Explanation on how personalisation impacts in people with mental health issues?
Abstract
Mental health is a wide spread issue in England and Wales and it has a high prevalence in health statistics. The purpose of this literature review is to explore the impact of personalisation in people living with severe mental health issues. In addition, it analyses the role of the health professional’s priorities in integrated mental health teams and its impact on personalisation approach. Hence, the key factors from this literature review suggested that even though the provision implemented to support individuals with mental health issues, there is a limited understanding of the experience of the mental illness. However, focusing on the use of personal budgets and their needs for mental health people and highlighting the role multi-agency working, this literature review has exposed the impact of personalisation on people living with mental healthy issues. It examines the impact of Mental health professionals and local authorities and their attitude in engaging with individual personal budgets. The role of Multi-agency working and local authorities are the main people to be responsible for personal budgets for service users and to ensure their needs to be met. Concentration on treatment, stability, and risk management frequently lead to low prioritisation of personal budgets and lead the professionals to avoid recommending the service users regarding this process for saving time.
Introduction
The literature review will give some exploration on individuals living with severe mental health issues in different settings byfocusing on issues they are experiencing in their daily lives. Furthermore, it will go in depth for identifying the risks, the services available for them, attitudes of care providers and commitment of multi-agency working. It will discuss the history of mental health illness and how personalisation impacts individuals with mental health issues. Moreover, it will identify the strength and the weakness of the policy towards mental health patients and examine the relevance of legislations, implemented for protecting the mental health patients. However, it will highlight the strengths and weakness of the relevant policies and the responses of multi-agency working. The response of the care providing organisation towards legislation has also been highlighted as they are responsible for the fulfilment of the policies and putting them into practice. Personalisation policy brings out the opportunities to help people with mental health issues and opens access to services available to them. It will analyse the impact and significance of mental health within health and social care provision. Finally, the literature review will re-evaluate each chapter and go in depth to find if the current provision is productive enough to reduce health inequalities among people living with mental health.
Chapter one
World Health Organisation (2010) has defined mental health as a state of well-being in which a person understands the capabilities to manage the normal stress of life so that he can work effectively and successfully to contribute in his or her community. mental health can be seen as a state of absence of illness, increases numerously distresses. Also, it leads itself to potential misinterpretations when it recognises the key factors for mental health which are positive feelings and functioning. However, who continues to say concerning well-being as the main aspect of mental health it is hard to deal with a lot of challenging life situations that makes their well-being not healthy. However, in real life people with good mental health may feel unhappy, unwell and angry which is normal.
Dhugra (2013) suggested that mental health is not single but, it is an umbrella word which covers three crucial parts including mental health, such as the state of mind that permits full performance of individual’s physical and social environment, the absence of illness, and a state of balance in individual themselves. Therefore, the meaning can be referring to needs such as survival, food, shelter, society, social support, freedom from pain, healthy life and protection from environmental dangers. Dhugra further defined the state of mental health as individual’s ability to preserve the relationship with others, to be able to perform social activities in their cultures, to be able to recognise, acknowledge, have positive communication and to manage sad emotions. However, Sheps (1997) mentioned factors that associate with mental health such as being joyful, loving, feeling glad and feeling positive in individual themselves. Mental health Foundation (2008) suggested that mental health can be defined as the way the human beings feel or think about their life as well as how they cope and manage in daily activities. On the other hand (MHF) found that mental health affects individual’ s ability to function and get involved in most of the opportunities available in the society and taking part in work place and in the family.
WHO (2010) suggested that mental health has often been classified as a morally constructive effect, that can be shown by feelings of joy and sense of emotional state over the atmosphere. They are three key components of mental health identified by the WHO; Firstly, emotional well-being and it contains happiness, interest in life and fulfilment. Secondly, the psychological well-being; which consists of being liked as a person as you are regardless of your personality and having the ability to manage the daily life responsibilities. Finally, social well-being; which includes positive functioning and the involvement and taking part in contributing to the society which makes the individual believe that community is a good place for people and feel that they are a part of it. Unfortunately, Lester and Glasby (2010) argued that people with mental health issues are facing discrimination and stigma in the society,, and these issues need to be addressed in mental health services.
Summary:The types of mental health illness and symptoms
WHO (2010) highlighted the types of mental health issues which are depression, schizophrenia, eating disorder, bipolar disorder, personality disorder, phobias, obsessive- compulsive disorder (OCD) and Dementia.
Depression
According to Winter (2013), depression is a brain disorder substances used by nerve cells to pass the message to each other, out of a sense of balance. Depression is a disease that can be a combination of genetic, mental and conservational factors. Moreover, depression has some complex symptoms that are severe and persistent such as sleeping problem, feeling weary in the day time, agitated, irritable, angry over minor things, lack of motivation, feeling hopeless, a feeling of unimportance and doubt, unable to concentrate and forgetfulness, withdrawal from socialising, sexual dysfunction and suicidal ideation.
However, some people can experience only one but to another it can be a mixture of anxiety, phobias and obsessive compulsion. However, Conrad and Swartz (2009) described depression symptoms such as low mood, lack of interest in everything, poor concentration, lack of energy, inattention, loss of appetite, low self-esteem and low motivation. Scott (2013) mentioned the risk factor of depression as suicidal tendencies and it is associated to previous attempts as well as family history. It is very common to depression sufferers to have suicidal thoughts, self -harm and self-neglect. They also, struggle to sleep, feeling low in their motivation to do anything and they do not have an appetite.
