The medical model is the most powerful and influential inmental health (Beecher, 2009). The model suggests brain disproportions createissues to the individual mentally (Tyrer, 2013, p.
11). It looks at the problemand ways to treat the person (Disability Nottinghamshire, 2017). Medical professionalsutilise their knowledge and complete assessments to determine whether theindividual has a diagnosis of mental health (Beecher, 2009).
The medical modelis grounded (Tyrer, 2013). However, there are limitations, such as theindividual having less power (Disability Nottinghamshire, 2017). Also, theirlabelled creating more issues for the individual (Beresford, Nettle andPerring, 2010).
The psychodynamic model emerged from the 19th centurystemming from Freud’s perspective (Coppock and Dunn, 2010). It considers howprevious events and feelings suppressed in the mind may impact the way theindividual thinks and feels now (ibid). It is suggested that everyone is unwellto a certain extent and this model provides a detailed concept in relation tomental health (Rogers and Pilgrim, 2014). Contrastingly, the social model gives importance to theperson’s circumstances and how social elements could provoke mental healthissues (Coppock and Dunn, 2010). It places emphasis on comprehending inequalitieson the structural level (Beresford, 2005). The social model is recognised morelargely due to limitations of alternative models (Tyrer, 2013). People withmental health issues felt that there are benefits in utilising the social modeland it looks at the situation holistically (Beresford, Nettle and Perring,2010).
The social model acknowledges the experiences of the personand how power differentials could result in inequality (Duggan, 2002 cited inBogg, 2008, pp. 44-45). It promotes the anti-discriminatory and anti-oppressivepractice, differences in ethnicity and culture, power-sharing between theprofessional and the individual (Beresford, 2005). Tahim has a hoarding problem. The Diagnostic and StatisticalManual of Mental Disorders (DSM) considers hoarding as a mental health issue(Mataix-Cols and Pertusa, 2012).
Hoarding is when an individual possesses largeamounts of items (NHS, 2015). Hoarding affects approximately “1 or 2 people inevery 100” (Royal College of Psychiatrist, 2016). Various factors increase thechances of an individual becoming a hoarder, for example, depression andloneliness (Mind, 2013). It is not unusual for hoarders to be amongst the olderpopulation living by themselves (Thompkins, 2015). Furthermore, the environmentimposes risks to the individual and others including, the risk of a fire andcreating difficulties to leave the premises in these situations, risk to theindividual falling and the potential physical implications from this (NHS,2015). Tahim has already injured himself and he spent time in the hospital dueto his fall. Tahim’s collection of magazines and newspapers could bedetrimental as it could hinder his day to day life (NHS, 2015).
Tahim has depression. People with depression experiencenegative emotions for a long period of time (Royal College of Psychiatrists,2015). Various factors could cause a person to become depressed such as thedeath of a significant person (ibid). There are various treatment methods suchas counselling and medication (Mental Health Foundation, 2017). In relation toTahim, he has anti-depressant medication. Medication can support the individualmanage and cope with their issues, however, there are disadvantages due to theeffects of these (Royal College of Psychiatrists, 2015).As an agent, our interaction with others could berestricted, limited and influenced for example, by our culture (Tew, 2011).
Thompson’s PCS model enables power differences to be examined between theindividual within their personal, cultural and structural circumstance(Thompson, 2007 cited in, Koubel, 2013, p.69). It supports us in comprehendingcommon values and what this means (Thompson, 2011).Tahim is from a Bangladeshi background and he is a Muslim.People that are from a minority ethnic background with issues relating to theirmental health experience inequality on the societal and communal level (Rehmanand Owen, 2013). Many have stated that they face inequality and that a”third of Pakistani’s and Bangladeshi’s” have asserted that they havebeen through ill-treatment due to their race (Rehman and Owen, 2013, p.
3). Itis implied that this could be due to their religious beliefs of being a Muslim(ibid).It is important to recognise Tahim’s religious identity as aMuslim.
In this religious group, mental health is viewed negatively andindividuals are not utilising services which cause further problems(Giannangeli, 2016). In some backgrounds, there are views that mental healthissues are related to devils (BRAP, 2012). In Islam, there is a view that mentalhealth issues arise due the works of devils and they can negatively affect theindividual (Tzeferakos and Douzenis, 2017). Furthermore, those that are from a different ethnicbackground have a greater chance of being identified with a mental health issueand being hospitalised (Mental Health Foundation, 2017).
