The medical model is the most powerful and influential in
mental health (Beecher, 2009). The model suggests brain disproportions create
issues to the individual mentally (Tyrer, 2013, p.11). It looks at the problem
and ways to treat the person (Disability Nottinghamshire, 2017). Medical professionals
utilise their knowledge and complete assessments to determine whether the
individual has a diagnosis of mental health (Beecher, 2009). The medical model
is grounded (Tyrer, 2013). However, there are limitations, such as the
individual having less power (Disability Nottinghamshire, 2017). Also, their
labelled creating more issues for the individual (Beresford, Nettle and
The psychodynamic model emerged from the 19th century
stemming from Freud’s perspective (Coppock and Dunn, 2010). It considers how
previous events and feelings suppressed in the mind may impact the way the
individual thinks and feels now (ibid). It is suggested that everyone is unwell
to a certain extent and this model provides a detailed concept in relation to
mental health (Rogers and Pilgrim, 2014).
Contrastingly, the social model gives importance to the
person’s circumstances and how social elements could provoke mental health
issues (Coppock and Dunn, 2010). It places emphasis on comprehending inequalities
on the structural level (Beresford, 2005). The social model is recognised more
largely due to limitations of alternative models (Tyrer, 2013). People with
mental health issues felt that there are benefits in utilising the social model
and it looks at the situation holistically (Beresford, Nettle and Perring,
The social model acknowledges the experiences of the person
and how power differentials could result in inequality (Duggan, 2002 cited in
Bogg, 2008, pp. 44-45). It promotes the anti-discriminatory and anti-oppressive
practice, differences in ethnicity and culture, power-sharing between the
professional and the individual (Beresford, 2005).
Tahim has a hoarding problem. The Diagnostic and Statistical
Manual of Mental Disorders (DSM) considers hoarding as a mental health issue
(Mataix-Cols and Pertusa, 2012). Hoarding is when an individual possesses large
amounts of items (NHS, 2015). Hoarding affects approximately “1 or 2 people in
every 100” (Royal College of Psychiatrist, 2016). Various factors increase the
chances of an individual becoming a hoarder, for example, depression and
loneliness (Mind, 2013). It is not unusual for hoarders to be amongst the older
population living by themselves (Thompkins, 2015). Furthermore, the environment
imposes risks to the individual and others including, the risk of a fire and
creating difficulties to leave the premises in these situations, risk to the
individual falling and the potential physical implications from this (NHS,
2015). Tahim has already injured himself and he spent time in the hospital due
to his fall. Tahim’s collection of magazines and newspapers could be
detrimental as it could hinder his day to day life (NHS, 2015).
Tahim has depression. People with depression experience
negative emotions for a long period of time (Royal College of Psychiatrists,
2015). Various factors could cause a person to become depressed such as the
death of a significant person (ibid). There are various treatment methods such
as counselling and medication (Mental Health Foundation, 2017). In relation to
Tahim, he has anti-depressant medication. Medication can support the individual
manage and cope with their issues, however, there are disadvantages due to the
effects of these (Royal College of Psychiatrists, 2015).
As an agent, our interaction with others could be
restricted, limited and influenced for example, by our culture (Tew, 2011).
Thompson’s PCS model enables power differences to be examined between the
individual within their personal, cultural and structural circumstance
(Thompson, 2007 cited in, Koubel, 2013, p.69). It supports us in comprehending
common 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 their
mental health experience inequality on the societal and communal level (Rehman
and Owen, 2013). Many have stated that they face inequality and that a
“third of Pakistani’s and Bangladeshi’s” have asserted that they have
been through ill-treatment due to their race (Rehman and Owen, 2013, p.3). It
is implied that this could be due to their religious beliefs of being a Muslim
It is important to recognise Tahim’s religious identity as a
Muslim. In this religious group, mental health is viewed negatively and
individuals are not utilising services which cause further problems
(Giannangeli, 2016). In some backgrounds, there are views that mental health
issues are related to devils (BRAP, 2012). In Islam, there is a view that mental
health issues arise due the works of devils and they can negatively affect the
individual (Tzeferakos and Douzenis, 2017).