Schizophrenia
Sawa et al. (2014) defined schizophrenia is an extremely complex and deeply devastating disorder that typically occur in early adulthood. Nevertheless, it rises as the individual grows at early brain development. Schizophrenia is a mental health condition which is severe and it is a long-term illness. It causes a wide range of various psychological symptoms. However, schizophrenia can be defined as a type of psychosis that can make the individual unable to differentiate their own opinions and ideas from the reality. Schizophrenia symptoms are hallucinations which make the person hear voices telling them what to do and see things that do not exist, believe in something that is not real, delusions having muddled thoughts and change the way the behave.
However, sawa et al. (2014) further highlighted schizophrenia symptoms as lacking engagement, disengagement from their feelings, avoiding people and not having an interest in anything. The patients see things on their own, which other people cannot see and hear voices. They have paranoid delusions, muddled thinking and language and self-neglect. They live in bizarre, delusions and psychic battles as if they are in a different place where people around them are either good or evil. Bailer et al. (200) found that Schizophrenia is comparatively common, and it is chronic and a devastating mental illness. It was evidenced by Sawa et al. (2014) that schizophrenia is genetic and it is a complex pattern of psychosis. that includes several genes with slight effects along with genetic insufficient penetrance.
Moreover, schizophrenia can affect people in a different way. Some people are not able to look after themselves, to do daily activities and take any employment but, some people can do daily activities as well as going to work. Hence, some individuals easily get to be upset, confused, disbelieving or suspicious as specific groups see them strangers in the community. They also feel worried and fearful that something is not right and ashamed to seek help. They have a feeling that other people are putting thoughts in their head and people are reading what they think.
However, Walker (2017) carried out a study on the causes of mental health. He found schizophrenia as genetic. If a parent has schizophrenia their children are more likely to have 10% chance of schizophrenia. if the parent has depression, the children will be eight times at risk of having depression but, if depression is first degree for the parent the child will be two to four times at risk of having depression.
Eating disorder
Goodwin and Gary (2010) stated that eating is a serious psychiatric sickness characterised by an inability to maintain a healthy body weight (at least 15% below ideal body weight) or failure to meet expected weight for children and adolescents. Regardless of the risk of weight loss, people are naturally obsessed of weight, struggle with further weight loss, and most likely to engage in unhealthy weight-losing activities, for example refuse to eat, riddance, purgative and diuretic misuse, keep doing excessive exercise to lose more weight. They get obsessed with how they look or their shape and weight has an impact on self- evaluation for people with AN. DSM-IV diagnostic. However, the principles entail amenorrhea for an of minimum 3 months but the diagnosis of AN, even though the condition is expected to be eliminated for DSM-5, for example, research suggests that there are much differences between individuals with AN who menstruate or not. Cynthia et al. (2013) highlighted the symptoms of eating disorder of 1 AN as a limiting subtype where an individual accomplishes and keeps low weight through caloric restraint and keep doing excessive physical exercise only, and binge-purge subtype, where the person frequently does binge-eating and purging behaviour such as self-induced vomiting or the misuse of purgatives, diuretics, or enemas to accomplish or sustain low weight.
Females have a higher rate of eating disorders than males. However, male seek help than female. Jacobi et al (2004) said eating disorders are caused by a variation of factors such as socio-cultural motivations, traumatic life events, and it can be genetic as well. Social influence like the media’s idealism and peer pressures to accomplish aquixotically tinny body which results in reducing body-weight for women. There is also a culture in eating disorder that emphasises slimness.
Bipolar
Goodwin and Gary (2010) described bipolar disorder as a recurrent effective disorder that does not have any difference from major depressive illness.until Leonhard’s work recognised it 50years later it was reconstructed recently. The psychiatry has now recognised bipolar disorder as a disease that can be treated but, it has high substantial mortality as well as economic and social impact. Furthermore, it has a question on mechanism and boundaries in treatment. There is nothing to determine that the person has bipolar or not.
Nevertheless, when most bipolar patients start to display depressive first episode, therefore if it is happening frequently then it is the course of the illness. It can be argued that bipolar people can be overdiagnosed or under diagnosed due to lack of understanding of the illness. Most professionals wait for a manic episode in order to make the decision for diagnosis. The psychotics rely on patient’s behavioural and potential physical issues to describe that the person is manic. When the individual has bipolar illness, they behave in a certain way however, they can be very happy, dancing and laugh or extremely angry in no time.
Personality Disorder (PD).
Pickard (2011) defined personality disorder is a disorder of personality which has a link with behaviour. The disorder is the inner person that describes the kind of person who they are and it is not an external illness occurs in them.
Furthermore, personality is the set of features or traits that describe them the kind of person who they are which is linked to how they feel, think and act responding to situations and in general. PD comes in different ways depending on who they are and the personality they have., They experience different challenges and behaviour according to their psychological distress and impairment.
Daniel (2013) mentioned factors that are associated with PD which includes family brok down, the death of the close family member, physical abuse or neglect, stressful childhood experiences, high levels of sexual abuse and it also includes social stressors which are poverty, war and migration. Moran (2002) said PDs has a strong link to violence, crime, self-harm, and suicidal. Moran suggested that PD comes from diverse backgrounds that lead the patients to a chaotic behaviour and live hopeless life, suffering from social exclusion and discrimination stigma. Due to these factors, they have an extreme significance on medical, social, legal, psychiatric and forensic.
