Care And Treatment In Mental Health Institutions

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Care And Treatment In Mental Health Institutions

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Care And Treatment In Mental Health Institutions

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Discuss about the Care and Treatment in Mental Health Institutions.

The recovery in the mentally-ill patients have been discussed from various angles in the theory and often found conflicting definitions (Barker, & Buchanan-Barker, 2011). The clinical recovery assumes that a patient is ill and requires treatment (ibid). This assumption may conflict with personal recovery where a patient may not have any clinical signs & symptoms but his/her self-esteem, confidence, productivity, social & economic life, have been shattered due to past mental illness and need to be recovered. The following sections discuss various recovery principles; the difference between clinical recovery and personal recovery in context with Janet’s stories.
Following are the basic recovery principles as agreed in SAMHSA (Substance Abuse and Mental Health Services Administration) conference on Mental Health by American Psychological Association.

Patients themselves decide their path and direction to recovery.
The recovery pathways depend on individual patient’s strengths, weaknesses, socio-cultural background, experiences and personal preferences.
The patients must be empowered to participate in decision making.
The recovery should be holistic and comprehensive covering all aspects of lives – physical, social, psychological and spiritual.
There may be occasional set-backs in recovery making it a non-linear process but is learning continuously and thus growing forward.
There is need to build up on strengths of an individual while recovering.
The mutual peer-support is indispensable in recovery.
There is a need to accept the patient and appreciate him/her by communities and societies.
The patients should be motivated towards self-care and self-recovery.
The recovery should aim towards a better future of the patient by over-coming all the obstacles.