Furthermore, those that are from a different ethnic
background have a greater chance of being identified with a mental health issue
and being hospitalised (Mental Health Foundation, 2017). Mental Health
Foundation (2017) suggests that available resources usually do not facilitate
and deliver services tailored to suit the culture. This gives the implication
of the inequality discrimination Tahim could experience.
The National Service Framework policy was established in
1999, aiming to enhance service delivery for adults with mental health problems
(Boardman and Parsonage, 2009). It was developed due to the events that took
place in the 1990s leading to demands from the wider population (The Kings
Fund, no date). The National Service Framework has a significant role regarding
mental health (Smith, 2000). It established 7 fundamental principles (DoH,
Research asserts that people with mental health problems
experience inequality and are marginalised which remains a significant problem
(Smith, 2000). The National Service Framework affirms the need to improve
people’s comprehension of mental health issues to tackle inequalities (ibid).
The Coalition government introduced ‘No health without
mental health’ (DoH, 2011). It suggests the attitudes of mental health are poor
and it affects the individual negatively, as they experience inequality (DoH,
2011). This is harmful to the different structures due to the implications such
as costs (DoH, 2011). The government established 6 fundamental principles to
promote positive mental wellbeing (DoH, 2011). It is a method of working in a
way for individuals to decide on how they want to live their lives, maintain
their wellbeing and how professionals can help the individual (DoH, 2011).
It gives the opportunity to make decisions in terms of what
the individual receives in their package to support them in the process of
recovering (DoH, 2011). Professionals acknowledge the views of the individual
and their family (DoH, 2011). Involving people in the planning of care is
important but, the majority of individuals claim that there is a lack of this
in practice (DoH, 2011).
Community Mental Health Teams utilise the Care Programme
Approach (CPA) to help the person with a mental health issue (Rethink Mental
Illness, 2017). The individual will have an allocated care-coordinator and a
plan will be devised and based on their support needs (ibid). Completing a
high-quality assessment enables the needs of the person to be clearly
identified (DoH, 2007). Consequently, this enables the professional to
understand the services needed to support the individual (ibid). It will
contain information regarding the steps to take in emergency situations
(Rethink Mental Illness, 2017). The review of the care plans happens annually
and all relevant people involved attend to identify aspects that are
benefitting the individual and what may need altering (Surrey and Borders Partnership
NHS Foundation Trust, 2017). In these meetings, the individual has the
opportunity to voice their perspectives (ibid).
The CPA requires an assessment to be undertaken and this is
to establish what the individual requires and how it will be achieved to
support them (DoH, 2008). It should consider what the individual wants and the
best way to achieve this (ibid).
Firstly, an assessment of Tahim’s capacity needs to be
undertaken. The Mental Capacity Act 2005 concerns those above the age of 16
regarding life decisions (SCIE, 2016). There are five significant elements of
the Act (SCIE, 2016). It focuses on the person, who is at the centre (ibid) and
the individual is deemed to have capacity unless there is evidence to suggest
there’s not (Gov, 2007).
There are two steps in determining the individual’s state of
capacity (Gov, 2007). In order to meet the first step, there needs to be
evidence that there’s an “impairment or a disturbance in the functioning
of their mind or brain” (Gov, 2007, p. 44). In relation to Tahim he has a
hoarding issue and depression, therefore, he fulfills the first criteria. The
second step is coming to the conclusion on whether Tahim is capable to make a
decision due to his mental health issues (Gov, 2007). A person is deemed to be
incapable 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 ‘unwise
decision’ (SCIE, 2011). Tahim was speaking in Punjabi despite him knowing
English. Tahim made this choice despite him being informed that the social
worker does not speak the language. Just because Tahim does not want to engage
does not mean he does not have the capacity and there is no indication that he
does not have capacity.
The strength is that the professional should not think that
the 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 advocate
to convey their perspective (ibid).
