Mental Health Care: Legislation, Theories and Issues

psychogenic wellness C be Legislation, Theories and IssuesCase Study, running(a) with Adults assignment ( amiable Health).This paper is a disputeion of the mixer diddle issues in the fictional character of bloody shame, a 44 course of study old woman with a history of compulsory admissions chthonic the MHA 1983. bloody shame has been variously diagnosed with bipolar dis put in, psycho depression she is looked to earn a borderline per countersignality disorder and intoxi go offt dependency syndrome. She is flowingly prescribed anti-depressants and a four-weekly anti-psychotic terminal figure injection. Her 24 year old son, Pete, has a substance misuse problem, and lives nearby. A instigate from support arising step up of her contact with societal gos, bloody shame has intermittent support from her sister, Sophie, a genial attention druber who lives in a nearby town.The victor and clinical dilemmas understood in bloody shames content are, arguably, super apocal yptic of wider problems in the diagnosis and safekeeping of the intellectually ill . They are specially relevant to the generic issues faced by kind workers in some(prenominal) similar possibilitys. Whilst it is obviously im contingent to generalize, the feature tolerates that the type of care offered allow for ultimately depend upon the decisions make by the relevant professionals, a fact which brings into focus the complex system of rules of checks and balances which has accumulated around psychicly unwell thickenings and perseverings. As Golightly observes, genial wellness services are at a crucial stage of redevelopment which, by the time it is complete, depart produce a service that is appropriate and responsive to service user needs. (Golightly 2008 p.2). Whilst this impetus is tangible and visible in various initiatives and insurance changes, the fact remains that it ultimately depends upon a complex operate of legislative, procedural and professional integrat ions, many of which remain very much a work in progress. Whilst this process is ongoing, it is up to practiti unitaryrs themselves to mediate these processes in the interests of their vulnerable clients. Over and preceding(prenominal) this, it is important to retain an anti-discriminatory perspective, taking account of the preconceptions which whitethorn skew cardinal analysis and practice in the case of certain issues. . As Thompson expresses it, au whereforetically anti-discriminatory practice must(prenominal) be part of a wider fabric which rings antecedent and privilege differences and which hinge on social divisions. This brings us.to the quest to wit if you are not part of the solution, you must be part of the problem. (Thompson 2006 p.78)1. critically evaluate the tinct of salient legislation and policy in your work with Mary.The principle impact of salient legislation and policy in this case adjusts in the area of coincide, and in particular the successive nuanc es to the processes with the client is adjudged to be either capable or incapable of determining the circumstance in which their care should bump off place. Given that Mary has been compulsorily admitted under sections 2 and 3 of the psychical Health humankind action 1983 on v separate occasions in the last ten years, (the most juvenile only two years ago), it would seem that in her case the precedents act upon once to a greater extentst the obtaining of consent. As these episodes realise also involved violence against two social work practiti superstarrs as police officers, any risk assessment would point to the fact of consent universe unlikely, and appropriate contingencies being put in place as a matter of professional responsibility. The question is, do the mediocre consent arrangements introduced after 1983, and in particular the graduated coming to issues of consent which arise pop of the psychological capacitance Act 2005 and the Mental Health (Amendments) Act 2007, offer practitioners or Mary herself, a to a greater extent than positive trajectory?As suggested above, prescribed intervention has taken the institute of a whole new tier of intermediate legislation (discussed more fully below) which fills a perceived vacuum, and gives a range of new protocols for the social work practitioner and otherwise agencies. As Bogg puts it, With the inception of partnership arrangements in the midst of health and social care came awareness that the regulatory frameworks that g everyplacened each sphere of influence needed to be aligned. (Bogg 2008 p.9). Parallel to this development was the transformation of the Approved mixer playacter (ASW) role into that of the Approved Mental Health Professional (AMHP). Questions remain as to the precise reasoning behind this development, and whether its provenance lays entirely in the re-framing of practice, or other contingencies. As Bogg points out, While the initial implementation of the Menta l Health (Amendment) Act 2007 entrust be to convert existing ASW mental faculty into AMHPs the opportunity for nurses, occupational therapists and psychologists to become ANHPs will be available from the