Mental disorder – Page 2 – Best Essay Writers

Mental Health Consumer Care

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Mental Health Consumer Care

“How would you feel when almost every individual within the society treats you differently by avoiding any form of interaction? Well, no one prefers to be treated that way. Mental health consumers are more often marginalized because of their mental state. This aspect can worsen their entire being and situation, which can propel them to neglect the self. By definition, a mental health consumer refers to persons who use mental health services in order to empower their mental health status while obtaining support or treatment.

Evidently, suffering from mental illness can be devastating to a patient and that situation can affect various aspects of their lives ranging from their physical status to their emotional being. On the other hand, self-neglect refers to the behavioral situation in which a person neglects or fails to attend to their personal basic needs such as feeding, appropriate clothing, tending appropriately to medical conditions, feeding or personal hygiene. Nonetheless, in extreme cases of self-neglect, the situation can be inferred to as Diogenes syndrome (Townsend, 2013).

Despite the severity of self-neglect in a mental health consumer, nursing professionals need to care for them in an attempt to improve their mental health issues. This presentation focuses on the relevance of nursing care of mental healthcare consumers who self-neglect to modern mental health nursing as well as to recognize the appropriate linkages with other mental health care providers.

In order to appropriately identify patients suffering from mental health problems, it is ideal to identify the various aspects that help in identifying them or the factors that assist in characterizing them. Most cases involving self-neglect are often recognized as a result of numerous complaints received from several sources such as community organizations, neighbors, GPs and healthcare professionals (Naik, Lai, Kunik & Dyer, 2008).

The process of managing and identifying cases is very complex and difficult, which requires a multi-disciplinary and multi-agency approach. Based on several studies, individuals with mental health problems are often poor and indulge in smoking habits, lack exercise, consume alcohol, have poor diets and consumer other drugs (Middleton, 2008; Richardson, 2007). The deteriorating state of their daily lives often affects their energy levels, organization skills, attention, physical abilities or motivation.

The effect on the patient can cause them to neglect the self. Studies also indicate that the side effects of certain psychiatric medications can cause a decrease in the motivation levels among mental patients (Townsend, 2008; Gunstone, 2003). Therefore, self-neglect among mental patients can be caused by illness alone. With the help of medical practitioners including nursing care cases of self neglect among mentally ill patients re likely to reduce.

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Notably, nurses constitute the largest population of health care professionals, thus, they have a key role in the management and identification of self-neglect among mentally ill patients. The relevance of nursing care to mental healthcare consumers in the modern nursing practice can be identified through the assessment, diagnosis, outcome identification, planning, and implementation and evaluation steps (Peate, Wild, & Nair, 2014).

In the initial process, nurses establish a database in which the database relates to the client using assessment tools such as KELS, geriatric depression scale and nutrition assessment (Pickens et al., 2007). The next process involves identifying the patients’ health care needs as well as the specific goals for care. The third process involves establishment of the specific criteria that measures the achievement of anticipated outcomes while the forth process involves designing the most appropriate strategy that facilitates the achievement of the desired goals.

The implementation process involves initiating and finishing actions that are necessary in accomplishing goals as the final process involves determination of the degree to which the objectives and goals of the implemented care have been achieved (Boyd, 2010). Through this sequential step, a nursing practitioner is capable of analyzing personal achievements in relation to providing care to patients, especially those with mental illness and having self-neglect. The outcomes of this process help both the nursing specialists and other medical professionals to identify the various steps that in deed help in solving the problem of self-neglect among mentally ill patients, for future referencing.

Currently, the nursing profession is working towards providing holistic care to patient. This means that other than assisting patients within hospitals, nurses also help patients outside the hospitals such as acceptance within the society. With reference to mentally ill patients, they are among the mostly segregated groups of people within the society. The nursing education helps in providing additional knowledge to nurses and it is disseminated to the public by informing them that mentally ill patients are just like other people with slight differences in their ways of thinking and making decisions.

Some of the interventions include adult protection services, drug misuse rehabilitation, housing services, budgeting services and neurological assessment among many others (Lauder, Anderson & Barclay, 2005). These shape the current approach in providing care to patients by integrating friendly approaches towards the patients. By dealing with cases of self neglect, nurses are capable of reducing the stigma that mental patients receive, which in turn promotes their general well-being.

In conclusion, within the modern nursing field, practitioners are more propelled towards the identification and management of self-neglect cases among mentally ill patients as a means of preventing the reoccurrence of the phenomenon. Since nurses constitute the largest portion of individuals within the health care sector, they play a chief role in ensuring the provision of proper care to patients.

In the nursing profession, taking care of mentally ill patients helps in identifying the most appropriate ways of providing care. Treating mentally ill patients with self-neglect issues helps in improving the health of the patients in general.”

References

Boyd, M. (2010). Psychiatric nursing: Contemporary practice. Philadelphia: Lippincott Williams & Wilkins. https://books.google.co.ke/books?id=a-GcGVtBnqQC&pg=PA893&lpg=PA893&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=H7F7RnZ_WT&sig=hFRFTS4lxe5tl53BEFM-1drGcpA&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Gunstone, S. (2003). Risk assessment and management of patients whom self-neglect: a ‘grey area’ for mental health workers. Journal of Psychiatric and Mental Health Nursing, 10, 3, 287-296. http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2850.2003.00568.x/abstract

Lauder, W., Anderson, I., & Barclay, A. (2005). A framework for good practice in interagency interventions with cases of self-neglect. Journal of Psychiatric and Mental Health Nursing, 12, 2, 192-198. http://www.ncbi.nlm.nih.gov/pubmed/15788037