There are limitations of the Mental Capacity Act 2005 (House
of Lords, 2014). There has been poor recognition, comprehension and the
responsibilities the Act entails has not always been complied with (House of
Lords, 2014). Furthermore, there should always be a presumption that the
individual has capacity however, it doesn’t necessarily happen (House of Lords,
2014). Moreover, there is a lack of assessment being undertaken regarding the
individual’s state of capacity and when they are undertaken they are not
completed to a high standard (ibid).
The Human Rights Act 1998 contains a set of rights that
apply to everyone in the United Kingdom and it is a significant piece of
legislation (Mind, 2017). Mental health professionals have a responsibility to
ensure they abide by the legislation (Mind, 2017). Article 8 of the Human
Rights Act 1998 asserts a “right to private and family life” (Mind,
2017). It emphasises that the individual can make decisions concerning their
life but, it could be restricted in some circumstances (ibid). In relation to
Tahim, he cannot be treated unfairly in terms of his decision in not wanting
carers because he has the right to a private life. Tahim has the right to makes
decisions as he has capacity and this should be respected.
The Mental Health Act 1983 can be utilised to detain an
individual without their consent (Coppock and Dunn, 2010). However, other options
to support the individual in their recovery should be explored first (Coppock
and Dunn, 2010). Section 3 of the Mental Health Act 1983 requires the
individual having a ‘mental disorder’ and ‘to receive medical treatment in
hospital and appropriate medical treatment is available for him or her and it
is necessary’ (Coppock and Dunn, 2010, pp.70-71). This to protect the
individual or others if there are no other options (ibid).
Before detaining an individual, there are assessment
processes (Mind, 2017). Professionals include an Approved Mental Health
Professional (AMHP) and 2 doctors (Mind, 2017). AMHP’s have specific
responsibilities in ensuring the individual’s circumstances are looked at in a
comprehensive way (Lancashire Care NHS Foundation Trust, 2017). The individual
should be informed of their rights and involved where possible (ibid). Although
professionals other than social workers can train to be an AMHP, the vast
majority are social workers (DoH, 2016).
For a long period of time, medical professionals have had
power over the comprehension of mental health problems (Kinney, 2009). AMHPs
fundamentally work to ensure rights are upheld, however, when an individual has
a mental health diagnosis and their under-going an assessment it is hard to
uphold this (Kinney, 2009). It may be easier for AMHPs to agree with the
medical professional’s view consequently, the outcome of many assessments lead
to the individual being detained (Kinney, 2009).
The Equality Act 2010 safeguards people from experiencing
inequality and 9 elements are included, including race and age (Citizen Advice,
2017). The strength is that it supersedes legislation prior to the
establishment of this legislation and consequently, it is simpler to comprehend
(Gov, 2015). Furthermore, people are not allowed to be treated unfairly in
terms of accessing and utilising services because of their age (Griffith,
2010). This applies to Tahim as he cannot be discriminated on the grounds of
his race, age, and religion.
Hoarding creates a high risk to the individual and to others
such as the neighbours (Suffolk Safeguarding Adults Board, 2017). In relation
to Tahim, he does have a mental disorder and he is a danger to himself and his
neighbours. Furthermore, Tahim smokes and this increases the risk of a fire to
happen. However, in terms of whether treatment for Tahim in hospital is the
right 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 type
of service that aims to help the individual to recover from their home (Norfolk
and Suffolk NHS Foundation Trust, no date). Various professionals in the field
of mental health help the individual at difficult periods of when their mental
health deteriorates (Mind, 2015).
The aim of these services is to lower the number of people
being admitted to hospital and provide other options to support them based on
their needs (Klevan., et al, 2016). Since CRHT has emerged it has relieved the
demands of hospital beds (Parliament. House of Commons, 2007). It is emphasised
that when CRHT is used properly there are positives because more service users
are 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 in
the individual’s life such as the carers (Klevan., et al, 2016). Although this
can create more pressures for the carer it does enable them to be involved
where possible (ibid). Furthermore, it gives the opportunity for the individual
to remain in their environment with their social network (Mind, 2015).