Anxiety
Robert et al (2010) said “anxiety disorder as a chronic disturbance categorised by extreme anxiety and worry”. It is related to one or more additional disorders which is associated to diseases such as phobia disorder and depression. Anxiety was described by Freud in 1895 and symptoms are similar with other disorder. NHS choice highlighted the psychological symptoms of anxiety such as lack of concentration, ill-temperament, agitation, sense of dread and feeling continuously on edge. Edmund Bourne (2004) mentioned physical symptoms of anxiety which are trembling or shaking, short of breath, sweating, irregular heartbeat, chocking, fear of dying, stomach ache, feeling sick, having pins and needle pricks, sleeping problems feel like something is ringing in their ears, need to go to the toilet, confused and disorientated. It has been supported by Jacobsen et al (2016) that family history has an impact in phobic disorder and it is a risk factor that runs in the family. In addition, Social phobia is an irrational fear that makes one feel embarrassed to perform in some situation and it makes them to avoid public gathering. The symptoms are comprehensive and severe and it imposes crippling boundaries that result in social seclusion and isolation.
Social Phobia
Mitchell (198) suggested that phobias as a psychology and expressive state of phobic anxiety.. t It means fear to be involved in something and dread being out of proportion to a degree that makes the person to be afraid of and avoid doing something. They can be afraid of animals, places, crowed of people, illness, storms or any other thing. It makes them distressed and ashamed. However, Edmund Bourne (2004) argued that the symptoms of phobias are bridges, planes buses, going to the hairdressers, being a big supermarket stores, restaurants and staying in the house alone. Social phobia is a disorder involving an intense fear of being judged by others and it affects the lives of many people.
Stravinsky (2014) described social phobia as a disease of sorts, characterized by abnormal anxiety triggered by an inner mental or physical defective mechanism. The relationship between the communication and the emotionl and feelings of the socially phobic pattern of the individual course them to fearful. Stravinsky (2014) further argued that social phobia can be expressed and understood by the individual only and the symptoms are different.
Obsessive-Compulsive Disorder (OCD)
According to the research curried by Peterson (2012) obsessive-compulsive (OCD) is a mental health disease that is chronic and it has a serious effect on daily activities. Hence, it has an impact in sleeping and the effect of altered sleep is crucial for mood and wellbeing. However, Wahl (2009) said (OCD) is categorised by the occurrence of either obsessions or compulsions that cause substantial suffering to tormented individuals. (OCD) is a comparativelypersistent psychiatric disorder with the 12-month occurrence in adults ranging from 0.6% to 1.0% for DSM-IV OCD.
Morley and Glicken (2009) highlighted symptoms of (OCD) such as repeated thoughts and behaviours that include repeatedly hands wash and counting. Laura (2015) says that these symptoms occurs in young people due to stressful events such as being abused in their childhood, witness of violence or victims and being exposed to natural tragedies and wars. The symptoms also include alcoholism, suicidal behaviour, inability in controlling what they think in their mind which is against their will. constant horrible thoughts of taking their life away, wish to be dead, plans for suicidal and attempting suicide are also some of the basic symptoms.
Dementia
Temple (2013) characterised Dementia as a brain disorders that vitally affect anindividual's life and the way they see and think. Moreover, it affects individual’s concentration, memory, orientation to time and place. As dementia progresses in individual it decreases the cognitive ability which affects their communication and thinking. Hence, dementia is an umbrella word that covers a set of symptoms including difficulties with thinking, language, memory loss and solving problems. When dementia becomes severe, it affects the person’s life and they may experience changes in their mood and behaviour. Temple further explained the courses of dementia that occurs when the brain is damaged by Alzheimer’s disease or a series of strokes.. The symptoms of dementia may vary depending on individual on the parts of the brain that are damaged. Some individuals become frustrated or irritable, apathetic or withdrawn, anxious, easily upset or unusually sad whereas, some people hallucinate and become delusional.
The courses of mental health
Roger and Pilgrim (2010) emphasised the causes of mental health illness as being physical and sexually abused which includes violence, sexual victimisation in childhood and family disturbance. Therefore, other factors that cause mental health illness are experience of major traumatic life events, bereavement, illness, deaths of close family member, friend or partner, divorce and isolation. In addition, Walker determined that poverty plays a big role on poor health condition. Emotional, behavioural and mentalhealth issues mostly happen in poor areas with a higher rate. People who live in deprived areas are greatly the victims of mental health issue due to circumstances. Individuals with lower incomes are more likely to develop mental health issues than people who have higher incomes.
