MOD004717 Contemporary Issues In Mental Health Care

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MOD004717 Contemporary Issues In Mental Health Care

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MOD004717 Contemporary Issues In Mental Health Care

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Course Code: MOD004717
University: Anglia Ruskin University

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Analysis and review the case study of contemporary issues on health.

This essay aims to discuss the causes of dementia and its implications. A case study of a confident Mr Davis is presented to understand the issues and its relevance. Also, a detailed review of the prevalence, ethical issues and critical analysis of the government and social policies and regulations associated with dementia are conducted.
Mental health is one critical part of a sustainable society. It is an issue that affects people of all ages. Mental illness is something which must be handled with care and sincerity, yet most of us don’t know how to treat mentally ill patients. In 2014 a survey of Adult Psychiatric Morbidity reported 17% of the surveyed suffering from a mental disorder and out of that 37% of them were actually under treatment. The most common forms of mental issues faced by the society are depression, anxiety, panic attack and dementia (The King’s Fund, 2018). Other rare types of mental disorders are schizophrenia, kleptomania etcetera. Mental health is also an issue for new mothers and pregnant women, or those who suffered miscarriage and loss. The effects of mental health are far and wide as it leads to risky behaviours, such as drug abuse, physical violence, suicide and murder. It is thus essential to understand the conditions and causes of the illness and the ethical implications towards its treatment. Also, a brief understanding of the policies that safeguard these patients and the society is crucial to make a critical analysis.
Dementia is a form of brain disease that leads to loss of memory and decreases a person’s ability to remember, and identify people or comprehend things. Dementia takes a toll on the life activities of a person as they slowly lose purpose, motivation and will towards life. Dementia is a total of symptoms that indicate forgetfulness, unable to communicate and understand language, unable to focus and loss of reasoning and thinking capacity. The common form f dementia is Alzheimer’s which affects the elderly. Stroke causes vascular dementia. Other causes of dementia could be accidents, thyroid problems and vitamin deficiency. These types of dementia are mostly curable whereas, cases of Alzheimer’s worsen with time. Dementia generally consists of three stages through which the patient goes through. The early stage comprises of loss in memory and difficulty faced in planning. The intermediate stage shows more significant loss of memory short term and long term and difficulty in reasoning. It is advisable not to leave such patients alone. In the ultimate stage, a dementia patient needs external care and guidance from caretakers and family to live their life. Such patients are prone to accidents and erratic behaviours (Siddique, 2018).
Dementia has been one of the most critical issues of mental health in the United Kingdom. With the population on the rise and high life expectancy, there have been a rising number of dementia cases in the country. Among these Alzheimer’s has been the most common contributing factor.  A report by the NHS England shows that 676,000 people in England and 850,000 people in the UK have dementia. Out of these, the majority of the patients fall under the 65years and above age bar, however, a significant number of the youth have also been diagnosed. But figures have also shown that the risk of developing dementia in each age group is falling significantly, wing to the preventive strategies and treatments. It is found that in the present UK spends over £23bn a year for dementia (England, 2018). It is estimated that 1.2 million people will have dementia by 2040 and thus it is essential that the country accumulates enough funding and support. This assignment aims to discuss the causes of dementia and its implications. A case study of a confident Mr Davis is discussed to understand the issue and its relevance. Also, a detailed review of the prevalence, ethical issues and a critical analysis of the government and social policies and regulations associated with dementia are conducted.
Case Study
Mr Davis is a 78-year-old man who lives with his wife. His only daughter is married and lives in a different nation. He has two grandsons, and they visit him occasionally. Mr Davis has been employed for more than 30 years in a printing company and has retired at the age of 60. Mr Davis had a very a professional life and was on good terms with his staff and colleagues. Socially he was an amiable person with a great persona. He visited clubs and had a proper functioning memory until 12 years ago when he was diagnosed with a case f Alzheimer’s. It took Mrs Davis before she could understand completely what her husband was going through. She started identifying the symptoms a little late. She detected significant changes in her husbands, behavioural pattern and how it affected his memory and thinking capacity. Initially, Mrs Davis has been the sole caregiver for Mr Davis, and she accompanied her husband to the Daycare centre and the doctor’s chamber. Later, Mrs Davis appointed a carer who visited their home twice a week to help Mr Davis with personal care. The carer at the day centre stated that Mr Davis did not show any interest or curiosity in the activities and had been refusing to take part in anything. Mrs Davis also noticed a substantial loss of interest in matters in Mr Davis. Thus, it was assumed that Mr Davis had lost feeling pleasure in life and his activities.