latter half of 2008, and these groups will therefore need to consider what this will mean for their practice and their professional perspectives.One particular concern in relation to AW provision is that of an ageing workforcethe introduction of the AMPH enables other professions to take on the statutory role within mental health service provision, and potentially expands the availability and perspectives of the workforce. (Bogg 2008 p.116).2. Critically explore the issue of consent and subject matter with elongation to Mental Capacity Act 2005The facts of Marys mental health and her current emotional state would seem to suggest that obtaining consent from her would seem unlikely at present. It whitethorn be argued that the Mental Capacity Act 2005, and the provisions of the sub sequent Mental Health Act 2007, introduce the governments cumulative response to converging concerns about man-to-man liberty and the functioning of the human services with regard to mental health. As the government itself states, The main purpose of the legislation is to ensure that people with good mental disorders which threaten their safety or the safety of the public send word be treated regardless of their consent where it is necessary to prevent them from harming themselves or others. (Golightly 2008 p.48)They also encapsulate the dilemmas which beset government and jurisprudence in this sphere, and the hegemony of the European Commission of Human Rights over human rights law in general. In other words, the British government is not the master of its own necessity with regard to the decision to deprive a client or patient of their liberty on the grounds of mental incapacity. The clearest evidence of this is the ostensibly intermediate status of the 2005 Act, which, a lthough enshrined in UK law, awaits its substantive validation through other processes, as Golightly indicates. Section 50 of the MHA has amended the MCA 2005 to provide safeguards for those incapable people over 18 years of age that are deprived of their liberty. The government hopes this will meet the requirements of the ECHR although we will have to wait until it is essayed in the courts. (Golightly 2008 p.50). put aside this extended validation process, it remains to critically assess the allied issues of consent and capacity as they are dealt with in the 2005 Act. In the offshoot instance, it may be helpful to understand the function of this legislation through its framing and provenance. The really novel and significant contribution of the 2005 and subsequent refinement in the 2007 Act arguably lays in the want of Liberty test and procedures, within which set out in Section 50 of the 2007 statute. below this, if no authorization has been obtained under the DoLs, a depr ivation of liberty can only be lawful through the satisfaction of two possible preconditions. Firstly, such an arrangement must be the subject of an order made by the court of protection under s.16(2) of the Mental Capacity Act. Subsequently, an practical application must have been made to the court under which such a deprivation of liberty is considered necessary in the meantime either to give birth the persons intent, or prevent a serious de backsidement in their condition. (Golightly 2008 p.50). These refinements were prompted by the case of an autistic man (HL) held informally by the Bournewood Trust, a situation which gave rise to the hearing of HL v. United Kingdom. As Golighty reports, this situation was unlawful, because the common law of necessity is likewise vague and has too few effective safeguards to comply with articles 5(1) and 5(4) of the ECHR. Thus, HL was de facto detained and the DoLs represent the governments attempt to remedy the problem that (the) Bourn ewood case richlylighted. (Golighlty 2008 p.49).In effect then the 2005 MCA was designed to add definition to the informal and often legally blemished protocols, which social workers and other professional had evolved in the around the 1983 Mental Health Act. After 2005 a new tier was added to the hierarchy of actions to which these agencies had recourse informal or voluntary admission under s.131 admission under the Deprivation of Liberty Procedures in the amended Mental Capacity Act 2005, or ultimately, compulsory detention under part 2 or part 3 of the Mental Health Act 1983. (Golightly 2008 p.48). The 2005 Act also initiated other safeguards, such as the system of single-handed Mental Capacity Advocates (IMCAs) for the runner time, potentially vulnerable clients without the support of relatives or friends have a statutory right to an appointed, i.e. non-instructed advocate. (Golightly 2008 p.51). This, it was intended, would furnish the client with both continuity of objectiv e advice and a pastoral perspective, which mogul otherwise be deemed wishing in the system of legal and clinical checks and balances devised for their care.3. Provide a critical overview of protection and risk issues in this situation.From a legislative perspective, the problem is that some of the most grand evidence is circumstantial, is derived from third parties, and may in fact be apocryphal. For