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Outline the key features of the medical model of mental illness also highlighting its main strengths and weaknesses?
A mental disorder is a major disturbance in an individual’s cognition, emotion, or behaviour that reflects a dysfunction in the psychological, biological or developmental process underlying mental functioning (APA, 2013). The medical model works from a biological emphasis and illness frame work to determine and prescribe the appropriate treatment and or determine the illness and suggest a prognosis (Rogers & Pilgrim, 2014). The medical model has strengths as it is logical and has an empirical status, whilst backed up on significant amount of scientific and biological evidence. The model uses effective pharmaceutical medicines to control incapacitating effects and furthermore, the medical model has a significant amount of ongoing research work (Rogers & Pilgrim, 2014).
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The medical model also consists of weaknesses, there is little attention given to the individual’s unique experience, voice and expertise on their mental illness (Van & Hovis, 2014). Additionally, little attention is given to the broader social, environment and cultural aspects. Which brings along labelling, stigmatising and othering to the mental illness community (Rogers & Pilgrim, 2014).
Outline the key features of a bio-psycho-social model approach and highlight is main strengths and weaknesses?
Biopsychosocial according to Engel draws attention to the idea that all levels of a system are interrelated from the cell to biosphere (Engel, 1977). Biopsychosocial model provides a framework to understand a client’s situation at all levels including biological, psychological and social functioning (Sands, 2001). A biopsychosocial assessment aims to hold all levels together and complete a picture. If we view the relationships of a person and their environments we are able to see the stress and difficulty’s that strain and support people as we begin to focus on the problem and strengths(Bland, Renouf and Tullgran, 2015).
The biopsychosocial model has strengths as it is more comprehensive and integrated, while encouraging a more holistic exploration of interactive and reciprocal effects of a person’s genetics, environment and social aspects of their lives (Pilgrim, 2015). Additionally, the biopsychosocial model allows workers to consider not only the biological and physical impacts of the mental illness but also the psychological and social impacts on the person’s wellbeing and daily functioning at any given time (Bland, Renouf & Tullgran, 2015).
The biopsychosocial model also consists of weaknesses, the model is conceptually unclear about the mind and body relationship as it doesn’t provide a straightforward, testable model. Additionally, it is seen to be too broad and difficult to be applied in practice (Ghaemia, 2011).
Succinctly outline the main features and 2-3 different treatment options of a mental health problem?
Schizophrenia is characterised by delusions, hallucinations, muddled speech and behaviour with other symptoms that cause social or occupational dysfunction (DSM, 2013). For the DSM diagnosis symptoms must occur in at least two to five areas for a significant time and reduce functioning at work, interpersonal relations and self-care (Bland, Renouf & Tullgran, 2015). Additionally, schizophrenia suggests a disturbance from some of the most basic functions that gives purpose to an individual (Bland, Renouf & Tullgran, 2015).
Treatment for schizophrenia normally involves both medication and psychological or psychosocial intervention (Bland, Renouf & Tullgran, 2015). The use of antipsychotic medication has been used to reduce and control the psychotic symptoms. Antipsychotic medication is used to block dopamine receptors in the brain (Dean & Bateman, 2016). Different antipsychotic medication is used and referred to as second generation or atypical antipsychotics (Dean & Bateman, 2016). Like any medication antipsychotic medication come with side effects, second generation medication is often associated with weight gain and factors leading to diabetes and cardiovascular disease. Additionally, atypical antipsychotic medication side effects include parkinsonism, akathisia and tardive dyskinesia (Bland, Renouf & Tullgran, 2015).
As well as the use of medication, psychosocial approach is an alternative treatment option in the attempt to prevent relapse. All psychosocial treatments are diverse, but rely on interpersonal interactions for therapeutic gain (Kane & Mcglashan, 1995). The application of stress-vulnerability model leads to interventions to reduce personal stress, build resilience and strengthen personal coping skills (Harris, Williams & Bradshaw, 2012). The model provides psychosocial approaches that demonstrate effectiveness including, skill training, social support, individual and team based case management, as well as psychoeducational family care (Yank, Bentley & Hargrove, 1993). These interventions help improve coping skills so the individuals social functioning can be improved and the rate of illness decreased. Additionally, the use of cognitive behaviour therapy (CBT) can help people by strengthening capacities for normal thinking and feelings through structured interchange and mental exercise (Kane & Mcglashan, 1995). While also helping people understand their symptoms and learn new coping strategies. Furthermore, Community support can also help those suffering with schizophrenia as it can help foster recovery. Having a stable living environment, supportive family and friends and meaningful activity’s and work are essential (Bland, Renouf & Tullgran, 2015).