The story of Janet
In case of Janet, the sexual abuse at a tender age from a known relative was a major disturbing factor which shaked-up her trust in the surrounding world. In the version one of her story she was not even able to achieve clinical recovery. She reached a stage in her life where there was absence of psychosis and auditory hallucinations; but she was in a vegetative state, just eating, sleeping and watching TV. She was still lucky to be in a developed country where she could survive like this by means of social security schemes. In less developed nations where there is no social security or if there is any it is only on papers; the condition of mentally-ill patients is even bad. In such countries, no work means, no food, and mentally ill patients being unproductive are thrown out of homes by their relatives and ended up being in mental hospitals, where the conditions are pathetic. Sometimes they do not even get clothes to cover their body and they are treated as pure animals and do not even get clinical recovery (Kochher & Sarkar 2012).
Coming back to Janet’s story; in version one, though there was absence of clinical signs and symptoms, which may be taken as clinical recovery by few, she was unproductive, not having any meaning in life, and her self-esteem was completely shattered. Mental illness results in an invisible disability that lasts throughout the life of a mentally ill patient and could only be minimised with the passage of time through personal empowerment. Personal recovery is an unending search for finding significance in the life of patients suffering/suffered from mental illness (Kidd, Kenny, & McKinstry, 2015). Mentally ill patients generally face ill-treatment and discrimination in each and every aspect of their lives including clinical recovery pursuits and they need to find solutions through multilateral dialogues, discussions and participation in social life (ibid).
Janet, in version one, also dropped out from her Nursing school as she believed that she could not perform well. The problem of internalised stigma is also very prevalent among patients suffering/ suffered from mental illness (Erilich-Ben et al 2013). They have faced social stigma, ignominy and ostracism throughout their life and as a result of it they internalise the feeling of stigma and develop inferiority complex. Their self-esteem and self-respect get shattered. They have been despised by everyone they came in contact with; which precipitated in the form of social withdrawal behaviour among such patients (ibid). Thus it becomes very imperative to help these patients find a meaning to their lives. After quitting nursing school, her alienation deepened further which could have been avoided at the first place, like in version two.
Clinical recovery Vs Personal recovery
The medicalised model of mental illness is an individualistic model which sees mental illness as purely hereditary and solely blames the individual and his/her genes for mental illness and thus treatment is also paternalistic which sedates the patient most of the time to make sure he/she does not pose any threat to sophisticated society, it also requires institutionalisation most of the times (Beresford, Nettle, & Perring, 2010). The existing recovery measures are rather penalising and are based on mere absence of pathological signs and symptoms (Burgess et al 2011). This was quite evident in the version one of Janet’s story. How she was penalised further by police when she got a psychotic attack. The nurse at the psychiatric ward also behaved the same way. Her sexual abuse history was also taken lightly by psychologists/ psychiatrists. No effort was done to find out the roots of her psychiatric problem and so the solutions in the version one of story. It seems as if whole profession was about selling some psychiatric drugs and injections in the name of psychiatric patients and munching money. There was no empathy by anyone towards Janet.
The social model of mental illness, on the other hand, looks at the social context of mental illness and aims towards social reforms and rehabilitation of mentally ill patients in the society by teaching them skills, bringing them into mainstream, providing them positive social environment, raising their confidence, believing in them and making them believe in themselves (ibid). The version two of the Janet’s story is an example of social model of mental illness. How everyone in the profession showed empathy towards her and offered help. She was accommodated well. She was helped out in completing her studies. She was also helped out in getting some music lessons for a faster recovery. She was also offered a job of mental health nurse so that she could find a meaning to her life, inspite of the fact that she could survive well on social security benefits in the country. Because life is much more than mere survival and so is the case with patiens with mental illness.
The personal recovery is much more than clinical recovery and involves a sense of wellness at all psycho-social levels (Brennaman & Lobo 2011). It includes a feeling of self-worth, self-esteem, desire to live to the fullest potential, and a sense of complete physical, mental, social, and spiritual well-being (ibid). Personal recovery includes positive thinking, hope, peers support, social security including job, housing and education (Cheng et al 2009). The interpersonal skills, team working, being social and sharing knowledge with and from others; are also important aspects of personal recovery (Cleary & Dowling 2009). All these psycho-social aspects of life were taken care of, in version two of Janet’s story, but were denied in the version one.
The incorporation of patient’s perspective and their participation while formulating recovery plans for them; is very essential for achieving the goals of personal recovery in addition to clinical recovery (Drieta, Agrest, Druetta, 2011). In Janet’s story version 2, she started working as a mental health nurse, which could be very beneficial for mental health services; because she can take help from her own experiences about what should be done and what should not be done while dealing with patients under psychosis.
In Australia department of health has come up with Framework for Recovery oriented Practice where the department has emphasized personal recovery and its various components (Department of Health 2011). It is very important to adopt a wellness approach while formulating recovery plans (Swarbick 2012). The patient has to be considered in totality with his personal and social environment, his/ her feelings and emotional/ psycho-social life (ibid). It is appreciable that governments are taking steps for mental and psycho-social well-being of its citizens. There is no separate group of citizens as mentally-ill, but any of our citizens could turn-out to be mentally ill, if social systems are not put in proper place. There is a need to maintain equity, harmony and social justice in our societies. Therefore the persons suffering/ suffered from mental illness can-not be ignored, because they reflect our own societies and social systems, which they are a part of; and their fundamental human right of a personal recovery needs to be taken care-of.
Thus I would like to conclude on a note, that a mental health nurse should have a holistic understanding of the subject and should learn clinical-reasoning skills which are more than mere clinical judgement and require an understanding of psycho-social aspects of life (Levett-Jones 2013). A nurse should be empathetic towards his/her patients including and especially mentally-ill patients. The goal of a nurse for such patients, should be their personal recovery which includes their self-esteem, self-worth, happiness, psycho-social welfare and achievement of self-realisation in life.
Barker, P, J, & Buchanan-Barker, P. (2011). Mental health nursing and the politics of recovery: a global re?ection. Archives of Psychiatric Nursing, 25(5), 350–358.
Beresford, P, Nettle, M, & Perring, R. (2010). Towards a Social Model of Madness and Distress? Exploring What Service Users Say. Joseph Rowntree Foundation, London.
Brennaman, L, & Lobo, M,.L. (2011). Recovery from serious mental illness: a concept analysis. Issues in Mental Health Nursing, 32, 654–663.
Burgess, P, Pirkis, J, Coombs, T, & Rosen, A. (2011). Assessing the value of existing recovery measures for routine use in Australian mental health services. Australian and New Zealand Journal of Psychiatry, 45(4), 267–280.
Cheng, R, Church, K, Costa, L, Moffatt, K, Mohammed, S, Poole, J, Reveille, D, & Stakehouse, R. (2009). Mental Health ‘Recovery’: Users and Refusers. What do Psychiatric Survivors think about Mental Health Recovery? Wellesley Institute, Toronto, ON. Available from: https://homeless.samhsa.gov/ResourceFiles/ummknsjl.pdf, (17 April 2017).
Cleary, A, & Dowling, M. (2009). The road to recovery: Anne Cleary and Maria Dowling examine the literature that focuses on the principal concepts of recovery in mental health and explore the importance of interpersonal skills, collaborative working and sharing knowledge. Mental Health Nursing Practice, 12(5), 28–31.
Department of Health (2011). Recovery-orientated Practice Literature Review. Victoria Victorian Government, Melbourne.
Drieta, A, M, Agrest, M, & Druetta, I. (2011). The concept of recovery: the importance of user perspectives and their participation. Revista Argentia de Psiquiatria, 22(95), 56– 64.
Erilich-Ben, O, S, Hasson-Ohayou, I, Feingold, D, Vahab, K, Amiaz, R, Weiser, M, & Lysaker, P, H. (2013). Meaning in life, insight and self stigma among people with severe mental illness. Comprehensive Psychiatry, 54(2), 195–200.
KIDD, S, KENNY, A, & MCKINSTRY, C. (2015). The meaning of recovery in a regional mental health service: an action research study. Journal of Advanced Nursing, 71(1), 181–192. doi: 10.1111/jan.12472.
Kochher, J, S, & Sarkar, U, N. (2012). Care and Treatment in Mental Health Institutions– Some Glimpses in the Recent Period. National Human Rights Commission, India.
Levett-Jones, T. (Ed.). (2013). Clinical reasoning: Learning to think like a nurse. Frenchs Forest, NSW: Pearson.
Swarbrick, M. (2012). A wellness approach to mental health recovery. In Recovery of People with Mental Illness. Philosophical and Related Perspectives (Rudnick A., ed.), Oxford University Press, Oxford, UK, pp. 30–38.

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