The Meaning of Mental Health
Mental health is not a definitive ‘state of mind’ (i.e. healthy or not) and understanding must encompass social context, it is difficult to succinctly define mental health. Some common themes to understand mental health discuss ‘positivity’; whereby people view themselves, others and the world around with a positive perspective i.e. tasks are achievable and relationships can be made. This is appears to result from a deeper belief in one’s own and others’ worthiness. Although a restrictive view, mental health is often thought of, as the absence of mental health problems and therefore many signs of good mental health include positive feelings, overcoming problems, maintaining relationships and achievements. A strong idea is that good mental health enables one to become resilient against the difficulties presented by life.
Mental ill health can arise due to changes in the way one thinks, acts or just feels but crucially the changes must be substantial enough for problems to arise for the individual or others. These problems can manifest, for example, as physical or emotional harm; inability to cope with challenges or poor self-esteem. Long-term mental ill health can increase the likelihood of injury, disability or death.
Components of Mental Well-Being
Arguably, the most important component of mental well-being is ‘resilience’. This is the ability to recover from challenging events (e.g. severe physical trauma). Resilience is exhibited by a feeling of calm and better engagement with other positive feelings (e.g. love). This calm correlates with a sense of satisfaction and being in control of events or negative emotions resulting from difficult events.
Other components can include being ‘comfortable in one’s own skin’ and being able to develop positive and/or supportive relationships with others. Strong mental well-being is associated with good sleep, diet and exercise – leading to good physical health. It then appears evident that these components, of mental well-being, operate in conjunction with each other.
Risk Factors to Developing Mental Health Problems
For any given distressing event or experience, the likelihood, of developing mental health problems, varies between individuals and is largely determined by risk factors. Risk factors are broadly categorised as social, psychological and biological. Some people may have a genetic propensity toward mental health problems (or indirectly, as genetics can cause somatic issues with subsequent mental health problems).
In addition to any genetic predisposition, gender and early life experience (such as school bullying) can increase the likelihood of mental health problems. If an individual is struggling with basic ‘survival issues’ (e.g. food, water, sanitation) then this increases the risks as processing, for example, emotional upset may be de-prioritised against fulfilling more basic needs. A lack of social support (e.g. friends and family) may contribute to the risks. In more recent decades, another risk factor has come to prominence: Substance abuse. With increasing ease of access to uncontrolled substances
(such as psychedelics) and patterns of usage indicating younger drug abusers, the risks are high that individuals may develop mental health problems.
Examples of Mental Health Problems
Individuals with depression can feel unmotivated and tired; over a longer duration compared to occasional bouts of sadness that most individuals experience. The long-term condition is associated with low self-esteem but the causal relationship between these characteristics is not evident. Anxiety is worrying about daily life or the perceived future and, by contrast to depression, can cause restlessness and signs of ‘high energy’ – it also cause sleep problems.
Obsessive compulsive disorder (OCD) is particular ideas repeatedly dominate one’s thoughts and/or certain behaviours are habitually repeated. Personality disorders are where the sum of a person’s thoughts and perspectives on the world may cause them problems in life. Although disputed among the psychiatric community, there are widely-regarded classifications of personality disorders, which
are diagnosed by observing characteristic traits common to each. Some example personality disorders are histrionic, dependent, and antisocial personality disorder.
How mental health care has changed over time
Prior to the mid 20th century, individuals with mental health problems were often ostracised from communities: often, primarily, to protect others. Mental health was poorly understood and rarely without the socio-political agendas of their time e.g. criminalisation of those affected. More formalised asylums were constructed with the introduction of the County Asylums Act in
the early 19th Century but since The Mental Health Act 1959, asylums have been replaced with community care. The historical approach to care has changed focus from isolation and protection from harm to more pragmatic approaches to empowering individuals.
Community care, since the closure of mental health asylums, focuses on providing individuals with the skills required to engage with everyday life. Mental health patients are encouraged to live as independently as possible and to adopt or formulate routines that enable them to be as functional as possible. The reduced segregation by changing the care setting from an isolated institution to within a community, has reduced the effects of stigmatisation.
