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An issue report.
The Effect and Treatment of Mental Health in the UK.
Surprisingly it is estimated that problems with mental health affect between 10% and 20% of young people in the UK and that at least 10% of young people in the UK have been diagnosed with a mental health disorder according to the office of national statistics. Camhs.org.uk. This figure shockingly represents approximately 6.4 million young people.
Association for Young People’s Health (AYPH)
It is thought that mental health disorders and specifically depression and anxiety may have a lasting and detrimental effect on health and attainment. This issue has not been proven conclusively through meta-analysis of many psychological studies across the world but it is founded in biological research and is supported by psychological evidence.
However the following data makes for interesting reading and looks at the link between education of a parent and the mental health of their children.
Association for Young People’s Health
The Biological Effect of Stress
The body responds to stress through the activation of the autonomic nervous system which is responsible for the flight or fight response within the body Long periods of stress inhibit the body’s ability to fight disease which can result in stress related illnesses as well as an increase in minor illnesses such as coughs and colds.
Evidence of the correlation between mental health and illness has been found by many researchers, the NHS found that depression has beenlinked to a 67% increased risk of death from heart disease and a 50% increase in the risk of death from cancer
An example of a disorder and its link to stress related illness was also published by the NHS. The results showed that schizophrenia doubled the risk of death from heart disease and tripled the risk of death from respiratory disease. I would consider evidence from the NHS to be reliable due to independent governance and watchdogs that are responsible for the protection of national health and not the NHS.
According to the national office for statistics stress related illness and serious mental health resulted in 14m working days lost in 2011 which has a huge effect on the economy in addition to this it should be noted that some of the illnesses noted in this graph can be attributed and or aggravated by stress or mental health disorders. Examples of these include minor illnesses due to the lowering of immunity caused by stress and certainly cardio vascular disease due to the pressure placed on the heart when under stress and minor illnesses.
Evidence of the problem of stress and illness has been researched by many psychologists and they have found that there are many factors which can affect immunity regarding stress and those include short term stressors, chronic stress and significant life events. Kiecolt –Glaser (1984) carried out a significant study on students before and after exams and found that the NK cell count was much lower during exams than it was before (AS Level Psychology 2008).
It is clear that the issue of poor mental health has a significant impact on physiological health which can further affect the lives of people and the general economy. There are many ways in which to respond to mental health through biological methods which will be discussed.
Solution: Physiological Intervention/ Medication
In order to investigate solutions for the treatment of mental health it is important to consider the methods of identification of stress and mental health disorders. Yes it is correct that stress and mental health disorders can and do effect physiological health which has a lasting effect on those concerned but it is also important to note that not everybody has the same response to stress. Selye (1974) and Cox (1978) both attempted to come up with a definition of what stress is but and both found that everyone responds to stress individually as a stressor is perceived. Therefore highlighting that stress can have serious physiological effects but may not need treatment in every case.
Many Psychologists have played a major part in the identification of mental illness and or how the brain actually works which is essential in diagnosing and treating those with mental health disorders. Selye (1974 made a considerable contribution to this by proposing GAS (General Adaptation Model) which provided both psychological and biological evidence for the HPA (Hypothalmic Medullary Pathway). The work of psychologists like Selye and psychiatrists has allowed for the categorisation and effective treatment of mental health.
We will firstly consider the biological method of intervention which is the use of drugs in managing the release and balance of hormones. There are 3 major types of drugs used in managing mental health and disorders; antipsychotic, anti-anxiety and anti-depressants.
Antipsychotic drugs were first discovered by accident in the 1950’s when the effect of reserprine was found to have a calming influence on psychotic patients. This finding led to the development of synthetic drugs which are used to control dopamine levels within the brain. The development of these drugs has had both positive and negative side effects. Antipsychotic drugs have meant that patients have been able to return to the community however a condition called Tardive Dyskinesia has been known to develop in upward of 18% of patients and the risk of developing these increases with age. The result of this condition is irreversible and is often worse than the initial disorder.
Benzodiazepines/ anti-anxiety drugs work by decreasing serotonin levels and enhancing gamma-amino butyric acid (gaba) levels. This is achieved by Gaba increasing the flow of chloride ions into neurones within the brain and making it difficult for the neurone to receive any stimulation. In addition to this the reduction of serotonin enhances the calming effect as serotonin is a hormone with an arousing effect on the brain.
Antidepressants work using 3 possible processes, the first is by blocking the receptors which allow for the re-uptake of norepinephrine and serotonin, the second is increasing their production and the third works by restricting monoamine oxidase which is the enzyme which breaks down norepinephrine and serotonin.
Is medication an appropriate solution?
It can be argued that the prescription of drugs simply covers over the underlying issue in some cases and it must be noted that research tells us that additional factors increase the risks of stress related illness or can reduce the risk of stress related illness. Examples of these factors include eating habits, smoking and exercise.
