Those With Mental Health Difficulties

Published Date: 02 Nov 2017

Introduction:

For the purpose of this assignment this student will examine and critically analyse how social determinants of health impact on the lives of those with mental health difficulties focusing in particular on sufferers of schizophrenia, identifying and discussing political actions taken to address inequities experienced by this social group. The World Health Organisation (2004) identified social determinants of health as:

"The social conditions in which people live powerfully influence their chances to be healthy. Indeed factors such as poverty, food insecurity, social exclusion and discrimination, poor housing, unhealthy early childhood conditions and low occupational status are important determinants of most diseases, deaths and health inequalities between and within countries"

Building on this, Bambra et al. (2005) suggests that, environmental factors also contribute to "…major determinants of health or ill-health…" having a basis in a socio-economic context, therefore giving rise to inequalities in health.

From a mental health perspective, this student will examine some of these social determinants of health and how they are possibly interconnected, examining what evidence of policies have been implemented to combat such inequalities and relevant outcomes. This will be achieved through the identification of what health and mental health is, looking at how the social detriments affect this specific group, the relevant policies and looking at possible health and social gain.

Health/Mental Health:

Not only does the WHO (2005) state that:

"…enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without the distinction of race, religion, and political belief, economic or social condition"

But it they also describe health as: "a state of complete physical, mental and social wellbeing ..." and further defining mental health as: (WHO 2001)

"… a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community"

It is suggested that one in four people worldwide will suffer with a mental health problem at some stage in their lives (Wittchen & Jacobi, 2005). From an Irish context there were 18,992 admissions (Health Research Board, 2012) to psychiatric hospitals in the State of Ireland during 2011, of which there are estimated to be just over 39,000 people suffering from schizophrenia (Schizophrenia Ireland, 2003). Sufferers of schizophrenia, due to the complexity and the biopsychosocial (Engel. 1977) nature of their illness are more predisposed to inequitable receipt of health care.

Evidence based research has shown that individuals with a mental health difficulty are prone to having a lower socio-economic status as outlined in the Central Statistics Office’s "Survey on Income and Living Conditions 2010" (CSO 2011), as direct correlation they are also at greater risk of been in "consistent poverty" (Combat Poverty 2004) due to the nature of their disability. The report also highlighted that higher levels of consistent poverty were reported when the head of the household was not working due to illness or disability while a lower risk of poverty was identified for those with private health insurance, a privilege that many suffers of mental health cannot afford, in fact the report goes on to point out that medical card holders were in fact at greater risk of poverty than non- medical card holders.

It must also be note that some state the "poverty can lead to mental health issues and vice versa". The experience of mental health difficulties and the challenges faced in recovery are compacted by the absence of social and economic supports such as access to housing, adequate income and social inclusion in education and employment (WHO 2010). Suffering an on-going mental health difficulty can have a significant impact on a "person’s sense of self" (Sheridan et al, 2012), their interactions with family and the wider community in general.

In general those diagnosed with schizophrenia have poorer physical health than the general population with reported higher rates of illness related to obesity (World Federation for Mental Health 2004), respiratory and cardiovascular disease (Lundbeck. 2006) related to smoking and possible side effects of anti-psychotic medications, indeed in one UK study Perkins and Rinaldi (2002) noted that employment rates for those diagnosed with schizophrenia decreased from 12% to 4.4% in a 10 year period.

It must be noted that it is not only the physical and biological nature of mental illness that can have a negative impact on an individual, sociological elements can also add to the vicious circle an individual and their families experience. Traditionally low birth weight babies (IPHI 2006) are born to those from a lower socio-economic groups, low birth weights is associated with developmental, educational and behavioural adversity, and this is before one even examines the possibility of these infants been genetically predisposed to the same mental health difficulties their parents may have been enduring.

Key Mental Health Legalisation:

There have been great advances in the provision of mental health care in recent times, two key Acts that underpin the delivery of mental health services in Ireland, are The Mental Health Act 2001(MHC 2001), The Disability Act 2005 and the Framework document "A Vision for Change" (Department of Health and Children 2006), these documents have come a very long way from the Prisons Act of 1787 and the demise of the old regional institutions/asylums.

The Mental Health Act 2001, implemented in November 2006, principal function is in the provision of protection afforded to patients been admitted to hospital either on a voluntary or involuntary basis, through the use of mechanisms that ensure standards of the delivery of mental health services in Ireland are met whereby he treatment and care of a person suffering from mental illness or a mental disorder under are under the clinical direction of a consultant psychiatrist. The Disability Act 2005 which provides the basis for independent individual needs assessment and a multi-sector approach to supporting disabled people.

One of the key principles of "A Vision for Change" involved the selling of the old psychiatric hospitals and reinvesting the funds into a community based delivery of mental health services and spearheading a framework for building and fostering positive mental health across the entire community and for providing specialist services for people with mental health difficulties.

Inadequacies in Health Funding:

Though these advances in provision of mental health service must be welcomed; there are great inadequacies in the funding for mental health services in Ireland. Prior to the demise of the "Celtic Tiger," mental health was due to be funded in part through the sale of the old styled institutional properties. €1.1Billion (non-capital) was spent on the provision of mental health services in 2008, this figure dropped to €770 million in 2009 and €712 million in 2011 (DoH 2012a). In 2010 spending on mental health services was 5.3% of the overall health budget, well below the 8.4% recommended in A Vision for Change, this decrease in funding also had a major detrimental effect on the direct provision of mental health care as mental health services account for 9 % of overall healthcare workers in Ireland, however, under the 2010 staff moratorium, 20% of the 1500 positions lost came from the mental health services.

Ireland has a unique combination of funding for the provision of health care through private health insurance (10%), out of pocket payments (15%) and taxation (25%) (The Adelaide Hospital Society, 2010) this creates a "two tier system" by allowing those who can afford it to "purchase" their primary care, thus allowing "financial means, rather than medical needs determine access." This is recognised by the Government in their document "A Strategic Framework for Reform of the Health Service 2012 – 2015" (DoH 2012b) which clearly acknowledges that that the current provision of health services -including mental health- dose not meet current demands, offer value for money and is unfair to patients. As a result, not only will the current provision for health under the HSE be amended but also there is the proposal of introducing a single tier health service, in an effort to create a more equitable health service. Though welcomed this must be treated with caution as the HSE (DoH 2013) advise that to in the provision of the Minister of Health’s framework document "Future Health," there will be a direct impact the delivery of frontline services. Frontline services directly affect the patient experience and the level of care received.

Conclusion:

A recent Health Research Board funded study (HRB 2012) found those with Type II Diabetes also present with other "multiple chronic conditions" including mental health difficulties, suggest that there needs to be a move away from "disease specific interventions" and move towards" managing multiple" conditions with an awareness of the "broader spectrum". Videbeck (2008) concurs with this, advising that recovery in mental health expands beyond managing symptoms and medications to include rehabilitations back into the community, enablement, independence and an "improved quality of life"

Through researching for this assignment this student feels that there have been plausible advances in the treatment of persons suffering with mental health difficulties within in Ireland and these must be commended, however, as O’Rourke and Hammond (2005) maintain, no single group exclusively functions in the provision of mental health services. Irrespective of the current economic climate there needs to be a multi-dimensional review of current policies, and a collaboration of all stake holders in the implementation of future policies pertaining to the provision of mental health services.