Provide a critical evaluation of current methods of working and service user provisions in the area of parents with a mental health problem, drawing upon developing knowledge and research.
In this thesis we discuss the role of parenting, the responsibilities that are involved and the issues of mental health problems in parents. We draw upon existing knowledge and research to understand mental health problems and psychological complications of parents and discuss health and social policies that are related to current methods of working for such parents within social work. Several research studies, legislative reports and health policies are discussed and we provide a critical evaluation of the provisions, current research materials available and issues regarding mental health and psychological problems of parents and service user provisions.
In 1998, the Department of Health emphasised on the programme of Modernising Mental Health Services, with three key aims:
Safe services – to protect the public and provide effective care for those with mental illness at the time they need it
Sound services – to ensure that patients and service users have access to the full range of services which they need
Supportive services – working with patients and service users, their families and carers to build healthier communities. (See DoH, 1998)
Service User Provisions and Mental Health – Studies and Approaches
Among the service provisions available to parents with mental health needs, the programme of the National Service Frameworks (NSF) is part of the Government agenda to improve quality and reduce any unacceptable variations in health and social services National Service Frameworks by the Department of Health, cover mental health issues and coronary disease the significant reasons for causing disability and ill health among the adult population in UK. The NSF frameworks address the mental health needs of working age adults and parents and set out the national standards of care and support, the national service models, local action, and national underpinning programmes for implementation and a series of national milestones and performance indicators to measure progress in this sector. National health standards are set out in five areas including mental health promotion; primary care and access to services; effective services for people with severe mental illness; carers of people with mental health problems; and reduction of suicides. This applies to tackling mental health problems in parents and provisions for access to care.
The National Service Framework for mental health concentrates on the mental health needs of working age adults up to 65, and covers health promotion, assessment and diagnosis, treatment, rehabilitation and care, and also encompasses primary and specialist care for these individuals. Adult Placement schemes are available for these individuals who are provided with carers, supported living, home based care and day services and extended family support from the NHS and NIMHE. Mental Health crisis intervention services with rehabilitation, counselling and psychotherapy are also provided by the Health authorities.
Several studies discuss the process and value of working with parents when their child or children are being treated with individual psychotherapy (see Robinson et al, 2005). A psychoanalytic understanding of the parents’ perspectives in seeing a mentally ill child and the psychological problems of the parents themselves are considered. The issues discussed have a broader applicability in other aspects and approaches of child and adolescent mental health practice (Zubrick et al, 2005). The central issues are interweaving the knowledge of family processes, child development and psychopathology and the uses of the understanding of transference and counter transference as psychoanalytic concepts. The aspects of the work which constitute child guidance are considered psychotherapeutic as it relates to parental psychopathology. To explore and define the boundaries between psychological process of child and parents, the psychotherapy of parenthood may be analysed and implications of parental psychotherapy can be considered along with children’s problems and issues.
Flouri (2005) reviews the evidence of the role of childhood adversities, family structure and issues of parenting in determining youth suicidal behaviour and Flouri emphasises that suicide research could benefit from investigating whether proper parenting can protect suicidal behaviour in young people who are vulnerable and at risks. The operationalization of non optimal parenting has often been considered as a risk factor for adolescent suicidal behaviour and influencing and identifying pathways of influence has been a major target. The measures of reducing suicidal risks in the vulnerable populations also tend to focus on parents with weak material and social resources, mental health problems and few networks, low social and emotional support, and high-risk children. The identification of causative factors relating parent mental condition an parental status might be beneficial in preventing youth suicidal behaviours as measures could be taken from a broad social perspective.
Citing one of the case studies, Derisley et al (2005) have attempted psychotherapy of parenthood and have used a study to compare mental health, coping and family functioning in parents of young people with obsessive-compulsive disorder (OCD), anxiety disorders, and no known mental health problems. For the methods, 28 parents of young people with OCD, anxiety disorders (N = 28), and no known mental health problems (N = 62), the three different categories of people, all completed Brief Symptom Inventory (Derogatis, 1993), the Coping Responses Inventory (Moos, 1990), and the McMaster family assessment device (Epstein, Baldwin, & Bishop, 1983). The results indicated that parents of children with OCD and anxiety disorders had poorer mental health and used more avoidant coping methods than parents of non-clinical and mentally stable children. The results also indicated that there were no significant group differences a measured in three groups in family-functioning. This suggested that there are basic similarities across parents of clinically referred children and active parental involvement in the treatment of OCD in young people can actually trigger or facilitate the cure and treatment of such young people.
