In this assignment the writer will critically analyse medical inequalities that are evident for people with a diagnosis of your severe mental condition. He will specifically concentrate on the inequalities which exist in relation to the prevalence, id and management of the physical health aspects for this set of complex conditions.
In the span of the assignment he will critically consider these health inequalities from an international, a national UK and a more local Scottish perspective.
In doing this he'll critically examine an array of health promotion strategies which underpin the physical medical of people with severe mental condition. He'll also systematically measure the effectiveness of a few of the differing strategies which contribute to the management of these conditions and the advancement of the health and social wellbeing of mental disorder sufferers around the world.
In order to analyse medical inequalities the writer will first specify some of the true secret terms that he will make reference to throughout the project.
Health was identified by the earth Health Company (WHO) (1948) as "circumstances of complete physical, mental and communal well-being rather than merely the absence of disease or infirmity". Though this is a good and accurate definition, some would contemplate it idealistic and non-realistic. Using the WHO classification classifies 70-95% of men and women as unsafe.
However Davis (2009) announced the added need for the wider explanation of health proclaiming "There is a biomedical element of health, but it is present in a setting that includes biological, personal, relational, communal, and political factors"
Looking at health in a bit more information the determinants of health are defined by the WHO (2010) as
"Many factors incorporate together to affect the fitness of individuals and areas. Whether people are healthy or not, depends upon their circumstances and environment. To a huge level, factors such as where we live, the condition of our environment, genetics, our income and education level, and our associations with relatives and buddies all have substantial effects on health, whereas the more commonly considered factors such as gain access to and use of health care services often have less of a direct effect. "
The determinants of health include:
the sociable and economic environment,
the physical environment, and
The person's specific characteristics and behaviours.
Alternatively European Union general population health information system (2009) define determinants of health as
"Many, often interacting factors that determine a person's health or disease state. These include
Socio-economic factors: education, profession, employment, poverty and income syndication;
Environment: cultural support, airborne particulate subject and working conditions;
Health behaviours: smoking, liquor use, drug use, food usage, exercise and breastfeeding; and
Biological and personal factors: heavy and blood pressure. "
WHO (2010) announced that Health inequalities can be defined as variations in health position or in the syndication of health determinants between different society groups. For instance, differences in ability to move between seniors and younger populations or distinctions in mortality rates between folks from different sociable classes. It's important to tell apart between inequality in health and inequity. Some health inequalities are attributable to biological variations or free choice among others are due to the external environment and conditions mainly beyond your control of the individuals worried.
Whereas Samuel (2000) represents health inequalities in a far more simple fashion as "unjust or unfair differences in health determinants or results within or between defined populations".
Severe Mental Illness
The Rethink operational meaning of severe mental illness (2008) is when people:
Are diagnosed as troubled generally from a mental condition, typically schizophrenia or a severe affective (ambiance) disorder.
Suffer substantial disability because of this of their health issues, such as incapability to look after themselves independently, support connections or work
Are currently exhibiting florid symptoms or suffer from a chronic long lasting condition.
Have suffered recurring crises leading to frequent hospital admissions or interventions and/or place a significant burden on the casual carers.
Occasion significant risk to their own health or safe practices or even to that of others.
The Ottawa charter for health campaign WHO(1986) identifies Health advertising as "the procedure of enabling visitors to increase control over and enhance their health" They express it as not simply the responsibility of the health sector which it should go beyond healthy lifestyles to physical condition.
Health campaign has been identified by the entire world Health Organization's (2005) Bangkok Charter for Health Promotion in a Globalized World as "the process of enabling people to increase control over their health insurance and its determinants, and in doing so improve their health"
The US Convention on the Privileges of Persons with Disabilities (2006) declare that "persons with disabilities have the right to the enjoyment of the best achievable standard of health without discrimination. States should take all appropriate actions to ensure access to health services with the same range, quality and standard as provided to other individuals. "
A UK founded study by the Disability Right Fee (2006) Equal treatment: Closing the gap detailed an analysis of 8 million health documents. It confirmed that people with severe mental illness have rates of cardiovascular and diabetes problems that are 2-3 times more common than would be likely in the general public. Bowel cancers is 90% more common in guys with schizophrenia and women are 42% more likely to get breast cancer.
The writer will now continue to explore the trend where many thousands of men and women with severe mental health issues are at risky of dying early on with physical health issues. He views this as a significant health inequality around the world and will take a look at some of medical promotion activities which have been attemptedto reduce this inequality.