Middleton, J (20 June, 2008). Self-neglect 2: nursing assessment and management. Nursing Times. Retrieved from http://www.nursingtimes.net/roles/older-people-nurses/self-neglect-2-nursing-assessment-and-management/1584631.fullarticle

Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Geriatrics, 63, 2, 24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847362/

Peate, I., Wild, K., & Nair, M. (2014). Nursing Practice: Knowledge and Care. Hoboken: Wiley. https://books.google.co.ke/books?id=xqXCBwAAQBAJ&pg=PA250&lpg=PA250&dq=Nursing+Care+of+Mental+patients+Who+Self+%E2%80%93+Neglect+relevance++to+contemporary+mental+health+nursing.&source=bl&ots=a6pjAEpAMS&sig=XBJXGriVDaILTkHpVefKU3FG_2o&hl=en&sa=X&redir_esc=y#v=onepage&q=Nursing%20Care%20of%20Mental%20patients%20Who%20Self%20%E2%80%93%20Neglect%20relevance%20%20to%20contemporary%20mental%20health%20nursing.&f=false

Pickens, S., Naik, A. D., Burnett, J., Kelly, P. A., Gleason, M., & Dyer, C. B. (2007). The utility of the Kohlman evaluation of living skills test is associated with substantiated cases of elder self-neglect. Journal of the American Academy of Nurse Practitioners, 19, 3, 137-142. http://www.ncbi.nlm.nih.gov/pubmed/17341281

Richardson, B. K. (2007). Psychiatric nursing. Clifton Park, NY: Thomson Delmar Learning. https://books.google.co.ke/books?id=yw2HAQAACAAJ&dq=psychiatric+nursing+by+richardson&hl=en&sa=X&redir_esc=y

Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Philadelphia: F.A. Davis Co. http://www.sbmu.ac.ir/uploads/townsend2011.pdf

Townsend, M. C. (2013). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia: F.A. Davis Co. https://books.google.co.ke/books?id=cxdengEACAAJ&dq=Essentials+of+psychiatric+mental+health+nursing:+Concepts+of+care+in+evidence-based+practice.&hl=en&sa=X&redir_esc=y

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Dementia PICO Analysis Method

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Dementia PICO Analysis Method

Part I: PICO analysis of research topic

Step 1: Frame clinical question using PICO method

P: the patients include people with dementia and psychosis

I: the anticipated intervention is to utilize typical antipsychotic drugs

C: the current standard or comparison group is atypical antipsychotics

O: the desired outcome is to have less mortality rates for elderly people with dementia and psychosis

The PICO question basically stands for patient, intervention, comparison and outcome (Elkins, 2014).

Part II: Search strategy

The PICO question is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O).

Step 1: Resources utilized to find articles

A number of scholarly articles relating to the identified issue are identified. The resources that were used in finding the articles that relate to the topic include the following: handbooks, electronic databases research, encyclopaedias, relevant books, and reputable journals.

Step 2: Search terms and criteria

With regard to search terms and criteria that were utilized, the search terms include the following: dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics. The inclusion criteria was as follows: scholarly peer-reviewed journal articles only, articles not older than 5 years, articles that are published in the English language, articles that focus on dementia and psychosis among the elderly population, and article that reports on primary research.

Step 3: Boolean search strings

With regard to the exclusion criteria, the articles that would be excluded are as follows: articles that are older than 5 years, articles not published in English, and articles that do not focus on the elderly patients with dementia. Using different Boolean search strings, keywords would be combined with operators like OR, NOT as well as AND in order to generate additional results that are relevant. For this research, the Boolean search strings that would be utilized include the following: atypical antipsychotics and psychosis, atypical antipsychotics and dementia, typical antipsychotics and dementia, typical antipsychotics and psychosis. Therefore, the search results would be limited only to the two keywords.

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Part III: Analysis of literature

Step 1: Summary of five articles

The following 5 articles in the table below were selected from the research effort.

Table 1: Summary of analyzed articles

Citation	Conceptual framework / theory	Main finding	Research Method	Strengths of study	Weaknesses of study	Level of evidence
Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43	Not specified	Atypical antipsychotics medications provide modest benefits up to twelve weeks /short term treatment of psychosis and dementia. Nonetheless, these benefits should be balanced against the risk of major adverse events such as increased death. With longer term prescribing, there are clear benefits, but the risk of death also increase.	Review of existing studies. The authors provide a summary of the evidence that pertain to safety and efficacy from short-term randomized controlled trials, as well as main findings from case register studies	Study is thorough. Presents both benefits and shortcomings of atypical antipsychotic drugs. The review provides an up-to-date and balanced overview of the safety concerns and effectiveness that relate to atypical antipsychotics in elderly patients with dementia, giving a full overview of mortality risk	The study only focuses on atypical antipsychotic drugs and does not also look into the safety concerns and efficacy of typical antipsychotics.	High level
Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936	Not specified	Broad statements that compare the comparative risk of specific adverse effects between conventional and atypical antipsychotics are mainly insignificant. Instead, comparisons need to be made between particular typical and particular atypical antipsychotic drugs.	The authors reviewed various studies including post marketing, surveillance studies, and observational studies and randomized controlled trials.	The study is comprehensive, thorough and up-to-date	A small number of studies were reviewed	High level
Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40	Not specified	Using atypical antipsychotics to treat dementia amongst older adults is linked to a higher rate of mortality.	A cohort study was conducted that comprised 696 elderly patients with Alzheimer	The study recommends new approaches for managing dementia to replace the use of atypical antipsychotic drugs which have potential risks of mortality	A small sample size was used and the study was carried out within a single hospital. This affects the generalizability of the findings	Medium level
Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal Of The American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061	Not specified	Shortly after initiating oral atypical antipsychotic drug, the likelihood of developing a major event in elderly people with dementia was high.	This was a population-based, retrospective cohort study.	A large sample size was used that comprised 21,526 elderly men and women with dementia	The study had more women that. Women were 13,760 while the number of men was 7,766.	High level
Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943		Atypical antipsychotic medicines might be linked to a slight increased likelihood for death in comparison to placebo where typical antipsychotic drugs were used.	The authors assessed the evidence for high death rates from atypical antipsychotic medications for patients who have dementia. The data sources were obtained from Cochrane Controlled Trials Register, MEDLINE, and meetings and presentations.	A large sample size is used hence the findings could be generalized. There a total of 5,101 participants	Some very old data materials from the 1960s were used which may not be relevant for use today	High level

