Posted at 11.02.2018
People suffering from mental illness are often looked differently and do not have equal usage of all the opportunities in life. Though, patient's family and medical care providers can play a fundamental role in the lives of the mentally sick people. Through supplying a proficient care and attention with warmth attitude they can certainly bring a good change in them. But, consider imagine if these caregivers will be the reason of mistreatment with mental patients? That is an ethical issue which I lately came across during my clinicals and for that reason decided to explore it in depth. Thus, the next paper is an attempt to evaluate this issue by integrating an honest model, spotlight its significance and also to discuss the causes, results on mental health insurance and practical ways of defeat this immoral problem of mistreatment with mental patients.
On my medical to psychiatric ward civil hospital I experienced a 60 years old girl, married and identified as having obsessive-compulsive disorder (OCD). The chief issues of patient were severe headache and aggressive habit. Since twenty years patient had record of repeated depressive illness seen as a weeping spells and low energy. On requesting about the support system patient became gloomy and said "I am by themselves and nobody likes to be with me and care for me". Further she said that credited to her behavior of cleaning things over and over her family becomes irritated and speaks harshly to her. On spending a while with patient I came to know that how much she adored them but no one came up to meet her since she got got accepted. After taking record of patient that day I also detected that whenever my patient called the nurse to inquire about the medication timings, nurse replied rudely that "how many times you will ask the same thing over and over. You are emotionally sick but please why don't we remain in health" and then that personnel nurse after making vicious gesture acquired out of this ward. This occurrence made patient further stressed out. It is an issue which is ethically wrong, as caregivers who should help the patient when they are in true need are abusing them. As the professional code of ethics explains the significance of this ethical concern, which is the bottom of sociable morality that "to begin with, do no harm". It also emphasizes that the goal of nonmaleficence includes not only distinct harm but also the chance of injury (Clinical Ethics, 2004). Therefore, an moral person must be constantly careful about the possible negative consequences of his words and actions with the mental patients. Furthermore, according to the world health business, In Pakistan we run into upsetting reviews about the mistreatment of emotionally ill people scheduled to societal hostilities daily (Gadit, 2008). Though, it is difficult to comprehend why such people are maltreated in Pakistan, an Islamic country where religious teachings are implemented. Therefore, to find the reason why behind this immoral deed, to recognize actions to lessen this in population and to make the caregivers inculcate this considered to support these folks in their difficult times, I consider this issue as significant and for that reason decided to focus on it in my own paper.
As described by SAVE project of communal services that mistreatment is a breach of person's real human and civil privileges triggering despair. And, this violation can appear once or constantly (SAVE Task, 1995). Mistreatment of elderly person may include physical, mental health or financial exploitation and it can be designed or unintended. Intentional mistreatment entails a purposeful effort to inflict damage such as physical maltreatment or mauling. On the other hand, unintentional abuse occurs when an unplanned action leads to damage, such as ignorance or too little desire of the attention providers to provide care (Jones, Holestege, & Holstege, 1997). As verbalized by my customer that at home she was beaten harshly and was always disregarded by the caregivers. Additionally, nurse also verbally mistreated the patient and showed insufficient desire to care. However, the empirically generated model, which can be an ethical model, provided by Fulmer & Malley (1987) gives in depth details of causes and risk factors leading to mistreatment in mental patients. They divided the causal factors of mistreatment into four major categories including physical and mental impairment of the patients, increased pressure on caregivers, family history of domestic violence and the societal behaviour. This model elucidates that domestic assault such as abuse and neglect will be the behaviors which are learned at home and are passed from one generation to another. Thus, elder misuse may be a continual phenomenon discovered in childhood. Second of all, the stress on caregivers can also lead to mistreatment. Facing behaviours by the elderly mental people like drug abuse, recurrent falls, incontinence or aggressive habits, the caregivers become worn out and can lash out their resentment on these innocent beings. As took place with my customer that scheduled to her habit of cleaning things frequently, caregivers always offended and taunted her. Other exterior stressors such as lack of job, personal condition or low income can also place overwhelming demands on good care providers which results in violent manners. Furthermore, this model shows that the ill health of elderly persons in itself is grounds for mistreatment. Functional impairments lead to dependency on the caregiver for the actions of everyday living. As these needs raises, the stress level of caregivers further increases. As encountered by my patient, who was simply always reliant upon her family and man for day to day routine work. This created irritation for the family and finally they left her at psychiatric medical center. Lastly, there are several societal behaviour that donate to mental person's maltreatment. Among these behaviour, Stigma is the most typical in psychiatric settings. There are many studies affirming that such patients are teased in communities by unkind brands (Gadit, 2008). In addition, in line with the World Health Statement (2001), stigma and prejudice are the key hindrance encountered by the mentally unwell today, these abstain them from seeking appropriate care and attention (Rameela, 2004). Besides this, patients are also mistreated in the ward options by the staffs, as occurred with my customer. It is because, persons in institutional health care are dependant, extremely delicate or chronically unwell. Furthermore, problems such as low salaries, staff shortages and poor working environment increase the likelihood of mistreatment. (Lucas & Stevenson, 2006).
