SOCIO-POLITICAL FACTORS THAT INFLUENCE MENTAL HEALTH This essay is about my involvement with the management of care and the impact of social and political issues relating to social exclusion that contributes to a client mental illness. There are numerous interrelated social and political factors that influence mental health; these include unemployment, prejudice, housing, media influences, stigma and discrimination.
Percy- Smith (2000) defined social exclusion as a ‘shorthand label for what can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown’. The name of the client and others including practice area will be concealed in accordance with Nursing and Midwifery Council (NMC 2007) Code of Professional Conduct on privacy and confidentiality. This essay will proceed to focus on the impact of unemployment with the client I worked with during my placement experience, who suffered from a mental health problem.
I will also examine other issues associated with unemployment in a mental health setting, such as component of recovery. I will also look into government policy in promotion of employment among people with mental health problems. According to WHO (2000), Mental health can be conceptualised as a ‘state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.
Finally the feedback from formative assessment will be highlighted. For the purpose of the issue of confidentiality, the client in the discussion will be referred to as “Sophie”. Roberts et al (2002) defined confidentiality as ‘an implicit promise that is present when one person discloses information to another, whether through words or an examination; and the person to whom the information is disclosed pledges not to divulge that information to third party without the confider’s permission”.
Sophie is a 30 years old Caucasian female who has a long history of depression and was recently diagnosed with Bipolar Affective Disorder. Sophie says that “I’ve lost time, I’m having delusions and anxiety” which she began to experience when she 24 years old, as a result of not having a job. She was referred to the Community Mental Health Team from the Crisis Team when she was about to be discharged. Initially, Sophie refused to engage with the team, but her CPN was very professional in motivating her and, later, gained her trust.
Sophie started to engage with the CMHT for treatment and support to improve her mental state. I decided to work in Sophie’s case because I was familiar to her previously in the in-patient ward, and I was appointed to monitor her progress under the supervision of my mentor. The full assessment was done by my mentor at the recovery centre where she attended as part of her recovery process. I decided to focus on the social aspect of life relating to employment in Sophie’s case. Sophie has been looking for a job, and was doing a voluntary job in the MIND organisation.
Sophie says that she is bored of staying at home all the time, which she believes has contributed to her relapse in the past. She also believes that her mental health problem could not really allow her to get a paid job. Sophie has become very depressed, withdrawn and tearful, as she used to have delusions of the world coming to an end resulting in her death as a result of mental health and social exclusion about getting a job. In the history of mental health services, work is considered in terms of an activity or therapy known to provide many valuable benefits to those who suffer from mental health problems.
Repper (2000) indicated that “In 1796, work was used as a therapeutic strategy for psychiatric disorders as part of the “moral treatment” at the York Retreat, and smaller Asylums adopting this approach achieved remarkable success in maintaining and developing skills”. Sophie believes if she could get a paid job, she will then be able to occupy her time rather than sit at home feeling depressed, and rely on her family for support financially. She wants something to engage her that will make her productive, fulfilled and satisfied with her time.
Sophie sees working as an empowerment to improve her life; she said “I want to work, I want to be myself, and I do not want to depend on my parents for up keep. I want a better life”. Strack et al (2007) stated “empowerment focuses attention on the degree of direct control. Individuals can assume over their own lives and improvements in quality of life. Empowerment has been associated with gains in self confidence, social support, self-esteem, quality of life and the development of skills in a variety of areas”.
Sophie wants a good quality life. She wants to have a job, get married and settle with her family, but her current situation is an obstacle to her. Sophie said “I want to improve my life and keep going with life”. Repper (2000) stated that “there is a strong relationship between unemployment and the development of mental health problems”. He went further by saying that “the high rates of unemployment among people with mental illness are thought to be associated more with social factors than with the disabilities of the illness itself”.
