Outline of the Incident:
35 year old Susan was born with a moderate type of learning disability, a branch of learning disabilities. Two years ago, she lost her partner Chris to prostate cancer. She was unable to cope with the loss, which led to neglecting her personal care and misbehaving in public. Sometimes, she was reported to have walked naked in the hallway of the council flat she lives in. Susan has not been able to pay her rent; therefore the council has threatened to evict her. Neighbours have also complained of occasional noise disturbances and offensive odour coming from her flat. The team of health and social care staff that works with her said that she suffers from schizophrenia. After a long stay in the hospital, she is now ready to move into a supported housing. However, Susan’s movement to a supported housing also creates complications, as she may have less interaction with family members, friends, and other peers, thus, contributing to her instability. In addition, Susan may not be willing to get along with other clients in the supported housing or may not be able to follow the rules set by the housing, which could lead to her expulsion. In this sense, instead of making her condition better, Susan may further experience instability.
Details of the Incident
As mentioned in the case, Susan, the client in question was diagnosed to have both a moderate learning disability accompanied with schizophrenia. It has been given emphasis that a moderate type of learning disability involves an IQ of 35 to 49. Individuals in this particular group account for about 10% of the learning disabled. Most of these individuals have better receptive that expressive language skills, which becomes a potent cause of frustration and challenging behaviour. Speech of such individuals is usually relatively simple and often better understood by people who know the individual well. Activities being done daily by such individuals, such as dressing, feeding, and attention to hygiene are usually acquired over time. However, extended activities of daily living such as the use of money and road sense generally need support. In this case, supported employment and residential provision become very important (“Type of Learning Disability”, 2008). Another diagnosis of Susan was that she has schizophrenia. Schizophrenia is a psychotic disorder characterized by major disturbances in thought, emotion, and behaviour. It is also characterized by disordered thinking in which ideas are not logically related. Faulty perception and attention, bizarre disturbances in motor activity and flat or inappropriate affect may also be observed. Thus, schizophrenic clients withdraw from people and reality, often into a fantasy life of delusions and hallucinations. Associated features also include learning problems, hypoactivity, psychosis, euphoric mood, depressed mood, somatic or sexual dysfunction, hyperactivity, guilt or obsession, sexually deviant behaviour, odd or eccentric or suspicious personality, anxious or fearful or dependent personality, and dramatic or erratic or antisocial personality (Mulhauser, 2008). Based on the diagnosis of the client, it can be understood that the symptoms of both intellectual disorders are being observed and manifested.
Based on the incident or case, it can be understood that the loss experienced by Susan due to the death of her husband triggered her mental illness. Because she suffered from moderate learning disability, it was difficult for her to express how she feels to the people around her, given her simple speech. In addition, because she was suffering from schizophrenia, this means that her inability to speak, her lack of interest, her depressed mood, and her bizarre and eccentric behaviour prevent her from being understood and being helped by the people around her.
Health and Social Care Context
Addressing the mental illness or disorder of Susan involves addressing the matter using both the health and social care context. This is because Susan’s moderate learning disability and schizophrenia are rooted in medical and social terms. In terms of a health care context, medically determining the causes and the treatment for her illnesses can be obtained. On the other hand, in terms of social care context, socially determining the causes of her illnesses, along with determining the social solutions would probably and most likely involve the participation and the contribution of the different individuals or members of the community or society.
In terms of the health care context, it can be given emphasis that the mental illnesses of Susan can be addressed medically. In this regard, it can be perceived that psychological and medical help can be provided to her in order to alleviate the illness and its negative effects, not only to her, but also to the community as a whole. As such, addressing the illness involves determining the genetic, biological, and biochemical causes of the mental illnesses of Susan. The health care context also involves addressing the mental illness by determining the different symptoms of both the moderate learning disability and schizophrenia. This is because determining the symptoms of both illnesses in the medical sense would enable medical and healthcare practitioners and professionals provide medical diagnosis and treatment. In terms of treatment, it can be emphasized that in relation to the health care context, pharmacology or the use of drugs and medicines is primarily administered. A battery of treatments has become available to ameliorate symptoms, to improve quality of life, and to restore productive lives. Pharmacotherapeutic interventions are primarily given by medical and professional practitioners based on the medical diagnosis made, and done because such interventions are expected to have optimal results on the medical condition of the client or patient. In addition, the health care context involves addressing and looking at the illness having medical causes. As such, medical causes mean that medical solutions must be needed by the client or patient. This also involves if the client has tendencies to become involved or engaged in the use of substances, such as drugs and alcohol. In this sense, because medical causes are being detected, medical solutions through medicines and drugs would be the most likely solution or answer.
