1. PURSUING WELLNESS – P ART 2 PSYC 377 Week 1 1

2. G ROUP W ORK – W HAT ARE THE ISSUES WITH MENTAL HEALTH SERVICES Five stakeholders: 1. Clients/Patients/Survivors and users of mental health services 2. Clients’ family members 3. Clinicians 4. Administrators 5. Policy makers 2

3. C LIENTS /P ATIENTS /S URVIVORS AND USERS OF MENTAL HEALTH SERVICES : Stigma: Cluster of negative attitudes and prejudicial beliefs Fearful of negative evaluation or criticism Immigrants are unwilling to reiceve help from mainstream services due to stigma Health-related quality of life: Medication and resulting weight gain and vitality Competence of service providers: Inadequate Insufficient No comprehension of traditional methods such as consultation with a traditional healer Cultural awareness : Somalian women and church activity Non-English speaking clients 3

4. C LIENTS ’ FAMILY MEMBERS Stigma: Difficulties accessing services such as respite Forced to give up custody to obtain mental health services Services not equipped to deal with their grief Culture of blaming them for problems Competence of service providers: Inadequate Insufficient No comprehension of traditional methods such as consultation with a traditional healer Even though the families play an important role in health care decisions of patients and their adherence/compliance to treatment, they are excluded from sessions 4

5. C LINICIANS Responsible for delivering, coordinating or monitoring services Increasing severity of symptoms Increasing complexity of clients’ health and mental health problems (hypertension coupled with depression and substance abuse) Medicine adherence – willingness to follow a medication plan: Side-effects (weight gain, sexual dysfunction, diabetes) Constipation, dry mouth, blurred vision, severe movement disorders Difficulties due to having to deal with treatment plans incorporating numerous health and mental health providers –a gency policy might not realize the importance of underlying health issues Co-morbidity: Substance abuse and mental health condition, Hypertension and depression Depression and cornoray artery disease 5

6. A DMINISTRATORS Structural and fiscal organization Human and economic costs associated with fragmented mental health system Human cost: Untreated mental illness would result in indivudals seeking more expensive medical care earlier than they would (individuals diagnosed with severe mental illness had higher rates of emergency room visists) Early treatments for symptoms might also increase lifetime costs of maintaining stability over time (people with schizopherenia recieveing early treatment live longer and require continuing living with economic dependency longer) 6

7. A DMINISTRATORS Economic cost: Cost containment- distribution of mental health services is restricted to a capitated budget (‘managed care’) and services that are most necessary are provided only Fragmented service systems and cost-containment practices restrict access to care for example children with depression tend to use emergency services more and children with ADHD use medical services twice the amount of other children 7

8. P OLICY MAKERS Mental health policy : ‘an organized set of values, principles, and objectives for improving mental health and reducing the burden of mental disorders in a population‘ (WHO, 2004) Mental health policy is shaped by historical, scientific developments and efforts of policy makers and politicians working on behalf of individuals, families and communities Policy makers do not have time to gather evidence and information Their position is difficult because they speak for their constituents but also for the government 8

9. H OW DO YOU BRING ABOUT MENTAL HEALTH REFORM Health promotion: Planned activities that are educational resulting in philosphical shift for example redefining focus of their work political resulting in policy reform using data from World Health Report, Health People and Insitute of Medince reports organizational accomodating integrated practice model for example attention to co-occuring illnesses (substance use and mental illness / HIV, shizophrenia and employment) 9