Appendix 1 provides an research of the search conditions and the databases results that he used in order to critically study this issue.
Miller et al (2006) in a well conducted and sturdy clinical study in the USA evaluated the mortality and medical morbidity of 20, 018 patients accepted to psychiatric services with a identification of psychosis in Ohio between 1998 and 2002. It recognized that 21 percent of instances died from cardiovascular disease and 7 percent from a tumor related disease and 3 percent from diabetes related disorders. They cited the possible causes of these problems as medication induced weight gain, poor personal hygiene, reduced physical activity, and increased prevalence of smoking, increased product misuse and a lower cultural support network. In the study these were also in a position to report that deaths in this customer group were three times greater than expected in the general USA human population (with Cardiovascular disease being the main cause) and the common age of fatality at 47. 7 years was 32 years young than the general population characters. They recognized in their report the necessity to better incorporate the delivery of both mental and physical professional medical by collaborating with all stakeholders to improve the standard of living outcomes for this population. They don't however continue to clarify how they might take this plan forward.
These international results are also supported by claims from the Australian Country wide Mental Health consumer and carer forum (2010) who state that the appalling health and early mortality of people with continual mental health problems is unacceptable.
These commentary from a nationwide user and carer forum are not defined in one particular review but from a body of research and audit from across Australia focussing on final results of a series of studies. The countrywide voice and suggestions from a major player in Australian professional medical with a give attention to the needs of the individual rather than services is really as significant in the writers' eye as an individual robust research.
They add these issues are experiencing a significant impact on the person's wellbeing and is also also adding to their cultural exclusion. They enhance the argument by saying that these triggers are iatrogenic (occurring because of this of the disorder or its treatment ) Each goes to add the other areas that are common in this group and that can add to the impact being poverty, neglect, discrimination, smoking, chemical misuse and poor diet habits. They add that the verification for these conditions occurs less often in patients with mental health problems hence they are less inclined to be treated. The Australian statement adds that the life span expectancy of the client group is 25 years less than the general people. An interesting fact that they add though is the fact their evidence suggests that the client group do not have greater than average rates of disease like tumors and heart disease but they pass away from the condition 2-3 3 times more regularly than everyone. They suggest again like the USA report that this is because of patients not acquiring appropriate preventative verification and treatment for these conditions. They go on to state that psychiatrists, Gps navigation and other prescribers of psychotropic medication have a responsibility to screen the effects of medication over a persons physical status as well as its effect on their mental wellbeing. Each goes on to recommend some actions for the future which include
State and place governments undertake to educate all stakeholders on "Physical Health Influences of Mental Health Problems and Disorders"
They permit appropriate screening, assessment and physical health assessments for all individuals with discovered mental health issues, including attention to dental health
The Australian Government takes management on these issues by requiring all discovered mental health money to be accountable for physical health maintenance
All mental health programs and coverage areas report on physical health screening, analysis and monitoring for many mental health consumers in receipt of services
Given the nature of mental disorder, providers need to innovate and reply creatively to address the physical health impacts of mental health disorders and their treatment
Doctors take responsibility, when prescribing medications for individuals with mental health issues, to treat them holistically and monitor their physical health changes and needs.
Likewise in britain Cormac (2009) in a Royal College of Psychiatrists newspaper cites several paperwork which indicate an increased incidence of physical health issues in people who have severe mental condition. Phelen et al (2001) explained that individuals with mental disorder have an increased risk of poor health and premature mortality and a meta-analysis of 27 studies almost a decade previously by Harris and Barraclough (1998) revealed a standardised mortality ratio of at least 1. 5 for this band of patients nonetheless it varied with the severity and kind of disorder.
Patients with schizophrenia had increased mortality ratios of almost 3-4 times that of everyone with fatalities mainly triggered by cardiovascular and endocrine type disorders. These studies were reported by Brown et al (2000), Osby et al (2000 and Enger et al (2004). More recent findings in the UK has been the high escalation of the chance of producing metabolic syndrome for schizophrenics which has been found to be 2-4 times higher than the general public, finding borne out in the analysis by Saari et al(2005) and Thakore (2005). Joukamaa et al (2006) added some additional evidence to claim that the risk of sudden loss of life in patients with schizophrenia boosts with the addition of each different psychotropic medication that is prescribed.
