service users.

Recommendations

As the media can play an important role in reaching out to many people, it is important to work with and educate them to ensure the portrayal of mental illness is factual, impartial and reliable As those aged under 19 years had particularly negative opinions towards all mental illness, attempts should be made to educate this age group about the issue, particularly on the dangers and effects of substance misuse and addiction In order to plan future services and shape policies further research must be undertaken with people who have direct experience of mental illness to gain more
understanding of the impact stigma has on their lives

Conclusion

The literature confirms the public hold negative beliefs about those with mental health problems. Despite national campaigns, there has not been a significant change in the way the public perceive mental illness. While much research has been carried out to explore the public’s perception of mental illness, future research should explore the experiences of service users and their families, carers or people close to them to understand and measure the impact that stigma has on their lives. This, in turn, could help to shape interventions and policies for improved legislation to help stop the discrimination faced by those with mental illness.

References:

Alonso J et al (2009) Perceived stigma among individuals with common mental disorders. Journal of Affective Disorders; 118: 180-186. Angermeyer MC, Matschinger H (2005) The stigma of mental illness in Germany: A trend analysis. International Journal of Social Psychiatry; 51: 276-284. Blenkiron P (2009) Psychiatry in the Media. London: Royal College of Psychiatrists. Bos AE et al (2009) Mental illness stigma and disclosure: consequences of coming out of the closet. Issues in Mental Health Nursing; 30: 509-513. Chan D, Sireling L (2010) ‘I want to be bipolar’ …a new phenomenon. The Psychiatrist; 34: 103-105. Corrigan P (2004) How stigma interferes with mental health care. The American Psychologist; 59: 7, 614-625. Corrigan P et al (2001) Prejudice, social distance, and familiarity with mental illness. Schizophrenia Bulletin; 27: 219-226. Crisp AH et al (2005) Stigmatization of people with mental illnesses: a follow-up study within the Changing Minds campaign of the Royal College of Psychiatrists. World Psychiatry; 4: 106-113. Crisp AH et al (2000) Stigmatisation of people with mental illnesses. The British Journal of Psychiatry; 177: 4-7. Department of Health (undated) Stigma.