On the other hand, addressing the matter or the illnesses of Susan in a social care context can also be done, which includes giving emphasis or importance to the social, environmental, and psychological factors that may contribute to the client’s condition. The social class, the family, friends, and the community as a whole are given focus in this context. In terms of the treatment of the client or patient, psychotherapy and other forms of therapy are relevant and important. In this regard, the role and responsibilities of the family members and peers of Susan take on primary importance in addressing her illness. In addition, the role and responsibilities of each and every member of the community where Susan belongs to are also relevant, useful and highly important.
Person Centred Care
It has been reported that the concept of person-centred care is a model of care, which focuses on the value of each individual and involves respecting and honouring the uniqueness of each individual, allowing the person to be involved in the decisions that impact his or her life. It can be differentiated with traditional care, which is disease-focused, manages behaviours, caregiving, losses, and abilities programming. This is because person-centred care is person focused, involves heavier acceptance, care partnering control, empowerment, and meaningful occupation. It has also been emphasized that the goal of this model of care is to move the individual, even momentarily, from loss to fulfilment, loneliness to connectedness, sadness to cheerfulness, confusion to orientation, worry or anxiety to contentment, frustration to peacefulness, fear to security, paranoia to trust, anger to calm, and embarrassment to confidence (Haller and Kramer, 2006). In addition, providing a person-centred care involves a highly individualised comprehensive approach to assessment and services in order to understand each person’s and family’s history, strengths, needs, and vision of their own recovery, including attention to the issues of culture, spirituality, trauma, and other aspects. As such, service plans and outcomes are built upon respect for the unique preferences, strengths, and dignity of each person (Adams and Grieder, 2004).
In order to understand the concept of person-centred care, a number of important phrases and terms must be taken note of from its definition. Primarily, valuing each client or individual, giving importance to their uniqueness means giving honour and respect to the client despite his or her condition. Second, involving them in the decision-making process also counts. Third, helping them cope with their physical, emotional, mental, psychological, and social illnesses is also involved, and lastly, the approach deals with individual or personalised needs of the clients or patients. Based on such important key words, the roles and the responsibilities of professional practitioners can be emphasized, which practically include and focus upon the treatment or cure, the prevention, and the education or provision of information to the clients or patients. In this regard, it can be understood that the person-centred care approach focuses on the roles and responsibilities of healthcare and professional practitioners, not only in terms of their profession but also in terms of how they perceive their clients or patients in a socially, psychologically, physically, mentally, and emotionally-appropriate light. In relation to the case described above, a person-centred care approach would be able to be implemented or employed both in the hospital and the supported housing through the support and the initiatives of the healthcare practitioners and staffs involved with Susan’s case. As such, those healthcare and medical practitioners would have the chance to contribute to the welfare of Susan.
Need for Person-Centred Care
As stated, medical and healthcare practitioners and professionals have important roles and responsibilities in addressing the problems of clients or patients with mental or psychological disorders, such as Susan. Not only because they have roles and responsibilities that are in line with their jobs or professions, but because they have chosen to provide service for such individuals. In this regard, in order to provide the best possible health care and service to such individuals, the need for a person-centred care must be emphasized.
