UK Mental Health Policy Mental Healthcare Service

UK Mental Health Policy

Mental healthcare service delivery in the UK has been subjected to a series of significant imperative policy in the last few decades, and number of people suffering from mental illness is on the increase. Recent statistics reveal that one out of four people in the UK has been diagnosed of mental problem. (Mental Health Foundation, 2013, Singleton, Bumpstead, O'Brien et al. Meltzer 2001). Although, mental disorders are widespread in the UK, however, mental disorders are predominant in some group than other group. (McGorry, Nordentoft, & Simonsen, 2005).

BME (Black and Minority Ethnic) group are four times more likely to experience psychosis than white people. (National Mental Health, 2010, Heller, et al. 1996). Evidence reveals that incidence of psychosis is significantly higher within Black-African and African-Caribbean groups than the White British Population living in the UK. (Cooper et al., 2008) . Black Caribbean have a record of 7 times of psychosis than the White British. (Harriss, 2007). The risk factors associated with mental illness include exclusion, stigma, racism discrimination, and social disadvantages. (Cooper et al., 2008) . Racism makes BME group to look different because of the belief than BME group are inferior than the White group. Impacts of racism are exclusion, stigma, discrimination, and social disadvantages, which consequently provokes mental illness. (Allen, 1997).

Objective of this report is to provide a critical analysis on the mental healthcare service delivery within social care practice for the BME (Black and Minority Ethnic) group.

Critical Analysis of mental Health Service Delivery for Black and Ethnic Minority Group

Provision of effective social support for people suffering from mental disorder has become challenging in the UK. A key challenge is that some ethnic groups are not receiving the equal mental health benefits compared to other groups in the UK. (Tummey, Turner, 2008). "People with mental health problems from Black and minority ethnic groups, women, asylum seekers and refugees are especially vulnerable to the consequences of oppression and discrimination." (Ray, et al. 2008, p.3).

Thus, "providing effective social support for people with mental health problems is a key challenge in an environment where the views of people who use services are seen as increasingly significant, where some social groups do not receive services fairly and equably, and where organizational structures are changing." (Ray, et al. 2008 p.1).

Social workers have a significant role to play in providing support to groups and individuals who may have negative experience to mental health service delivery. (Ray, Pugh, Roberts, et al. 2008). Different ethnic groups in the UK have different experiences about mental health problems based on their different cultural and social economic context. Black and minority ethnic group are likely to be more diagnosed of mental health problems than the British white group due to number of factors, which include racism, unemployment, exclusion, poor housing and poverty. (Churchill, 2011). Moreover, the mental health of black minority is likely to deteriorate because of social exclusion that this group of people experience in the UK. (Davidson, 2009). The major argument is that the mainstream of mental health services delivered to the minority group is gradually diminishing in the UK. (Coleman, and Smith, 2007) .Moreover, Black minority ethnic group in the UK is reluctant to be engaged in the mainstreams of health services. (Mental Health Association, 2012).

The 2005 and 2008 census results reveal that Caribbean and Black African communities are three times more likely to be hospitalized than the whole population . (Littlewood, and Lipsedge, 1997) .The same group are 44% more likely to be detained by the police. In 2009, police detention of the Black African, and Black Caribbean are higher than average.

In the UK, 8.94% of mental patients are Black and 4.52% of mental patients are Asian compared with 3.32% of mental health patients in England and Wales. (Office for National Statistics Census 2011).

"The 2000 EMPIRIC survey of mental illness in the community used large samples to examine the prevalence of common mental illness, such as depression and anxiety, in five ethnic minority groups (Bangladeshi, Black Caribbean, Indian, Pakistani) relative to a baseline White British group." ( National Mental Health development Unit 2010p.3).

The table below reveals relative prevalence of mental disorder by ethnicity.

Percentage of UK population with common mental disorder

White

Irish

Black Caribbean

Bangladeshi

Indian

Pakistani

Men

11.6

18.4

13.8

12.9

12.1

12.6

Women

19.9

18.6

19.8

12.3

23.8

26.0

Total

15.8

18.5

17.3

12.3

18.1

19.6

Source: National Mental Health development Unit (2010).

From the data presented in the table, the African Caribbean records higher rate of mental illness than other black ethnic groups living in the UK. Moreover, African Caribbean is more likely to be admitted to mental home via the police or the courts, and they are more likely to be treated under the Mental Health Act than other ethnic groups in the UK. (American Psychiatric Association, 2004)

On the other hand, Asian people have better record of quickly recover from mental illness due to family support. Suicide rates are generally low among Asian people because western medical approach to the treatment of Asian people is unsuitable. (Heller, et al. 2009). However, there is a little record of Chinese suffering from mental disorder because many Chinese receive a strong support from family members. Moreover, Chinese are reluctant to receive mental health service in the UK because of the fear of stigmatization and shame. (Barnes, M and Maple, 1992).

