Care Of Clients With Mental Health Problems
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This essay will look at the relationship between schizophrenia and bio psycho social issues it will also explore the concept of recovery and also look at some of the approaches that are used to promote the recovery process. The National Health Service (2005) describes schizophrenia as a mental illness with substantial short and long term consequences for individuals, family, health and clinical services and society. One in hundred people experience schizophrenia in their lifetime with highest incidence of the disease in late teens and early 20s. People with schizophrenia suffer distress and long term disability and there is a lot of accompanied stigma and prejudice involved with the disease that can have negative effects on employment, relationships and life satisfaction. A person's family is completely destroyed with schizophrenia and carers and family members also carry the burden of the disease and caring the person for a long time.
"Schizophrenia is a severe mental disorder characterized by profound disruptions in thinking, affecting language, perception and thee sense of self. It often includes psychotic experiences, such as hearing voices or delusion. It can impair functioning through the loss of an acquired capability to earn a livelihood or the disruption of studies" (WHO, 2009)
Schizophrenia is not caused by one single factor but a combination of different factors these factors are biological, psychological and social. This is what is known as the bio psycho social model of schizophrenia (Santrock, 2007).
There are thought to be many causes of schizophrenia one of these are genetic factors. Riley & Kendler (2006) state that 70% of people who develop schizophrenia have a relative who has schizophrenia, the closer the relation the more likely a person is to get the disease if a person has an identical twin with schizophrenia they have a 50% chance of developing schizophrenia.
There is a genetic component to schizophrenia which means someone may be predisposed to developing schizophrenia but it does not mean that they are pre-determined to develop the illness. Biological factors can include age or a virus and environmental factors for example life stressors can trigger an onset of schizophrenia. Stressful life events that occur can include having a baby, losing a job, moving house or losing someone who is close but not everyone who goes through these stressful situations will be diagnosed with schizophrenia as some people can handle stressful situations better than other people will.
Risk factors may be different for different individuals - while one person may develop schizophrenia due largely to a strong family history of mental illness (e.g. a high level of genetic risk), someone else with much less genetic vulnerability may also develop the disease due to a combination of pre-pregnancy factors, pregnancy factors, social and family stress or environmental factors that they experience during their childhood, teen or early adult years. This suggests that individuals possess different levels of vulnerability to schizophrenia, which are determined by a combination of biological, social and/or psychological factors. It is proposed that vulnerability to schizophrenia will result in the development of problems only when environmental stressors are present (Riley & Kendler, 2006). If the vulnerability of an individual is sufficiently high, relatively low levels of environmental stress might be sufficient to cause problems. If the vulnerability is much less, problems will develop only when higher levels of environmental stress are experienced (NHS report, on Schizophrenia 2005).
In mental health recovery has a lot of different definitions and does not always refer to a person having complete recovery from mental health problems in the same way that a person can fully recover from having physical health problems. A person not only has to recover from the distress and trauma of psychotic experiences they also have to deal with social exclusion, discrimination, stigma, loss of position in society, feelings of hopelessness, possible forced hospitalisation and the trauma of receiving a diagnosis.
The National Institute of Mental Health (2009) suggests that there is no single meaning of the concept of recovery for people with mental health problems, but the easiest way to explain the recovery model is one of hope and that it is possible for a person's meaningful life to be restored, despite serious mental illness. Recovery is often referred to as a process, outlook, vision, and conceptual framework or guiding principle (Watkins, 2007).
The Mental Health foundation (2007) state that the recovery process should provide a holistic view of mental illness that focuses on the person as a whole and not just their symptoms. They also believe that recovery from severe mental illness is possible and it is a journey rather than a destination but it does not necessarily mean getting back to where a person was before their diagnosis recovery will happen in 'fits and starts' and, like life it has many ups and downs, calls for optimism and commitment from all concerned, is very much influenced by people's expectations and attitudes requiring a well organised support system this can be from family, friends or professionals it also requires mental health service providers to accept and take on new ways of working.
Recovery highlights that while people may not have full control over their symptoms, they can have full control over their lives. According to the National Institute of Mental Health recovery is not about 'getting rid' of mental health problems. It is about being able to help people beyond their problems helping the person to be able to recognise and develop the opportunities that connect their abilities, interests and dreams. Mental illness and social attitudes such as stigma that still surrounds mental illness can often impose restrictions on people experiencing ill health (Hinshaw, 2007). Recovery looks past these restrictions to help people achieve their objectives.