A person-centred care is needed because this approach upholds the value of the person regardless of his/her level of functioning. In this sense, medical and healthcare practitioners are able to observe ethics in terms of the diagnosis and treatment of the clients or patients. This is because they honour respect for the personality, uniqueness, and dignity of the client. The use of person-centred care involves immersion of interactions in core psychological needs, such as love, comfort, attachment, inclusion, occupation, and identity. Because the clients or patients suffering from psychological or mental disorders are typically isolated from their family and friends, they are the ones more susceptible to feeling loneliness, desperation, and despise. However, with person-centred care, medical and healthcare professionals are able to provide them the affection, love, protection, and care that they need. In addition, person-centred care is needed because it promotes positive health, which can be done through coming up with the right diagnosis, providing the appropriate treatment, and providing the adequate information for the clients and his/her family. Person-centred care is also needed to reframe problem behaviours as a demonstration of the need to communicate and as an opportunity for communication with caregivers. Individuals with mental or psychological illness have difficulty in terms of expression and communication with other individuals, thus, making it hard for caregivers to provide them with what they need. Lastly, the person-centred care is needed for hiring of staffs who demonstrate emotional availability to persons in their care (Nissenboim, 2004). This is important because not all individuals are willing and are capable of providing adequate and proper healthcare and treatment to the mentally ill.
Policies and Procedures
One of the relevant policies and procedures in terms of providing care for mentally ill individuals is the NHS plan. It has been given emphasis that the NHS Plan outlines the vision of a health service, which is designed around the client or patient. It focuses on a new delivery system for the NHS, as well as changes between health and social services, changes for NHS doctors, for nurses, midwives, therapists and other NHS staff. Most importantly, the plan also focuses on changes for clients or patients and changes in the relationship between the NHS and the private sector. In addition, the remainder of the plan provides strategies for cutting waiting time for treatment and improving health and reducing inequality. The actions for addressing clinical priorities and for services to older individuals are also outlined (Department of Health, 2000). Based on this plan, it can be perceived that the government also supports the changes that must be undergone by medical and healthcare facilities and institutions in order to appropriately and adequately address the needs of clients like Susan. Because the focus of the NHS plan is to design health service based on the client or patient, this just means that such changes are geared toward the provision of person-centred care, which places primary importance on the welfare of clients.
Another initiative of the country’s government and Department of Health is the Agenda for Change, which involves the single pay system in operation in the NHS, and applies to all directly employed staff with the exception of doctors, dentists, and some very senior managers. Three core elements are the focus of this initiative, which include job evaluation, harmonised terms and conditions, and the Knowledge and Skills Framework or KSF. The three core elements are important as they dramatically simplify the process of designing new ways of working and establishing extended roles of hospital staffs (“Agenda for Change”, 2008). With this initiative, it can be perceived that it addresses providing additional or extended roles to healthcare or medical professionals, thus, making way or room for allowing them to come up with personalised or individualised plans for the benefit of their clients.
Third, National Service Frameworks, which are long term strategies for improving specific areas of care, and are set national standards for identifying key interventions that, put in place agreed time scales for implementation. Some of the diseases included in the framework are high blood pressure, cancer, COPD, CHD, diabetes, and mental health conditions (“National Service Frameworks”, 2008). Through this initiative, it can be understood that long term plans and strategies are being focused upon by the government and the Department of Health, thus, focusing on the mental welfare of individuals suffering from different mental diseases. Through these initiatives, clients or patients, such as Susan would be able to obtain adequate and proper treatment from medical and healthcare institutions, thus, helping her to attain the treatment and cure that she deserves.
Professional Identity and Interprofessional Collaboration
Membership of a professional group is said to form part of an individual’s self concept, which helps explain why perceived threats to that group, or to membership of that group, causes anxiety and even hostility towards others. The creation of professional identity is said to be part of the socialisation process of health practitioners, a process wherein it begins with undergraduate education, but continues in the workplace. A study of nursing practitioners suggested that their mentors had more of an impact on their professional identity that their undergraduate training. Doctors are also said to model their professional behaviour on their mentors. Thus, this indicates that the socialisation process immediate develops into professional boundaries and territories (Reeves, 2000).
On the other hand, inter-professional rivalry, tribalism, and stereotyping are known to operate, as in turf protection. These have significant influence on the ability of team members to work in a multidisciplinary fashion, as professionals struggle to come to terms with differences in values, language, and worldviews (Horak et al., 1998). In addition, the differing accreditation and licensing regulations, payment systems, as well as traditional organisational hierarchies, which act as barriers to cross-disciplinary learning, then what has occurred is the dominance of role over the meeting of client’s needs.
