The burden of mental ill-health for the individual Flashcards
When studying the personal impact of mental disorder, why is schizophrenia a paradigmatic disorder?
The personal impact of schizophrenia concerns: > Symptoms - hallucinations - delusions - thought disorder - anxiety - functional impairments - cognitive impairments
> Hospitalisation, often under compulsion
Medication side-effects
Premature deaths
- due in part to lifestyle, suicide, metabolic effects of medication and other things that we don’t yet understand
Loss of self-identity
Stigma, comes with the diagnosis
Discrimination
> Unemployment
Poverty
Homelessness
Social isolation
Smaller social networks, tend to be non-reciprocal
Small likelihood of marriage / cohabitation
Small likelihood of having and caring for children
> People with schizophrenia have an increased risk of being victims of crimes or being perpetrators
-> increased contact with the Criminal Justice System
What are the different types of impact of mental disorder on carers?
How can the burden carers experience be reduced?
> Emotional
Financial
Practical
Social
We now know that the burden that carers experience can be much reduced by appropriate policy and service interventions.
What does the phenomenological approach of the impact of mental disorder consist of?
> Personal impact:
- becoming mentally ill
- escaping the illness identity
- recovery from illness
What does Davidson (2003) presents in ‘Living Outside Mental Illness, Qualitative Studies of Recovery in Schizophrenia’?
> Process of becoming ill
“Phenomenological” enquiry, of people about their experiences
He uses the metaphor of a black hole, where unlike the physical black whole, you can get out
Schema:
- Life before illness
- Delusions and hallucinations -> cognitive intrusions and disruptions -> decline in functioning + decreased sense of agency -> demoralisation and despair -> increasing social withdrawal
- “Inside”
- circle of demoralisation and despair - Towards “Outside”
- Belonging and hope -> Successes and pleasure -> Enhanced sense of agency and belonging -> Active efforts at coping and adaptation along with increased community involvement
What exists on the recovery literature?
“first-person” literature about becoming or being labelled as mentally ill
- dates back to the 18th century
- > important part of the contemporary recovery narrative in mental health
- personal pathways that people have experienced
How is the current iconography related to disability?
Solely on physical disability, even though not every disability is visible.
How does WHO define disability?
What’s their number for people living with disability?
An “umbrella term, covering impairments, activity limitations, and participation restrictions. […] disability is a complex phenomenon, reflecting an interaction between features of a person’s body and features of the society in which he or she lives.”
-> disability is, in fact, a fashionable term in popular discourse BUT very unfashionable in the mental health world
Over 1 billion people living with disability.
What are the concepts and tools for measuring the impact of illness at the individual and societal levels?
> Quality of Life
Health-Related Quality of Life
Quality-adjusted Life Years (QALYs)
Disability-adjusted Life Years (DALYs)
What is Quality of Life (QOL) according to the Centers for Disease Control and Prevention?
“A broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life…”
What are the six approaches to Quality of Life (QOL), according to Holloway and Carson (2016)?
- Objective indicators
- income
- access to resources
- living conditions
- occupational and social roles
- > all significantly impacted in people with a mental disorder diagnosis - Needs satisfaction -> Maslow’s hierarchy of needs
- basic physiological needs (bottom)
- safety and comfort
- belonging and love
- esteem
- self-actualisation (top) - Subjective well-being
- hedonic state (“happiness”)
- overall life satisfaction
- satisfaction within particular life domains - Psychological wellbeing
- self-efficacy
- sense of autonomy and control
- self-esteem
- morale - Capabilities - model of welfare economist Amartya Sen
- what people are actually able to do in order to achieve outcomes that they value
- poverty + ignorance + oppression = capability deprivation (Sen, 2003) - Health-related Quality of Life (HRQoL)
- “a person’s subjective perception of the impact of health status, including disease and treatment, on physical, psychological and social functioning and well-being”
What is the problem with the health questionnaires SF-36 and EQ-5D?
Neither is satisfying in assessment of mental health impact of one’s life.
Why is the Health-related Quality of Life (HRQoL) an important construct?
Medicine regulators require evidence of impact on health-related quality of life before licensing new medications.
What is the Quality-adjusted life years (QALYs)?
How is the cost-per-QALY calculated?
What is the cost-per-QALY NICE uses as cutoff for approving an intervention as cost effective?
A measure of the value of health interventions:
- [survival in life-years] x [“utility” associated with a particular health state]
- 0 = death rates ; 1 = full health
> Cost-per-QALY calculated by measuring what each option offers
- health gain
- resources
-> one could choose to do X instead of Y provided more QUALYs per unit cost than overall ambition to use scarce resources to maximise health gain
What is the cost-per-QALY NICE uses as cutoff for approving an intervention as cost effective?
NICE uses a cost-per-QALY of about £30,000 as a cutoff for approving an intervention as cost effective.
What is the Disability-adjusted life years (DALYs)?
Years Lived with Disability (prevalence of disorder x disability weight for condition)
+
Years of Lost Life (impact of premature mortality)
- Weight 0 = perfect health
- Weight 1 = extreme ill-health