Discuss some of the key social consequences that social worker/ human service workers need to be mindful of when working with clients presenting with this mental health concern?
Some key consequences that social workers need to be mindful of when working with a client presenting with Schizophrenia is having an awareness of power issue such as anti-oppressive practice (Tew, 2002). To combat this the social worker, need to focus on their needs rather than the diagnoses and work from and empowerment practice framework (Tew, 2002). The social worker also need to focus on the importance of the lived experience of mental illness, focus on the unique individual journey, the importance of hope, good support and personal agency. While ensuring focusing on strengths, positive outcomes and respectful use of language to ensure it is not stigmatising beliefs and behaviours. We need to be mindful of the uniqueness of each individual as clients are actively stigmatised and discriminated against (Pritchard, 2006).
Social workers need to be aware of the knock-on effects of mental illness in regard to housing insecurity, poverty, separation from family and friends, high rate of imprisonment, welfare dependency, unstable employment and loneliness (Pritchard, 2006).
Identify and discuss three different key points that stood out for you in listening to a guest speaker?
On the 8th of August, we heard a guest speaker April talk about her life experience with bi-polar disorder. She was diagnosed with Cyclothymic Bi Polar Disorder at the age of 21. Bi-polar disorder is characterised by elevated mood and depression episodes, which are accompanied by change in activity and characteristics of cognitive, physical and behavioural symptoms. Mania is an elevated mood that leads to disturbance of behaviour and function (Anderson, Haddad & Scott, 2013). Cyclothymic bipolar is when people experience hypomanic and depressive episodes without fulfilling the criteria for major depression, manic or hypomania.
The thing that stood out to me was the amount of stigma associated with bipolar disorder. April said when she was diagnosed people judged her and believed she was just acting. Sigma reflects people’s responses to individuals who show undesirable or unusual characteristics (Thomé, Dargél, Milgliavacca, Potter, Jappur, Kapczinski, et al, 2012). Stigma related to mental health can be implied from a simple diagnostic label to psychiatric medication or history of psychiatric treatment (Stuart, Mileve & Koller, 2005).Not only does the individual with the mental illness suffer from stigma the family is also impacted. According to Perlick et al, 43% to 92% of caregivers of people with mental illness reported to feel stigmatised (Perlick, Miklowitz & Links, 2007). Additionally, Families are holding shame and a mixture of guilt and disappointment due to a stereotypical community attitudes towards mental illness (Meadows, Farhall, Fossey, Grigg, & Singh, 2012).
Another thing that stood out to me was that when April was in a manic state she noticed a huge distinction in attitude and treatment by staff, in hospital settings especially. She stated the difficulty of dealing with people who are in manic but they shouldn’t be treated differently. She found it hard when Mental Health Practitioners would question her diagnosis. Additionally, Mental health professionals need to recognise and value the healing potential in relationship between the consumer and service providers (Bland, Renouf & Tullgren, 2009).
Another thing that stood out to me was simple person first before disability in language. It is such a simple concept and it makes such a difference. For example; saying April suffers from bipolar disorder, instead of saying she’s crazy or mental can help. The use of first person language gives privilege to one’s personhood, rather than their disability or illness (Bland, Renouf & Tullgren, 2015). By simply changing one’s language it reduces the stigma and recognises the person we see first and their illness second (Danda, 2017). The use of person-first language can transform the way we view those we care for, their view of themselves, and promotes opportunity to be more than just an illness (Danda, 2017).
Discuss key engagement practice skills when working with clients in the area of mental health social work?
When working in mental health the social work practice looks at promoting recovery, restoring wellbeing, enhancing the development of each individual’s power and control over their lives and to advance social justice (Bland, Renouf & Tullgran, 2015). When working with clients in the mental health sector the key engagement practice skills we need to take into consideration are; emphasising personhood that looks at recognising the complexity of the human experience and see beyond the limits of the illness and labels. Furthermore, we also need to address; valuing the lived experience of individual consumers and family members and carers to ensure we show respect for the individual, family and carers.