Step 2: History and purpose of research question

Every antipsychotic drug has warnings of increased mortality for elderly patients (Schneider, Dagerman & Insel, 2012). Antipsychotic medications are broadly utilized in managing psychological and behavioural symptoms in dementia in spite of concerns as regards their safety (Ballard et al., 2011; Piersanti et al., 2014). Compared to typical or conventional antipsychotic drugs, atypical antipsychotic drugs are linked to a statistically significant rise in the likelihood of mortality for older men and women who have dementia (Haddad & Sharma, 2012).

The purpose of the research question is to find out whether the use of typical antipsychotic medication, which is the intervention, results in less mortality rates than atypical antipsychotic medication, which is the comparison group, in elderly patients who have dementia and psychosis.

Step 3: Strengths and weaknesses of existing literature

The strengths of the existing literature is that there are studies which focus mainly on the atypical antipsychotics and others that focus mainly in typical/conventional antipsychotics and their correlation with mortality. The weakness of the existing literature is that there are no studies that compare typical antipsychotics and atypical antipsychotics on the rates of mortality on elderly patients with dementia and psychosis (Rochon et al., 2013).

Step 4: Gap in current literature

At the moment, the gap in current literature is that there are no studies which have focused specifically on the association of atypical and typical antipsychotic medications on the rates of mortality among the older adults who have dementia.

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Conclusion

In conclusion, the PICO question for the research study is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O). The purpose of the research question is to find out whether the use of typical antipsychotic medication results in less mortality rates than atypical antipsychotic medication in elderly patients who have dementia and psychosis. The resources used to find articles included electronic databases research, relevant books, and reputable journals. The search terms that were utilized include dementia, mortality, psychosis, atypical antipsychotics, and typical psychotics.

References

Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43

Elkins, M. Y. (2010). Using PICO and the brief report to answer clinical questions. Nursing, 40(4), 59-60. Retrieved from the Walden Library databases.

Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936

Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40.

Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal of the American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061

Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943

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The Nursing Care of Mental Health Consumers Who Self – Neglect

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The Nursing Care of Mental Health Consumers Who Self – Neglect

Despite the severity of self-neglect in mental health consumers, nursing professionals need to care for them in an attempt to improve their mental health issues. This presentation focuses on the relevance of nursing care of mental healthcare consumers who self-neglect to modern mental health nursing as well as to recognize the appropriate linkages with other mental health care providers.

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Notably, nurses constitute the largest population of health care professionals, thus, they have a key role in the management and identification of self-neglect among mentally ill patients. The relevance of nursing care to mental health consumers in the modern nursing practice can be identified through the assessment, diagnosis, outcome identification, planning, and implementation and evaluation steps (Peate, Wild, & Nair, 2014).

References

Naik, A. D., Lai, J. M., Kunik, M. E., & Dyer, C. B. (2008). Assessing capacity in suspected cases of self-neglect. Geriatrics, 63, 2, 24-31. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847362/

Townsend, M. C. (2008). Nursing diagnoses in psychiatric nursing: Care plans and psychotropic medications. Philadelphia: F.A. Davis Co. http://www.sbmu.ac.ir/uploads/townsend2011.pdf

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PICO Analysis for Dementia

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PICO Analysis: Dementia

Part I: PICO analysis of research topic

Step 1: Frame clinical question using PICO method

P: the patients include people with dementia and psychosis

I: the anticipated intervention is to utilize typical antipsychotic drugs

C: the current standard or comparison group is atypical antipsychotics

O: the desired outcome is to have less mortality rates for elderly people with dementia and psychosis

The PICO question basically stands for patient, intervention, comparison and outcome (Elkins, 2014).

Part II: Search strategy

The PICO question is as follows: In elderly patients who have dementia and psychosis (P), does treatment with typical antipsychotics (I) or atypical antipsychotics (C) result in less mortality (O).

Step 1: Resources utilized to find articles

Step 2: Search terms and criteria

Step 3: Boolean search strings

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Part III: Analysis of literature

Step 1: Summary of five articles

The following 5 articles in the table below were selected from the research effort.