Mr Davis was reported lost quite a few times and as found at odd places and odd hours. Mr Davis was puzzled and felt unbalanced due to this reason. He could not wholly comprehend time and missed his meals, forgot to bath, take his medications or of his Doctor’s appointment. Mr Davis had to be kept under surveillance for 24 hours. In the last few months, it has been noted that Mr Davis’ mental and physical health drastically deteriorated as he could no longer sustain his life without the assistance of his wife and the carer. Mr Davis’ case worsened as he was hospitalised for a urinary tract infection. After returning from the hospital, significant changes in the sleeping pattern and behaviour was witnessed. Mr Davis would lay awake at night, and try to get up. With time, Mr Davis turned crank and became physically and verbally aggressive and violent. Thus, Mrs Davis contacted Mr Davis’ general Physician as well as the community mental health team, and psychiatrists. The social workers and the department of health helped Mrs Davis with her husband and took an active part in raising dementia awareness among the people in the community. Unfortunately, Mrs Davis is looking toward placing her husband in the care of a Nursing home for better care.
A critical discussion of the issues raised in the case study
At present, there is an estimate of 850,000 people in the UK who are suffering from dementia. This figure is expected to rise in the future. A consultation report on Alzheimer’s Research shows that 1 in 3 people born this year might develop dementia. The research also suggests that people over 65 are most likely to develop dementia, as already seen in the case of Mr Davis. Dementia is reported in 1 in 79 out of the entire UK population and 1 in every 14 among people aged 65 and above. While age is considered the biggest risk of dementia, the high life expectancy is the reason behind the rise in dementia. It is also seen, that the higher life expectancy in women means they are more prone to the disease. About 2 million people who have dementia is estimated for the year 2051 (Dementia Statistics Hub, 2018). The UK has seen an early onset of dementia in over 40,000 people. Although, it is a preconceived notion that dementia affects only the elderly significant number of younger people also suffer from it. The condition is worsened by the lack of public health intervention and awareness in the society. The cost of dementia in the UK economy is roughly £26.3 billion, out of which NHS pays 4.3 billion and social care 10.3 billion. Two third of the cost is carried by the patient and their family in unpaid care or private social care. Mr Davis was diagnosed with dementia 12 years ago, he is 78 years old now, and hence at that time, he was 66years old. Mr Davis’ age during the onset f the disease places him in the prevalent group of the population. Such issues common in the country and the high cost born by the economy is a major concern for the health standard of the country. Special attention and actions must be taken immediately to lower the numbers as forecasted by the research.
Dementia is not a specific disease but a summation of the symptoms. It results from the damage in brain cells. This damage inhibits the ability of the brain cells to communicate with each other. This, in turn, affects the thinking capacity, behaviour and feelings.  The brain has different regions for different functions like judgement, movement and memory. Thus when cells in a particular region are damaged, it affects the function related to that region. The different kind of dementia depends on the region of the brain affected (Alz.org, 2018). If we look into Mr Davis’ case of Alzheimer’s, it is the high level of some specific proteins inside and outside the brain cells make them harder to stay healthy and communicate with each other. The region affected by this is called the hippocampus, which is the region of learning and memory for the brain hence, in Alzheimer’s; it is the memory which is impaired first. This process is called neurodegeneration. Cerebrovascular dementia is caused by strokes, where blood vessels reduce the flow of blood and oxygen to the brain thereby damaging its cells. Certain infections from bacterias, viruses and parasites also damage brain cells causing memory loss and dementia. Dementia also causes an unbalanced diet, malnutrition, drug overdose and metabolic disorders. Other factors leading to dementia are serious head injury and concussions which damage brain cells. Thus, the urinary infection in Mr Davis could also have worsened his condition. Although most cases of dementia are permanent, memory loss and thinking can still be recovered as they are often caused by depression, medicinal side effects, alcohol abuse and chemical imbalances.
Theories and Concepts
Dementia is an ailment that affects an individual’s memory, logical reasoning, attitude towards life and behaviour toward their loved ones and at people in general. There are very few theories that describe the development of dementia and how it should be treated. It is seen that people who have dementia tend to alienate themselves from the society. In case of Mr Davis, he felt lonely and depressed after his retirement. He missed his colleagues and friends at the club and had his wife for company. His daughter and grandkids visited him rarely, and so his life turned mundane. In this context, the attachment theory could be applied to understand dementia in the elderly (Freitas, 2015). The attachment bonds play an important role in maintaining mental health in a person. Thus, according to this theory strong emotional as well as the physical attachment of an individual with their society and primary carer is essential towards personal development. In case of Mr Davis, the loss of attachment to his friends and family onset dementia, and eventually, it leads to his de-attachment with his wife. The theory of cognitive development could also be applied in this scenario. According to Matteson, Linton and Barnes (1996), the loss of cognitive abilities makes a person show regressive behaviour and act in a childlike manner. Mr Davis, getting lost and his verbal and physical aggressiveness have been an effect of the cognitive disturbances and disorientation he felt. In this regard, the Theory of mind can be applied which states that cognitive development is a result of the individuals capacity to understand the emotional state and connect with the caregiver (Gregory et al., 2002). Mr Davis failed to connect and understand the mental state of his wife and his carers and thus lead to a fall in his cognitive development. Mrs Davis resorted to community healthcare and government help as Mr Davis failed to respond to her.
