Deck 10 Flashcards
What social values determine mental health?
- Race (biological, innate?)
- Sex (biological, innate)
- Ethnicity (culture, language, beliefs, religion, nationality, biogeographical ancestry)
- Gender (culture, beliefs, social understanding)
Give some facts about ethnicity.
Ethnicity - “[ethnicity] implies one or more of the following: shared origins or social background; shared culture and traditions that are distinctive, maintained between generations, and lead to a sense of identity and group; and a common language or religious tradition”.
• Large, national surveys, using largely quantitative but also qualitative methods of research - Census and Health Survey of England
• People of minority ethnic origin constitute
about 14 per cent of the total population of
England & Wales (the 2011 Census) – of whom
over 50 percent were born in the UK (however
more changes due to recent East European migration).
• Over 40 languages spoken in Greater London; 45.1 percent minority population. • Point of interest - a third of all UK medical students and junior doctors are from
minority ethnic groups
Can be problematic as people are lumped into fictive unities (non-white for example), wide range of expectations (stereotype). Stigma and help seeking may be different in different.
In terms of mental health, women are more likely to..
- more likely to be admitted to psychiatric hospitals
- more likely to receive a script for a psychotropic drug
- more likely to receive a diagnosis of depression
Is this because they are:-
more likely to be classified as suffering from depression
more likely to seek help for emotional distress
more likely to suffer from mental disorder
Gender and Mental Health
- 20% women and 13% of men in the UK have some a common mental disorder (Mental Health Network 2011)
- 56% of sentenced women are reported to have a psychiatric disorder compared 37% of sentenced men.
- Men more likely to have a diagnosis of psychosis and women of neurosis
In mental health, men are more likely to..
• Boys show higher rates of mental illness than girls
• Men ‘successfully’ commit suicide 3.5 times more than women in the UK (ONS, 2013)
• Elderly white men have a suicide rate 6 times higher than the national average
• Men are more likely to be diagnosed as suffering from psychosis, alcohol or drug
abuse (disorders of behaviour).
Latest figures on suicide in UK (ONS, 2013) show: 4858 male suicides (78%) and 1375 female suicides (22%). Greatest gender difference since records began.
A view that men are unwilling or less able (than women) to use health services - women, notably intimate female partners, promote men’s access of such services and fostering social practices that may promote health.
What problems exist within men and mental illness?
Suicide Prevention Strategy for England (Department of Health, 2012)
• No reference to gender or male specific issues
• Vulnerable groups included young, LGBT, refugees, asylum seekers and minority
ethnic communities
• 2013 update – 1 page on gender relating to GPs and community outreach.
Constructions of masculinity leaves men unwilling to give expression to their emotions and constructing identity through work.
• This means hiding anxieties and uncertainty; in short, suppressing emotion and feeling.
• In other words, men’s bodies are privileged as ‘healthy’ and strong in contrast to women’s ‘weaker’ bodies
• Men become disconnected from their bodies, seeing them as separate and discrete objects that simply provide the means to ‘do’ things – bodies as machines that function (or not) almost independently.
Meyer 2003 - LGB higher rates of suicide, substance abuse, depression, anxiety and cancer and immune dysfunction relative to heterosexual population.
What is the minority stress model?
Focused on race and sex, gender-variant.
Exposure to Distal (external) stress
Increased exposure to Proximal (internal) stress. By-product of distal stress.
Vigilance, negative feelings.
Leads to adverse health issues
What problems exist with racism and sexism in research and practice?
One in 8 ethnic minority people experience some form of racial harassment in a year. 3% experience physical attack on themselves or their property.
Repeated racial harassment is a common experience.
25% of ethnic minority people say they are fearful of racial harassment.
20% of ethnic minority people report being refused a job for racial reasons, and
almost 3/4 of them say it has happened more than once.
20% of ethnic minority people believe that most employers would refuse somebody
a job for racial reasons, only 12% thought no employers would do this.
White people freely report their own prejudice:
One in four say they are prejudiced against Asian people;
One in five say they are prejudiced against Caribbean people
• Black Report (DHSS, 1980) Widespread health inequalities in UK caused by economic inequalities.
• Whitehead Report 1987, Acheson Report 1998 Marmot Review 2010
• Wilkinson, R. and Pickett, K. (2009) The Spirit Level :Why More Equal Societies
Almost always do Better, London: Allen Lane
Racism can affect health - how?