Table 1: Summary of analyzed articles

Citation	Conceptual framework / theory	Main finding	Research Method	Strengths of study	Weaknesses of study	Level of evidence
Ballard, C., Creese, B., Corbett, A., & Aarsland, D. (2011). Atypical antipsychotics for the treatment of behavioural and psychological symptoms in dementia, with a particular focus on longer term outcomes and mortality. Expert Opinion on Drug Safety, 10(1): 35-43	Not specified	Atypical antipsychotics medications provide modest benefits up to twelve weeks /short term treatment of psychosis and dementia. Nonetheless, these benefits should be balanced against the risk of major adverse events such as increased death. With longer term prescribing, there are clear benefits, but the risk of death also increase.	Review of existing studies. The authors provide a summary of the evidence that pertain to safety and efficacy from short-term randomized controlled trials, as well as main findings from case register studies	Study is thorough. Presents both benefits and shortcomings of atypical antipsychotic drugs. The review provides an up-to-date and balanced overview of the safety concerns and effectiveness that relate to atypical antipsychotics in elderly patients with dementia, giving a full overview of mortality risk	The study only focuses on atypical antipsychotic drugs and does not also look into the safety concerns and efficacy of typical antipsychotics.	High level
Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936	Not specified	Broad statements that compare the comparative risk of specific adverse effects between conventional and atypical antipsychotics are mainly insignificant. Instead, comparisons need to be made between particular typical and particular atypical antipsychotic drugs.	The authors reviewed various studies including post marketing, surveillance studies, and observational studies and randomized controlled trials.	The study is comprehensive, thorough and up-to-date	A small number of studies were reviewed	High level
Piersanti, M., Capannolo, M., Turchetti, M., Serroni, N., De Berardis, D., Evangelista, P., Costantini, P., Orsini, A., Rossi, A., & Maggio, R. (2014). Increase in mortality rate in patients with dementia treated with atypical antipsychotics: A cohort study in outpatients in Central Italy. Riv Psichiatr, 49(1): 34-40	Not specified	Using atypical antipsychotics to treat dementia amongst older adults is linked to a higher rate of mortality.	A cohort study was conducted that comprised 696 elderly patients with Alzheimer	The study recommends new approaches for managing dementia to replace the use of atypical antipsychotic drugs which have potential risks of mortality	A small sample size was used and the study was carried out within a single hospital. This affects the generalizability of the findings	Medium level
Rochon, P. A., Gruneir, A., Gill, S. S., Wu, W., Fischer, H. D., Bronskill, S. E., & … Gurwitz, J. H. (2013). Older Men with Dementia Are at Greater Risk than Women of Serious Events After Initiating Antipsychotic Therapy. Journal Of The American Geriatrics Society, 61(1), 55-61. doi:10.1111/jgs.12061	Not specified	Shortly after initiating oral atypical antipsychotic drug, the likelihood of developing a major event in elderly people with dementia was high.	This was a population-based, retrospective cohort study.	A large sample size was used that comprised 21,526 elderly men and women with dementia	The study had more women that. Women were 13,760 while the number of men was 7,766.	High level
Schneider, L. S., Dagerman, K. S., & Insel, P. (2012). Risk of death with atypical antipsychotic drug treatment for dementia – Meta-analysis of randomized placebo-controlled trials, JAMA, Journal of the American Medical Association, 294(15): 1934-1943		Atypical antipsychotic medicines might be linked to a slight increased likelihood for death in comparison to placebo where typical antipsychotic drugs were used.	The authors assessed the evidence for high death rates from atypical antipsychotic medications for patients who have dementia. The data sources were obtained from Cochrane Controlled Trials Register, MEDLINE, and meetings and presentations.	A large sample size is used hence the findings could be generalized. There a total of 5,101 participants	Some very old data materials from the 1960s were used which may not be relevant for use today	High level

Step 2: History and purpose of research question

Step 3: Strengths and weaknesses of existing literature

Step 4: Gap in current literature

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Conclusion

References

Elkins, M. Y. (2010). Using PICO and the brief report to answer clinical questions. Nursing, 40(4), 59-60. Retrieved from the Walden Library databases.

Haddad, P. M., & Sharma, S. G. (2012). Adverse effects of atypical antipsychotics: Differential risk and clinical implications. CNS Drugs, 21(11): 911-936

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The diagnosis and management of depression

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The diagnosis and management of depression within the American population

Identifying a Problem

The diagnosis and management of depression within the American population remains one of the health factors affecting the health sector. Sources determine that the prevalence of depression within the American population is ascertained to stand at 8.5%, a factor that has seen less people seek medical attention (Wagner, Müller, Helmreich, Huss, & Tadić, 2015). Thus paper therefore seeks to develop a PICOT question in determine the aspect of depression and its effects within this population.

PICOT Question

It is essential to consider that the PICOT P, Population: I Intervention C, Comparison, O, Outcome and T Time is developed in guiding this study. In the American population between the ages of 30-35 of the working class (P), is there a need of developing a tool that will analyze depression (I), compared with the other approaches of care (C) that ensures appropriate procedures are developed in order to detect depression (O) within a specified time (T)? The aim of the PICOT question is developed to determine enough evidences that justify the element of depression among the American population through the use of effective tools.

Selecting Sources of Literature

In considering the results of this paper, it is essential to search through multiple databases that include EBSCOhost, Google Scholar, PsycINFO and the Cochrane and other sources from Health Care research centers. In getting the results of this study, there are key search words that need to be considered (Wagner, et.al.2015). These words include: screening, depression, depressive disorders, BECK or BDI-ii and the population. The use of both the published and the unpublished materials in searching the literatures was incorporated with the materials reviewed dating back between 2005-2010.

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Selecting Sources of Literature

According to Wagner et.al.2015, a metal-analysis was conducted to determine the effects of depression on the American population. The findings of the study identifies that a majority of the population presented traumatic symptoms. This material determines that depressive disorders among the younger generation may lead to suicidal and homicidal thoughts and attempts (Jackson, Dianne & Garnefski, 2015).

Some of the symptoms that are presented by this author include chest pains, headaches, painful urination, dizziness an excessive sweating. This source intrinsically supports the specified area of study since it provides evidence to some of the effects of depression among the American population.