Likewise the Department of Health (2010) in the Our health and wellness and Wellbeing statement suggest that looking beyond neighborhoods and deprivation, certain teams have poorer health insurance and some are distinctively disadvantaged because of a combination of these circumstances. For instance: People who have schizophrenia: A total of 0. 4% of the population experience psychosis each year. A recently available UK study discovered that, of those coping with schizophrenia locally, men experienced 20. 5 years lower life span and women 16. 4 years lower life span than the general population. The major single reason behind this inequality can be an increased rate of smoking, more than three times that of the overall population.
Moreover the NHS in Scotland (2008) in their record "Improving the physical health and wellbeing of those experiencing mental disorder" again cite evidence from studies across the world that the physical health of patients with severe mental condition is compromised. They say that "research in European countries and the united states shows that mortality rates from physical disease for those with mental disease is significantly greater than the general human population. Schizophrenia is normally known as a life shortening illness with sufferers dying typically 10 years earlier than the general population. Two thirds of the excess mortality is due to poor physical health. " They also identified that group are developing these conditions at a more radiant time and are dying from them previously with 5 calendar year survival rates reduced by up to 16%.
NHS Scotland (2008) also refers to the aspects of stigma and discrimination. They say that "Legislation requires that all Agencies dealing with the general public remove discrimination and promote equality, yet a "See Me"(2006) study reports that some people with mental health problems still feel stigmatised. The Highland Users Group ( 2008) have found that as it pertains to their physical health needs they could be at the mercy of unequal access to services and can feel stigmatised and discriminated against when they make an effort to access health and wellness care services. They feel their physical health concerns are all too often put down to their mental health problem, especially if their symptoms are medically unexplained. Frayne et al (2005) claim that research has verified that they do not always have the same procedures as all of those other public and therefore their health results can be worse. "
Additionally the Scottish Administration (2008) in the "evenly well" report features Mental Illness and Mental wellbeing as important factors in the debate. They say that
"Mental disease and mental wellbeing are specific priorities for the duty Force. People with mental illness are more likely to die before from suicide, or diseases such as coronary disease (CVD) and tend to have generally poorer health through conditions such as diabetes.
Mental wellbeing is associated with good mental health, but is definitely not exactly like lack of mental illness. A lot of the Task Force's work is based on the importance of factors such as resilience, hopefulness and optimism that create mental wellbeing and quality of life. These allow visitors to deal effectively with life's problems and normal stresses, to make the most of their talents and the opportunities available and play a good part in their community.
People whose wellbeing is good are more likely to take care of their own health. However, melancholy is carefully associated with poor physical health, for example increasing significantly the potential risks of CVD.
The writer concludes from the overriding proof around the world that those suffering from a severe mental health problems have much poorer physical health which in turn causes them to have a shorter life expectancy. These conditions are identified as largely cardiovascular and metabolic type problems. There is certainly evidence that consumer group has unequal access to health services and feel stigmatised and discriminated against.
Naidoo and Wills (2000) identify 5 methods to health campaign.
Medical or preventative solutions which target the complete society and are aimed at reducing premature deaths and avoidable diseases.
Behavioural Change strategies view health as the property of the average person and stimulates them to adopt healthy behaviours that are thought to be key to improving health.
Educational solutions are strongly linked to heath education and seek to provide knowledge, information and develop skills so that individuals can make prepared alternatives about their health behaviour.
Empowerment approaches are bottom up methods which encourage communities to recognize their needs, develop skills and make appropriate life changes.
Social change techniques is a top down approach which targets specific groupings and populations and defined by a belief that socio-economic circumstances determine health position in individuals. Its focus is usually at policy or environmental levels.
The writer will now explore some of the interventions used around the world within the models/solutions above.
In the uk Phelan et al (2004) launched a physical health check tool to support the monitoring and management of physical health issues with patients with severe mental disorder. This would be observed in the aforementioned model as a medical or preventative procedure which aims to examine need in a target populace and then develop an agreed action plan with the patient on how they are going to address the defined health needs. The evaluation is completed over a 12 regular basis and is designed to supplement normal medical care and review. The results demonstrated that 50% of clients possessed a diagnosed physical health problems with 78. 3% declaring they had one or more physical symptoms. 65% of patients decided to a number of of the actions available including getting advice about smoking cessation, diet and starting regular physical exercise. The outcomes have seen a rise in the quality of the examination and recording of the physical needs of the patients and a huge jump in the actions being care prepared within a organised care programme approach care plan. The study likened the group with a neighbouring community mental health team and showed that the utilization of the structured assessment and care and attention planning tools significantly increased the grade of information recorded. The failings in the report highlight that although staff were able to evaluate and plan caution there was as yet no evidence that this approach had advanced the health effects of patients and the life span expectancy of them. When we connect this to the models above we see that the medical and organisational policy approaches are simpler to do and measure compared to the change behaviour that is required by the individuals worried. The author suggests that further longer term studies are required to evaluate the long-term health impact of this approach to the organisation of physical healthcare management.
