During mental health rotation I ran across the scenario, which compelled me to reflect on it. A 30 years old man patient diagnosed with schizophrenia since four to five years and has multiple admissions during earlier years. During examination and record taking I came to know that he is being accepted since two year back Civil Medical center with the grievance of aggression, hallucination and suspiciousness. He was accepted by his sister who needed to reduce the responsibility of caring for him. Furthermore he belongs to low socioeconomic record from the outskirts of Karachi. He's married and has 4 children, his elder sibling and all the relatives are encouraging him menially. Matching to his sister he should be restrained with "Zanjeer". They feel that he is putting up an function. His elder sibling has remaining him because of his disease. He has remaining taking his medications since six months and with no person recognizing it. After six month when he became very aggressive and his family was unable to control him, he was brought for entrance in Civil Clinic.
Looking within my patient's situation I assume that there have been multiple factors which led him to mental health problems. Most severe of the were poverty, illiteracy, low socio-economic status, stigmatization and finally most of they developed family support from him. If we just see what family is: regarding to Shomaker (2006 )
"A group of people who are bound by strong mental ties, a sense of owed and a interest for being involved in another's lives. " (pp. 163)
Therefore maybe it's said with compound that family members live in different compositions including nuclear, extended, multigenerational, single-parent and same gender households. Relating to B. A. Marry(2005): "so either they are connected emotionally or by blood vessels or in both ways". Hence family is composite institution where every member is psychologically and emotionally damaged by the life of other members. Also that, the presence of family members in healthy point out influences the steel health of rest of the members of the family. In Pakistan, the expanded family system is most typical family system. In such family systems, specific autonomy is the same as group autonomy and the group is the complete family product. People in Pakistan dearly follow the joint family system and live their life with their people. (Naeem, 2005). Quite simply, it can be said that expanded family system has many advantages, it is also of harm sometimes to the users. Because of the large size of the family, the people are denied specific attention and health care that is so required for any patient. The identical took place to my patient who was left by itself by his prolonged family.
According to De Sousa(2009):
"The family is both something and a unit in society, a primary multifunctional establishment into which all human beings are born, brought up and nurtured by various interpersonal romantic relationships. Thus family serves as the essential architect of the individual's personality. The partnership between the specific and the members of the family can determine the disposition to illness and health in every level of life from infancy to old age. He further says that the family is proper centre to comprehend human feelings and connections that play pivotal roles in both positive health and disease. It's the major support system for the individual that is emotionally ill but at times the patient is often deprived of psychiatric treatment scheduled to family burdens that exist".
Family support and role of each member starts since the time of beginning as parents as brother as sister and a great many other different roles which ultimately shows their health care and passion through bodily gestures, verbal and nonverbal communication and a feeling of security to the infant and it go on throughout the life. De Sousa(2009) talk about that the individuals who receive a insufficient support early in life remain at an elevated threat of experiencing illness later in life". If one has lack of family support than he/she might be not able to resist of normal stressors and ultimately the individual will end up in mental condition. It would thus be likely to say our lives are tightly looking for support from other people, without which our existence might not be possible.
Family people of person with mental disability can play a critical role in enhancing the treatment and treatment of their sick family members; nevertheless the ability of family to fulfill their caregivers' role- is adversely affected by amounts of barriers alike. Lack of family support it can be due to social stigma which is the primary reason that psychologically ill people's sociable network becomes thin. Gotlib and Feely (2000) helps that the notion by stating that "as time passes, due to sociable stigma associated with serious mental health issues, developing and keeping associations can be difficult". A support system is essential for people living with mental disease yet at the same time the condition places relationship vulnerable. The unwanted effects are at threat of being exacerbated in case there is family not being present and poor prognosis and relapse may be the result.
According to Naeem (2005)"As the attitudes people hold towards mental health problems has been studied to some extent in Europe. There is nothing known about what people think about mental health issues in Pakistan. Still we have been far behind to know the role of family in mental health. " even as we did not have sufficient literature to aid and, thinking in advance for the assignments of family to contribute will take time.