Research shows that Black and Minority communities are more likely to suffer from inequalities in access to mental health services, they also report inequalities in their experience of services for mental health care, and they also tend to have more problems and complaints with the outcome of these services. For instance, the Department of Health points out those BME patients are significantly more likely to be detained compulsorily or diagnosed with schizophrenia in mental health situations. The mental health scenario and care provided to minority communities have a direct impact on anti oppressive and anti discriminatory practice. The Department of Health, and the NHS is developing a comprehensive programme of work to tackle inequalities of service provisions to mentally ill patients.
In the area of service user provisions for mental health care and support, with an aim to promote anti discriminatory and anti-oppressive practices, the Department of health has identified a strategy for improving mental health services for black and minority ethnic communities in England. Community development workers or social workers are appointed to enhance the capacity within minority ethnic groups, especially adults and parents in dealing with the burden of mental ill health and tackling the inequalities inherent in the services provided. These Community Development Workers contribute to: (source: NIMHE, 2005)
Seeking out the strengths and capabilities within particular communities around mental health and the resources available to individuals suffering from mental illness
Enabling mental health organisations to bridge the gap between Western models of care and the values and norms of the community they serve
Supporting community groups and networks, directing them to resources that are available and funding as appropriate
Facilitating community participation and ownership of parents/adults in mental health provision and in combating health inequalities.
For provisions of quality services, improved partnership/collaborative work between the NHS, local authorities, prisons, residential homes and the probation services are also required for service development and the care of service users, especially for individuals with severe mental illness.
In a study by Hart et al (2005), the implications of user involvement are studied that address the views of clients and their parents on service user delivery in a specialist Child and Adolescent Mental Health Service (CAMHS) serving a population of 250,000.the study explores the complexities inherent in children’s services when parents are integral or involved significantly to different modes of treatment. In the study concerned, 27 teenage clients, 11 boys and 16 girls were recruited from CAMHS and 30 parents were also consulted and they were all from different socioeconomic backgrounds. A series of structured interactive techniques were used by focus groups who also conducted home visits to get interview data. the data was then subject to qualitative analysis and descriptive statistics were generated from interview data and focus groups information. From these data the three issues that were used to describe service user provisions are the core values implicated in establishing a therapeutic alliance, the style of therapy, and mode of practice with the inclusion of family members. Style of therapy and core therapeutic skills of service providers have been given fundamental importance and Hart et al provided a model of organisational user involvement with a model of therapeutic user involvement for use in negotiating modes of practice with the service user especially in case of mental health practice. The study was thus collaboration between service users, health professionals and researchers and explored different themes of therapy and complexities inherent in children’s services as well as role of parents in mental health care. In fact provisions of parent led self help group and therapeutic approaches are important for achievement of attuned practice.
The skills of staff working in adult mental health and child welfare, those that benefit mentally ill parents and their children are recognised by effective collaboration and development of co-ordinated service provision. Health services and local authority staff, as well as workers in education and the voluntary sectors are required to understand the necessities of service provisions. This involves, foundation knowledge, working together and assessment, planning and intervention for mental health care.
The attitude of service providers is important and a study by Rasaratnam et al (2004) investigates the influence of attitudes of carers of people with intellectual disability (ID) towards giving medication. In the study 93 carers of service users who were attending an outpatient’s clinic (Harrow Learning Disability service) were interviewed, and the ratings scale used for measures was the RAMS (Rating of Attitude to Medication Scale) interview schedule. The results indicated a single association between relationships of the carer to the service user and overall positive or negative attitude towards medication was also studied. The study found that a disproportionate number of parents have expressed negative attitude in comparison with professional carers (46% vs. 11%) towards medication. the study suggests that standards of compliance with medication needs to be emphasised and researched on especially in case of family carers of mental health problems. Psychiatric disorders seem to have a stigma associated and providing medication for mental illness is still considered unacceptable. The family carers’ attitude to mental health problems and general mental illness may be shaped by such social and psychological factors. All these issues seem to be important in determining the kind of medication a psychiatric patient should have.