Jackson et.al.2015 in his literature consequently revealed that the screening of depressive disorders among the American population undergoes a process of identification, assessment, and initiation of approaches aimed at managing this disease within the American population (pp.197). This author details a quantitative randomized study within this population and establishes that the abuse of substances is as a result of depression, a factor that explains the reasons why several Americans engage in risky sexual behaviors.

On the other hand, the population is also likely to engage in drugs and substance abuse as a result of depression. The author determines that there is a need of developing a concurrent treatment method that uses psychotropic drugs and other stable stimulants in the management of depression. The inclusion of psychotherapeutic method is also essential in the management of depression.

The author also mentions that depression within this population needs to be effectively managed since discoveries have been made that establish individuals in this state engage in unprotected sex and the inclusion of multiple sexual partners, a factor that would result into a health concern within a nation.

References

Wagner, S., Müller, C., Helmreich, I., Huss, M., & Tadić, A. (2015). A meta-analysis of cognitive functions in children, adults and adolescents with major depressive disorder. European Child & Adolescent Psychiatry, 24(1), 5-19. doi:10.1007/s00787-014-0559

Jackson, E. M, Dianne S, & Garnefski, N. (2015). Depressive Symptomatology and Child Abuse in Adolescents with Behavioral Problems. Child & Adolescent Social Work Journal, 20(3), 197-210.Retrived From: http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=10067979&site=ehost-live

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Beck’s Cognitive Theory of Depression: Incorporating Theory

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Beck’s Cognitive Theory of Depression: Incorporating Theory

Description

For the proposed research, the PICO question that guides the study is as follows: In young adults aged 30 to 35 years-old (P), is using a screening tool for depression (I), in comparison to the usual standard of care (C), more accurate in detecting depression (O). This PICO question helps in finding out whether or not there is sufficient evidence to support screening young adults aged 30 years to 35 years for depression with the use of a suitable screening tool.

Utilization in Supporting Solution

The theory that could be utilized in supporting the proposed solution is Beck’s Cognitive Theory of Depression. Beck identified 3 main components or mechanisms which are responsible for depression. These include: (i) negative self schemas; (ii) the cognitive triad; and (iii) errors in logic, that is, faulty processing of information (Abela & D’Allesandro, 2012). The cognitive triad are 3 types of negative thinking which are common in people who have depression: that is negative thoughts concerning the future, the world, and the self.

These negative thoughts are automatic in individuals with depression since they occur impulsively. Beck pointed out that people who are prone to depression develop a negative self-schema. Such an individual possesses various expectations and beliefs regarding himself or herself which are pessimistic and negative. Individuals who have negative self schemas are inclined to making logical errors in their thinking. They are also inclined to focusing mainly on particular facets of a situation whilst disregarding other information that is equally pertinent (Abela & D’Allesandro, 2012).

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The rationale for selecting this theory is that this theory helps to describe what really is central to depression; that is, the main cause of depression. According to Beck, the cognitive symptoms of depression in fact precede the mood and affective symptoms of depression, and not the other way round. What is central to depression, as Beck pointed out, are the negative thoughts and not low reinforcement rates or hormonal changes as other theorists had suggested (Abela & D’Allesandro, 2012).

This theory works to support the proposed solution in that using depression screening tools, the researcher will be able to determine more accurately the main cause of depression amongst young adults in the United States. In other words, using appropriate screening tools for depression, it would be possible to detect the negative thoughts in people aged 30-35 in the United States considering that negative thoughts are central to depression as per Beck’s Cognitive Theory of Depression.

Incorporation

The theory would be incorporated into the project by using screening tools for depression which are in line with Beck’s Cognitive Theory of Depression. One particular screening tool that would be used is the Beck Depression Inventory-II (BDI-II) which was developed by the same theorist who conceptualized Beck’s Cognitive Theory of Depression. The BDI-II screening tool for depression would be utilized to detect depression among 30-35 year-old young adults and it would be compared with the usual standard of care currently being practiced in the country.

In essence, using Beck’s Cognitive Theory of Depression, the negative thoughts of people would be carefully monitored using Beck Depression Inventory. It is expected that depressed people negatively misunderstand information and experiences, as they limit their focus to the negative facets of a situation, therefore feeling hopeless regarding the future (Abela & D’Allesandro, 2012). Using Beck’s Cognitive Theory of Depression in the project, a direct correlation is postulated between severity of symptoms of depression and negative thoughts.

References

Abela, J. R. Z., & D’Allesandro, D. U. (2012). Beck’s cognitive theory of depression: The diathesis-stress and causal mediation components . British Journal of Clinical Psychology, 41, 111-128.

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Mental healthcare Decentralization

Improving mental health efficiency by using of community health workers to decentralize health care services

Overview of healthcare industry, markets and competition

Recent changes in the UK in National mental Healthcare Services (NHS) have introduced new complexities into the accountability arrangements of the healthcare facilities. The current mental health systems are best described as command and control system. The mental budgets as well as policy are strategically set centrally by the Department of Health (DoH) and the government is administered locally by the NHS organization but accountability lies with the DOH.

The situation is more complex than the explanation of the ‘command and control.’ The balances between the central government and the local government have led to fluctuating autonomy and misallocation of resources (Normand, 2011).

The UK mental healthcare system relies on highly centralized and costly expertise to delivery healthcare services. This type of system relies in intuitive medicine, and is best suited for healthcare issues that are complex and episodic. In addition, this type of healthcare system is associated with mismatch for chronic diseases, preventive measures and wellness care; which results into additional barriers and disparities especially among the underrepresented population.

It is time for the National Health System (NHS) to depart from a one-size-fits all model and develop channels that will enable better delivery of services that can serve the dynamic needs of the population (Clayton, 2009).