A care pathway is an outline of anticipated care, placed in an appropriate timeframe, to help a patient with a specific condition or set of symptoms move progressively through a clinical experience to positive outcomes. The Department of Health Dual Diagnosis Practice Guide (2002) state that someone with dual diagnosis Schizophrenia and substance misuse issues will have an integrated care pathway as their care can be complex as there is likely to be multi agency involvement.
The Summary of Assessments of Risk and Need (SARN) is a tool designed to be used in mental health services for describing service users' needs for care. (Self et al 2008). It provides a brief description of the needs of people entering into Mental Health services or presenting with a possible need for change in a care plan. It was developed to aid in the process of establishing a classification of service users based on their needs so that appropriate service responses could be developed both at the individual and service level. It allows professionals from a range of backgrounds to summarise their assessments in a shared format. Thus it provides a common language for describing health states and related social conditions and improves communication between different users including service users themselves (National Health Service, 2009).
There are several strategies used to promote the recovery process and these can include pharmacological interventions, CBT, family therapy.
Those who have family benefit most if their families are well informed about the illness have support and skills to deal with the ill family member.
Social skills training, vocational assistance and environmental modification help support recovery because if someone is in control of their finances have a job that they can go to this is likely to help with their personal growth and their self esteem.
Cognitive behavior therapy can help reduce the distress and disability caused by symptoms of schizophrenia. Improve understanding and self management, reduce the risk of further relapse, improve mood and self esteem it involves client as an active participant in treatment. NICE guidelines (2009) state that psychological interventions should play a key role in the treatment of schizophrenia and that the best evidence is for CBT and family intervention. NICE guidelines now explicitly recommend CBT to be offered as a treatment option and family interventions should be available to families who are living with someone with psychosis or who are in close contact with someone with psychosis.
CBT offers a collaborative approach ensures client is at the centre of care and is an active participant in decisions about treatment; this enhances engagement with services (Freeman & Felgoise, 2005).
Motivational interviewing was originally developed as a treatment for drugs and alcohol addiction. However, it is now used with clients with psychosis to enhance compliance with medication (Rollnick & Miller, 2002). It is also used for clients with a dual diagnosis of drug or alcohol use and psychosis (Haddock et al, 2002). Motivational interviewing is based on the theory of stages of change or cycle of change (Proschaska & Diclemente, 1982).
According to Rollnick & Miller (2002) the different stages of change are; In 'pre-contemplation' the person does not acknowledge a problem exists. In 'contemplation' the person is ambivalent - they are in two minds about what they want to do. In 'action' the person is preparing and planning for change. When they are ready the decision to change is made and it becomes all consuming. In 'maintenance' the change has been introduced into the person's life. Some support may still be needed through the maintenance stage. 'Lapse' is a temporary return to 'old' unhelpful thoughts, feelings or behaviours. 'Relapse' is a full return to the old behaviour. Lapse and relapse are viewed as natural part of the Cycle of Change and do not assume failure. It does not mean that lapse or relapse is desirable or even always to be expected. It simply means that change is difficult, and it is unreasonable to expect anyone to be able to change a habit perfectly without any slip ups (Rollnick & Miller, 2002). When a relapse occurs, several trips through the stages may be necessary to make lasting changes. Each time the person is encouraged to review, reflect and learn from their slip ups. Rollnick and Miller (2002), state that motivational interviewing is especially effective when clients are either in the 'pre-contemplation' or 'contemplation' stages.
Relapse rates in psychosis are extremely high, even if people stay on their medication so it is always good practice to work closely with the client and their family and list early warning signs (Witkiewitz & Marlatt, 2007). This can lead to an action plan that can be implemented to help spot signs of relapse. Once a list of early warning signs has been completed a detailed action plan can be drawn up this will usually include, which the client and their family should do if signs of relapse are spotted. These plans can include what services should respond to the client and families concerns and give a list of available resources e.g. extra medication, phone numbers to call in crisis. Doing this can be empowering for both the client and their family it can enhance the relationship between them and mental health services giving them more control over their treatment and also enables them to feel supported in practical ways (Witkiewitz & Marlott, 2007) .
As with all therapies there is always problems the main ones associated with CBT and motivational interviewing are initial engagement, encouraging people to talk about their symptoms and problems, funding, time limitations and resources and ensuring that skilled mental health workers have sufficient training in carrying out these therapies.
Being diagnosed with schizophrenia shouldn't mean that a person can't live a full and happy life. With the right help and advice and continuing support from mental health services a person who suffers from schizophrenia should be able to work, build relationships and live a normal life just like anyone else. According to Mind (2009) this is due to a better understanding of schizophrenia the introduction of more effective medications and the increasing use of therapeutic interventions.
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