History Of Mental Illness Health And Social Care Essay

History Of rational Illness Health And Social C ar demonstrateMental nausea is a general term for a group of distemperes. Mental dis inns will from biological, develop moral and/or psychosocial factors. A moral illness brush aside be mild or severe, temporary or prolonged.Mental illness can come and go throughout a souls life. Some the great unwashed stick their illness only once and fully recover. For other(a)s, it is prolonged and recurs over time. Mental illness can make it difficult for someone to cope with work, likenessships and other aspects of their life. exposition of rational illnessMental illnesses be medical settings that disrupt a persons thinking, feeling, wittiness, ability to relate to others and daily functioning. Just as diabetes is a disturb of the pancreas, psychogenic illnesses argon medical conditions that very much result in a diminished capacity for coping with the ordinary demands of life.Serious mental illnesses include major diminished gear, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic separate out disorder (PTSD) and borderline personality disorder. The good news close mental illness is that convalescence is possible.Mental illnesses can preserve persons of each age, race, religion, or income. Mental illnesses argon not the result of personal weakness, lack of character or low upbringing. Mental illnesses are make doable. Most great deal diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual discourse plan.In addition to medication handling, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups and other partnership services can overly be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends and crockedingful paid or volunteer activities contri neverthe lesse to overall health and wellness, including mental illness recovery.History of Mental illnessTimeline1247 Bethlehem Hospital (more frequently known as Bedlam) opens in London to house distraught and lunatik people.1566 The untested Worlds first mental hospital is established in Mexico City.1774 The Act for Regulating Madhouses, Licensing, and Inspection is passed in England. The law forbade a persons commitment to a madhouse without a physicians certification of that individuals delirium.1790s A Quaker called William Turke opens the York Retreat near York, England, an asylum for the mentally ill. The Retreat favored humane treatment personal restraints were not utilise and patients were good housed.1790s French physician Phillipe Pinel begins working at the Bicentre and Salpetriere asylums where he develops traitement morale, a form of treatment that focused on the mental origins of madness. His kind treatment of his patients brought about recovery for many1817 Quakers in Philadelphia open the first asylum in America based on the principles of moral treatment.1841 Dorothea Dix, a schoolteacher from Cambridge Massachusetts, give outs inspired to take up the cause of the mentally ill. She travels to several states where she lobbies state legislatures to better their treatment of the mentally ill. Over thirty state mental hospitals were opened as a result of her efforts.1867 The Packard Law passes in Illinois. Named for Eliza Packard, a woman committed against her will by her husband after a property dispute, the law required that a patients insanity be determined by a jury before he or she could be sent to an institution.1927 The US Supreme Court rules in saddle v. Bell that the forced sterilization of defectives, including the mentally ill, is constitutional.1954 The Durham Rule is established by the US Court of Appeals for the partition of Columbia. It states that a person accused of a crime is not responsible if the criminal act was the product o f a mental disease or a mental defect. It was later rejected ascribable to problems defining mental disease and product.1963 Congress passes the Community Mental Health Centers Act. This bears to the closure of many large state psychiatric hospitals.1966 Lake v. Cameron, a case of the US Court of Appeals for the District of Columbia Circuit , declares that patients in psychiatric hospitals go for the right to receive treatment in the setting that is least restrictive.1975 US Senate holds hearings about the use of neuroleptics (antipsychotic drugs such as Thorazine) in juvenile jails and homes for the developmentally disabled.1979 NAMI is founded.1988 The Fair Housing Amendments Act prohibits housing difference against people with disabilities, including mental disabilities.1990 The Americans with Disabilities Act is passed. It prohibits discrimination against people with physical or mental disabilities.2004 DuPage County begins the Mental Illness Court Alternative Program (MICAP .)2008 Congress passes the Mental Health Parity and Addictions Equity Act. It requires that any limits to insurance coverage for mental illness be no more restrictive than those for physical health issues.2010 Williams v. Quinn, a case heard by U.S. District Court for the Northern District of Illinois, rules that Illinois residents with mental illnesses life story in nursing homes and other institutions for mental diseases (IMDs) nominate the right to live in integrated settings in the friendshipTypes of Mental IllnessThere are many various conditions that are recognized as mental illnesses. The more leafy vegetable types include anguish disorders People with concern disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiousness or nervousness, such as a rapid heartbeat and sweating. An trouble disorder is diagnosed if the persons response is not appropriate for the situation, if