Ethical Issues and Principles
Dementia has been a significant factor in the high mortality rate beyond 80. Dementia could lead to voluntary death like suicides and even accidents. It is necessary that a person suffering in the later stages of dementia is kept under constant supervision and surveillance. There are quite a few ethical issues associated with dementia. In the case of Mr Davis, his relationship with his wife and caregiver deteriorated along with his condition (Schulz and Martire, 2004). It is a complicated issue, as his cranky behaviour irritated the carer, it is his/her duty to treat Mr Davis as a child and not as a mature adult. Mr Davis also abused his wife verbally and his misdemeanour affected his wife mentally and psychologically. Hence, Mrs Davis decided to put her husband in 24 hours care in a nursing home (Hughes and Baldwin, 2006). This could be ethically incorrect as an attachment and connect with loved ones have always proved to be a developmental factor. However, Mr Davis started spending sleepless nights and was often lost and found by the Police, and this had Mrs Davis in a very complicated situation. It must be taken into account that Mrs Davis is the primary guardian of Mr Davis after his dementia and that kind of responsibility on an aged woman like Mrs Davis is also unethical. Thus the ethical principle of justice must be considered in this regard. The theory suggests that each person should be given what they deserve and hence, both Mr Davis and Mrs Davis require empathetic behaviour. Since Mr Davis has lost his cognitive abilities and is physically unable to sustain his life, he needs somebody to take care of him intimately. While Mrs Davis’ action of taking him regularly to the day-care centre was physically assaulting, yet her decision of employing a carer at home to help her was a superior decision-making (Woods and Pratt, 2005). However, it is harmful in context to the principle of non-malfeasance that is against causing harm. In this case, it should be the duty of the daughter to come to her parents’ aid. An emotional connection with his grandsons would have also been effective in this scenario. At this point, it must be said, any negative behaviour from the patient like Mr Davis should not be taken into account. However, Mrs Davis’ decision to put Mr Davis in a nursing home was hasty and immoral.
Dementia has been a growing concern for the government of UK. With the high life expectancy, dementia has become one of the most critical health and care issues that have rocked the nations. The growth figures and the billions spent on dementia have made it a key priority for NHS England and the government. The government and NHS are spending heavily in formulating policies and legislation, which will not safeguard the patients but also the families, and the social carers. Therefore, it is important to discuss the various laws and regulations associated with dementia care and how it affects the society (Alzheimer’s Society, 2018).
The Mental Capacity Act 2005 covers the rights of the caregivers who help those without the thinking capacity. Its key principles are the presumption of capacity, supporting individuals in decision making, individuals’ freedom to make unwise decisions, acting in the best interest. The Act tests a person’s ability to take particular decisions. It also provides power of attorney and mechanisms to provide the patient with some control. It is essential for the caregivers to stick by the code and understand its implications. This Act protects the deprivation of liberty. It is unlawful for any individual to deny some other individual of their freedom aside from in specific situations and with due lawful authorisation. However unfair use of the liberty is an unforeseen limitation (Housinglin.org.uk, 2018).
The Equality Act 2010 was introduced because of the discriminations between the dementia patients as well as their carers. When adequate support and medical assistance is not provided to a patient with dementia and the carer, it is a violence of human rights. The reason behind such acts is a social stigma, ageism and inability to retaliate. The Equality Act 2010 dictates that dementia patients would be treated equally regardless of their age, caste, gender, religion, colour and sexual preferences. The Act also offers provision to the care providers to provide complete support to the patients and make adjustments so that the dementia patients are not alienated by society (Mind.org.uk, 2018). The Alzheimer’s society has stopped discrimination against people without mental capacity, the old and the young as well as migrants and minorities in the UK. But, the Equality Act 2010 still suffers from some limitations such as UK employers still do prefer employees who have dementia regardless of their age. This alienates the patients from the society who seek support.
The National Dementia Strategy was developed in 2009 and works towards creating a dementia service throughout the country that will ensure dementia awareness in all age groups and enable early identification and diagnosis of the disease. The strategy aims to provide step by step assistance and quality treatment to those suffering. The positive implication of this strategy is 100 percent support from healthcare homes to the patients and their carers reducing risks and accidents. However, it restricts the equality and liberty of the patients and carers (Greaves & Jolley 2010). In case of Mr Davis, this strategy would be highly effective as he would be under care for 24 hours.