The paper provides key theoretical ideas and process related to current mental health system and its application to the mental health service to the BME group.

1. Key theoretical ideas and processes within the current mental health system and how to apply these to practice situations.

Over the years, there has been a theoretical debate on the strategy healthcare professionals should employ to improve quality of life of patients. (Singleton, Bumpstead, O'Brien et al. Meltzer 2001). Medical model views abnormal behavior as a state of physiological problem and should be treated medically. From the perspective of medical model, medical professionals should study underlying pathological disorder of patients in an attempt to cure the disease and correct the abnormality. Concerning mental illness, the mental disorder lies within the individual's brain, and medical treatment such as medication and drugs should be directed to correct imbalance in the brain. (Breggin, 1993). Following the medical model perspectives, medical professionals use medical intervention for the treatment of mental health patients. For example, antipsychotic medications have been proven effective to treat acute psychosis as well as reducing the risk of future psychotic episodes. (WebMd, 2013).

The most popular drugs to treat depression include:

Fluoxetine (Prozac),

Citalopram (Celexa),

Sertraline (Zoloft),

Paroxetine (Paxil),

Escitalopram (Lexapro). (Read. 2009).

Medical professionals such as psychiatrists also apply the system theory to understand and address people's problem by exploring pattern of behavior of individual. The system theory argues that there is a need for an integrated approach to therapy, and the strategy is to focus on the cognitive and behavioral pattern of an individual in solving his or her problem. (Reeves, 2000, Warren, 2007). Essentially, mental healthcare professionals use the system theoretical perspective to deliver therapy to people suffering from mental problems. (Thomson, 2000). The goal of system therapy is to gain insight into member role and relates it to the health functionally. (Hornstein, 2009, Webber, 2008)).The technique is to identify a specific behavior of people and identify how their member leads to a mental problem. Using this technique, healthcare professional can transform behavior of people suffering from mental problems into more adaptive and productive behaviors. (Wilson, 1995) .The system therapy is able to attain positive objective by assisting people with mental problems to attain state of positive well-being. (Rogers, Pilgrim, 2010, Friedman, & Allen, 2009). Healthcare professionals such as psychiatrists have been applying the system therapy to assist people to cope with stress, anger, depression, loneliness, phobia and other health problems that could lead to mental health problem. (Romme, 2000).

On the other hand, social model argues that social attributes are the main cause of mental illness, and social attributes such as unemployment, poverty, and poor housing can be linked to mental disorder among people. (Johnstone, 2004, Johnstone, 2005). The social model also points out BME has been put at the lower social class in the society. Major intervention to address the problem of mental disorder is to implement a policy to address problems of poverty, unemployment, poor housing and remove social injustice from the society. (Duggan, Cooper, & Foster. 2002). Mental illness is higher among BME group in the UK because poverty and unemployment rates are prevalent among this group. (Johnstone, 2000). Mental problem is higher among the BME because many BME group suffer from leaned helplessness because of the believe that nothing they can do could improve their negative social identity. (Seligman, 1975).

Parton, (1994) points that social intervention to mental health improvement is very important to reduce the incident of mental health problems among the BME group. An example of social intervention was the implementation of Beacon Housing project to ameliorate the housing problems at poorest wards at Cornwall. The outcomes of the project are as follows:

80% decline in the post natal depression,

60% decline in the number of children registered for child protection,

50% decline in the child accident rate,

50% decline in the overall crime rate. (National Mental Health, 2010).

Feminist theory uses gender inequality to identify women as being unequal to men sometimes leading to gender oppression. Ballou, and Brown, (2002) argue that BME women group suffer from oppression because racism and poverty. In the UK, black women face different form of discrimination in services. Typically, male power over female is very rampant among BME group and the male dominance over female leads to depression and schizophrenia in women.

Moreover, racism is a critical form of discrimination that is more directed to black community. Black people are more discriminated in the workplace than white counterpart and if a black is living in white area, he is more likely to suffer from mental health than living in black community. (Mental Health Foundation 2012).

Chakraborty, et al. (2013) point out that most outcomes of racial discrimination are psychological distress, and depression. Before the independence of African and Caribbean countries, people from African and Caribbean serve as source of slaves for the British Whites. General believe that Black and Caribbean people are the children of former slaves provoke discrimination against BME group, which further provokes mental disorders among BME group.

