The effects on gender has long been established, gender inequalities means that female activities and lives are considered to be of a lower status to that of men. Gender inequalities can be seen through out society, in terms of lower power and pay. In addition, families and close relationships may also reflect the gender inequalities. There is evidence that suggests women who live on or below the poverty line are more likely to be at risk of physical and sexual abuse, unemployment and divorce (Byrne et al, 1999). These are all factors that may increase the likelihood of a mental health problem. It is evident that there are gender differences within the mental health service. Women are more likely to have their mental health needs minimised, marginalised and trivialised (Beal and Gardner, 2000; Williams, Scott and Bressington, 2004).
There are a variety of ways in assessing mental health. The psychological model treats mental disorder as an emotional response to threatening, traumatic experiences or unsatisfied instincts. Based on the research of psychologists such as Sigmund Freud, a psychologist will try to find a connection between the unconscious mind and the patient’s mental disorder. From a psychological viewpoint, mental health generally originates from childhood experiences and personality development in childhood is relevant to the mental disorder. Furthermore, a relationship such as parenting determines how we feel and behave. Information can be gathered from irrational behaviour, dreams and what a patient says during therapy.
Treatment or therapy for a disorder is based on talking in a relaxed atmosphere with a psychoanalyst. Using free association, which is saying whatever comes to mind, particularly dreams, hopes, wishes and fantasies. The analyst’s objective is to help the patient confront the conflicts through a further two processes, catharsis is when the patient releases emotions when they become aware of the repressed information. Transference is transferring pent up emotions generally towards the analyst finally resolving the issues, allowing the patient to gain self-understanding.
Research suggests that short-term therapy can be beneficial to some patients (Messer et al, 1992). Another positive view is the insight a patient receives, giving them a better understanding of themselves. However, reaching in to a patients repressed memory may cause more distress, which could intensify the disorder. In addition, the therapy relies heavily on the therapist’s interpretation of the information given, which may be judged by his or her own personal background. Another flaw may be that the information given to the therapist relies on memory recall. This information may be unreliable. Therapy can only work if the factors involved are reliable such as, a client's motivation, dedication, openness and the therapists experience and skill. Time, resources, and support must also be taken into account.
The medical model takes a biological and scientific approach to mental health, and views mental health as an illness or disease orientated. The model became dominant in the middle 19th century. It is still the most dominant model to date. The medical model views the causes of mental illness as chemical imbalances in the brain, genetics, substance missuse, nutrition and brain injuries. Belief is within science to ‘cure the disease’ with a range of treatments such as, medication, ECT (Electroconvulsive therapy) and psychosurgery. Medication may help a service user deal with the effects of a mental disorder, however, it doesn’t treat the root cause of the disorder and widespread use of medication may slow down the development of other forms of treatment. In addition, different types of medication have unpleasant side effects these may range from insomnia and nausea to high blood pressure and strokes. Taking medication does not necessarily mean it will be effective and it may cause psychological and physical dependence when taken over a long period of time. Many people have mixed feeling about taking medication. It carried an association of long term illness, potential long term damage and concerns about physical health (Mental Health Foundation, Nov 1999, p.37). ECT is a procedure that involves giving the patients electric shocks that produce convulsions. The procedure primarily reduces the symptoms of schizophrenia but it is also used for severe depression. ECT has been questioned on ethical ground as the treatment may be a terrifying experience and may cause more psychological and physical problems. Psychosurgery is a surgical procedure that is performed on the brain; this procedure is only carried out on conditions that have not responded to alternative treatments.
Following physical, neurological and psychiatric examinations a diagnosis will be given. The medical model uses a framework of classifications to diagnose an individual, known as the DSM (diagnostic statistical manual) or the ICD (international classification of disease) classification systems. It identifies groups of behaviour or symptoms that form together to a particular disorder. For a legitimate diagnosis there are five levels of diagnosis to complete, these must be in order to ensure the diagnosis is complete. It compartmentalizes individuals and categorizes them. Furthermore, medicine has always been focused on making the patient better but there is a power imbalance between the doctor and the patient.
Pervasive and powerful medical model views are reinforced in the media, books, films and language. Society has become dependant on modern science to resolve our health issues. Social and economic factors are discarded as causes of mental health and the social model is frowned upon. The mental model also overindulges in the categories within the diagnosis system and ignores the individual’s capability in their own progression. In addition, the mental model has a lack of appreciation for the role of culture in mental health, therefore it is not diverse.