The Dementia Challenge launched by Prime Minister in February 2015 has set a goal for 2020 to promote the UK as the top country in dementia care and support. The legislation also aims, to make the country most suitable for research in dementia and neurodegenerative diseases. The vision of the legislation is to encourage the GPs, to actively help promote dementia awareness and care throughout the UK an ensure coordination with the community for caring the patients. It aims, to provide all NHS staff quality training to provide the best care to the dementia patients. Mr Davis and his wife would be benefitted with this legislation as they will be actively taking in the care process and generate awareness. Although, there is a certain limitation to this legislation, as it does not provide same opportunities to the young patients and those without Alzheimer’s (Davis, 2004).  Such limitations have prevented the UK from completely subverting the ill effects of dementia.
Mental health is a serious issue, and dementia has been a major concern for the government and economy of UK. Dementia is essentially a result of brain cell damage caused by neurodegeneration, strokes, infections, accidents and malnutrition. Its symptoms are memory loss, low thinking capacity, inability to comprehend and reasoning. Alzheimer’s is the most common form of dementia that has affected Mr Davis our subject for a case study. He was diagnosed with it at 66years of age, placing him in the prevalence population of above 65 years. The theory of attachment towards caregiver and cognitive development has been applied to understand dementia and its role. Mr Davis’ case has two-folded ethical issues linked to the principle of Justice and non-malfeasance as to how his wife treated him. Finally, a critical analysis of the laws and legislation of UK are conducted. Policies stated by the Mental Capacity Act, Equality Act, National Dementia Strategy and Dementia Challenge aims to provide anti-discriminatory and complete support to the patients with dementia and their caregivers. Although there are some limitations to these legislations, a proper understanding of their implication would prove beneficial for health and social carers to spread awareness and reduce the risk.
Alz.org (2018) Dementia – Signs, Symptoms, Causes, Tests, Treatment, Care | alz.org. [online] Available at: https://www.alz.org/what-is-dementia.asp [Accessed 17 May 2018].
Alzheimer’s Society (2018). Dementia UK report. [online] Available at: https://www.alzheimers.org.uk/about-us/policy-and-influencing/dementia-uk-report [Accessed 17 May 2018].
Davis, D. (2004). Dementia: sociological and philosophical constructions. Social Science & Medicine, 58(2), pp.369-378.
Dementia Statistics Hub. (2018). Prevalence by age in the UK | Dementia Statistics Hub. [online] Available at: https://www.dementiastatistics.org/statistics/prevalence-by-age-in-the-uk/ [Accessed 17 May 2018].
England, N. (2018). NHS England » Dementia. [online] England.nhs.uk. Available at: https://www.england.nhs.uk/mental-health/dementia/ [Accessed 17 May 2018].
Freitas, J. (2015). The dementia concept. Massachusetts: Blue Sail.
Greaves, & Jolley, , 2010. National Dementia Strategy: well intentioned — but how well founded and how well directed? NCBI, 60(572), pp.193-98.
Gregory, C., Lough, S., Stone, V., Erzinclioglu, S., Martin, L., Baron?Cohen, S. and Hodges, J. (2002). Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer’s disease: theoretical and practical implications. Brain, 125(4), pp.752-764.
Housinglin.org.uk. (2018). Legislation – Dementia – Topics – Resources – Housing LIN. [online] Available at: https://www.housinglin.org.uk/Topics/browse/HousingandDementia/Legislation/ [Accessed 17 May 2018].
Hughes, J. and Baldwin, C. (2006). Ethical issues in dementia care. London: Jessica Kingsley Publishers.
Matteson, M., Linton, A. and Barnes, S. (1996). Cognitive Developmental Approach to Dementia. Image: the Journal of Nursing Scholarship, 28(3), pp.233-240.
Mind.org.uk. (2018). Equality Act 2010 | Mind, the mental health charity – help for mental health problems. [online] Available at: https://www.mind.org.uk/information-support/legal-rights/disability-discrimination/equality-act-2010/#.Wv21vZq-nIU [Accessed 17 May 2018].
Schulz, R. and Martire, L. (2004). Family Caregiving of Persons With Dementia: Prevalence, Health Effects, and Support Strategies. The American Journal of Geriatric Psychiatry, 12(3), pp.240-249.
Siddique, H. (2018). Dementia and Alzheimer’s leading cause of death in England and Wales. [online] the Guardian. Available at: https://www.theguardian.com/society/2016/nov/14/dementia-and-alzheimers-leading-cause-of-death-england-and-wales [Accessed 17 May 2018].
The King’s Fund. (2018). Mental health. [online] Available at: https://www.kingsfund.org.uk/topics/mental-health [Accessed 17 May 2018].
Woods, B. and Pratt, R. (2005). Awareness in dementia: Ethical and legal issues in relation to people with dementia. Aging & Mental Health, 9(5), pp.423-429.

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