This study proposes that decentralizing mental healthcare services will aid in lowering cost of care, broaden accessibility and maintain as well as improve quality of care. For instance, the physician specialist will have the capacity to work in outpatient, the nurse practitioner will effectively provide care in retail clinics, and lay community health promoters or workers will improve health education, thereby reducing health complications associated with disease progression.

For example, the system will improve diabetic self management at patient’s residents. This measure is in line with Institute of Medicine (IOM’s) health disparity vision of confronting ethnic and racial disparities using strategies that improve care delivery and or implement preventive measures and to enhance risk reduction (Black & Gruen, 2005).

Perceived problems in current healthcare systems

The fundamental issue that is believed to affect mental healthcare activities includes quality of care, safety issues, access to healthcare, cost of care, and delivery of services. These issues arise because of the problems that affect healthcare systems which include misallocations of national health resources, allocative inefficiency, and increased inequalities. Most of the health facilities get less proportion of healthcare budgets. An example of healthcare system that suffers from misallocation of resources is the mental healthcare system, which suffers due to misallocation of resources within the sector (Goodwin, Gruen, & Iles, 2006).

In my facility, funding is done on low cost effective-interventions such as non-essential prevention strategies. For instance, People diagnosed with substance use along with mental health (commonly referred to as dual diagnosis) is associated with many health demands, yet they suffer too much to access quality healthcare services. These patients have complex needs and often experience multiple adversities in their lives including deprivation, childhood abuse, poverty and loss of support from their family members.

These persons are also associated with multiple needs such as homelessness and unemployment that makes them become prone of exploitation. This increases their risk of poor physical health, self harm, suicide and perpetrating violence. Dual diagnosis is unpopular in the UK, partly because the society is entrenched perceptions of substance abuse where most people believe that is a lifestyle choice instead of a health issue that needs urgent care and treatment (Normand, 2011).

Dual diagnosis is one of the issue facing mental health and substance abuse. In the past one and half decades has lead to development of specific initiatives but all of them have had no improvement. The same changes have been implemented since the 90s. Today, mental health services today still exclude people if the problem is not perceived as substance related disorders. The misallocation of resources is associated with inefficient delivery of care as most of the healthcare resources are wasted (Kirk and Glendinning, 1998).

For example, it is inefficient to give patient a brand name over drugs cheaper generic ones that have same efficacy. The misallocation of resources also results to underutilization of resources which also affects the productivity efficiency. In current type of healthcare system often leads to indiscretions such as specialists handling numerous uncomplicated cases at high cost, cases that primary care centers could handle with ease (Normand, 2011).

The aforementioned factors have lead to increase on cost of care without matching consumer’s health benefit. In addition, the existing weak monitoring system enables leakages of public subsidies to private sectors and medical covers which are already financially stable. This results to increased health disparities where poor and under-privileged in the society lack care affordability (World Health Organization, 2000).

These affected populations unfortunately are the majority, and often receives low quality of care. One of the best strategies is to train the staff in mental health facility in order to equip them with skills that will help make dual diagnosis by improving their knowledge and skills but have not managed to change the society’s perception and values.

Therefore, the two great challenges in this aspect of mental health a) to increase awareness on dual diagnosis in order to change attitudes people’s attitudes on mental health and b) to provide effective services to people diagnosed with dual diagnosis, especially in this unprecedented mental health crisis (Normand, 2011).

Change in mental healthcare systems

Change in the healthcare system is intended to improve the performance by adjusting the way services are delivered and relocating or roles and responsibilities for specific healthcare services and the processes of delivering care to the population including financing, implementation process, monitoring as well as regulation. There are various drivers of change in the current health care system including the expected shift in political, social and economic factors that will come with new governing system. In addition, the increase in technological advancement should be enhanced to not only improve quality of care, but also the accessibility (Normand, 2011).

The key drivers for the proposed change within the mental healthcare system in NHS includes changes in population growth, demographic characteristics due to immigration, technological advancement, health’s infrastructure conditions, and increased patient level of acuity. Change in ideologies refers to the modifications of frameworks used by the public health services to deliver care. For instance, new labor in 1997 removed department of health monopoly which created more opportunities for private sector and voluntary services that helped better healthcare system to some extent, at higher cost of care.

Similar changes have been observed with the coalition government in 2009 which removed government agents and gave more roles to local authorities and the private providers, which led to increase misallocation of resources. Therefore, decentralizing delivery of healthcare services using community workers will create freedom for providers to innovate strategic services that meet the specific demands for patient needs (Pickard and Glendinning, 2002).

In addition, the current infrastructure conditions are too old and are not adaptable to provision of modern care for dual diagnosis. The current healthcare infrastructure demerits include high cost of care, reduced staff retention and inconsistencies in delivery of care. Therefore, vertical integration of decentralized health care in this community is aimed at addressing these challenges by reconfiguring healthcare services to suit the specific community demands.

For instance, technological advancement has made it easy to access patient information and also increased portability of patient’s health information and education of appropriate optional treatment. It is time to tap on the innovative techniques to increase efficiency in delivery of mental healthcare system and manage delivery of care in a way that maximizes population health benefits (Duguid & Pawson, 1998).

Changes in population growth and the demographic factors is also another driving force for decentralization of mental healthcare services by the NHS. The increase in population has put pressure on the current healthcare system as it has led to dilapidation of healthcare facility caused by congestion due to population growth, which has led into high demands building of bigger healthcare facilities that will accommodate the patients.

