diversity and differences Flashcards
define health
“… a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
positive and holistic view
WHO
define mental health
“… a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community” (WHO, 2013)
incorporates wellbeing
places mental health within the wider social determinants of health and wellbeing
mental health not in a vacuum
what are the wider determinants of health and wellbeing?
think basic needs
Holistic: • Physical, emotional, psychological • Self-actualisation • Personal goals • Being productive • ‘Belonging’
what is wellbeing
dynamic state
impacts ability to feel and function
satisfied with life- evaluation
impact of external factors on wellbeing
Autonomy, Control, Purpose
• ‘urbanicity’ increases incidence of schizophrenia and bipolar
disorder (Krabbendam & van OZ, 2003; Pederson & Mortenson 2007)
• High Wellbeing i.e. functioning well, positive feelings à
‘Flourishing’ (New Economics Foundation (nef), 2012)
nef model of wellbeing
good feelings day to day and overall good functioning and satisaction of needs external conditions personal resources = flourishing
nef - wellbeing
‘good feelings day to day and overall’
happiness
joy
contenment
nef - wellbeing
‘good functioning and satisfaction of needs’
to be autonomous, competent, safe and secure, connected to others
nef - wellbeing
external conditions
material conditions
work
productivity
income (levels and stability)
nef - wellbeing
personal resources
health
resilience
optimism
self-esteem
what are the two diversity and difference legislative framework
- Human Rights Act (1998)
* Equality Act (2010)
what is public sector equality duty
universities, NHS, local government have specific duties
actively promote opportunity
•Eliminate unlawful conduct prohibited by the Act e.g. discrimination, harassment and victimisation
- Advance equality of opportunity between people
- Foster good relations between people who share a“protected characteristic” and those who do not
what are the protected characteristics - there are 9
Protected characteristics • Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity (including breast feeding) • Race • Religion and belief (including lack of belief) • Sex • Sexual orientation
what is the NHS ethos as part of healthcare policy context
NHS ethos – 3 Core Principles:
• Universal : to provide same standard of health care throughout the UK
• Comprehensive: cover all health needs
• Free at the point of delivery: available to all citizens equally on the basis of need, not ability to pay.
founded to eradicate inequalities
what are the areas that the policies are aimed at reducing persistent inequalites
- Health (DH, 2003; DH, 2013)
- Mental Health: Gender (DH, 2002, 2003) Ethnicity (DH, 2005)
- Social Care (2014)
what is Epidemology?
Epidemiology: disease prevalence and incidence
what can you predict from illness patterns and need
age is associated with cognitive disorders - ageing population - dementia
obesity- diabeties and cardiovascular disorders
physical health - mental health
understanding diversity and difference supports service desing and delivery, give examples
Supports service design and delivery
• Strategies to reduce inequalities
• Screening and disease prevention vs illness interventions
• Workforce planning
• Facilitates intersectional vs ‘one-size-fits-all’ approach (Banks & Kohn-Wood, 2002)
how much higher is the risk of depression anxiety suicide in LGBT people
1.5
how much higher is the suicde risk in gay men
2-4 times
how much higher is the self harm rate in LGBT people
2x general population
% depression in gay young people who arent bullied
35%
what contributes to worse mental health in LGBT people
• Discrimination
- social stress
- concealment
- stigma
- internalised homophobia linked withworse mental health
when was homosexuality decriminised and not classified as a mental illness
- Homosexuality decriminalised 1967 (1980 Scotland)
* Until 1993 homosexuality classified as mental illnesses (DSM)
how much higher is the risk of psychosis and being sectioned in the black population
Black people more likely to:
• Be diagnosed with psychosis (e.g. 6-9 times great risk schizophrenia compared with White British)
-compulsorily admitted to hospital (4 times more likely to be ‘sectioned’ under the Mental Health Act (2007)
what do black people report in their experience of mental health
Report worse care experience • Have poorer treatment outcomes • Disengage from mainstream mental health services - Leading to social exclusion - Deterioration in their mental health - High rates of relapse and readmission to hospital higher doses of medication more likely to be held in seclusion
what do African/Black Carribean people report in terms of mental health
Lower rates of diagnosed common mental disorders (CMD) (e.g. anxiety & depression) than other groups but higher rates severe mental illness (SMI)
what do South Asian people report in terms of mental health
don’t have information for east Asia
Low rates of suicide and depression in men, high in women.
High rates of alcohol use in Indian men.
what do White Irish people report in terms of mental health
White Irish: High rates depression, alcohol use, increased risk of suicide – especially
men
are there differecnes in men and women experiencing mental health problems
no, overall no significant differences in men and woman (50% hospital admission)
what effects hospital input data
more likely to talk to gp
men seld medicate
willingness of ability to access the diagnosis
what conditions are more commonly diagnosed in women
• Depression 2:1 (women: men)
• 60% OCD, phobia = women
• PTSD 20.4% for women vs 8.1% for men
• Link between reproductive cycle and MH problems e.g. ‘perinatal depression’ (15% women)
• Others not e.g. 25% suicide = women
Gender-sensitive services – recognise role of trauma
In the UK, the difference in life expectancy for men with diagnosed mental illness and those without is:
16 - male
12 female
the gap is widening
deaths in mentally ill people with cardiovascular disease
- Majority excess deaths due to physical conditions:
- Cardiovascular disease:
- 32% male, 46% female patients with schizophrenia
- ‘Other psychoses’: 33% male, 41% female
- Neurotic disorders: 38% male, 38% female
are people with mental illness at a disadvantage in regards to common physical conditions
yes
“Significant advances in reducing death rates due to common physical conditions, but people with mental illness have not benefited to the same extent as the general population” (Lawrence et al, 2013)
do children of people diagnosed with mental health problems do less well
yes
young carers
greater level of emotional, psychological and behavioural problems
poorer academic achievement -> higher risk of mental illness
Children of people diagnosed with mental health problems do less well
True Pakistani & ‘British-born Pakistani women’, higher rates perinatal (antenatal & postnatal) depression
• Associated with:
•Poorer physical outcomes in children
-Lower birth weight babies, higher rates of infant mortality, psychological problems
• Poorer psychological outcomes in children
-E.g. problems with the infants’ adaptive behaviour
• Increased risk of chronicity - ilnesses going on to become long term - in women
- Up to 50% cases
deaf people and mental health
As sociated with:
• 40% Deaf children experience mental health difficulties compared with 25% hearing children
• Prevalence of depression and anxiety 33% compared with 15% rest of the population
• Around 90-95% Deaf children born into hearing households
• Deaf children in families with communication difficulties (e.g. ‘language deprivation’) 4 times more likely to develop psychological difficulties than families with no communication difficulties
• Increased risk of bullying, social isolation, increased risk of suicide
• Reduced educational attainment and health literacy
what are the inequalities in access for deaf people
Inequalities in access, experience and outcomes
• Intersectionality
• Communication: Diagnosis, Care Planning & Experience, Advocacy
• Culturally aware/sensitive care – often culture=ethnicity/race
• Accessible Information Standard
• Focus on spoken and written language à translation, interpretation
• Deaf people
• Limited number of professional BSL interpreters
• Lip reading: Average Deaf adult can lip-read only 26% to 40% of speech
• Fear being mis-diagnosed and ‘sectioned’
what is Parity of esteem
describes the need to value mental health equally to physical health
what qualities impact access care and outcomes - inequalities
gender ethnicity SES age disabilities