The problems of lower income inequalities roll over in society and cause problems such as family disruption, stress, frustration and then these problems increases crime and violence rates. Correspondingly, it was evidenced by Royal College of Psychiatrists that people who are living in debts are at higher risk of getting mental health issues. It was noted that one in two individuals with debts suffers from mental health issue and one in four people has mental health issues due to poverty. Mental health issue are related to debts because of job loss which causes the financial crises and can result in struggle to take responsibilities in meeting daily needs. However, financial issues classified as a high influential factor for suicide which can make individual to have panic attack, depression, anxiety, low self-esteem, social isolation as well as other mental issues. In addition, Walker determined that poverty plays a big role as consequence of poor health can cause less development as well as maintenance of emotional, behavioural mental health issues which happen mostly in poor areas at a higher rate. People who live in deprived areas they have influence on mental health due to circumstances also, individuals on lower incomes are more likely to develop mental health issues than people who has high incomes. The problems of lower income inequalities roll over in society and cause problems such as family disruption, stress, frustration and then these problems increase crime and violence rates. Correspondingly, it was evidenced by Royal College of Psychiatrists that people who are living in debts are at higher risk of getting mental health. It was noted that one in two individuals with debts suffer from mental health and one in four people has mental health due topoverty. Mental health live in debts because of job loss which causes the financial crises and can result in struggle to take responsibilities in meeting daily needs. However, financial issues classified as a high factor suicide it can make individual to have panic attack depressed, anxiety, have low self-esteem, lead them to social isolation as well as other mental needs.
According to the study carried by Neira et al. (2005) the cause of bipolar and schizophrenia is the experience of physical and sexual abuse. It was evidenced that individuals affected by schizophrenia and bipolar has high rate of sexual victimisation and it is associated with other mental illness. However, Neira et al. (2005) argued that the factors that causes mental health illness are the experience of discrimination and stigma, living in poor housing or homelessness, job loss or unemployment, having severe stress, poverty, debt, taking care for family member or friend, misuse of alcohol or drugs, severe physical condition, social isolation and exposure to domestic violence or abuse as an adult.
MacManus (2007) stated that the Mental health issues is currently major problem in the UK. According to Gov. of the United Kingdom 1 in 4 people is diagnosed with mental illness in England every year and, it is increasing. Mental health affects both men and women as well young people and adults; however children can be affected biologically through genes or brain. According to NHS.Org, mental health is an illness that includes emotional, psychological and physical wellbeing and it has an effect in the way the person think or feel. Mental health issue can make the person behave in strange ways; changing moods on some cases and taking unwise decisions. According Org.UK, 1 in 10 people suffers from mental health, 9 out 10 face discrimination stigma and 3 among 4 are afraid of the response of friends about their mental illness.
According to study carried out by Wallace et al. (2016) people on mental health in ethnic minorities experience racial discrimination while living in a community. The individuals feel unsafe, avoid going out in other places, insulted or threatened, called names and physically attacked. Discriminations occur in schools, public places, at work, on public transport, outside, and home. Wallace further stated that the individuals mentioned that they were insulted, avoid going out, feel unsafe, been assaulted due to racial discrimination because of their ethnicity, nationality, and religion. The other issues discrimination include their age, sex, ethnicity, sexual orientation, health, disability, language, dress code or appearance and accent. In addition, Corker et al. (2013) supported that people with mental health issues experience stigma and discrimination in the public attitudes towards them. In spite of the fact that the personalisation has brought wide range of services to protect the people with mental health issues Corker’s study on public attitude discrimination scored 11.5% towards mental health people.
Brief history of mental health
Barnard (2011) stated that in the eighteenth century mental health problems were not recognised. However, people had some ideas and attitudes regarding mental illness in Britain. Some families decided to exclude mental health individuals from them and the society because they were ashamed of their mental illness. Due to isolation, mental health patients intended to live in the streets which made their mental illness worse displaying abnormal behaviour. In fourteenth to eighteenth centuries people with mental health issues were considered as witches and possessed by devil spirits. Consequently, there were no therapeutic asylums to identify them and they were badly treated, for example burning them, leeching and exorcism. During that period, there was no psychiatry or therapy to help them. Norman and Ryrie (2004) stated that when the asylums began to recognise mental health patients, they were kept in unhealthy circumstances such as dark rooms with stones floors, cold and dirty walls. In 1970s, moral therapy technique was created which enabled the patient to control themselves in calming environment provided. In 1990s Mental Treatment Act started providing treatment for outpatient and legislation become more active and enabled people to have rights to medication. Psychology started to develop in 1980s.Sigmund Freud (1856-1939) founded the school of psychoanalysis which was a small group of psychotherapy and therapeutic communities. In 1948, NHS started to give control to local authorities. Since then more legislation followed. Deterrence approach, community care, full philosophies of care began to widespread at the end of twentieths century and more mental health acts started to be legislated.
Carr (2008) stated that personalisation is a new approach that enhances choice and control for individuals using the services and it is a priority in health and social care in England and Wales. Larsen et al. (2013) says personal budgets has been implemented to ensure mental health patient’s needs are met and to identify barriers that they can come across.. In addition, Larsen et al. (2013) mentioned that even though personalisation is implemented individuals will need support and assistance from the multi-agency to get the access to the services. Hamilton et al. (2016) emphasises that the aim of implementing personalisation in social care in England is to find out whether personal budget is efficient enough to provide power, choice and control of their lives.
Community care (2010) Personalisation is a cornerstone which was rationalized by the Department of Health (DH 2008) and it means thinking about care and support services in an entirely different way. Furthermore, it is not about personal budgets only but it brings in wide range of services and it ensures that care of the service user remain central. Hence, it is linked with direct payments and personal budget and it allows service user to choose the type of service they want to receive. Moreover, Personalisation entails that services are tailored in order to shape individual’s needs instead of being delivered the same on different service users with different needs. In addition, it involves the provision of improved information and advice on care and support for families, investment in preventive services so that the delays for individual’s needs for care are reduced and the promotion of independence and self-reliance in service users and the community can be exercised.