In addition, the gentrification of the low socioeconomic households by the middle class has led to inconsistence in delivery of services. The increased patient level of acuity and knowledge on quality issues is pushing the healthcare providers to improve delivery of care in order to meet their expectations (Clayton, 2009).

Recommendation

Change refers to any alteration of healthcare services with the aim of improving its quality. Changes in healthcare system are wide and ranges from revolutionary technology to refining of health workers responsibilities. There are three types of change namely originates, borrowed and adapted. Borrowed changes are easy and cheap to implement. However, these types of changes are often not appropriate to meet the local needs as no community is similar to another, which implies that one size fits to all may not apply (Goodwin, Gruen, & Iles, 2006).

The proposed change is adapted change, which mainly implies that the strategies are borrowed from elsewhere and gets modified to fit the community needs. However, factors such as situational circumstances, management approach, wrong adaptation, and changes in political as well as economic environments determines if the change process will be effective or not.

Originated changes would be more effective as it involves more creativity than the adapted changes, but their implementation process is expensive as it requires an organizational climate that promotes innovation and creativity. The proposed change is a technical change as it modifies the ways in which normal activities are carried out by altering the organization and program structures (Clayton, 2009).

Decentralization is kind of change that involves dispersal of administrative, political and financial functions. It involves a process of shifting authority, power and responsibility from national to local government levels of the healthcare systems. The main advantages for vertical integration of decentralization in mental healthcare system includes technical benefits such as improving delivery of healthcare services, leading to better health outcomes. In addition, this method eradicates challenges associated with bureaucracy and monopoly that hinders effective delivery of healthcare services to the needy service users (Atun, 2007).

Political benefits associated with decentralization of healthcare services are that it extends democratic control of healthcare services to the needy individuals at community level. This may also increase opportunity for the citizens and services users to participate in decision making processes. This is effective strategy as it helps the government to identify the specific community needs.

Decentralization process also helps in minimizing financial burden associated with public procurement processes by transferring risks from a central point and distributing them to lower and private sector. This helps promote innovativeness and competition, which further improves the service user’s outcome (Bossert, 1998).

In this context, decentralization is the recommended as an approach of improving administrative activities that will help deliver healthcare services. This is also done for the purposes of achieving effective service delivery. In addition, decentralization helps improve local participation as well as autonomy in healthcare services. This acts as a means of redistributing power when it is effectively done, thereby reducing health disparities associated with tribal and regional tensions.

Decentralization is also invoked as a means of increasing cost efficiency in mental health care systems, which is attained by giving the local units better and greater control over the available resources as well as healthcare revenues. In turn, this approach sharpens NHS accountability in healthcare services and operations. The approach helps to covertly offload financial burden from resource poor governments to local service providers (Saltman et al., 2007).

Conclusion

The Mental healthcare system relies upon on highly centralized and costly. The optimal for mental healthcare system is based on intuitive medicine, and is best suited for complex and episodic mental health complication. This increases additional barriers to healthcare care disparities and the minority groups. It is important for the NHS mental health care system to depart from the one size fits all paradigms and to establish better channels that will ensure that healthcare delivery is improved to meet the growing dynamic needs for the underprivileged service users.

The potential impacts of decentralization intervention are that it creates opportunities that improve the prevention strategies. The balance between the primary and tertiary preventive measures regarding saving. The strategy will also increase access to healthcare services by ensuring that the downstream expenses are balanced. In addition, the approach will help replace the costly unnecessary services with less expensive and quality ones.

References

Atun, R. (2007). Privatisation as decentralization strategy, Chapter 14, 247-266. In Saltman, R. B., Bankauskaite, V., & Vrangbaek, K. Decentralization in Healthcare. European Observatory on Health Systems and Policies Series. McGraw Hill, Open University Press. Maidenhead, Berkshire, England.

Bossert, T. (1998). Analysing the decentralization of health systems in developing countries: decision-space, innovation and performance. Social Science & Medicine. 47(10), 1513 – 27.

Black, N., & Gruen, R. (2005). Understanding Health Services. Open University Press, Berkshire, England

Clayton, M. (2009). The Management Models Pocketbook. Management Pocketbooks

Duguid, S. & Pawson, R. (1998). Education, change and transformation: The prison experience. Evaluation Review. 22(4), 470-95

Goodwin, N., Gruen, R., & Iles, V. (2006). Managing Health Services: Understanding Public Health. Open University Press, Berkshire, England

Kirk, S and Glendinning, C. (1998). Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom. Journal of Advanced Nursing 28:370-81

Normand, C. (2011). The healthcare system in Ireland: Controlling growth in expenditure and making best use of resources. Chapter 3 (pp 57-74). In Callan, T. (editor). Budget Perspectives 2012. Economic & Social Research Institute (ESRI) Research Series 22, Dublin.

Pickard, S and Glendinning, C. (2002). Comparing and contrasting the role of family carers and nurses in the domestic health care of frail older people. Health and Social Care in the Community 10: 144-50

Saltman, R. B., Bankauskaite, V., and Vrangbaek, K. (2007). Decentralization in Healthcare. European Observatory on Health Systems and Policies Series. McGraw Hill: Open University Press.

World Health Organization (2000). The World Health Report 2000. Health Systems: Improving Performance, WHO, Geneva.

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Intellectual Disability: Research Paper

About 1 percent of the entire population has intellectual disability, which is a considerable disorder in adaptive as well as intellectual function in the early stages of development (Aveyard 2014). Individuals with the intellectual disabilities rate of developing mental illness are greater in comparison to the whole population, however, challenges in communication, access to services, literacy means that mental issues in persons with intellectual disability are inadequately recorded.