Since BME group is overrepresented in mental health service, they are more likely to be on heavy medication, and less likely to receive therapies. For instance, David Rocky Bennett was subjected to racism leading to his death and the issue made the UK community to conclude that the BME group was not receiving required treatment at mental health hospital. The treatment that David Rocky received at the hospital was very limited because of his race. Moreover, David's cultural and social needs was not attended to because he was generally considered as nuisance at the hospital, and he was often given heavy doses of anti-psychotic. (Institute of Race Relations, 2003). Labeling theory argues that self-identity of individual determines the method people will classify him or her in the society. Labeling theory is associated with stereotyping and BME group are being diagnosed and treated differently in the mental health hospital based on the negative label on them, which generally affecting their social identity. (Macionis, and Gerber, 2010).

2. Analysis of current services and therapeutic approaches available to mental health service users, their families and carers.

The psychosocial therapy approach can assist people suffering from mental health. Alternative approach to mental health is therapeutic approach, which include expressive therapies, self-help, diet, yoga, stress reduction techniques, and relaxation. Medication could also assist people to stabilize their life and medication is viable when there is no available therapeutic approach. (Department of Health, 2002) .The primary medication to treat mental disorder such as schizophrenia are called antipsychotics and these medications include Stelazine, Thorazine, Navane, Mellaril, Haldol, Trilafon and Prolixin. Although these medications do not totally cure the trouble symptoms such as hallucinations, thinking problems and delusions, however, they assist in relieving the most troubling mental symptoms. (WebMd, 2013, Breggin, 1993).

"The available evidence suggests that people of black and minority ethnic (BME) groups have higher rates of psychiatric admissions than the general population." (Hackett 2008, p. 1). Moreover, the BME group stays longer in psychiatrist hospital than other group, and when in psychiatric care, the services they receive are generally poor. (McKenzie and Bhui, 2007; Singh and Burns, 2006, Healthcare Commission, 2007).

Thus, Hackett (2008) suggests that home treatment is an effective health strategy to care for BME group with mental disorders. For example, Cahts (crisis assessment and home treatment Teams) offers an intensive support at home for BME group suffering from mental health crisis. Caht guideline includes:

Minimizing the use of institutional interventions in BME group healthcare;

Involving non-statutory and voluntary agencies for BME group health interventions,

Working towards alternatives to institutional psychiatry. (Department of Health, 2006).

Family therapy is also an effective healthcare intervention for the loved one. The family therapy reduces exposure of BME group to hospital. (Department of Health, 2007).

While some people with mental health problems recover using therapeutic approach alone, however, some people combine therapeutic approach with other traditional treatments such as medication and psychotherapy. (Soothill, Morgan & Dolan, 2008). A large-scale survey conducted reveal that between 30 and 50% of people use alternative care to solve their problems. (Kessler, Soukup, Davis, et al.. 2001).

Psychotherapy is also one of the effective therapeutic methods to solve the problem of mental disorder. The psychotherapists can assist people to recover from mental problems such as depression, emotional problem. Traveling and Scuba diving is another alternative therapeutic that could assist BME group recovering from mental health problem. (Jones, 2010). The feeling of marine air, beautiful marine life, wind beating down on air and sun beating on the body can assist people in enhancing speedy recovery from mental problem. Traveling and scuba can increase self-esteem and make confidence of people to grow and assisting people to achieve positive aspects of life. (Department of Health, 2008)

Cognitive Behavior Therapy (CBT) is another type of therapy that combines behavior therapy with cognitive therapy that can be used as the healthcare intervention for BME group.

"CBT theory suggests that it is not events themselves that upset you, but the meanings you give to them. Your thoughts can block you seeing things that do not fit in with what you believe to be true. You may continue to hold on to these thoughts and not learn anything new." (The Mind, 2013, p 5).

The CBT focuses the understanding on how individuals think about things going on around them, and the thinking includes images, attitudes and beliefs that could lead to abnormal behavior and negative patterns. (Laurance, 2003). A therapist could change behavior of individuals having mental problems using therapeutic techniques and change the way they view things. The CBT treatment tends to be short-term and is between six weeks and six months depending on an individual case. (Bentall, 2009) . CBT always focuses on what is going on presently rather than the past.CBT can assist people to cure negative thought as well as eliminating depression. The limitation of CBT is that it is less likely to solve severely disabling or long-standing problems since CBT uses short therapy to assist people.

Gender sensitivity services are also effective in treating women suffering from mental illness. Gender difference can affect women mental health and gender sensitivity services are able to achieve better mental health outcomes for women by treating women as individual and use social model to enhance women health outcome. (Women Center of Health Matter (2009). Holistic health approach is an alternative to medicine using physiological method to treat BME group. Sometimes holistic health practitioners use spiritual method to treat mental health patients. (Wilhelmsson, 2007).