Likewise the Department of health (2006) in their commissioning platform document choosing health give types of case studies which represent some of the health promotion interventions over the UK. In one study an array of clients from across a city were involved with a physical health appointment with a senior nurse. This diagnosis occurred in their own house as there have been a previous reluctance to attend clinics for this purpose. Once the health issues were identified in an diagnosis patients were picked for inclusion in 2 healthy working groups. One focussed on healthy living and was went to by 15 patients whilst the other got a give attention to physical exercise, was based in the local sports activities centre and got an attendance rate around 20 patients per week. A voluntary walking group was also available. There have been very positive outcomes from the study including the following
57% reduction in alcohol consumption
Only a 1% DNA rate at activities
32% decrease in smoking
50% upsurge in activity levels
95% improvement in patient self applied esteem
These significant health advancements for patients can only just contribute to bettering their life expectancy.
The author is convinced that the above mentioned interventions get caught in a number of the approaches to health promotion determined by Naidoo and Wills (2000) for the following reasons.
Medical and preventative- These interventions are directed at a particular sector of the populace in order to prevent the forming of disease within an identified prone group. The original screening selects the ones that move forward for health promotion activity. This is a top down expert led method of focus on interventions at a prone client group minimizing costs in the long-term and improving results.
Behaviour change- information, support and advancements in access to health, social, lifestyle and athletics facilities has encouraged visitors to make informed options to adopt more healthy behaviours. The evidence in the outcomes has shown that individuals have made real advancements in their health by firmly taking responsibility (even though in some cases it was backed initially by personnel) and changing their lifestyle significantly.
Health education- the specific classes and education provided by personnel supported the individuals to make up to date choices about their health and the behaviours that these were adopting to aid it.
Empowerment - in this field the nurses were being viewed as catalysts of change or facilitators to be able to aid individuals. The fact that local athletics and leisure facilities was engaged was proof a social addition aspect of the service where it was seen to be normal to engage with local facilities rather than in specialist private hospitals or treatment centers.
Social change approaches- the targeting of this consumer group in a high down methodology by clinicians in lots of ways is proof this approach over the uk.
Likewise in the United Kingdom another approach which identifies this interpersonal change procedure is the mental health element of the general professionals contract and the product quality and outcomes platform that they work to.
British Medical Connection (2009) areas in their advice on interventions to Basic practitioners that Patients with serious mental health issues are at noticeably increased risk of physical ill-health than the overall population. It is therefore good practice for an associate of the practice team to review each patient's physical health with an annual basis. Health advertising and health reduction advice is specially important for folks with serious mental disease however there is certainly good evidence that they are much less likely than other members of the overall populace to be offered, for example, blood circulation pressure investigations and cholesterol assessments if they have concurrent coronary heart disease, and cervical verification.
They feel the importance of this by identifying lots of focuses on in mental health two which relate with physical health and are detailed below.
MH 8. The practice can produce a register of individuals with schizophrenia, bipolar disorder and other psychoses
MH 9. The ratio of patients with schizophrenia, bipolar affective disorder and other psychoses with a review registered in the preceding 15 months. Within the review there must be evidence that the patient has been offered boring health campaign and prevention advice appropriate to their get older, gender and health status.
They also recommend that a review of physical health will therefore normally include:
1. An enquiry about smoking, alcoholic beverages and drug use
2. A blood pressure check
3. A cholesterol check where clinically indicated
4. Dimension of body mass index (BMI)
5. A look for the development of diabetes
6. Cervical screening where appropriate
7. An enquiry about cough, sputum, and wheeze.
Reports on the two targets have observed achievements in the high 90% range in the united states hence showing evidence of improvement in screening.
This procedure in primary attention is commendable but there are a number of patients who still find it difficult to engage and access services. This customer group require additional support to access services and NHS Quality Improvement Scotland (2007) believed it was an important enough subject to add it in their Mental Health Integrated Health care Pathway criteria. The GP targets which only are the offer of health examination are enhanced further and include a tracking of the completion of an assessment and actions associated with the outcome such as health campaign, communication with interested functions and research that action has been taken on the findings. The author will abide by NHS QIS that it was necessary to take this top down sociable change approach in order to bring about change that may improve the health promotion of this complex client group.