Hence, personalisation means the aspirations and presence of the service usershould be strengthened as an individual by identifying their needs, making choices, choose how they want to live their lives and where they want to live and how they want to be supported to enjoy their life. It requires a significant transformation of adult social care so that all systems, processes, staff and services are geared up to put people first. The traditional service-led approach has often meant that people have not received the right help at the right time and it has been unable to shape the kind of support they need.
Community care (2008) stated that personalisation is about giving people much more choice and control over their lives and goes well beyond simply giving personal budgets to people eligible for council funding. However, personalisation covers the wide range of service in health and social care. It is not only about the personal budget but is about addressing needs for service users, decision making, choice and control and empower people to recover and to live independently. Community (2008) continues to say, to ensure that the care for the individual remain central, it is important to empower them to design care package which suits their needs, support them to get well, stay well and have their life back, fix problems themselves, being creative and removing barriers. It was evidenced by community care (2008) that personalisation enables individual to choose the kind of care they want and where they want to live to get access to transport for their shopping and other things.
Furthermore, the aim of personalisation is to ensure that individual have access to information, advice, advocacy as well as leisure and strengthen community by encourage the inclusion education, housing, health and jobs opportunities regardless of age and disabilities. Hence, advocates have big role to play to help incapacity people who can, make decision. Sanderson and Lewis (2012) said, the Association of Directors of Adult Social Services (ADASS) and Department of Health (DH 2010) stated that social workers have central key role in emerging and distributing personalised social care and support services. Beresford (2014) supported Sanderson and Lewis and said that the social workers have a vital contribution in personalisation to focus in promoting choice and control, supporting independence of individuals having problems due to mental health issues, disabilities, effects of age and other health issues.
In addition, all professionals have a big role to contribute to ensure that services are personalised and human rights are safeguarded through working with different professionals and other organisations. Glasby (2010) suggested that when different professionals work together bringing different ideas and expertise, they will achieve good outcome for people, empower individuals in their family and communities. Practitioners know advices give them guidance in applying legislation as well as accessing practical support and services. Reith (1998) suggested that health professionals should fellow policies, procedures, assessments of the statutory, other duties and requirements passed to other agencies and authorities to make sure that are being carried out accordingly. However, there are some issues and challenges arise when different agencies are working together, consequently, it needs good efficiency in engaging with service users within NHS trust and private sector, to ensure that service users are getting the support they need and access to the services.
Brief History of Personalisation
Personalisation was introduced in 1997. At that time it was only eligible for adult people with disability in social care who were receiving direct payments. It was originated from the US, for disabled people and then introduced in the UK in 1990s. However, at that time direct payment was not active to disabled people which they have campaigning for further extension and greater take-up. Glasby and Little Child (2009) said, the campaign for direct payments was seen as part of a wider struggle for greater choice, control and independent living. Moreover, personalisation made huge removal of crucial barriers to disabled people who were participating as equal citizens. The concept of developing and implementing the personalisation policy has made other policies rolled out by disabled people.
Davies (2012) emphasise that “policy think widely on civil on ethnicity and gender this independent living movement has been very successfully in challenging traditional attitudes and approaches to disability”. When the disabled people were offered the access to direct payments which allowed them to obtain the kind of care they want, however the Act changes to National Assistance Act 1948 working to with local services providing cash paymentto service users assessed by the professionals according to their availability. Glasby and Lester (2006) argued that the voice of disabled was taking into consideration by the government and the Act symbolically played a big role to allow service users to have direct payments to choose care services from agency, voluntary and private sector that shapes their needs. The act was important as it made the disabled people accepted and become managers of their care. Initially the direct payment stretched to other user groups such as old people, carers, people with mental health issues, and people with parental responsibility for disabled child.
Spander and Vicky (2006) explained the philosophy of personalisation as the independent living and being flexible to arrange full support on individual’ best interest. Personalisation is the ability of needs met of the service users that is best for them. Carr (2008) suggests that the philosophy of personalisation is to ensure service user is in control of direct payment, empowered to be able to manage their support services, inclusive of prevention and early intervention. Community care 2008 stated that in order to put personalisation into practice social work should have five values of human dignity such as competence, integrity and worth, social justice, and service to humanity.
Justification
The World Health Organisation WHO (2016) stated that in 2013, mental health issue in England and Wales, have affected 615 million people and it is increasing. About 416 in the UK have suffered from anxiety and depression in the same year. Current figures state that each year one in four adults will experience at least one diagnosable mental health problem in Britain. However, only 230 of every 300 who need help will visit their GP. Boardman and Alan (2010) said, even though people with mental health issues are accepted in society, there are barriers such as employment, healthcare, family, support and community which people with good mental health may take for granted. Hence, social exclusion can affect individuals and cause mental health illness which leads them to poor health, debt, and unemployment and family problems.
Methodology
Due to sensitive of the nature of the subject the methodology of this dissertation will be presented as a critical review. However, the aim of this literature review is to identify the strength and weakness of personalisation approach and how it impacts on people with mental issues. The dissertation will deliver historical analysis of mental health aiming to compare between the previous and current approach and identify which is more effective. Hence, the literature review will include secondary research in order to provide the dissertation the required answers since primary research is not effective enough. The literature review will use various sources such as; policies, journals, books, newspapers, articles in order to conclude whether the personalisation approach is effective enough to promote independence to people with mental health issues.