Mental HealthFoundation (2017) suggests that available resources usually do not facilitateand deliver services tailored to suit the culture. This gives the implicationof the inequality discrimination Tahim could experience. The National Service Framework policy was established in1999, aiming to enhance service delivery for adults with mental health problems(Boardman and Parsonage, 2009). It was developed due to the events that tookplace in the 1990s leading to demands from the wider population (The KingsFund, no date).
The National Service Framework has a significant role regardingmental health (Smith, 2000). It established 7 fundamental principles (DoH,1999). Research asserts that people with mental health problemsexperience inequality and are marginalised which remains a significant problem(Smith, 2000).
The National Service Framework affirms the need to improvepeople’s comprehension of mental health issues to tackle inequalities (ibid).The Coalition government introduced ‘No health withoutmental health’ (DoH, 2011). It suggests the attitudes of mental health are poorand it affects the individual negatively, as they experience inequality (DoH,2011). This is harmful to the different structures due to the implications suchas costs (DoH, 2011).
The government established 6 fundamental principles topromote positive mental wellbeing (DoH, 2011). It is a method of working in away for individuals to decide on how they want to live their lives, maintaintheir wellbeing and how professionals can help the individual (DoH, 2011). It gives the opportunity to make decisions in terms of whatthe individual receives in their package to support them in the process ofrecovering (DoH, 2011). Professionals acknowledge the views of the individualand their family (DoH, 2011). Involving people in the planning of care isimportant but, the majority of individuals claim that there is a lack of thisin practice (DoH, 2011).
Community Mental Health Teams utilise the Care ProgrammeApproach (CPA) to help the person with a mental health issue (Rethink MentalIllness, 2017). The individual will have an allocated care-coordinator and aplan will be devised and based on their support needs (ibid). Completing ahigh-quality assessment enables the needs of the person to be clearlyidentified (DoH, 2007). Consequently, this enables the professional tounderstand the services needed to support the individual (ibid). It willcontain information regarding the steps to take in emergency situations(Rethink Mental Illness, 2017). The review of the care plans happens annuallyand all relevant people involved attend to identify aspects that arebenefitting the individual and what may need altering (Surrey and Borders PartnershipNHS Foundation Trust, 2017).
In these meetings, the individual has theopportunity to voice their perspectives (ibid).The CPA requires an assessment to be undertaken and this isto establish what the individual requires and how it will be achieved tosupport them (DoH, 2008). It should consider what the individual wants and thebest way to achieve this (ibid). Firstly, an assessment of Tahim’s capacity needs to beundertaken. The Mental Capacity Act 2005 concerns those above the age of 16regarding life decisions (SCIE, 2016). There are five significant elements ofthe Act (SCIE, 2016). It focuses on the person, who is at the centre (ibid) andthe individual is deemed to have capacity unless there is evidence to suggestthere’s not (Gov, 2007).
There are two steps in determining the individual’s state ofcapacity (Gov, 2007). In order to meet the first step, there needs to beevidence that there’s an “impairment or a disturbance in the functioningof their mind or brain” (Gov, 2007, p. 44). In relation to Tahim he has ahoarding issue and depression, therefore, he fulfills the first criteria. Thesecond step is coming to the conclusion on whether Tahim is capable to make adecision due to his mental health issues (Gov, 2007). A person is deemed to beincapable of doing this if their unable to comprehend the information provided,maintain this, utilise it to inform their decision and convey their view (Gov,2007). An important principle is that Tahim is able to make an ‘unwisedecision’ (SCIE, 2011). Tahim was speaking in Punjabi despite him knowingEnglish.
Tahim made this choice despite him being informed that the socialworker does not speak the language. Just because Tahim does not want to engagedoes not mean he does not have the capacity and there is no indication that hedoes not have capacity. The strength is that the professional should not think thatthe individual does not have capacity due to how old they are, their image,mental health issue or other health-related issues (Mind, 2015). Furthermore,if an individual is deemed to lack capacity then, their entitled to an advocateto convey their perspective (ibid).There are limitations of the Mental Capacity Act 2005 (Houseof Lords, 2014). There has been poor recognition, comprehension and theresponsibilities the Act entails has not always been complied with (House ofLords, 2014). Furthermore, there should always be a presumption that theindividual has capacity however, it doesn’t necessarily happen (House of Lords,2014).
