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This report will explore on mental health and community care within the historical view of community care and the impact of ideological perspectives that have influenced it. It will further analyse the benefits and shortfalls since its implementation, taking into account the impact of the 1990 NHS Community Care Act and current reforms will be considered. Again, the effects of poverty and social exclusion for those accessing community Care will be discussed. The author will further consider key aspects of mental health and the gradual transition from insitutionalisation to deinstitutionalisation (community care) since the early 1950s will be discussed. Recommendations shall be made regarding, especially, how the mental health system (including community care) could be improved.
In the pre-medieval period people believed that mental illness was a result of the possession of the human body (patient) by evil spirits. In order to get these perceived evil spirits out they drilled holes in the skull of such people. Andreasen (2001) tries to give credence to this by mentioning that scientists have found fossils of drilled skulls that are about 10,000 years old. During the middle ages a belief in Europe was that witchcraft was the reason for mental illness. As a punishment such people with mental illness were killed by burning, hanging or drowning. Some were put in government institutions called poorhouses. By the 1500s many European nations had built special institutions to separate the mentally ill from the rest of society. One of the most famous of such institutions was the St. Mary of Bethlehem in London which was built in 1247 and declared a hospital exclusively for the insane by 1547 It is widely known widely known as Bedlam. According to Butcher et al (2009), inmates suffered from unsanitary conditions, beatings and other harsh treatment. This included violent patients being used for shows display shows for the public to pay and watch, while gentler patients were sent to beg for charity on the streets.
A lot has changed in the United Kingdom especially with the relative improvement in the mental health institutions or hospitals and also with the emphasis on community care since the 1950s. In fact some see care in community, usually referred to as community care in as a replacement for hospitalization and any other form of institutionalization of people with mental ill health. However, these historical perspectives of mental illness can stick in people’s minds, and can still cause stigma today. Goffman(1961)
Skidmore (1997) describes community care to be the various services available to help individuals manage their physical and mental health problems in the community with dignity and independence in order to avoid social isolation. Similarly, Clough and Hadley (1996) explained that community care can be means of providing the right level of intervention and support to enable people to attain utmost autonomy and control over their own lives. The author notes that in order for these to be achieved, it will require support by formal and informal carers input
The development of community mental health care has evolved over a period of years as opposed to institutional care. Goffman (1961) stated that social and political changes influenced the movement away from isolation of mentally ill in old Victorian asylums towards their integration into the community. Currently, there are various services that have been put in place to support people who have mental health problems and are leaving in the community. These services includes (Sainsbury centre of mental health 2003)
Community care has historically always been financed through a mixed economy financed by both the state and by user’s charges, and provided by voluntary sector organisations, commercial profit organisations, the state and the family (Lewis. J). Social scientist have made an association with informal care to family member participation. Informal care has historically been the origins of the present day community care. The origins of the term community care appear too traced back to the Royal Commission on Mental Health and Mental deficiency (1957) which notes ‘The Development of Community Care’ (Bulmar 1987). However community care has a ‘multiple meaning’ (Bulmar 1987) and historical official use failed to distinguish these differences.
problem as it is a product in part of at least, the impact of political process and policy development.
According to Levites et al (2007), Social exclusion is a difficult and multi-dimensional process which involves the lack or denial of resources, rights, goods and services, and the inability to participate in the normal relationships and activities, available to the majority of people in a society, whether in economic, social, cultural or political arenas. Similarly, Townsend (1979) defines poverty as “the absence or inadequacy of those diets, amenities, standards, services and activities which are common or customary in society”. I will argue from the above definition that, social exclusion and poverty are linked. Pierson (2009) argues that government likes to use the term to hide poverty. Barker (2003) stated that in recent years the government has launched a range of initiatives to help tackle social exclusion and reduce inequalities which has specific objectives relating to education health, employment, crime prevention and wider social well being. These initiatives include the need for communities to put into action; supportive and innovative approaches in order to promote local involvement to support people with mental health problems, as this will minimize exclusion. The structure of care in the community (in relation with mental health) can lead to poverty because many people who experience mental distress, experience stigma and discrimination as well. These issues may make it hard for them to find adequate housing or access employment. As a result, people can become seriously isolated and excluded from society. If this also includes being excluded from working life, then this may lead to poverty. Social Exclusion Unit (2004).
Usual Mental Health Professional Team
There is now a range of more specialist community mental health teams (CMHTs) in the United Kingdom (UK) these includes: Home treatment, Crisis intervention, Early Intervention, First episode psychosis, ABT (assessment and brief treatment), Continuing care, Rehabilitation, Assertive Outreach and Forensic services. These teams are as a reform to government policy to promote community care. They work with people with mental health problems by helping them to become independent, working with them to develop their strengths, working together to resolve problems and many other supports that enables the promotion of wellbeing. A typical mental health professional team include the psychiatrists who prescribe medication, the psychologists who administer and interpret psychological tests, the psychiatric nurses who administer prescription medication and give injections, and the social workers who have specialized knowledge in assessing and planning treatment (Suppes and Wells, 2000).
The gradual transition from institutionalisation to community care since the 1950s is certainly not unhealthy. It only would yield no positive results if, borrowing the words of Skidmore (1994), people with mental health problem are not just decanted into the community without an identification of the informal carers.
Social exclusion is a major concern in promoting recovery for those experiencing mental health problems and if not tackled on time will discourage and lead to relapse for those who have experienced or facing these difficulties. Promoting social inclusion will usually includes promoting equal opportunities for those who are excluded and experiencing discrimination so I can therefore say there is a clear link between promoting social inclusion and promoting equality and diversity to alleviate poverty. I also believe that the Mental health practice which is currently driven by the National Service Framework which aims at reducing discrimination and social exclusion to improve mental health of the population should be supported by mental health professionals to build social inclusion into clinical practice by including in the care plans of users their aspirations for work, education, relationship and other chosen journeys of ‘recovery’.
The following recommendations are worthy of consideration in the bid to improve the current mental health system in the United Kingdom.
Research concerning how institutional and community care can be improved
Reduction of stigma against people with mental illness since that can jeopardize their speedy recovery whilst in the community.
Involvement of informal carers in decision-making regarding treatment of patients
Attend to the health needs of informal carers
Informal carers should be trained on how best they can take care of patients.
The British government should invest more in community care especially with the needs of patients in communities.
Deinstitutionalization should be done more gradually and carefully especially in the case of people with chronic mental illness.
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