the person cannot control the response, o r if the anxiety interferes with normal functioning. Anxiety disorders include infer anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and specific phobias.Mood disorders These disorders, likewise called affective disorders, touch persistent feelings of mourning or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The around common mood disorders are depression, mania, and bipolar disorder. insane disorders Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations the experience of images or sounds that are not real, such as hearing voices and delusions, which are false beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an specimen of a psychotic disorder.Eating disorders Eating disorders involve extreme emotions, attitudes, and behaviors involving burthen and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders.Impulse control and addiction disorders People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships.Personality disorders People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the persons patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the persons normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder, and paranoid personality disorder.Other, less common types of mental illnesses includeRecommended tie in to Mental HealthAdjustment disorder Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a nerve-racking event or situation. The stressors whitethorn include natural disasters, such as an earthquake or tornado events or crises, such as a railcar accident or the diagnosis of a major illness or interpersonal problems, such as a divorce, death of a loved one, harm of a job, or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within half-dozen months after the stressor stops or is eliminated.Dissociative disorders People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of t hemselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or split personality, and depersonalization disorder are examples of dissociative disorders.Factitious disorders Factitious disorders are conditions in which physical and/or emotional symptoms are created in order to place the individual in the role of a patient or a person in need of help.Sexual and gender disorders These include disorders that affect sexual desire, performance, and behavior. Sexual dysfunction, gender identity disorder, and the paraphilias are examples of sexual and gender disorders.Somatoform disorders A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness, even though a doctor can find no medical c ause for the symptoms.Tic disorders People with tic disorders make sounds or display body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourettes syndrome is an example of a tic disorder.Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimers disease, are sometimes categorize as mental illnesses, because they involve the genius.Causes of Mental IllnessWere aware of several disparate forms of mental illnesses, right from bipolar disorder to schizophrenia to compulsive disorders. How often we come across murders carried out by mentally unstable people In fact, thither are scores of famous people with bipolar disorders. Mental illnesses are especially common in the United States. Approximately 26.2 % Americans above 18 years of age are believed to suffer from mental disorders every year, thitherby conducing to one of the leading causes of disabilities in the US and Canada. But what causes mental illness?Mental illness is a condition affecting the brain, that influences the way a person thinks, feels, behaves and relates to others around him or her. The symptoms of mental illness may range from mild depressive symptoms to severe behavioral problems.Genetic FactorsDepression and mental illnesses are often passed on from one generation to another through the genes. This instrument, a person with a family history of mental illness is more vulnerable to develop a mental illness. It is believed that mental illness is associated to various abnormalities in not just one, but several genes. This is the reason why the person inherits the vulnerability to develop this illness, but does not inherit the illness itself. When such people go through horrendous situations the balance of their mind tips and they get engulfed by mental illnesses. .Physical FactorsPeople who have landed up injuring their head several times in accidents , are seen to damage certain areas of their brain and central nervous system, that lead to mental illnesses. accidental injury occurring at the time of birth can withal cause damage to the brain. Moreover, fluster of early fetal brain development can also lead to conditions kindred autism, etc. Some biological factors such as chemical imbalance in the brain, are also associated to mental illnesses. The chemicals called neurotransmitters help nerve cells in the brain to transfer impulses, thereby facilitating communication. However, when this balance tips, messages are not transferred correctly, leading to mental illness. Diseases affecting the brain such as Huntingtons chorea, multiple sclerosis and infections equivalent Tuberculous meningitis, Encephalitis lethargica, etc. also result in mental illnesses.psychological FactorsPeople who have gone through harrowing experiences in their lives ilk emotional, physical, sexual abuse, domestic violence or bullying are often unable t o cope with their traumatic past. Sometimes, the death of a loved one, betrayal or neglect during childhood years, also mars the persons emotional state of mind. This sometimes can be the reason of mental illness of a person.Social