example, neighbours have been reporting disturbances at erratic and unsociable hours, but this at shell represents a general indication or suggestion that Marys mental health may be entering a effortful phase, or even deteriorating. It cannot, unilaterally, support anything approaching an admissions procedure given that her son Pete, (who himself has a history of substance misuse), is apparently at her flat often, it is not necessarily the case that Mary is herself the cause of these disturbances. Conversely, it is quite possible that disagreements among Mary and Pete are the cau se of the disturbance. However, given that they are both frequently in an altered state of mind, either due to mental health issues or either alcohol or substance misuse, the likelihood of being able to make an objectively worthwhile assessment based purely on investigation of this situation does not seem strong.4. Critically discuss the role of inter-professional collaboration and practice in relation to Marys situation.According to the development supplied in the case study, those in contact with Mary currently embody her social worker, the consultant psychiatrist, and the CPN assigned to her.From the information available, it seems that there is significant dissension within the multi-agency effort to assess and plan for Marys needs. regulation amongst these is the position of the Consultant Psychologist, who has expressed doubts as to her diagnosis as mentally ill, and requested that she is transferred to the substance misuse service. He has further stated that a home vis it although requested by the care coordinator is unnecessary, and that Mary should be offered inpatient detoxification. This may prove to be either a major(ip) stumbling block, or, at the very least, a significant determining factor in the direction of Marys care. As Golightly points out, Consultants will point out that they have clinical responsibility for the individual and hence medical-legal responsibility. This has been further compound with the emergence of nurse prescribers. (Golightly 2008 p.139). At present, it is debatable whether or not the consultants hegemony would be operable in the context of a many-sided formal assessment under part two or ternion of the 1983 Act. There is, however, a sense in which his current intransigence may eventually produce a repetition of Marys forward compulsory admissions, if it contributes to a lack of action in respect of her current difficulties. As Bogg points out, the professionals involved need to identify with and own the teams purpose and goals if there is to be effective multi-disciplinary cooperation. (Bogg 2008 p.35)5. Drawing on a range of theories and approaches critically demonstrate the evidence base for your work with Mary and Pete.There are several principle theoretical frameworks which may be deemed applicable in the case of Mary and Pete. It is important here to descry and retain the link between the theoretical base, the evidence base, and the pertinent policy framework. Given that the multi agency effort incorporates both social and clinical practitioners, the two theoretical places which should be applied are the social, the medical, the biopsychosocial, and the recovery. In this part of the reciprocation we will consider the case of Mary and Pete discretely within each variant.As Bogg observes, the social model places the emphasis of the condition on the consequence of the mental distress or disorderinstead of looking at symptoms and disorders as an entity in themselvesthe social model focuses on the social consequences and how to improve the theatrical role of life and wider responses the individual is facing. (Bogg 2008 p.44). From this position, it has to be recognised that the evidence base currently held is inconclusive in respect of the precise course of action which might benefit Marys condition. This is principally due to the subjective and fragmentary nature of such evidence although, overall, it combines to present her situation as alarming, in fact the total of such evidence may be more than the real sum of its component parts. In other words, the detaility of each apparently negative social interaction at Marys workplace, with neighbours, friends or relatives needs to be looked at in more detail originally an accurate, overall picture can be agreed upon. Meanwhile, the medical model, again defined by Boggs, is, in its psychiatric sense, ordinarily a reference to the biological model. This rests on two principles first, that mental disorder is a read/write head disorder, and second, that all mental events are neurological events. Bogg 2008 p.45). The controversies thrown up in the space between the social and medical models have in crop produced more graduated approaches in the biopsychosocial and recovery models.In the case of Mary and Pete, with all of its implications regarding possible and actual substance dependence and misuse, the recovery model seems to offer the most realistic mean of potency. Given Marys history of psychotic diagnosis, the medical model obviously cannot be discounted, and will continue to represent a significant part