Furthermore, there is a rise in the number of people visiting mental health professionals, apparently due to the recent economic downturn. Corrigan et al (2007) indicated that “research has shown that adults with psychiatric disorders are unable to attain work and other independent life goals because of stigma and discrimination”. Sophie explains in her personal experience that even such jobs that are voluntary in the community; the moment they know that she has suffered mental illness before or now, she feels they try to exclude her by giving excuses.
She said “They do not want to give me a chance or an opportunity to show that I can do a lot of things”. She also said that “my mental illness continues to relapse because I do not do anything; I stay at home and sometimes go out with my friends to a cafe or any other social spot”. Sophie is good at researching and has done so for MIND in the past as a voluntary worker; she also studied Psychology at Nottingham University. Unemployment is defined by Bryne (2000) as “being without a paid activity and work”.
Hannigan et al (2003) stated that “unemployment is linked to poverty and low incomes forthcoming from welfare benefits. Almost all social activities – going out with friends, using local sports centre, and going to pictures – requires money”. Sophie’s situation in getting a job remains an ongoing issue for her as even voluntary jobs too are not easy to get. There is still a huge disparity in employment for individuals with mental illness despite Government legislation favouring their inclusion in job creation programmes. Disability Discrimination Act (1995). This Act states that “it is unlawful for any employers including small organisations to discriminate against disabled employees or job applicants. This is consistent with Articles 23 of the United Nation’s Declaration of Human Rights (1998), which states that “everyone has a right to work, to a free choice of employment, to just and favourable conditions of work and to protection against unemployment”.
Unemployment leads to considerable deterioration in emotional and psychological health and such predisposes the individual to suicide risk. Research has shown that people who are unemployed are two to three times more likely to commit suicide than those with jobs (Mental Health Foundation, 2008). Sophie sometimes expresses her feeling of being rejected by the society; loosing respect of her peers and can no longer make a contribution to society as a result of her unemployment status.
Hatloy (2007) indicated that “the government say they want to help people with mental health problems back to work, yet there are few vocational interventions designed for people who have mental health problems, including those who have had long-term mental health”. People with mental health problems are still experiencing unemployment, like the case of Sophie; she was ready to work and get herself engaged in something meaningful, but she could not get a paid job; only voluntary jobs with charity organisations.
Sophie wants to work and be able to be economically empowered rather than rely on benefits and family; she wants to contribute to the society and the community through paying tax. Grove et al (2005) stated that “wage earning sets apart some employment interventions both because if it’s symbolic significance as evidence of social inclusion and because if it’s economic impact, permitting the worker to reduce dependency on benefit and become a taxpayer (in principle) or a net contributor to society”.
There is increasing recognition for mental health practitioners to routinely identify and address the employment needs of those who use their services. Nevertheless, the ethos of the setting where Sophie was; the multidisciplinary team had access to a vocational employment support service who plans with service users and the clinical team to assist these individuals to prepare for employment, enabling them to secure and retain jobs. The National Institute for Health and Clinical Excellence (NICE) recommends that supported employment should be made available for people with schizophrenia if they wished to work.
This appears to be congruent to the current Government’s agenda of promoting social inclusion for those with mental health problems, as it is mirrored in various white papers including the recent documents “Our Health, Our Care, Our Say”. In accordance with this policy, it was agreed by Sophie and the multidisciplinary team that her pathway to employment will encompass training, taking a job as a volunteer worker and gradually moving on to paid employment.
The aim of mental health service providers is to design person-centred care for mental health consumers focusing on their strengths, thereby promoting self-efficacy and independence. Therefore, it can be argued that the path towards employment and recovery will be different for each service user depending on his/her individual cognitive and emotional abilities; their willingness to engage with employment services and their specific needs. Sophie was at a point in her recovery journey where she had a good insight of her illness and her symptoms were well managed.
Consequently, she was better placed to embark on a programme to prepare her for employment. DOH (2006) stated that “the mental health and social exclusion report identifies that being in employment and maintaining social contact improves mental health outcomes, prevents suicide and reduces reliance on health services” In order for the success of these programmes, the government should set up monitoring services toward the implementation. Regular evaluation will also enable improvement. The government should also involve the service users in the decision making process relating to employment.