And how can we change this?
- Socio-economic disadvantage.
- Awareness of discrimination and relative disadvantage.
- Experience of harassment may have direct effect.
- Hypertension as internalised anger.
- Recognising that distress is universal
- Acknowledging diversity
- How best to deal with universality through the differences of language, culture, religion and lived experience by respectful accessible and appropriate services.
- Culturally competent care - Papadopolous (2006)
What are the features of institutionalised professionalism?
A commitment to serve the public good
Presupposes generalised and systemised knowledge
Standards are set by profession & element of self-regulation
Involves certification or licensing procedure
Existence of a professional body which sets professional standards, oversees disciplinary
mechanisms, determines content for training, carries out certification and licensing.
What is the role of the General Medical Council?
“The GMC registers doctors to practise medicine in the UK. Our purpose is to protect, promote and maintain the health and safety of the public by ensuring proper standards in the practice of medicine.” (GMC)
Professional body for doctors in the UK
Decides who is and isn’t fit for practise
Stipulates in general terms the medical training syllabus
Provides good medical practice guidelines for doctors
How is medical professionalism assessed?
“Medical professionalism consists of those behaviours by which we – as physicians – demonstrate that we are worthy of the trust bestowed upon us by our patients and the public, because we are working for the patients’ and the public’s good.” (Swick 2000: 614)
Subordinating own interests to the interests of others
Adhering to high ethical and moral standards
Responding to societal needs
Evincing core humanistic values, including honesty and integrity, caring and compassionate
Exercising accountability for themselves and colleagues
Demonstrating continuing commitment to excellence
Exhibiting commitment to scholarship
Dealing with high levels of complexity and uncertainty
Reflecting upon actions and decisions
Students are responsible for:
Their own learning
Ensuring patient safety by being aware of the limits of your own competence, training and
status as medical students
Raising any concerns about patient safety, or any aspect of the conduct of others which is
inconsistent with good medical practice
Providing evaluations of their education for quality management purposes
The GMC expects of new graduates that they:
20) Will be able to behave according to ethical and legal principles 21) Reflect, learn and teach others
22) Learn and work effectively within a multidisciplinary team
23) Protect patients and improve care
Professionalism expectations arise in different spheres of life:
University settings (e.g. attendance and punctuality; academic probity; relations with others)
Clinical settings (e.g. consent; dress; working with others; confidentiality; recognition of own
limitations; patient safety; reflection on practice)
Social / personal settings (e.g. responsible for use of alcohol, use of social media, own health
needs)
How does HYMS assess professionalism?
Routinely as part of Record of Achievement In response to disclosure of incidents:
• Expression of Concern form
• Any other mechanism of disclosure
• Critical incident
Criteria set out in HYMS guidance, GMC guidance, also requires students to have insight into expectations of doctors.
Prime concerns are:
• Safety of patients and protection of public
• Maintenance of public trust and confidence in doctors, and preserving the profession’s
reputation
What are the supportive processes that HYMS enforces?
Supportive processes
(Lead to consensual outcome)
Recorded concern (e.g. Borderline professional behaviour)
Attempt at informal resolution (e.g. meeting with Associate Dean following Unsatisfactory professional behaviour)
What are the formal processes that HYMS enforces?
(Lead to imposed outcome)
Formal investigation
Hearing of health / conduct subcommittee (“FtP panel”)
“A student’s fitness to practise is called into question when their behaviour or health raises a serious or persistent cause for concern about their ability to continue on a medical course, or to practise as a doctor after graduation. This includes, but is not limited to, the possibility that they could put patients or the public at risk, and the need to maintain trust in the profession”.
Chair is “lay” (Chairman of an NHS Trust) Members are mix:
• University and NHS employees
• Doctors, other health professionals, academics
Meets regularly 4 times a year
Reviews issues without knowing student identity
Fitness to practise panels arranged to investigate major cases (not anonymous, student appears in person to present his / her case)
What are the outcomes of a fitness to practice process?
Outcomes of formal FtP processes
- No action
- Remedial support or therapeutic action
- Additional monitoring / supervision / appraisal
- Issue of Warning
• Application of sanctions
- Undertakings
- Conditions
- Suspension
- Termination of studies