and environmental FactorsPoverty, living in a difficult and unsafe environment like in war zones, residing in earthquake prone and other natural disaster-prone areas, living in neighborhoods plagued by gangsters, etc. can lead to mental illnesses. These people develop a constant fear that conduces to mental illness. Moreover, unhealthy environment factors at home, such as growing up in a dysfunctional family, with narcissistic parents or neglecting parents can cause the balance of the childs brain to tip. The persons appearance regarding heyday and weight also causes depression in certain people.Mental illnesses should be not confused with mental retardation. People with mental illnesses do not represent limitations in mental, cognitive and social funct ions. Thus, causes of mental retardation and causes of mental illnesses are obviously different. The above mentioned causes cannot be viewed in isolation. Its when two or three different factors come together, such as past abuse and present horrendous situation come together, that it often causes the mental illness.It is important to not look upon people with mental illnesses with disdain and ostracize them. What they need is unconditional love. Espouse them and help them out of their pits of depression.The symptoms of mental illnessA person with a mental illness can experience problems with their thinking, emotions and/or deportment. These changes may happen quickly, or they may be gradual and subtle. It may take time to understand and identify what is happening.Psychotic symptomsThese symptoms can includeThoughts and feelings that are out of the ordinary or difficult to understand, such as thought of being persecuted or under surveillance for which there is no proofExperiencing s ensations (seeing, hearing, smelling, tasting something when there is nothing there that others can identify)Odd behaviour.Schizophrenia is a psychotic illness.Mood symptomsSome of the symptoms of a changed mood may includePersistent and pervasive feelings of sadness, elation, anxiety, fear or irritabilityChanges in sleep patternsChanges in appetiteLoss of interest in things that were previously enjoyablePeriods of increase or decreased activity, where things may be started and not finishedDifficulty thinking and concentratingExcessive worriesChanges in use of alcohol and other drugs.Exact causes are unknownMany mental illnesses are thought to have a biological cause. What are the exact causes , its unknown.The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. treatmentExtraordinary advances have been made in the treatment of mental illness. Understanding what causes some mental health disorders helps doc tors tailor treatment to those disorders. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders.Psychological treatmentPsychological treatments are based on the idea that some problems relating to mental illness occur because of the way people react to, think about and perceive things. They are particularly relevant to many people with anxiety disorders and depression. Psychological treatments can slew the distress associated with symptoms and can even help reduce the symptoms themselves. These therapies may take several weeks or months to show benefits.Different psychological therapies used in the treatment of mental illness includeCognitive behaviour therapy (CBT) examines how a persons thoughts, feelings and behaviour can get stuck in unhelpful patterns. The person and therapist work together to develop new ways of thinking and acting. Therapy usually includes tasks to perform outside the therapy sessions. CBT may be useful in the treatment of depression, anxiety disorders and psychotic disorders such as bipolar and schizophrenia.Interpersonal psychotherapy examines how a persons relationships and interactions with others affect their own thoughts and behaviours. Difficult relationships may cause stress for a person with a mental illness and improving these relationships may repair a persons quality of life. This therapy may be useful in the treatment of depression.Dialectical behaviour therapy is a treatment for people with borderline personality disorder (BPD). A key problem for people with BPD is handling emotions. This therapy helps people to better manage their emotions and responses.Treatment with medicationMedications are mainly helpful for people who are more seriously affected by mental illness. Different types of medication treat different types of mental illnessAntidepressant medications about 60 to 70 per cent of people with depression respond to initial antidepressant treatment. These me dications are now also used (in combination with psychological therapies) to treat phobias, panic disorder, obsessive compulsive disorder and eating disorders.Antipsychotic medications are used to treat psychotic illnesses, for example schizophrenia and bipolar disorder. Newer antipsychotic medications may have some side effects, but tend to have fewer of the effects that were associated with the older medications, for example stiffening and weakening of the muscles and muscle spasms.Mood stabilising medications are helpful for people who have bipolar disorder (previously known as manic depression). These medications, such as lithium carbonate, can help reduce the recurrence of major depression and can help reduce the manic or high episodes.Other forms of treatmentEffective treatment involves more than medications. Treatment may also involveCommunity support including information, accommodation, help with finding suitable work, training and education, psychosocial rehabilitatio n and unwashed support groups. Understanding