Themes
To demonstrate the role of personalisation approach that supports the mental health of the people. To identify current interventions that have been taken to help the mentally challenged people living in the community. To identify more therapeutic care for the mentally challenged people. To minimise efficacy of treatment, early assessment, diagnosis before it gets critical. To get the support from multi agency team promoting the independence of the mentally challenged people through personalisation approach. The Adult Psychiatric Morbidity Survey (APMS) in 2007 identified the number of the people who were suffering from mental health problems at that moment in England and Wales. According to the survey 23% adults were suffering from generalised anxiety disorder, mixed anxiety and depressive disorder, and obsessive and compulsive disorder. In addition, the percentage of the adults who had common mental disorder was16%. The list of Common Mental Disorders (CMD) includes several types of depression and anxiety. These are the causes of distress and problems for people in their daily lives but it does not affect their ability to think rationally. George Arnett (2015) says, women are more affected by mental health illness than men. In contrast, men have a higher rate than women on panic disorders and obsessive compulsive disorder. Due to the severe mental health issue in 2012/13, 1.6m people in contact with specialist mental health services in England. About 705,000 contacted mental health services among whom, 885,000 were female. Also, there are some incidents where individuals with mental illness admitted to the hospital due to self-harm and in this case, the number of female is more than the number of male. According the Office for National statistics (ONS) in 2011, 11.1 adults out of 100.00 has committed suicide in the UK and 5,891 of young people also committed suicide. However, the number of male suicidal case is three times more than female suicidal cases and the rate is at 18.2 per 100.000 and 1 in 4 males between 20 and 34 of age committed suicide. According to the survey there is high number of mentally challenged people, who committed suicide and self-harm. Mental health also issues includes, high levels of distress which influence the mentally challenged people to commit suicide. 63% of men and 58% of women attempt suicide and most of them are young adults and 42% of men and 53% of women getting help from their GPs. Who (2012) said, even though treatments are available for the mentally challenged people, nevertheless two-thirds of the mentally challenged people have never tried get help from the health professionals. Furthermore, people with mental health issues are experiencing stigma, discrimination and neglect due little understanding of the illness and prevention. According to Allen (2007) personalisation has transformed the life of mentally challenged people and they are receiving support from different mental health teams which include crises teams and early intervention teams. Furthermore, personalisation allows mentally challenged people to get the opportunity of getting admitted at the hospitals under Mental Health Act (1983). When they are admitted to the hospital they will get a named nurse who provides one to one service if there is any issue in the treatment that they get in the hospital and the duties of other nurses are to give medication, check patients physical observation, preparing the care plans and referrals. Occupational therapy (OT) helps the patients in wards and they accompany them if they want to go outside for walk or shopping. Social workers help the individuals to get suitable accommodation, deal with safeguarding issues, assess if the individual is living safe in the community, assess if the service user is safe alone or deal with financial issues or any other. Community psychiatric nurse (CPN) helps with preparing patient records, doing care plans, risk assessments and working with family, educating them and patients about their mental health issues. Stanton (2011) highlighted the doctor’s duties in supporting mental health people in accessing appropriate healthcare, assessing, and prescribing suitable medication, making decision when discharging the patients, doing ward rounds every week to review the medication, make changes if there are issues with anything and deal other issues for the patients while in the hospital. Carers help the patients with personal care if needed, carry out one to one observations for patients who are on level 1a and b and observe patients on general observation and level 2. Solicitor provides services if there is a problem in anything, highlights the rights of the patients, represents in tribunal courts, supports them on discharge, supports them if they have life threat, supports in need to save money, gives advice and makes decision, makes application to upper tribunal or appeal hearing if needed. Advocates also, have an important role in supporting mental health people who does not have access to solicitors. They provide legal information about treatment, connect them to different partnership working, explain and exercise their rights, request review, explain about the care while in hospital and raise the concern for any problems, support during ward rounds, meeting, care reviews, involved in their care plans and assist them to check any conditions or restrictions apply to them. Personalisation has impact in tegrating all health professionals to assist the people with mental health issue to meet their needs and in decision making.
Mayer et al (2010) supported if service user displayed inappropriate behaviour during the episode of acute illness, staff has the right to place them in seclusion because they can harm themselves or others.
Seclusion measures ought to prevent human rights abuses. Such as minimization of isolation and distress; improvement of communication between service providers and service users; and promotion of attitudinal changes which reflect respect for other people’s dignity.
According to Organisation for Economic Co-operation and Development (OECD) Mental health issues cost the UK 70 billion every year. Davies (2011) explained that out of 327 patients, 95 patients 29% admitted to hospital due bipolar disorder, with a 85 inpatient days 95% per hospitalised patient. 95 patients it costed £2.43million per 95 patients in UK. Over 8,108 inpatient days The total cost acute psychiatric admission in 6,428 days was £1.86million. The total cost in 621 days, £165,186 for rehabilitation admission and admission for patients stayed for long time in 434 days costed £91,574. Davies further explained that the cost of mental health admission in 57 days was £32,832. However, in 568 days the total cost was £273,208 for forensic medium secure unit admission.