“Social capital refers to the social context of
people’s lives” (Tew, 2005, p.90). The works of Bourdieu, Coleman, and
Putnam in relation to social capital cannot be undermined (Tew, 2005). It is
vitally important to have people around the individual, that they’re
comfortable and open around for positive mental health (Rehman, 2009). In
relation to Tahim utilising this service means that his social capital will
widen and he has his neighbours, brother, and niece in his social capital.
The Care Act requires the Local Authority to complete
assessments in relation to individuals that may need additional help (SCIE,
2016). It promotes the ‘wellbeing’ of the individual (DoH, 2016). It emphasises
the local authority’s responsibility in delivering services to ensure early
intervention (DoH, 2016). The Care Act considers hoarding as a form of neglect
to oneself (DoH, 2017). It is significant to acknowledge that Tahim has
experienced the loss of his wife and this suggests his hoarding behaviour could
be a way of him coping. Tahim was a translator in a news agency, the collection
of newspapers and magazines gives the implication that it could be because he
is attached to them (Barnett, no date). Furthermore, Tahim’s social life has
reduced significantly and some hoarders isolate themselves because they are
ashamed to have people in their home (ibid).
The individual with the mental health problem is affected
and other people in their social network may be too, for example, the carer
(Sheppard, Boardman and Slade, 2008). People from the social network usually
have play a vital role in helping the individual recover, however, in order to
do this properly, they need to comprehend the individual’s circumstances
properly (ibid). Tahim’s niece is involved in Tahim’s life and she needs to
fully comprehend his situation in order to help him.
Tahim’s niece visits at least once a month and she is
concerned with the safety of Tahim and she may have specific needs to help her
care for Tahim. The Care Act requires the local authority to carry out an
assessment based on the needs of the carer (DoH, 2016). The carer is the
individual who provides support to another individual regarding everyday life
of that person (DoH, 2016). The effect the caring has on the person providing
it will be thought about and the needs will be identified (NHS, 2015).
In relation to Tahim co-production can be utilised in the
assessment process to give him a sense of control over his care plan.
Co-production regarding mental health shifts the power
allowing people to participate (NDTI, 2016). It emphasises the importance of
balancing power between professionals, the individual and the wider community
(NDTI, 2016). Co-production facilitates change within the system to work
towards equality (NDTI, 2016). Some people may experience inequality and
discrimination, for example, people that are from a BME group (SCIE, 2013).
However, despite the differences co-production asserts the importance of valuing
all individuals (SCIE, 2013). Co-production emphasises the ideas of
‘reciprocity’ and this means the individual contributing gets something in
return (ibid). However, there are issues with implementing co-production in
practice (NDTI, 2016). This includes various procedures and people not wanting
to change (ibid). Co-production can be utilised by professionals in the
assessment process and by viewing the individual as a valuable person in these
procedures (Hall, 2017).
The concept of recovery is about the individual living a
life they are content with (Thornton and Lucas, 2011). Recovery emphasises the
importance of the individual regaining power in matters concerning their lives
(Thornton and Lucas, 2011). There is a connection between the individual recovering
and being included in society (Thornton and Lucas, 2011). For the person
recovering it is important for them to understand themselves and not be defined
by their diagnosis (ibid).
The professional supports the individual by informing them
of the available services in order for the individual to utilise these to
enhance the quality of their life (Sheppard, Boardman and Slade, 2008). In
relation to Tahim, he could be signposted to services such as Bangladeshi
Support Centre (no date) or providing information to Tahim about his nearest
mosques which may be important to him due to religious beliefs.
An aspect that needs to be understood is that every
individual can recover but, some people might not want to recover or they may
not be ready (Sheppard, Boardman and Slade, 2008). However, professionals
should promote the concept that everyone can recover (ibid). In relation to
Tahim, the social worker has the impression that Tahim may believe that he
cannot be helped. Here the social worker should inform Tahim that recovery is
To conclude it is significant for the social worker to
understand Tahim in his situation and the discrimination he could experience
due 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 help
professionals involve Tahim and relevant people in his social capital such as
his niece to help empower him. It is important to involve Tahim in the
assessment processes to understand his views, wishes and needs to ensure he
receives a quality service to meet these.