of hr care. As Bogg observes, with acknowledgements to insights derived from Mahler and Tavano, recovery can offer both a conceptual framework for understanding mental illness and a system of care to provide supports and opportunities for personal development.while individuals may not be able to have full suss out over their symptoms, they can have full wangle over their lives (Bogg 2008 p.48) As in all similar cases, whilst the policy base provides an inter-disciplinary and multi-agency framework within which to organize care packages, the theoretical base may vary according to perspective employed. However, the evidence base in Marys case strongly suggests that a holistic approach may gradually enable her to make her own choices about regaining control over her own life. It also has to be considered that at some point, the case worker may have to share their considerations of Marys case with the relevant ASW/AMHP, whose expertise and training may be helpful. As prior(prenominal) observes, there is a concentration of specialist training in this one area. This concentration on some staff throws into sharp relief the lack of training opportunities available to others. (Prior, 1992 p.108)6. Critically analyse and take into account the causes and impact of inequality and favouritism on Mary and Pete.There are, it may be argued, many possible sources of discrimin ation and inequality which may have force upon Mary and Pete. Some of these, taking into account the social model, are implicit in the structure of coetaneous society perhaps inevitably, some of these said(prenominal) factors feature in the practice of the human services. The situation in which Mary and Pete currently find themselves in relation to social services is, arguably, highly indicative of the transformations which have been required of the profession, and of the residual tensions implied by such transformations. such tensions can be illustrated by comparing two intra-social work perspectives one proposing a Third-Way or tough love approach to social issues, the other favouring a less sanguine, more interventionist position.The first of these approaches can be summed up in the position of Ferguson, who argues that we now live in a post-traditional order where processes of individualization have resulted in the self becoming a reflex(a) project. Identities are nowconstr ucted by individuals themselves, rather than inherited and this has given rise to a new agenda of life political science. While it should not replace a concern with emancipatory politics and life chances, I am arguing that life politics needs to be at the centre of how social work is understood and practised today. (Ferguson, 2001 p.42). For those opposed to this position however, the idea of life politics does not adequately replace earlier ideas of life chances, or the mood in which these are systematically denied to certain individuals. For adherents of this position, an approach which addresses this problem should lay at the core of effective social work practice. As Thompson indicates, a social work practice which does not take account of oppression, and the discrimination which gives rise to it, cannot be seen as good practice, no matter how high its standards may be in other respects. (Thompson 2006 p.15). For some observers, similar concerns are raised by the idea that the empowerment of the individual can flesh a holistic approach to their care, rehabilitation and support. As Adams points out, the difficulty with the empowerment paradigm is that its contemporary forms have all fed off anti-sexist, anti-racist, anti-disablist, and other critical, anti-oppressive movements, whereas its historical roots lie partly in traditions of mid-Victorian self-help which tend to reflect the dominant social values of that time. Whereas in theory, self-help is a neutral concept, in practiceit was wielded by themiddle classes to extol their own virtues. (Adams 2003 p.18). Essentially then, such disagreements may be related back to the question as to whether the contemporary transformation of the profession, as one implicitly focused on official targets and competencies, is the model best adapted for the care of clients, or whether a more problematical relationship would be better. As Jones expresses it, social work must always be a difficult and troublesome activit y irrespective of the government in power and the prevailing orthodoxies. (Jones, 1997 p.62)At a clinical level, the possible diagnosis of Mary as having one of a range of different problems may have profound implications for the way in which she is treated, both within the social care and health systems, and society itself. In a sense this is a technical question which relates back to the discussion of multi-agency cooperation, and touches on the question of diagnosis and a hierarchy of needs. As Bogg points out, The criticism of diagnostic categories (such as the stigma created by giving an individual a specific label) is not dispelled or underestimatedand a diagnosis can hold as much detriment as it can benefit (Bogg 2008 p.46). 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