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It is important to recognise; Affirming the importance of partnership and mutuality, by working respectfully with partnerships to ensure they have choice and self-determination. Also, the need to address powerlessness, marginality, stigma and disadvantage is important as social workers we need to promote equality, access and participation and recognise civil and human rights. The National survey of people living with psychotic illness noted that stigma and discrimination affected one in ten and was one of those suffering with a mental illnesses top three challenges (Morgan et al., 2011). Finally, we need to address conveying empathy, compassion and hope to ensure human qualities of empathy, compassion and hopefulness to our work (AASW, 2008). Furthermore, it is against the law to discriminate against a person because of their disability and or their associates under the Disability Discrimination Act 1992 (Mental Health Legislation and Human Rights, 1992). These engagement skills clearly align with the core principles of the recovery oriented approach and the Australian Association code of ethics.
Discuss your understanding of effective and respectful assessment practice in mental health social work?
For social workers to ensure effective and respectful assessment practice in the mental health sector it is important to explore client’s strengths that are unique and resourceful while fostering a level of resilience (Bland, Renouf & Tullgran, 2015). It is also Important to ensure listening skills are used to best practice, with awareness of one’s own body language and non-verbal ques, while remaining empathic and paraphrasing reponses and ensuring we listen from the heart and uphold hope (Bland, Renouf & Tullgran, 2015). Furthermore, it is important to help clients explore a broader range of life domain, while assisting clients tell their story, help prioritize presenting concerns and check support systems in their lives.
Another important aspect to look at is how the referral came about, who initiated it and what expectation they had. It is important to address where the referral came from to ensure we aren’t placing our client at risk. Another aspect to take into consideration is the awareness of the setting and meeting space, to ensure the client feels safe and comfortable (Trevithick, 2010).
It is important when working in the mental health sector to recognise the threefold focus of social work engagement and assessment practices. Broader social context focuses on exploring the broader socio, environmental, cultural life domain that impacts the clients lived experience with their mental health concerns (Bland, Renouf & Tullgran, 2015). Another focus point is social justice issues related to stigma, discrimination and othering to ensure equality of access to information and resources as well as treatment and support for both clients and carers. Furthermore, critical importance of relations and support network in a client’s life should be addressed to ensure the client has a high level of quality of support available (Bland, Renouf & Tullgran, 2015).
Succinctly outline the main mental health problems facing your chosen population group; drawing on relevant academic research work?
Race-based discrimination impacts negatively on both the individual and community (Paradies et al, 2009). Discrimination against Indigenous Australians is one of the most prevalent forms of discrimination in Australia (Paradies et al, 2009). Discrimination can take form in stereotypes, behaviour and automatic response. Some common stereotypes perceived by the community are that Indigenous Australians are sometimes lazy, are given unfair advantages by the government and should act more like other Australians Beyondblue.org.au, ND). As for behavioural discrimination just simply moving away from an indigenous Australian when they sit near them is an act of discrimination. Furthermore, automatic response as simple as telling joke about Indigenous Australians is an automatic action that discriminates (Beyondblue.org.au, ND).
The mental health of Indigenous Australian in relation to the Aboriginal concept of health is “physical well-being of an individual to social, emotional and cultural well-being of the whole community in which the individual is able to achieve their full potential as a human.” It is based on the whole of life view and included the concepts of life-death-life (NACCHO, 1997)
There is strong evidence of a link between discrimination and mental health in relation to the negative impact of race-based discrimination. (Paradies, 2006). Race-based discrimination can humiliate, enrage, confuse and prevent optimal growth and functioning of individuals and community’s (Harrell, 2000). Discrimination can have an impact on young indigenous Australians as it affects their psychological adjustment and wellbeing through to adulthood (Mossakowski, 2003). It was found that Indigenous Australian suffer from the depression, anxiety, distress, lower self-esteem, less confident and humiliation (Beyondblue.org.au, ND). It was also found that stigma and discrimination is fundamental to social exclusion (Leff & Warner, 2006).