Impact of Changes in Mental Health Care
It was observed that there were several exacerbating effects from the approach of mental health care in hospitals. Individuals may become institutionalised, whereby their routines within the environment became rigid and the individuals were less able to cope in the outside world; despite in many cases recovering from the original mental health condition. The institutions were often very removed from the reality of outside life because residents would have mental health issues – all of which may differ and be problematic when interacting. Medication heavily featured in hospital care, which arguably provided symptomatic relief but did not ‘cure’ underlying causes. Other therapies such as electron-convulsive shocks were more commonly used in hospitals – many therapies are controversial because although effectiveness may be observed for treating certain conditions, the mechanisms of why such therapies work are still not clear.
Community care focused on empowering individuals with skills to undertake everyday life while residing in a community; and to promote recovery. Although the care provision was traditionally divided between health and social care; in more recent years, this has become more appropriately coordinated across various service providers (including charities) and multi-disciplinary teams such as Community Mental Health Teams (CMHTs).
As a consequence of the trend to move care into the community, health care roles had changed. Care coordinators enable a more holistic patient-centred approach to care. Community psychiatric nurses (CPNs) specialise in mental health work by visiting patients at home. CPNs have become increasingly autonomous in their role regarding the prescription and administration of medicines (e.g. anti-psychotics). Social workers tend to have more intimate knowledge of a patient and provide
care for more everyday needs over a longer-term with longer periods of patient contact; compared to other health professionals. Occupational Therapists (OTs) focus on developing an individual’s skills to undertake home chores or working life, for example.
Difficulties individuals may face
Mental health problems can inhibit individuals undertaking a range of activities; that many may ‘take for granted’. Individuals may have poor attendance or engagement with school or work. They may struggle to complete household chores or paying bills; or even more generally face difficulty with making decisions. Many physical problems may result such as poor sleep, poor nutrition, decreased libido or the side affects medication could place further constraints on freedom – some medications induce drowsiness, for example.
Some difficulties may both occur from but also exacerbate mental health problems such as social isolation. An individual can become reluctant to socialise, which then decreases a support network and a resultant long-term emotional instability could further add to anxiety around socialising.
The Social Context of Mental Illness
Public opinion toward mental illness is fairly consistent irrespective of demographics; and largely
misinformed. For example, many struggle to distinguish mental illness from learning difficulties – even assuming mental illness makes somebody stupid. There is fear toward mental illness – perhaps that those with schizophrenia are dangerous. The public can become resentful at any cohort perceived as having better circumstances and many people regard those seeking benefits due to poor mental health, are ‘faking it’, lazy or choose not to improve.
Portrayal of Mental Illness
Films illustrate the extreme scenarios that mental health disorders can give rise to. This skews the impression of the severity of mental illness among an audience (as films would not sell with more mundane portrayals). The film ‘Psycho’ could imply that psychopathy leads one to murder or eat people. ‘One Flew Over the Cuckoo’s Nest’ had many scenes of the “Crazies” which could cause an audience to view those suffering with mental illness as one homogenous group. ‘A Beautiful Mind’ could imply that mental illness could have benefits for sufferers.
Even with just the language employed, many newspapers can cause offence and provide poor example to readers that derogatory terms are acceptable. The sensationalisation, inherent with journalism, can portray mental illness as dangerous or unpredictable.
Some media coverage (especially tabloid newspapers) have linked mental illness to violence – which has been more biased and sensationalised than the objective statistics suggest. This adds to stigmatisation, which can also mean somebody is reluctant to engage with a diagnosis of a mental health concern if the media has previously put mental health in a negative light. However,
some positive aspects of (mainstream) media coverage are appearing such as celebrities discussing their own experiences with mental health problems and disorders.
Impact of Social and Cultural Attitudes on Individuals
Stigmatisation can leave somebody more anxious or depressed and even socially isolated. This can exacerbate any problems. Stigmatisation may mean somebody is reluctant to disclose their metal health issues early and therefore may not have the same chances to retain employment, recover quicker or recover while minimising any medication. The less opportunity somebody has to engage with care providers as early as possible, the less quality of life (or general happiness) they are likely to enjoy; as the condition worsens.