In our modern culture mental disease is used as a stigma and still people aren't clear about the causative factors of the disease, rather they may be linking it with supernatural forces as cited by Karim. S. et al(2004) "it is broadly identified that mental disorder is caused by supernatural makes such as heart possession, punishments for your sins. "if we connect these feels with literacy status of your country then it is quite visible that the low the literacy rate the greater the force of these believes will be. He further says "the literacy rate was 47. 1% in 1997-2000" not only low literacy rate but low socio financial position which is making people to strive for their basic needs. Though in Pakistan living collectively family is our culture however the trend lacks definitive solutions. For instance, the family don't realize the roles they are anticipated to try out. This breeds in self-assurance among the family members protecting against them from leading emotionally healthy lives.
Family support is necessary at every years of life, family support and communal network shows positive effect on health and well being. Mustafa (2005) suggests that support of family is important to maintain the mental health of people. As he pointed out in his work that "Social net work communicates love and passion to them who are in their network' though patient has a cultural network (family) despite of these he is left alone. There's a process of public support which includes; (family, friends, neighbours etc) and cultural climate. In this technique first" need" is discovered than psychological and instrumental support is delivered through family network and when all parties incorporate together when compared to a social climate is manufactured for each and every other's need. After each type of support is provided result appears in a form of mental health advertising. Need is about id of need of family support, willingness of receiving support, and willingness of supplying support in several circumstances. :
If I connect this stage need with my patient then his need was attention, nurturing attitude from his family however he was fail to acquire it. No positive supports identified in case it was recognized than it was the only physical part of his good care, they were caring for his physical need however no one was noticing what actually his need was? This deficit of supportive family role brings about closing patient in the drawback of most his medication. So the ramifications of family existence and mental health issues play a major positive role during the treatment like increase likelihood of early rehabilitation and prevent relapse.
David. T(2006)" distinguishes between two facets of family involvement-family involvement with the client (apart from treatment) and family participation specific to the client's treatment because they may have different antecedents and repercussions and because households may be engaged in a single way, but not the other. For example, a family member may provide financial assist with the client but not be engaged in the client's treatment. Both types of participation are functional zed in terms of the quantity, nature, and identified quality of the engagement. Like although his mother was present with him but the majority of enough time she was concerned about his physical need
Calgary Family Treatment Model (CFIM): One of many ways to think about change. CFIM is an organizing construction conceptualizing the intersect between a specific site (i. e. , cognitive, affective, or behavioral) of family functioning and a particular intervention made available from a doctor (Wright, Lorraine & Leahey, 1994). This model emphasis on early engagement of family in patient's cares where positive and negative feedback can get to encourage and improve coping. Families are required to be involved atlanta divorce attorneys level of interventions. As family education and consciousness about disease, its management and prognosis is very important. In keeping above situation at heart for group level interventions one can refer to Gravois, Paulsson and Fridlund (2006) grounded theory style of mental doctor support (MHP). It is predicated on the needs of individuals with an associate suffering from severe mental illnesses. In this model researcher give four group of MHP support that being present, tuning in, writing and empowerment.
In this model 'Being present' identifies the early contact, early identification o f role changing and supplying early on information about coping and disease management. Listening takes on very important role in mental condition management. In this model assessment is based on active listening of patient and family experiences. After assessing the burden and worries of family and patient. Health care professional can do treatment that can help family to comprehend patient needs and find out effective coping skills to cope with the patient. They can also form support groups for family so that they can share their feeling and motivate one another to consider better treatment of patient and decrease pain of stigma. Sharing in this model means preserving coordination with family and as team could take decisions for the patient. Interaction with shared responsibility will create sense of security in family that will lead to available communication between MHP and family. Thus leading to good prognosis of patients.