It is important to recognise the impact on mental health due to historical events related to the invasion and colonisation including Truman and loss, premature death, racism, social disadvantages, family breakdown and separation of children (Swan & Raphael, 1995). While linking this to the ongoing consequence in the high level of stress, grief, depression, suicide and substance misuse (Swan & Raphael, 1995). Additionally, to combat discrimination in South Australia the Government has outlined a number of legislation to help support diversity and reduce race-based discrimination.
Discuss a population approach to mental health targeting this group. This discussion to include attention to three different PA intervention levels. Briefly outline your understanding of these three PA interventions; give specific examples of how they could be applied to the mental health problems facing your chosen population group?
Population health looks at understanding the populations as a whole. It encompasses the needs assessment, developing and implementing intervention to promote health and reduce illness across the population. It looks to understands mental health as a complex interaction of biological, psychological social, environment and genetic factors ((WHO, 2002) Its fundamentally adopts a social justice perspective to health care on all levels. While ensuring all Australians have a right to participate meaningfully in individual and community life without discrimination, stigma or exclusion (CDHA, 2000). Population health includes looking at three different levels of intervention; primary, secondary and tertiary.
Primary level look to protect, support and sustain emotional and social wellbeing of the population group (Commonwealth Department of Health and Aged Care, 2000). At the primary level, we would focus on reducing social disadvantage, racism and oppression. Increase mental health literacy and ensure culturally appropriate initiatives determined by the local communities. While ensuring make the community capacity to be resilient to adversity (CDHA, 2000). Additionally, we would be looking at enhancing protective factors for mental health problems and mental disorders. While, ensuring to reduce risk factors around issues of loss, trauma, incarceration, violence and substance misuse in relation to the Indigenous Australian community (CDHA, 2000). This could be achieved through anti-bullying campaigns and other awareness raising programs about the effects stigma and discrimination has on an individual.
Secondary level we would be looking at ensuring the mainstream services are aware of the impact of cultural issue are having on Indigenous Australians mental health. While ensuring information and education of early signs and symptoms are provided to ensure people are able to distinguish what is happening to them (CDHA, 2000). Additionally, we need to ensure we provide a range of support and strategies to help minimise the level of fear and confusion to help better early management (CDHA, 2000).
Tertiary level looks at the need for integrated and respectful multi-disciplinary approach between different professional bodies (Commonwealth Department of Health and Aged Care 2000). A multicultural approach would have a significate impact, as mainstream services need to have awareness of issues relevant to people from diverse backgrounds. This would incorporate staff changing work practices to ensure they are able to work with diverse backgrounds while ensuring culturally aware and sensitive practice is in use (Commonwealth Department of Health and Aged Care 2000). Just a simple change is professional bodies can help influence the wider community to change their outlook on specific cultural community’s by helping change the discrimination and stigma upon the community.
- AASW (2008). Practice Standards for Mental Health Social Workers, Canberra, ACT: Australian Association of Social Workers
- American Psychiatric Association (APA) (2013) Diagnostic and Statistical Manual of Mental Disorders.
- Anderson, I, Haddad, P & Scott, J 2013, ‘Bipolar disorder’, British Medical Journal, vol. 346, no. 7889, pp. 27.
- Beyondblue.org.au, (n.d) Discrimination against Indigenous Australians: A snapshot of the view of non-Indigenous people aged 25-44
- Bland, R., Renouf, N. and Tullgran, A. (2015). Social work practice in mental health. 2nd ed. New South Wales: A&U Academic.
- Commonwealth Department of Health and Aged Care 2000 (CDHA, 2000), National Action Plan for Promotion, Prevention and Early Intervention for Mental Health, Mental Health and Special Programs Branch, Commonwealth Department of Health and Aged Care, Canberra.
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- Harris, N., Williams, S & Bradshaw, T. 2002, Psychosocial interventions for people with schizophrenia: a practical guide for mental health workers, Palgrave, Basingstoke, UK
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- Meadows, G, Farhall, J, Fossey, E, Grigg, M & Singh, BS 2012, Mental Health in Australia Collaborative Community Practice, 3rd edn, Oxford University Press, Sydney.
- Mental Health Legislation and Human Rights, 1992; An Analysis of Australian State and Territory Mental Health Legislations in term of The United Nations Principle for the Protection of Persons with mental Illness, Sydney.
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