Moreover, there is a lack of assessment being undertaken regarding theindividual’s state of capacity and when they are undertaken they are notcompleted to a high standard (ibid). The Human Rights Act 1998 contains a set of rights thatapply to everyone in the United Kingdom and it is a significant piece oflegislation (Mind, 2017). Mental health professionals have a responsibility toensure they abide by the legislation (Mind, 2017). Article 8 of the HumanRights Act 1998 asserts a “right to private and family life” (Mind,2017). It emphasises that the individual can make decisions concerning theirlife but, it could be restricted in some circumstances (ibid). In relation toTahim, he cannot be treated unfairly in terms of his decision in not wantingcarers because he has the right to a private life. Tahim has the right to makesdecisions as he has capacity and this should be respected.
The Mental Health Act 1983 can be utilised to detain anindividual without their consent (Coppock and Dunn, 2010). However, other optionsto support the individual in their recovery should be explored first (Coppockand Dunn, 2010). Section 3 of the Mental Health Act 1983 requires theindividual having a ‘mental disorder’ and ‘to receive medical treatment inhospital and appropriate medical treatment is available for him or her and itis necessary’ (Coppock and Dunn, 2010, pp.70-71). This to protect theindividual or others if there are no other options (ibid). Before detaining an individual, there are assessmentprocesses (Mind, 2017).
Professionals include an Approved Mental HealthProfessional (AMHP) and 2 doctors (Mind, 2017). AMHP’s have specificresponsibilities in ensuring the individual’s circumstances are looked at in acomprehensive way (Lancashire Care NHS Foundation Trust, 2017). The individualshould be informed of their rights and involved where possible (ibid). Althoughprofessionals other than social workers can train to be an AMHP, the vastmajority are social workers (DoH, 2016). For a long period of time, medical professionals have hadpower over the comprehension of mental health problems (Kinney, 2009). AMHPsfundamentally work to ensure rights are upheld, however, when an individual hasa mental health diagnosis and their under-going an assessment it is hard touphold this (Kinney, 2009).
It may be easier for AMHPs to agree with themedical professional’s view consequently, the outcome of many assessments leadto the individual being detained (Kinney, 2009). The Equality Act 2010 safeguards people from experiencinginequality and 9 elements are included, including race and age (Citizen Advice,2017). The strength is that it supersedes legislation prior to theestablishment of this legislation and consequently, it is simpler to comprehend(Gov, 2015). Furthermore, people are not allowed to be treated unfairly interms of accessing and utilising services because of their age (Griffith,2010). This applies to Tahim as he cannot be discriminated on the grounds ofhis race, age, and religion.Hoarding creates a high risk to the individual and to otherssuch as the neighbours (Suffolk Safeguarding Adults Board, 2017). In relationto Tahim, he does have a mental disorder and he is a danger to himself and hisneighbours.
Furthermore, Tahim smokes and this increases the risk of a fire tohappen. However, in terms of whether treatment for Tahim in hospital is theright decision can be argued, even though his psychiatrist is inclined to this.The alternative to this is Crisis Resolution Home Treatment. The Crisis Resolution Home Treatment (CRHT) team is a typeof service that aims to help the individual to recover from their home (Norfolkand Suffolk NHS Foundation Trust, no date). Various professionals in the fieldof mental health help the individual at difficult periods of when their mentalhealth deteriorates (Mind, 2015). The aim of these services is to lower the number of peoplebeing admitted to hospital and provide other options to support them based ontheir needs (Klevan.
, et al, 2016). Since CRHT has emerged it has relieved thedemands of hospital beds (Parliament. House of Commons, 2007). It is emphasisedthat when CRHT is used properly there are positives because more service usersare pleased with the service (Parliament. House of Commons, 2007). Furthermore,many elements of the individual’s life can be looked at (Klevan., et al, 2016).It endeavours to work in partnership with relevant people that are involved inthe individual’s life such as the carers (Klevan.
, et al, 2016). Although thiscan create more pressures for the carer it does enable them to be involvedwhere possible (ibid). Furthermore, it gives the opportunity for the individualto remain in their environment with their social network (Mind, 2015).”Social capital refers to the social context ofpeople’s lives” (Tew, 2005, p.90).