According to Crisis (2003) “engaging service users in the development and implementation of programmes is one way of moving away from the one-dimensional perception of social inclusion as equivalent to participation in employment of rehabilitative activity”. Warner (2004) indicated that “our perception of work is socially determined; we perceive work as natural and unemployment as unnatural. This value are accepted and internalised by us and used as the moral code by which we live and are reinforced through political, economic, and social system”.
This view is held by the unemployed which is an added cause of stress. It can therefore be stated that employment is extremely important in reducing mental health prevalence, as well as improving the quality of life and individual’s hope and aspirations, to the extent to which people feel able to progress towards work. Nurses through a caring approach should offer psychological support to unemployed people and help them to come to terms, accept the situation and plan for future employment.
In conclusion, due to the therapeutic skills adopted by my mentor as her care co-ordinator and services of the Recovery Centre in Sophie’s case; within a short period of intervention and evaluation of her care, she was able to decrease in her symptoms; increase her self-esteem and is now mentally stable and in- touch with the reality of staying unemployed for a while. She also has an insight into her unemployment status and can now freely socialise; sleep well and make plans of attending social events with friends with contingency plans.
The formative assessment session in the module has helped me to enhance my understanding of social exclusion which aided the development of this essay. The feedback helped me to consider the importance of key point in this essay and it gave me an awareness of the areas that I needed to develop prior to writing this essay. References; 1. Bryne, P. (2000) Stigma of Mental Illness and Ways of Diminishing It: Advances in Psychiatric Treatment. 2. Corrigan, P. W. L; Jonathan, E. K. Sachiko. A. (2007) Rehabilitation Psychology. Mental Illness Stigma and the Fundamental Components of Supported Employment.
American Psychological Association. 3. Crisis (2003). Mental Health and Social Exclusion. Crisis’ response to a Consultation Request from the Social Exclusion Unit. 4. Disability Discrimination Act (1995). London: HMSO. 5. Department of Health (DOH) (2006). Vocational Services for People with Severe Mental Health Problems: Commissioning Guidance. UK. 6. Grove, B. Secker J and Seebohm, P. (2005). New Thinking about Mental Health and Employment. (1st Ed). UK. Radcliffe Publishing Ltd. 7. Hannigan, B and Coffey, M. (2003). The Handbook of Community Mental Health Nursing. (1st Ed). UK. Routledge. 8. Hatloy, I. (2007).
Statistic 6: The Social Context of Distress. MIND: Information Fact Sheets and Booklets by The Social Context of Distress. MIND: Information Fact Sheets and Booklets by Subject. 9. Nursing Midwifery Council (2007) The NMC Code of Professional Conduct; Standards for Conduct, Performance and Ethics. London. 10. Percy-Smith. J. (2000). Policy Responses to Social Exclusion towards Inclusion. (1st Ed). UK. Open University Press. 11. Repper, J. Perkins, R. (2003). Social Inclusion and Recovery: A Model for Mental Health Practice. (1st Ed). UK. Bailliere Tindall. 12. Roberts, L. W. Geppert, C. M. A Bailey, R. (2002).
Ethic in Psychiatric Practice: Essential Ethics Skills, Informed Consent, The Therapeutic Relationship and Confidentiality. Journal of Psychiatric Practice. 13. Strack, Kirsten M. ; Deal, William P. ; Schutenberg, Stefan E. (2007). Coercion and Empowerment in the treatment of individuals with serious mental illness: A preliminary investigation. 14. Warner, R. (2004) Recovering from Schizophrenia, Psychiatry and Political Economy. London: Routledge and Kegan Paul. 15. World Health Organization (WHO) (2008). World Health Investigation GAP: Mental Health Gap Action Programme. Scaling Up Care for Mental, Neurological and Substance Use Disorders.