Young (2011) carried a study for direct care cost. He mentioned that the cost of bipolar disorder roughly estimated was around £342 million for patients admitted. also, outpatient mental health 26.7%, and medication 7.4% of the total direct costs of care. The consultants associated to bipolar disorder were 866,409 and patients who had follow-up with the consultant were 78%. The cost was £266 patient per year and total coast of consultation was £18,194,581 per year. The cost for telephone consultation cost £21 for face to face fee £35 in connection with care prescribed of bipolar disorder management. In a year, 703 patients received 17,425 prescriptions.
Chapter three
Martin et al (2014) suggested that implementing personalisation is significant and it gives independence to the people living with mental health issues. The aim of personal budget is to ensure people are at the centre of care and support based on their needs. Personal budgetidentifies individual’s strength and preferences and it allows them to have choice and control over their lives.Due to the campaign disability rights groups and the independent Living Movement, personal budget has become a key in health and social care policy in England. Department of Health (DH) (2007) suggested that the vision for the future commitment and transformation of health and social care in England is to put people first and to provide them with choice, control, well-being and independence. Additionally, Her Majesty’s Government (2011) states as follows; “no health without mental health.”
Ainsworth (2013) said personal budget is a kind of funding which is different from other funding which is being delivered by the local authority and it can be seen as a social care budget. Hence, it can be described as a way of working and the assessment and care planning are being used in different terminology. The nurses do not engage a lot in doing assessments but social workers are generally engaged in system and paper work. As a result, other professional seemed to be working arrangement that nurses should pass personal budgets work on to social work even though it is not generally a sanctioned approach. Nurses are skilled to give medication and are associated with treatment, stabilisation and medication management.
Apparently, personalisation in mental health, all professionals such as nurses, CPN, social workers, doctors, GPs, OTs and lawyers should be integrated and agreed the same kind of thing in decision making. However, it has been found to conflicts and challenge multi-agency working teams. According to study carried by Ainsworth it has been found that nurses are being given work which is on side-lined participating and engaging with service user in their personal budgets. However, it can be argued that personal budgets involve nurses to work with other practitioners and the same goes out of boundaries of their job role and are overlapping. Whereas, Mayer suggested that social workers and occupational therapists engage more closely with personal budgets. Also, they noted that personalisation has given them the chance to regain their focus away from the medical model and went back to traditional occupational therapy goals.
Ainsworth further suggested many ways of working when based within multidisciplinary teams.. However, other services such as social needs, housing, benefits and employment remain as part of social worker’s role and involves clinical or treatment needs. Occupation therapy in mental health gives the opportunity to know the person better,having time with them doing activities, it is important and it takes them away from isolation. Even though, it does not cover medicine, personalisation includes providing social context to the service users and it brings in wide range of services. Through personalisation mental health people get advocacy support service if the individual does not have capacity to make decision but the process uses person centred care. Capacity Act (2005).
Consequently, Department of Health (DH)(2009) found implications in the ways that personal budgets or personal health budgets are being delivered in mental health services. However, for personal budgets to be successful it needs the focus of multi-agency working and care systems also, how personalisation fits with professional values and ways of working.McNichol (2013) supported that mental health services require to consider the impact of overriding medical models and hierarchical role limits in applying new practice. It was evidenced by McNichol that some local authorities startedto move away from integration with the NHS which causes problems in implementing personalisation. It is important to consider the barriers when considering implementation, practice development and organisational systems.
In contrast, Webber (2014) emphasises that control of the medical model and the hierarchical policy of social needs and personalised working have consequences for person-centred care in mental health especially in implementing personal budgets. Hence, some professionals found that personalisation is valuable, which means practitioners either avoid engaging with personal budgets, or they have done the process quickly to reduce service user’s involvement. Webber further states that there is an indication that personalisation are being pushed down the hierarchy by the medical model across integrated mental health teams. Therefore, the practitioner should be empowered to produce solution with the service users. However the process linked with personal budgets appeared to be a problem. As a result, personalisation seems to reflect hierarchical nature of healthcare.
Literature Review
Personalisation as policy approach has achieved satisfactory results in promoting the wellbeing of mental health patients. They can live independently and it provides them with power, choice and control, on how they want their care to be delivered and where they want to live. On the other hand, personalisation also, faces challenges in terms of cutting health cost and, it has been noted by the different authors that it cannot fulfil needs of all individuals due to lack of wide range of services. Clark (2014) criticised that problems are arising in terms of personalisation for people living with mental health in connection with their needs because of being presented under “responsibility and power”. It means individuals are being given power to lead and take responsibilities for their personal budget. Service users will take risks to misuse that money and buy something which is not related to their care as they have the power and responsibility regarding personal budgets.
However, if the individual chooses the wrong care provider who is not able to deliver appropriate care due lack of skills and trainings, for example some care agencies do not train their staff properly, the others issue decision in integration with NHS and Local Authorities they need engage effectively with service users within multi-agency working. As a result, Lymbery (2012) says professionals who are qualified should have the ability to enable individual to improve experiences through direct payments but, as it stands social workers are being marginalised. Arguably, the policy is affecting financial considerations as well as creating major problems for local authorities and the numbers of social workers is also being reduced. As a result, mental health patients are at high risk if the social workers are not enough to support.