The works of Bourdieu, Coleman, andPutnam in relation to social capital cannot be undermined (Tew, 2005). It isvitally important to have people around the individual, that they’recomfortable and open around for positive mental health (Rehman, 2009). Inrelation to Tahim utilising this service means that his social capital willwiden and he has his neighbours, brother, and niece in his social capital. The Care Act requires the Local Authority to completeassessments in relation to individuals that may need additional help (SCIE,2016).
It promotes the ‘wellbeing’ of the individual (DoH, 2016). It emphasisesthe local authority’s responsibility in delivering services to ensure earlyintervention (DoH, 2016). The Care Act considers hoarding as a form of neglectto oneself (DoH, 2017).
It is significant to acknowledge that Tahim hasexperienced the loss of his wife and this suggests his hoarding behaviour couldbe a way of him coping. Tahim was a translator in a news agency, the collectionof newspapers and magazines gives the implication that it could be because heis attached to them (Barnett, no date). Furthermore, Tahim’s social life hasreduced significantly and some hoarders isolate themselves because they areashamed to have people in their home (ibid).
The individual with the mental health problem is affectedand other people in their social network may be too, for example, the carer(Sheppard, Boardman and Slade, 2008). People from the social network usuallyhave play a vital role in helping the individual recover, however, in order todo this properly, they need to comprehend the individual’s circumstancesproperly (ibid). Tahim’s niece is involved in Tahim’s life and she needs tofully comprehend his situation in order to help him. Tahim’s niece visits at least once a month and she isconcerned with the safety of Tahim and she may have specific needs to help hercare for Tahim. The Care Act requires the local authority to carry out anassessment based on the needs of the carer (DoH, 2016).
The carer is theindividual who provides support to another individual regarding everyday lifeof that person (DoH, 2016). The effect the caring has on the person providingit will be thought about and the needs will be identified (NHS, 2015). In relation to Tahim co-production can be utilised in theassessment process to give him a sense of control over his care plan. Co-production regarding mental health shifts the powerallowing people to participate (NDTI, 2016). It emphasises the importance ofbalancing power between professionals, the individual and the wider community(NDTI, 2016). Co-production facilitates change within the system to worktowards equality (NDTI, 2016). Some people may experience inequality anddiscrimination, for example, people that are from a BME group (SCIE, 2013).
However, despite the differences co-production asserts the importance of valuingall individuals (SCIE, 2013). Co-production emphasises the ideas of’reciprocity’ and this means the individual contributing gets something inreturn (ibid). However, there are issues with implementing co-production inpractice (NDTI, 2016). This includes various procedures and people not wantingto change (ibid). Co-production can be utilised by professionals in theassessment process and by viewing the individual as a valuable person in theseprocedures (Hall, 2017). The concept of recovery is about the individual living alife they are content with (Thornton and Lucas, 2011). Recovery emphasises theimportance of the individual regaining power in matters concerning their lives(Thornton and Lucas, 2011).
There is a connection between the individual recoveringand being included in society (Thornton and Lucas, 2011). For the personrecovering it is important for them to understand themselves and not be definedby their diagnosis (ibid). The professional supports the individual by informing themof the available services in order for the individual to utilise these toenhance the quality of their life (Sheppard, Boardman and Slade, 2008). Inrelation to Tahim, he could be signposted to services such as BangladeshiSupport Centre (no date) or providing information to Tahim about his nearestmosques which may be important to him due to religious beliefs.
An aspect that needs to be understood is that everyindividual can recover but, some people might not want to recover or they maynot be ready (Sheppard, Boardman and Slade, 2008). However, professionalsshould promote the concept that everyone can recover (ibid). In relation toTahim, the social worker has the impression that Tahim may believe that hecannot be helped. Here the social worker should inform Tahim that recovery ispossible.To conclude it is significant for the social worker tounderstand Tahim in his situation and the discrimination he could experiencedue to his ethnicity, race, and religion, on the community and societal level.Tahim’s cultural views of mental health could create a barrier from engaging.However, from utilising co-production and the recovery model will helpprofessionals involve Tahim and relevant people in his social capital such ashis niece to help empower him.
It is important to involve Tahim in theassessment processes to understand his views, wishes and needs to ensure hereceives a quality service to meet these.