3. Evaluation and critically review social policy and legislative developments that apply to social work practice with mental health service users, their families and carers

Mental health is one of clinical priorities of the UK government, and the UK mental health crisis affects one out four people and the risk factors include stigma and social exclusion. Mental health problem costs approximately £38.5 billion between 2000 and 2001 in England. The public perception is that "people with mental health problems are violent and pose a threat to society. However, this is not generally the case, vast majority of people with mental health problems pose no danger to society at all." (Parliament Office of Science and Technology 2004, p.1).

The UK has traditionally adopted apply holistic approach to assess individual patient's needs. The new mental health policy is to reorganize the UK mental healthcare policy. The Mental Health Act 2007 is the latest legislation that deals with mental health problems in the UK, and the legislation is the amendment of Mental Health Act (MHA) 1983. In 2002, the UK government published a bill to propose changes to the current MHA 1983. (Barber, Brown, Martin, 2012)

Section 145, subsection (1) of MHA recognizes "medical treatment," for the people with mental health problems. (UK Government, 2007). Moreover, section 118(2) of the Act recognizes avoidance of all form of unlawful discrimination. Section 114 of the Act state that a local social service authority may approve an approved mental health professional to assist in the mental health intervention for people suffering from mental illness. (Department of Health, 1990), UK Government, 2007).

Current legislation set out a measure to compulsory admits patients to hospital. Moreover, the legislation provides guidelines that legal authorities could employ to treat people suffering from mental disorder. (Bentall, 2004).

"Under the Act, any compulsory treatment received by patients with a 'psychopathic disorder or mental impairment' must be 'likely to alleviate or prevent a deterioration' of their condition." (Parliament Office of Science and Technology 2004, p.1).

Typically, Mental Health Act 2007 integrates the needs of ethnic minority people in the UK healthcare systems by allowing community treatment under compulsion as well in a hospital. (McLaughlin, 2008).The new MHA also aligns closely with modern human right law to protect the right of individual. The goal of new legislation is to assist minority ethnic group by introducing incapacity legislation. (Department of Health, 2008, Morris, 2006). The incapacity law aims to assist adult mental patients who lack capacity to receive mental treatment at hospital. (Morris, 2008) . The mental incapacity law introduces a new mechanism to allow healthcare, welfare and financial decision to be taking on behalf of all individuals in the UK who lack capacity to treat themselves. The incapacity law aims to empower adults who lack capacity to care for themselves. (Department of Health, 2009).

Moreover, the UK government set up a CPA program to assist mentally ill people. Care Programme Approach (CPA) is a secondary mental health system to assist people with mental illness. Early Intervention Team, Assertive Outreach Team and Community Mental Health Team are the examples of CPA. Under the CPA guidance, an individual could get help under the CPA if the person is suffering from a severe mental illness. (Rethink Mental Illness, 2013).

Despite the effectiveness of new legislative policy in assisting people with mental problem, the new policy is being criticized on the ground that the legislation excludes number of potential dangerous individual with personality disorders who are consider untreatable. (Department of Health, 2011).

In the UK, social workers are working towards the implementation of the Act in assisting the BME group with mental problems to achieve quick health outcomes. (Newbigging, 2006) .Part of the work of social worker is to ensure that the equal treatment of all no matter the ethnic origin by applying anti-oppressive practice and equal opportunities for all people suffering from mental problems. (National Treatment Agency,2002).

To address the problem faced by the minority ethnic groups in the UK, social workers have a greater role to play as Approved Social Worker (ASW). Under the ASW, social workers have a key role to play following the enactment of 1983 Mental Health Act and 2007 Mental Health Act. (Kinney, 2009). Under the law, the UK government set the code of practice that social workers must follow in the application of their professional practice. (NHS, 1999) . The code of practice stipulates that social workers must treat individual as a person and they must not indulge in any form of discriminations. (Women's Aid, 2008). Moreover, social worker is obliged to maintain the dignity and promote the equal opportunities of workers. (Laing, 1967). Social workers must also apply healthcare service professional code in their professional conduct to enhance healthy and safety of people. (Fernando, 2010, Women's Resource Centre, 2008).

In the context of assisting minority people with mental problems, health professionals and social workers are obliged to assist people suffering from mental health problems. The development of value base practice is the core of the practice of social workers with reference to mental health policy where they are obliged to deliver their services without discrimination. More importantly, social workers are to work with people of all ethnic groups including the Black minority ethnic group in the UK. (Gofman, 1968, Taylor, Coleman, and Baker, 2007).