The Legal Context of Mental Illness
The Mental Health Act (1983) mainly governs patients’ rights and the process allowing someone to be detained (‘sectioned’) if they are pose risks to themselves or others. The NHS and CC Act (1990) devolves responsibility for the assessment, planning and provision of community care to patients. Some care is in the home, some is at day centres and some care is targeted at the carers themselves. Written care plans are a key element and used to coordinate various care providers, including GPs.
The Human Rights Act (1998) underpins a lot of legislation and supersedes any conflicting legislation. It is important to ensure patients are aware of their Rights proactively. The Mental Capacity Act (2005) essentially looks to empower people with decision making for their own care (more immediately or in future when decision-making capacity may be reduced). There are five main considerations such as assuming someone has mental capacity (unless proven otherwise); individuals are involved in decisions as much as practicable; people have the right to make a decision (no matter how irrational it may appear); everything should be done for the individual’s best interest; and that the less restrictive option is preferable when acting on behalf of someone (i.e. the least intervention).
The Mental Health Act (2007) amended the MHA (1983) and the Mental Capacity Act (2005) to bring legislation inline with the Human Rights Act (1998). It re-defined mental disorder more consistency, enhanced legislation regarding detention, dealt with age-appropriate accommodation and introduced new safeguards regarding ECT. The Health and Social Care Act (2008) later introduced consolidated regulatory bodies into a more-powerful Care Quality Commission; and reformed professional regulation.
The Equality Act (2010) has implication for care providers and essentially protects the public from discrimination against protected characteristics such as age, sex or religion.
Implications for the provision of care
Individual with mental health problems are less stigmatised by organisations since the introduction of the Quality Act (2010) which guards individuals against discrimination on protected characteristics. Arguably, this has helped reduced overall discrimination against people. The Human Rights Act (1998) also protects the very basic rights of any individual and has been encompassed with subsequent legislation. Effectively, individuals are now more empowered with decision-making toward their own treatment Mental Health Act (2005) and less able to be detained against their will – the Mental Health Act (2007).
The care individuals receive is now preferred to be community based and people who have been detained can continue treatment in the community (MHA 2007). The Health and Social Car Act (2008) enabled better regulation, which has resulted in improved quality of care overall. All this legislation has been better able to define mental health disorders and mental capacity – both of which has reduced stigmatisation and enabled better and quicker access to care providers – resulting in mental health problems being addressed more readily with better outcomes.
Provisions for individuals unable to make decisions for themselves
The Mental Capacity Act (2005) means that people are more empowered to make decisions for themselves. There is an initial presumption of mental capacity – unless proven otherwise. This shifts the onus on to care providers to demonstrate somebody does not have the capacity. Even then, the patient must be involved as much as practicable in their care planning. People’s rights are protected to the extent that if a decision is made, they are to be supported even when that decision does not appear rational.
The difficulty, then, arises as to how informed a decision is i.e. does the individual have all the relevant information at their disposal. The care must be, in accordance with the MCA (2005), in the individual’s best interests and any option taken, on behalf of an individual, must be that with results in the least interference.
There are many mechanisms that support those individuals that do not have full capacity for making decisions. The Lasting Powers of Attonrey (LPA) enables individuals to appoint a decision-maker on their behalf. The Court of Portection and Deputies is able to appoint a deputy; whose powers are tailored to the individual’s case and who are registered with the Office of the Public Guardian.
Confidentiality and Data Protection
The Caldicott Report (1997), that reviewed patient information handling, recommended that patient identifiable information (PII) is restricted only to those who need to access the information to undertake their responsibilities. It recommends that everyone, then, who accesses the information is suitably trained on handling information confidentially. These recommendations are subsequently legal responsibilities since the Data Protection Act (1998).
Data protection is multi-faceted but fundamentally ensures that the minimum amount of patient identifiable information (if at all) is recorded for a specific purpose i.e. no excessive information is stored. Data protection also ensures that data is maintained i.e. that it is correct and current; but also has considerations that data is not retained for longer than necessary. The Data Protection Act (1998) also seeks to ensure that data is kept securely (i.e. against unauthorised access) as well as within the UK unless the individual’s consent has been explicitly provided.