The social model places a greater emphasis on the role of network and communities in maintaining the mental health of individuals. The social model treats mental health problems as individuals who experience problems with living. This stems from interpersonal relationships and environmental circumstances that block the path of self worth. Factors such as oppression, social and economic status, perceptions, social exclusion and injustice are all viewed as the root causes to mental health. Most mental illnesses are social related, such as anxiety, depression, anger and panic attacks, and do not warrant being treated as a brain disease (Thomas Szasz, 1961).
The social model embraces the individual and encourages freedom and responsibility. Working with an individual the aim is to discover and utilise the importance of self worth in all aspects of life. The model is designed to aid the service user to overcome personal barriers and to address vital factors behind the mental illness. Writing from the perspectives of her own experience Helen Glover states “People who experience the distress of mental illness have the right to understand their distress and develop the understanding that one can grow from that experience” (2001, p.7). The social model uses the expertise of the service user and values their experiences within the model. Working with the service user the model enables the user to regain control of their lives; the key is empowerment of the service user. The social model will challenge any oppression or stigma that the label of mental health carries allowing the service user to deal with day to day activities. Individuals need to have confidence in the service that is been provided, confidence that the service will help them over a period of time, not just instantly and will adjust to their personal needs (Spicker, 1995).
The effectiveness of the social model lies in the fact that it is individualist, so many services fail to match the needs of the user and their families. The role of specialist social workers was obviously pivotal in the system of care. They both arranged for services, and were the service themselves (Macdonald and Sheldon, 1997, p.51). The social model works with communities and strengthens the individual to deal with the social and economic issues that may have been the root cause of the mental health problem. In addition, the social model does not label people and therefore eliminates the stigma and the shame that can arise. However, the social model is still in need of vital clarification on its usefulness and effectiveness, there is a tendency for the model to be placed at the bottom of the mental health agenda. The media also continues to distort the general public’s perception of social workers; this sequentially declines the status of the social model.
In reality, all the models have their purpose, what may work for one person may not work for another. Some service users feel that their medication is the key to staying in control, while others feel that the social model was the core service to their recovery. However, the dilemma lies with how each model is viewed, each model is important within its own right. The medical model is not necessarily better at treating mental health than the social model and both models should have equal worth. Mental health covers a wide range of disorders, each having different root causes the models need to be integrated so the service user gets the best outcome possible.
There are other alternative approaches in dealing with mental illness; cognitive behavioural therapy tackles mental illness by how an individual’s thinking can affect their actions. This suggests that it is not the environment or the situation that may cause distress but the way an individual thinks and reacts to it. The therapy includes helping an individual to see how their negative thought process could determine their negative behaviour. The client will have to use a variety of techniques that will aid the service user to take control of the negative impact of their thoughts and feeling have. A diary or problem list is used to reflect a person’s emotions and a rating scale is used to assess the degree of negative behaviour that is experienced by the individual. In addition, the client will have ‘homework’ which generally consists of diary work to reinforce the work that is done with the trained therapist.
Research suggests that cognitive behavioural therapy can be very successful. Beck (1993) reviewed evidence regarding the effectiveness of cognitive behavioural therapy for depression, eating disorders, panic and anxiety disorders. The outcome showed very clearly that cognitive behavioural therapy is highly effective. In addition, studies conducted by Clark et al (1994) and Shear et al (1994) has shown that cognitive based therapies can be extremely effective in changing the behaviour and cognitions in 90 per cent of those treated.
However, the model only deals with the thought process and behaviour; it fails to take social and economic factors into account that may be the root cause. The therapy may leave the patient feeling even more inadequate and distressed as they have had their worst points placed in front of them, some individuals may find this hard to handle.
Overall, there are sufficient models and therapies available to help people deal with mental health. Whether or not they are being used to their full potential is another matter. Mental health is largely dominated by the medical model and discrimination and prejudice is still very much evident. A change is needed within the mental health service to recognise the true potential of other models, such as the social model. As well as addressing the prejudiced attitudes and discrimination that takes place within the services. Until these changes have been implemented it is the service user who pays the price. The service user is the key to understanding mental health upon them. Human experience can be considered as the most powerful thing there is.
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