The results of the survey conducted on the local authorities indicated that there is an enormous success since the implementation of personalisation which included engaging with service users, good partnership working, and culture shifts. Also, there are challenges on local authorities when they move to personalisation as it is associated with culture change between front line staff and other staff within the Council. It appeared to be very difficult to change in running a care management and budget cuts on financial health providers. Personalisation has seen to have wide range of support and it a way of thinking about good services on vulnerable people living with severe mental health. Personalisation is generally recognised as a “good thing”. Ferguson, (2007) argued that the image of personalisation seems to have suffered between staff and service users as a result of implementing direct payments as a financial restriction. Hence, personalisation should promote choice and control not be seen as cost-cutting to personal budgets. Similarly Needham (2011) supported that personalisation as a policy approach is being used for rationalising and cutting budgets. Apparently, Beresford (2009) also, supported that personalisation is being used without adequate funding which means it can lead to “cuts by stealth”. Hamilton (2015) supported those personal budgets in mental health needs good effective engagement of health and social-care systems. In addition, change of care methods requires strong leadership, clear vision and personal commitment. Also, personal budget is being led by the service user but, the key element is stakeholders which include front-line practitioners to ensure it remains the key policy priority in adult social care in England. Therefore, it is increasingly vital in the care of adults and young people with mental health problems. Hamilton further supported that personal budgets can enable people to achieve outcomes that are relevant to them in the context of their lives, particularly through enhancing their wellbeing and social participation. Furthermore, personal budgets should consider the difference between individuals who are independent and to identify those who do not have potential to engage get more support and pursue their goals.
It has been argued by Ferguson (2007) that personalisation due to agreement with key themes of New Labour thought, to put the service users first and to give them responsibilities. As a result, they take all the risks are being transferred from the Government to the service user. In this context, it can be concluded that, it is giving the permission of the marketisation of social work and social care as well as neglecting issues of poverty and inequalities. It is encouraging people who use social work services to potentially stigmatised and them to depend on welfare and potentially promoting them, instead of challenging, the unprofessionalism of social work. Hence, the philosophy of personalisation is not about letting the social workers accept uncritically but to ensure that service users are getting the right services.
Conclusion
Clark further, suggested, that the purpose of personalisation is to break down inadequate funding and poor quality and inappropriate provisions. It was founded by the New Labour government which was convinced that the best way to deal with these two competing problems is to implement a policy, which enjoys cross-party support. Thekey factor was to introduce personal budget in order to induce cost savings as well as, enhancing the satisfaction of service users. In addition, personalisation gives the chance to further reduce mental health stigma and institutionalisation by increasing self-autonomy, independence, choice and control for and with people having mental health problems themselves. There are some challenges of implementation within mental health such as effective delivery of care within integrated NHS and other care providers.
Mental health is an area whichneeds to be accurately tested or evaluated, however personalised care needs to be accomplished through the new systems of services delivery. Hence, if personal budget is being delivered appropriately it gives the individual good flexibility, and it enhances their ability to achieve their aims. Personal budgets give choice and it is worth to consider the way they want rather than delivering care in a unique way but, it may make the service users feel uncomfortable. Allen (2007) has suggested that good integration is beneficial for the client and it leads to fulfilment of practitioner’s aims. The policy brings in new medication for mental health issues and it’s regulations. Personalisation has increased the use of modern anti-psychotic medication and CBT therapists with the promise of an increase in their number. The team psychiatrists have now increased up to 55 per cent and the number of psychologists has now increased up to 69 per cent.
Mental health nurses are now more as compared to the situation before. Personalisation has created easy ways of working as they have enabled putting females on their wards and males on their own. Personalisation, allows the mental health people to be socially involved in therapies. However, engaging in these services helps to reduce anxiety and interactions are a useful source of relieving stress. Implementing personalisation is a huge opportunity to mental health professionals as it can render support in anything they need and those who lack capacity they have a backup from advocacy. Personalisation gives individuals the chance to explore issues which they struggle to overcome during counselling with the practitioners on one to one basis. These services ought to apply to all individuals having severe mental health issues.
Mithran (2009) suggested that social workers and managers understand that personalisation will benefit users but it is far expensive in terms of money, training and guidance required. According to Mithran’s study, personal budgets supports people in the medium and long run also it is found to be helpful in terms of advice, information and advocacy services. Generally, about half of the respondents said the progress on personalisation was fully integrated and led to good engagement with local authorities. Moreover, about one fifth of the respondents said that at early stage and half of the respondents found out that in order for personalisation to be successful huge investment is required. Mithran further, explained the most important factor is to understand the culture of personalisation and keeping it into practice includes partnership working and involving people in co-producing systems. In addition, problem solving and a wider, joined up, whole system view will be vital ingredients for success.
In contrast, Dickinson and Glasby (2010) suggested that personalisation has good potential to deliver services diversely and it covers all the needs for the service user as well as, carers. Nevertheless, personalisation is a comprehensive policy, if implemented appropriable third sector organisations will play a major role in helping the development to fulfil the needs of the individuals. In fact, third sector should in a way that it shapes, design and able to deliver personalised services in order to fulfil the implications of personalisation and understand it, as well as putting into practice. Personalisation changes requires sensible consideration in order to have a clear vision for the future. It requires the third sector to engage appropriately otherwise they will potentially incur loss in business opportunities.