Moreover, the stated objectives of multidisciplinary teamwork and inter-professional practice, including the sharing of power as well as expertise, means that this can be perceived as a threat to professional and personal identity, although a number of authors argue that genuine collaborative practice actually leads to the empowerment of all the health professionals involved (Parsell and Bligh, 1998). Resistance from faculties and educational institutions to implement inter-professional education programs has been attributed to similar fears. The notion that professional identities, power and associated hierarchies might be diluted has been said to cause similar anxieties in some academics and faculties, although a more generous analysis is that the lack of evidence for the effectiveness of inter-professional education may also fuel the reluctance (Wagner, 2000).
Moreover, the notion of collaboration is central to both inter-professional learning and practice. Multiple definitions of collaboration occur in the health education and services literature, but most include the concepts of sharing in the matters of decision-making, interventions, information, values, perspectives, and responsibilities, and partnering for a common goal. In this sense, in the provision of medical or healthcare, building professional identity and inter-professional collaboration is important due to a number of needs. Primarily, through implementation of such concepts, medical and healthcare practitioners are able to deal with complex care needs, and therefore clients with chronic conditions are able to obtain adequate and proper health services. Second, medical and healthcare practitioners are able to be more effective at coordinating and responding to multiple client needs. They can also deliver across multiple health care settings, such as community based care and rehabilitation centres. Medical and healthcare practitioners are also able to reduce the utilisation of redundant or duplicate services, thus, are able to provide better quality care. They can also find more creative and alternative solutions to difficult problems due to the diversity of their members. Furthermore medical and healthcare practitioners and professionals are able to work with clients or patients needing critical acute, geriatric rehabilitative, mental health, and/or palliative care, and result in improved outcomes shorter stays for clients and fewer medical errors (Braithwaite and Travaglia, 2005).
References
Adams, N. and Grieder, D. (2004). Treatment Planning for Person-Centered Care: The Road to Mental Health. London: Elsevier Academic Press.
“Agenda for Change”. (2008). Department of Health. Retrieved May 26, 2008, from http://www.dh.gov.uk/en/Managingyourorganisation/Humanresourcesandtraining/Modernisingpay/Agendaforchange/index.htm.
Braithwaite, J. and Travaglia, J.F. (2005). Inter-professional Learning and Clinical Education: An Overview of the Literature. Canberra: Braithwaite and Associates and the ACT Health Department, 1-59.
Haller, R.L. and Kramer, C.L. (2006). Horticultural Therapy Methods: Making Connections in Health Care, Human Service, and Community Programs. Binghamton: The Haworth Press, Inc.
Horak, B.J., O’Leary, K.C. and Carlson, L. (1998). Preparing Health Care Professionals for Quality Improvement: The George Washington University/George Mason University Experience. Quality Management in Health Care, 6(2): 21-30.
Mulhauser, G. (2008). Counselling Resource. Retrieved May 26, 2008, from http://counsellingresource.com/distress/schizophrenia/dsm/schizophrenia.html.
“National Service Frameworks”. (2008). Department of Health. Retrieved May 26, 2008, from http://www.dh.gov.uk/en/Healthcare/NationalServiceFrameworks/index.htm.
Nissenboim, S. (2004). Caregiver’s Home Companion. Retrieved May 26, 2008, from http://www.caregivershome.com/professional/professional.cfm?UID=18.
Parsell, G. and Bligh, J. (1998). Interprofessional Learning. Postgraduate Medical Journal, 74(868): 89-95.
Reeves, S. (2000). Community Based Interprofessional Education for Medical, Nursing and Dental Students. Health and Social Care in the Community, 8(4): 269-276.
“The NHS Plan: A Plan for Investment, A Plan for Reform”. (2008). Department of Health. Retrieved May 26, 2008, from http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4002960.
“Type of Learning Disability”. (2008). Depression-Guide. Retrieved May 26, 2008, from http://www.depression-guide.com/learning-disability/type-of-learning-disability.htm.
Wagner, E.H. (2000). The Role of Patient Care Teams in Chronic Disease Management. British Medical Journal, 320(7234): 569-572.
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