W4-T3 Community Care in Practice Flashcards
Frank Holloway opinions of mental illness from his experiences
mental illness is complex
cause people around them to suffer
the patient can live well despite the continuing mental disorder
society doesn’t like the fact many people live with a mental disorder
good quality treatment helps
no magic bullet against the impact
according to Frank what is beyond medication and psychological treatment
presentation of mental health in society
how do alleviate and promote mental health
according to Tyrer (95), what is community psychiatry
it can mean many things ranging from:
the implication of “extramural psychiatry” (extramural = beyond the wall)
represents a specific form of care that involves particular skills and procedures
a form of policy to close outdated hospitals.
what was the criticism of the National Schizophrenia Fellowship (1984)
to Bulletin of the Royal College of Psychiatrists
the costs to move mental patients out of the hospital and into the community leading to disastrous
human and social problems
there is widespread failure to provide adequate aftercare or to grant aid to those for whom this care is available
how was community care policy received by others
there were serious concern including from National Schizo fellowship (today is called Rethink Mental Illness)
other criticism community care received
community care is widespread with political correctness that ignores the harsh realities for both the patient and the carers.
when the mental hospital was closed in England
1984
what was the perspective on community care to Julian Leff book published in 97
perspective on community care
3. residential care works well for most people
3. deinstitutionalized resulted in acute hospital breakdown
4. community care cost is not cheaper than hospital
5. training staff for supplies/services remain an issue
6. integration could work
what was the rise and fall of the psychiatric hospital according to Julian Leff
- policy went through a curve and ideological route
- failure of the community mental health movement in America
what was the pitfall of the hospital closure according to Leff
patients who are difficult to manage do mostly improve over time.
people with severe disabilities have not gone away because the mental hospitals closed.
how to provide a comprehensive community psychiatric service, which became a reality in England for a while in the late 2000s.
future of community care – false antithesis between hospital and community.
The hospital is part of the community. Hospital serves the community.
How Thornicroft and colleagues described community mental health care
as comprising ‘the principles and practices needed to promote mental health for a local population,’ and that
composes of four elements.
1, addressing population-based needs in ways that are accessible and acceptable
2, build on the goals and strengths of the people who are experiencing mental illnesses
3, promoting a wide network of support, services, and resources, adequate capacity
4. emphasising services that are both evidence-based and recovery-oriented.
approaches of need according to Holloway
two contrasting models:
- an implicit model (individual user)
based on the concept of ordinary human needs –
recovery (then known as normalization theory)
commitment to user involvement, and empowerment.
the problems are located largely within society
the approach is holistic, attractive, and fashionable
optimistic
lead to staff burnout
risk of people ‘rotting with their rights on’. - psychiatric model – (epidemiological perspective)
focuses on the need for specific treatment and care by a
psychosocial
model of mental illness to gain adherence from the
patient to treatment
the problems are located largely within the individual.
emphasis is perhaps on biological treatments
staff cynicism
coercive and confining
what is a measure of need based on the Camberwell Assessment of Need Short Appraisal Scale
22 domains - provides ratings of whether there is no problem in that domain, there is a met need and an unmet need, or the need is unknown
domain under CANSAS include
accommodation, food, ability to look after the home, self-care, daytimedefi activities, physical health, symptoms like psychotic symptoms, psychological distress, safety to self, safety to others, the provision of information on the condition and its treatment, drugs and alcohol, issues related to social life, company, intimate relationships, sexual expression, requires help with
childcare, educational needs, access to telephone and mobile phone, help in terms of transport, and money
and benefits
define need under according to assertive community treatment (ACT) (Stein and Test, 1980)
based on key requirements of people at risk hospital admission
material resources
coping skills
freedom from a dependent relationship
motivation
support and education of community members
effective treatment of symptoms and distress
assertive support system
Quality of Life assessment skill according to Manchester Short Assessment of Quality of Life (MANSA)
depends on how satisfied people are with their life as a whole and within particular domains
occupation (training, job, employment)
accommodation, safety, financial institution
health (mental, physical)
interpersonal relationship and activities
the common theme in all three model (MANSA, ACT, CANSAS)
required facilitated services for people to achieve good outcomes and beyond alleviating symptoms
(i.e. functional skills, somewhere to live,
relationships, activities and occupations,
meaning)
what is the key point of service according to Holloway
make sure people’s problems and needs are assessed
1. identify the problem
2. identify entitlement to service (policymaker procedure)
3. identify steps for action
4. identifies the outcome
what is recovery paradigm in mental health term
offer a new perspective on living with mental health
problems,
which starts from the experience of the person with the identified problem
define meanings of the word ‘recovery’ according to Roberts and Boardman (2013)
- natural healing response and approximation to cure
- clinical - recover from symptoms in response to effective care and treatment as described in evidence-based guidelines
- personal recovery - recovery of a valued pattern of life and living
what are the different meanings of recovery?
getting better (Clinical)
living well (personal)
make service work in a recovery-oriented way (recovery-oriented approaches)
knowing if you are in it or not (the recovery movement)
how to relate the term recovery and the understanding of mental health care
acknowledges that the identified patient is an agent rather than an ‘illness’
focuses on the person’s goals and how to support achieving them.
emphasize the importance of hope and empowerment
it stresses the value of peer support and peer-led services. creativity within patients
define psychiatric rehabilitation
whole system approach to recovery from mental illness, maximize individual’s QoL, social inclusion by encouraging skills, promote independence and autonomy to give them hope, leads to successful community living through appropriate support
what is a balanced care model (Thornicroft and Tansella)
what’s achievable in a high-resource setting isn’t necessarily appropriate for a low-resource setting (specialized service for high-resource vs limited speciliast staff for low-resource)
the bedrock of mental health service lies in primary care
always a need for inpatient provision
the idea of operating service component (Thornicroft and Tansella)
crisis and emergencies;
early intervention (psychosis)
case management
assertive-looking treatment,
so supporting people out of hospital
outpatient clinics
day hospitals
partial hospitalisation programmes
residential care provision; and
programme support family members and caregivers medication
managing recurring physical disorders
programmes that help people manage their illness.
defined catchment area
community mental health service integrated with primary care social services,
housing authorities
education providers,
faith communities
technical therapeutic skills
require access to inpatient services
specialist mental health
services for specific complex issues beyond the generic level of competence.
appropriate staff - care about their work, are well-motivated and managed
needs that go beyond protocol-based treatments of defined disorders or conditions.
awareness of the functional impairments patterns associated with mental health problems and how these may be overcome.
staff need to have an optimistic problem-solving approach.