Lastly, the empowerment which implies that when the family cope with the problem and obtain a deeper understanding of mental health/health issues, they seem to possess gained empowerment. Thus, MHP counseling about mental health/health issues, in a group or individually, empowered the family" (Gravois, Paulsson & Fridlund(, 2006. )
At specific level, I positively listened to the patient After through diagnosis of patient, data were organized and the ones areas were outlined which need change. This is the very important step as in the scenario the main problem with the patient was disease process which was aggravated credited to lack of support. As with good family support patients can live better life. THEREFORE I concentrated the family as well as the given individual to deal with the trouble. Firstly I prepared to provide patient education about disease process, developing insight and interacting with delusion, as anticipated to withdrawal of psychiatric medication since half a year he was very hostile and his grandiose delusion were quite strong indeed, therefore i tried to give consciousness about himself so the co-operation from his side will make family support easier for him. Subsequently I engaged patient in different activities to boost her interpersonal network and beside this I've planned patient teaching for the family including understanding about mental disorder and discharge coaching. "To enhance the standard of living, psychosocial involvement with the family and the emotionally ill person e. g. family problem dealing with, drug compliance, problems management, training of social skills and cognitive behavioral strategies are suggested". (Gravois & Fridlund, 2006). But sadly I had not been able to connect to client's family. Interventions were carefully designed in keeping culture and educational degree of client in mind.
Support organizations can be produced for better coping. Perese and Wolf (2005) say, "The principal goal of an support is to increase participants' coping potential when confronted with stress, to strengthen 'the central main' of individuals" beside this helping family functioning and cohesiveness via acknowledging their principles, and advocating for retaining sense of self applied worth. Organizations will also provide a sense of friendship. Additionally psycho education periods could be done to help the young families. In addition, institution plat forms could be used to deliver health education to increase recognition and to build organizations. Moreover, I am going to plan this plan with the help of psychotherapist in determining the same patients who are suffering from insufficient family support. In execution I will make sure they are share their life activities; this can help them learn through each other's experiences. To judge a mini study could be done to compare the social support system before and after the involvement with support group and beside this I've planned patient coaching for the family including recognition about mental health problems and discharge coaching. "To enhance the quality of life, psychosocial treatment with the family and the mentally unwell person e. g. family problem solving, drug compliance, problems management, training of cultural skills and cognitive behavioral strategies are suggested". (Gravois & Fridlund, 2006). As cited by Gotlib &Feely (2000)" an approach to developing strengths is to help households develop knowledge or competencies that can allow them to cope and develop. Family members can be aided to find and access experiences or materials to augment their knowledge. " But sadly I had not been able to connect to clients. Institutionally health awareness sessions can be done to make people aware of life needs and need for mental health advertising. Media can be utilized for Speeches to convey our text messages to the federal government to resolve some psychosocial factors: poverty, lack of parental support. Some steps should be done to improve poverty as this is actually the common factor for mental health issues. Could work with NGO's to perform different training seminars for mental health promotion, this will boost education level of the population plus they themselves will need step to triumph over factors adding to mental disorder. To plan a seminar at organization level I'd make a plan of what need to be mentioned in this seminar, I am going to discuss the prospective inhabitants with directorial level. With this seminar psychiatrists can be included for broadening the horizon of knowledge. Following this I will ensure that on implementation multimedia coverage will there be. To evaluate this, small research could be done to start to see the prevalence of mental disease in the community. Furthermore, small questionnaires can be used to compare the data level before and after workshop.
When I stopped at the psychiatric hospital I was upset by looking at patients' condition. I got astonished that how this disease has took your hands on patient and exactly how this is done all of a sudden. It had been my prejudice that genetic and biochemical factors will be the most dominant ones, to cause any disease however it is incorrect psychosocial factors could possibly be the most influencing one to have an illness as it is in my own patient's circumstance. I assumed that having less family support only is accessible in Pakistan however through literature search I emerged to know that it's global issue. It is also very important to keep this simple fact at heart that family and mental health care professional frame the role of members of the family in the treatment process. After analysis my patient's life with the present condition I felt i am blessed by God by getting the supportive family, friends, and the community.