Moreover, the majority of persons with intellectual disability exhibit challenging behaviors, meaning characters of intensity, duration, and frequency that endangers their physical safety or those around them or even restricts accessing community services.

For a long period, there have been concerns that psychotropic medicine especially, antipsychotics are overused as such prescribed for problem behavior instead of diagnosing mental sickness, regardless of insufficient proof on their effectiveness. Nonetheless, getting an accurate amount of psychotropic in persons with learning disabilities is intricate, while present literature is limited due to varying descriptions.

In spite of inadequate proof from policy context, there is no detailed assessment of psychotropic in adults with learning disability in United Kingdom primary care conducted, while results from other nations cannot be generalised due to variations in health care provisions as well as practices (Guerzoni & Zuleeg 2011).

Proof demonstrates that psychotropic use in entire population has been increasing tremendously for the past years, however, few studies have investigated that the patterns used to prescribe psychotropic among persons with intellectual disability. Regarding deinstitutionalization, creating warrens of psychotropic use, adverse effects and efforts to minimise its use to individuals with learning disability through the implementation of prescription standards are not clear. Furthermore, with the large as well as representative sample size, it is apparent that there are increased rates of mental illness, challenging behavior and psychotropic medicine among people with intellectual disability.

Research Question

Do challenging behaviors among persons with learning disabilities result from mental impairments?
Are social workers faced with challenges caring for persons with learning disabilities?

Research Objectives

To establish whether or not challenging behaviors among persons with learning disabilities result from mental impairments
To understand some of the challenges that come with caring for persons with learning disabilities

Hypothesis

H₀: Challenging behaviors among persons with learning disabilities do not result from mental impairments
H₁: Challenging behaviors among persons with learning disabilities do not result from mental impairments
H₀: Social workers caring for persons with learning disabilities do not undergo challenges that wear them down
H₁: Social workers caring for persons with learning disabilities undergo challenges that wear them down

What is challenging behavior?

An individual’s conduct may be regarded as challenging if it threatens their safety or those around, particularly care or even contributes poor life quality. In addition, such behaviors can influence their capacity to participate in routine activities. Challenging behaviors consist of self-harm, destructiveness and aggression among others. Communication determines the way in which people express their needs.

In the event that communication is problematic, it may extremely discourage individuals leading to challenging behavior. If such behavior contributes to desire results, it may be repeated over and over. Challenging behaviors are common in persons with problems that impact communication and the brain including learning disability, and dementia (Economist Intelligence Unit 2011).

Challenging behavior or behaviors that challenge are culturally anomalous behaviors of frequency or duration that endangers their safety or others. In most cases, an individual must display trends that are a threat to services for a significant timeframe. Seriously challenging behaviors are not transient occurrences. According to the National Institute for Health and Care Excellence (NICE), challenging behavior is a concept that is associated with aggression, stereotype, and agitation or self-harm, withdrawal, and sexual misconduct (NICE 2016).

Additionally, challenging behavior involves persons whose conduct present considerable challenges to services. This comprises of behaviors that are associated with mental health issues. Challenging behaviors are widely used among persons with learning or intellectual disability, in addition to those with autism. Nonetheless, there are other groups that can be regarded to have challenging behaviors such as those with dementia and serious mental issues.

Impact of challenging behavior

Challenging behavior is described as ‘socially unacceptable behavior’, ‘bad behavior’ (Craver 2015). The term also reflects a challenge to those concerned. It indicates that something is not working well, and it needs to be rectified and stopped. Behavior is challenging if it causes harm to another individual, or prevents them from fulfilling certain things in their lives. Challenging behaviors are detrimental to the lives of the affected persons and those around them. Hence, dealing with challenging behaviors requires careful handling in a way that supports the safety and well-being of people and others

Aggression and assault

In a study conducted by 76 social care workers in institutions that provide intellectual disability services, three-quarter of respondents had faced aggression, self-harm, and disruptive behavior. Recent studies of employees working with persons with dementia discovered that roughly three-quarter of workers faced fearful events during their work (Springer et al. 2013). The most common reported cause was physical assault. Among the respondents sampled, a fifth said they had been injured, a quarter experienced fears during interaction, and half of the interviewees stated that they adopted a more personal centered style while others learned to be more vigilant.

This study gives indications of nature and level challenging behavior experienced by staff in care homes for people with dementia. Recent studies of perception of severe behavior and fear of assault showed that the degree of fear was greater when staff was exposed to challenging behavior. Researchers, however, found unclear evidence for the relationship between the quantity of challenging behavior and the level of fear of assault.

References

Emerson, E. 2011, Challenging behaviors. Available from http://www.amazon.co.uk/Challenging-Behaviour-Eric-Emerson/dp/0521728932/280-1066416-6180644?ie=UTF8&camp=1634&creative=19450&creativeASIN=0521728932&l inkCode=as2&redirect=true&ref_=as_li_ss_tl&tag=mentalhealt08 [25^th May 2016].

Guerzoni B. and Zuleeg F. 2011, Working away at the cost of aging. Brussels: European Policy Centre. Available from:http://www.epc.eu/documents/uploads/pub_1265_working_away_at_the_cost_of_ageing. pdf ,[25th May 2016].

Hayes, S. A., & Watson, S. L. 2013. The impact of parenting stress: A meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. Journal of autism and developmental disorders, 43(3), 629-642.

Mental health center 2016, Oppositional defiant disorder. Available from http://www.webmd.com/mental-health/oppositional-defiant-disorder?page=222 [25^th May 2016].

National Center for Learning Disabilities. 2012, What are learning disabilities? Available from http://www.ncld.org/types-learning-disabilities/what-is-ld/what-are-learning-disabilities [25^th May 2016].

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