In a study by Evans et al (1994), the All-Wales Mental Handicap Strategy (AWS) has promised not just governmental leadership and emphasis on the area of mental health service provisions but also availability of resources for developing community based residential, domiciliary, respite, day-care and professional services for people with mental handicaps and their families. Thus the strategy aims at providing the best for mentally ill people to experience community life. For the study a sample of people with mental handicaps was used to track changes in mental health services received, in professional input, the number of community activities pursued, and the size and range of individuals’ social networks and involvement in individual planning and the impact of health care strategies. There was a decrease in the proportion of patients living with parents and an increase in those living independently or in another family situation although private residence and serviced residence were both equally used for living purposes. Residential service associated with care facilities were also noted and there was marked preference for family based care. Family support services in the form of family aides and short-term care increased significantly, and day service also diversified. The health strategy as followed by the AWS seems to have brought individuals with mental health problems in greater contact with other members of the community although there was no difference in people’ friendship networks or extent and nature of associations. Yet the service provisions an family and user experiences were found to be in accordance with the direction and goals set by the AWS yet changes are still required and the a new patterns of services have been identified as necessary. The authors point out at the end of the analysis that the mental handicaps do conform to the guiding principles of AWS health strategy and its implications can be significant.
If this study is extrapolated to understand the dynamics of the working and provisions for the service user in the contemporary mental health scenario, we can learn several lessons and identify several new provisions that may work with mentally ill patients. Providing a well integrated community network and service provisions at home as well as making resources available to the mentally ill patients either in their residential places or in the community or even at health and clinical settings could be major priorities of any health care strategy. The AWS strategy can thus be a blueprint or a primer for further modern health strategies and provides us with an opportunity for critical appraisal of service provisions that can be made available to mentally ill individuals in need of special care and support.
There are however several issues that need to be considered as important in a critical evaluation of service user provisions for mentally ill patients.
One of these issues involves improvement of the quality of information about clients referred to a community mental health team for referral purposes. For improved services to clients, improved information is also necessary and new ways of devising this quick availability of information should be encouraged.
The second recommendation for improving service provisions involves following clinical guidelines. Michie and Lester (2005) determine whether writing or written clinical guideline recommendations in behaviourally specified plain English language can increase the likelihood of their implementation by service users or the patients. Following clinical guidelines, medication or therapy procedures is an important aspect of treatment and improvement of service user provisions can be made by stronger emphasis and written specification of approved and recommended guidelines. A evaluation of behavioural outcome and the inclination of following these guidelines should also be studied.
Using and providing specialist service as in specialist educational intervention for acute inpatient mental health nursing staff and service user views in this regard have been studied. Richards et al (2005) evaluated the impact of an innovative 18-day educational intervention for acute ward-based mental healthcare nursing staff on reported quality of nursing care and on service user views of care using the educational intervention. The quality of inpatient mental health care for people with acute psychiatric problems has remained questionable and several studies have suggested that specialist educational courses and nursing interventions are needed to improve these services.
An integration of health and social service care provisions and also day care for mental health patients have been emphasised considering social networks and care needs of the users. Increasing integration of health care and social services requires understanding the difference between health service day hospitals and social service day centres. A study by Catty et al (2005) has suggested that day centre clients had much larger social networks, including a three-fold difference in total contacts and two-fold difference in confidants, but had more needs for care, particularly relating to psychological distress.
Our final recommendation for service user care for mental health patients and parents in a mentally ill home ambience is greater involvement of service users in mental health service planning and evaluation. Thornicroft and Tansella (2005) emphasise that service user involvement in the planning and provision of mental health services has been growing in recent years especially in areas where institutional service provision has been changed to a more community-orientated model of care. Recent studies have shown that during mental health crises, joint crisis plans by health providers and service users can significantly reduce the use of compulsory admission during crises.
In this essay we provided a critical analysis of the provisions and policies provided by social services and health care services and evaluated the need for certain practices in providing quality service to service users with mental health needs.
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Rasaratnam R, Crouch K, Regan A. Attitude to medication of parents/primary carers of people with intellectual disability. J Intellect Disabil Res. 2004 Nov;48(Pt 8):754-63.
Richards D, Bee P, Loftus S, Baker J, Bailey L, Lovell K. Specialist educational intervention for acute inpatient mental health nursing staff: service user views and effects on nursing quality. J Adv Nurs. 2005 Sep;51(6):634-44.
Thornicroft G, Tansella M. Growing recognition of the importance of service user involvement in mental health service planning and evaluation. Epidemiol Psichiatr Soc. 2005 Jan-Mar;14(1):1-3.
Zubrick SR, Ward KA, Silburn SR, Lawrence D, Williams AA, Blair E, Robertson D, Sanders MR. Prevention of Child Behavior Problems Through Universal Implementation of a Group Behavioral Family Intervention. Prev Sci. 2005 Sep 14;:1-18
For Department of Health publications, see Mental health section DoH
also see NIMHE website, for role of Community Development workers.