However it must be acknowledged here that mental illness is supported by biological evidence as described above and must therefore be treated medically through physiological intervention. However we will discuss further thee methods used in diagnosis as recently there has been a major change in policy which encourages authorities to adopt a clear approach to integrated services and treat the patient as one rather than seeing mental health as a separate issue.
Mentalhealth.org.uk Crossing Over Boundaries
If diagnosis of mental health disorders continues to follow its current trend of a 6.8% rise in prescriptions per year then this may have environmental implications which may include the development of infrastructure to support the production of medication. This in turn results in further environmental impacts such as the development of housing and community amenities to support an increasing population around a source of jobs. The manufacture of drugs may not take place within the UK however the environmental impact will be felt and evident.
The development of any new drug within the UK requires that it be tested by more than one mammal and that one of those is larger than a rodent. This of course raises a question around the ethics of developing and testing new drugs for the use of treating mental illness. However the Home Office requires that to test on animals three licenses must be acquired and it must be proven that there are no alternatives and the potential benefits must be identified bbc.co.uk. This particular source contains reference to legal documents which represent the law and animal testing regarding drugs therefore making this reference a reliable source. However this only covers the UK and not necessarily where the manufacture of medication/testing is taking place which means that the issue of the ethics around animal testing still remains.
Benefits to Human Life
Making an accurate diagnosis of illness and in prescribing the correct medication allows the person affected to regain control of their mental health in many ways. In particular the advantages of those experiencing psychosis are more significant. For those patients the limitations of their illness have historically led to isolation and in more extreme cases patients being placed in asylums. The history of the treatment of mental illness makes for disturbing reading and pre 1950s categorised many patients incorrectly due to the basis of treatment being derived from religious thought, prejudice and lack understanding and biological evidence, one example of this is mothers who had a child out of wedlock.
After the 1950s legislation around the treatment of mental health began to change and coincided with the development of synthetic drugs used in the treatment of psychosis, this combination of greater understanding of mental health and more suitable therapies meant the abolition/ phasing out of all asylums in many countries. The result of this was the development of community care and further psychological studies into mental health, mentalhealth.org.uk.
In conclusion the development of synthetic drugs and has resulted in patients being able to remain part of the community and their families and has seen the abolition of previously used practices such as straight-jackets.
It is widely acknowledged that there are many side effects of antipsychotic drugs and drugs used in the treatment of depression and anxiety and it is important to note that the development of treatment has its risks. In modern society it is difficult to believe that our approach to the treatment of mental health is still so primitive. It is disturbing to think that it has only been in the last decade that we have seen a positive change in policy and investment into mental health. However the risk to human life in the development of medications are considerable and as previously stated can lead to severe side effects which include: sleep problems, shaking (Parkinson’s like symptoms), Tardive Dyskinesia, dizziness, high blood pressure and a higher risk of developing diabetes as well as becoming addicted to a medication.
Medication in the treatment of mental health is a solution but does come with risk to human life through invasive and sometimes inaccurate treatment and through severe side effects, however in making an informed opinion regarding the risk it is still a viable solution for many people and aids them in regaining control and becoming a contributing member of society.
Alternatives to medication:
The medical treatment of those with a mental illness or disorder can be the only form of treatment for many people however there is evidence to suggest that alternative methods of treatment may be as effective if not more so.
One alternative to physiological intervention is psychological intervention of which there are many methods including CBT, SIT and counselling as well as many more. We will consider CBT in more detail.
CBT has been found to be effective in the treatment of the following psychological problems; anxiety disorders, depression, social phobia, phobias and has had positive effects on sufferers of PTSD and OCD (obsessive Compulsive disorder).
The foundations of CBT once again draw on the research of psychologists and their observations of human nature just as the method described above in the development of medication. Those researchers include; Skinner, Pavlov, Meichenbaum and Beck (Stallard 2010). This particular source is a book used by Psychologists, CAMHS and other mental health services in understanding of CBT and contains references to many psychological studies. I believe this book to be a reliable source due to the evidence and its practical use in the treatment of mental illness.
Another method which has been discovered through the work of psychologists in managing stress and mental illness is the value of regular exercise and its effects on the brain.
Regular exercise has been found to have a positive effect on the brain and in particular serotonin and dopamine levels which aid in mood stability. Regular moderate exercise has also been found to stimulate neurotropic factors which result in new brain cells.
As already discussed stress and mental illness can have a negative effect on the immune system which can result in major or minor stress related illness. Illness itself can also be a major stress factor in people’s lives and increase stress. Sapolsky (1994) found that regular exercise does boost the immune system therefore reducing one of the physiological effects of stress (AS level Psychology 2008).
In addition to the evidence above the Mental Health Foundation published a report in 2013 which set out the findings of research into integrated services for those people suffering with mental health. The findings within this report calls for a number of improvements regarding integrated services and it must be noted that the report calls for further research into the connection between health and mental health and that this evidence must underpin services in the future.
It is apparent that the evidence suggest that all of the solutions mentioned in this study are appropriate in some ways but that present policy and increasing evidence states that a combination of medical treatment, psychological treatment and general improvements in public perception and education around health in would all increase the overall mental health of the population.
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