13a The care and attention record shows that physical health needs are assessed at least annually using the following features:
the conclusion of a physical health assessment
the provision of health promotion advice, and
service users obtaining medication should have side-effects and physical health evaluated and managed in line with the appropriate algorithm for your medication.
13b The care record shows information on the management of physical health needs, including:
home elevators who is in charge of the physical health assessment (primary good care or specialist services)
research that results have been shared
proof that results have been acted upon, and
evidence that information and/or advice on promoting a wholesome lifestyle has been provided.
Marder et al (2004) make lots of tips in their paper in the American journal of psychiatry about the monitoring and appropriate prescribing of antipsychotic medications. They suggest that the main element is to identify the chance factors for each individual patient and tailor the prescribing matching to their display and the adverse side effects of a number of the medications available. They present proof side ramifications of diabetes and cardiovascular issues and claim that appropriate prescribing will certainly reduce the potential risks or expanding or exacerbating these conditions in patients with schizophrenia. That is borne out also in the NHS QIS (2007) benchmarks above in Scotland where they advise that "service users receiving medication should have side-effects and physical health assessed and managed based on the appropriate algorithm for that medication" NHS boards have been asked to build up prescribing algorithms and audit tools that will guide clinicians in evaluating the physical health needs and using these details to make enlightened choices on the best medications for patients which have reduced risks associated using their physical health. These systems are under development across Scotland but can in the foreseeable future only increase the outcomes in the physical health management of patients with schizophrenia.
The writer in this assignment has demonstrated a few of medical inequalities that are apparent for individuals who suffer from severe mental disorder from around the world. A number of the inequalities are something of the diagnosis itself where patients frequently have symptoms that cause them to have reduced drive to help themselves in many situations. Often this patient group also comes with a lower socio economic deprivation with a poor work and education history which again provides obstacles to their self management according with their physical health.
Recent advances in the treatments designed for psychoses which have physical health related side results and the intro of the impairment human protection under the law legislation which stipulates the necessity of equal gain access to for many has further highlighted some of medical inequalities that exist for this sophisticated patient group.
The needs identification and health promotion interventions that the author has looked at split themselves into key areas.
This customer group requires support to gain access to to services and every one of the interventions determined this need and acquired both support to gain access to, organised recall systems and the facilitation of services near to patient's home as their key designs.
Assessment of physical health needs and the prescribing of the very most appropriate psychotropic medication because of their mental illness requires to be structured and coordinated within an improved fashion. Set up physical health assessments frameworks and prescribing rules associated with physical health symptoms were the simplest way of coordinating this technique because of this patient group.
A mixture of a cultural change and educational procedure is a model that appears to mix well with the review of mental health nursing in Scotland and around the world with mental health services now promoting a far more patient inclusive and community participation role. This allows nurses specifically to facilitate ownership of these health problems and use their teaching skills to teach patients how to improve their life-style and effectively manage the physical health challenges they have. Nurses will build relationships local leisure and sports facilities to make support available in a far more normal alternatively than institutional fashion.
The publisher in doing this project has had the opportunity to explore different aspects of the problem that exists in Scotland and compare the Scottish methods with what is going on in the areas. He has found an extremely similar routine of difficulties and also some similar alternatives although they seem to be to be at different levels of implementation. He observed the American studies focussed a great deal on the prescribing issues and getting appropriate prescribing correct. He sensed this is probably due to the costs and charging insurance policies associated with the American system and possible litigation if there are side ramifications of recommended medications which continue to cause disease where risks are known and revealed. He believed this is becoming more apparent in the UK now but the study in America was in the past.
The solutions used were similar but there seemed to be a far more coordinated approach to the evaluation and monitoring of patients in the UK. The author believed that this was due to the NHS role in the coordination of attention across the country where in fact the USA has many different health economies and is also focussed on the charging and insurance type policy.
Mental health nurses should continue work in an individual focussed way motivating patients to consider individual ownership of these needs and promote healthy living.
The services in Scotland should coordinate themselves to ensure a physical health check is commissioned; takes place and the correct actions are implemented through. Patients should be reinforced to access primary treatment services to allow this screening to occur.
Medication algorithms should be developed and audited to ensure that recommended medications are appropriate to the health profiles of patients which medication for psychiatric reasons will no harm in relation to the patient's physical health.