As the fundamental duty of most care and attention providers is to execute efforts to increase the standard of living of patients. However, if these caregivers would show this abusive tendencies to the mental patients this will have an impact on their psychological as well as physiological health. As shown in my own consumer who along with psychological symptoms also suffered with insomnia and reduced appetite due to worries of being alone. Besides, as mentioned in books that, negative habits and biases towards those having mental health problems is the greatest hurdle to restoration (Chambers et al. , 2010). Like, it was seen in my patient who lost all the hopes of being in normal condition as before. This is shown in her verbal responses that "everyone thinks that I am mad and for that reason behaves with me in harsh manner and I am certain I'll never be fine again". This demonstrates how important role the caregivers and their attitude play in the development of mental patients. As very rightly said that "Support has been known to help effect and stimulate a habit change in an optimistic way" (Clark et al. , 2005, p. 20). Thus, if there would be lack of support system for these people it would lower their self esteem, intrinsic determination and causes decrease self principle (Lowder, 2007). If these mentally un well people are discriminated, this would hinder their capacity to assimilate into population and this can result in public isolation. Also, corresponding to labeling theory, that once open public label these people as mentally sick, their presence becomes undesired in community hence leading them to interpersonal seclusion (Lowder, 2007). As occurred with my consumer that whenever she asked her hubby once to meet their relatives, he previously beaten her scarcely with solid wood stick just because he felt ashamed to take her in family gatherings. This affected her personality hugely and from that onwards she herself remained lonesome and isolated. By reflecting after this we can imagine that what sort of single dishonest action or altitude of caregivers can massively effect patient's life. In addition, the interpersonal model of assault in mental health by Chappell and De Martino (2003) also agrees to the point that if patient's needs and wants are blocked till great amount, it could intensely have an effect on patient's mental health hence resulting in disturbing effects such as ineffective adherence to treatment agenda and damage of personal (See appendices). Like, my patient tried several times to commit suicide to be able to diminish her loneliness and reduce her hostility towards others. This show that it is very significant for caregivers to fortify the mental health of the people rather than making them more vulnerable to harmful health repercussions as conferred above.
After thorough books search I then found out some useful interventions to promote the ways of lowering mistreatment with mental patients. It would be on individual, family, community and administration level. At specific level, patients should be awarded liberty to consider decisions regarding their life and really should not be tortured or harmed. That is supported by Man Rights Function (1998) that areas "no-one shall be put through torture or even to inhuman or degrading treatment or punishment" (Clinical ethics, 2004, p. 24). Furthermore, the stair circumstance model illuminates involvement strategies concerning maltreatment prevention in 3 steps which are reluctance, reputation and rebuilding. This consists of interventions such as breaking through denial, lowering interpersonal loneliness, sorrow and do it yourself blame, providing teaching and advocacy (Loughlin & Duggan, 1998). Health care professionals can integrate these interventions in their treatment platform. I also attemptedto apply this model in my patient's health care. I attempted to make my client verbalize her feelings by providing her concrete items like blank newspaper and colors. This helped her in verbalizing her interior feelings that have been not shared with others since very long time. Furthermore, throughout my clinical weeks I remained engaged in treatment through non judgmental conversation and body language. As supported by literature that your talk and dynamics should convey esteem and a non-judgmental frame of mind (Loughlin & Duggan, 1998). To reduce communal isolation, I engaged my customer in group occupational therapy and also centered on her hobbies that were, drawing and coloring the religious labels. In this way I was able to socialize her somewhat. As supported by literature that, Organizations provide a route for people with OCD to get emotional support while learning how to manage their condition. Also, this can help victims to lessen the obstacles that the memories of abuse place in the form of normal life (Davis, 2008; Child misuse, CPS facts). In addition, abuse creates sense of hopelessness and low self-confidence in patients as reviewed previously therefore caregivers should be trained to encourage and reward clients on the little efforts to boost their self strategy.
On family level, a good communication and involvement in patient care can be a best security against mistreatment. Furthermore, providing psycho education can also enable family members to stay involved in the care. As, the strain level of caregivers can also be reduced by giving tips of attention supplying to them and concerning in family remedy (Davis, 2008). At community level, social and health staff including community leaders should have responsibility for figuring out conditions of mistreatment and then organizing interventions to lessen the risk of any future maltreatment (Loughlin & Duggan, 1998). Furthermore, I would recommend that the emotional counseling services as well as cultural gathering area for mental patients should be established in the community, where these people can socialize themselves. On federal level, various laws and regulations and punishments for the abusers and considerable awareness promotions on care and attention and destigmatization of mental condition should be organized (Raj, 2009). Besides, federal should also create monitoring system to ensure that real human rights are being implemented in all psychiatric facilities (Gadit, 2008). Last but not least, I recommend that by using mass media instances of abuse with mental patients should be reported so the strategies should be prepared on local and countrywide level to minimize the chance of any future mistreatment.
It was a good learning experience for me to write a scholarly paper. I have learnt the importance of promoting mental health without abusive and negative attitude. Moreover, faculty facilitation and literature review helped me to learn and combine all concepts related to the issue which will help me in my own future clinical settings.
In conclusion, these provided evidences are frustrating that the mistreatment with mental patients is the disobedience of real human rights as strongly proved by real human privileges declaration that "All human beings are delivered free and identical in dignity and privileges. " (UDHR, 2006, p. 2). In addition, the paper also discussed the complexities and consequences of this immoral problem of mistreatment with mental patients. Now, it's the obligation of caregivers to adhere to the strategies provided above, in order to provide a competent care with encouraging attitude and bring a positive change in the lives of the people.