and acceptance by the community is very important.Electroconvulsive therapy (ECT) this treatment can be a highly effective treatment for severe depression and, sometimes, for other diagnoses when other treatments have not been effective. After the person is given a general anaesthetic and muscle relaxant, an electrical current is passed through their brain. hospitalization insurance this only occurs when a person is acutely ill and needs intensive treatment for a short time. It is considered better for a persons mental health to treat them in the community, in their familiar surroundings.Involuntary treatment this can occur when the psychiatrist recommends someone needs treatment but the person doesnt agree. In general, people receive involuntary treatment to ensure their own safety or that of others.Mental illness in PakistanMental health in Pakistan has remained a event of debate since the last few years. The incidence and preponde rance have both increased tremendously in the background of growing insecurity, terrorism, economical problems, political uncertainty, unemployment and disruption of the social fabric. 1 Sinking below poverty line by almost 39% of the individuals is an alarming factor worth noting. Many people are now presenting to psychiatrists probably because of the growing awareness through the good work of media. Though there are many things which can be done to improve the mental health of the people in the areas of social environment, economic improvement and political harmony etc. but the important subject for debate is that, how uttermost we are in the areas of education, service and research related to mental health having direct impact on the patient population. From 1947 to 2005, almost 58 years have passed since the independence of the country and many countries with this age have done wonders in overall upkeep of health care and specially the mental health. The scenario though is impr oving, but is it at the required pace? If we first take the area of education by virtue of which we train our future doctors who in turn can become navigators helping us in sailing smoothly through the heavy storm of up surging mental illnesses, we find lacunas which are evident when it comes to eventual(prenominal) care of patients. With the exception of very few institutions, the subject of behavioral sciences which has been introduced by the PMDC in the early years of medical teaching is not being interpreted serious enough, low number of behavioral scientists cannot alone be blamed for this, there are no organize rotation programmes for senior medical students which means a calendar indicating topics, patient sessions, log book and evaluation strategy with weightage in the final year marking system. Low interest by students in the subject of psychiatry despite few institutions model teaching/training programme is understandable in view of no separate paper in psychiatry and ve ry low representation in the paper and clinico-orals of the subject of General Medicine. Regarding the departments, are we fulfilling the international requirements of a good department of psychiatry with full-fledged faculty in all hierarchies? The answer is simply no. Regarding the graduate(prenominal) education, how many recognized centers follow structured programmes emphasizing adequate patient exposure, on-going continuing medical education programmes, research, exposure to subspecialties like, child, geriatric, forensic and rehabilitation psychiatry etc., is there a rural exposure, is there training in cultural issues, is there emphasis on liaison service and multidisciplinary team approach, is there a standard methodology for continuous monitoring and evaluation with resultant weightage in postgraduate exit examinations, is there training in audit and psychiatric administration, the answers to most of these questions will remain unanswered nationally. It is precautionary n ot to say a intelligence agency about the selection criteria of evaluators and examiners lest it is not politically biased and motivated. It is also worth noting that during postgraduate training how many of the prospective specialists are monitored and assessed for culturally relevant mental state examination, adequate case note management, observation of prescribing practices and its justification, communication skills etc.Once certified, there is no provision of higher specialist training for a period of at least three years on the pattern of UK with evaluation of practice-based efficiency, infact, the UK model is worth adopting. 2 There is no trend for CME quote maintenance and hence no programme specifically designed for psychiatrists though there are many such programmes for the general practitioners of course with no condition of maintaining credit certification, this is mostly prompted by the pharmaceutical companies with a view of improving sale as evidence has shown that the knowledge of even most common disorder depression was not adequate among general practitioners.When we come to service, though the major teaching hospitals have established separate departments of psychiatry but in most of the cases they are not well equipped specially in terms of psychiatric manpower both skill and number wise. Still Pakistan has very low number of psychiatrists and these too are continuously being drained by the developed countries especially by the western world where they are being offered an winsome package and lifestyle that the question remains as to who comes back and serves the nation. 4 It is not surprising that there are a large number of Pakistani psychiatrists in United Kingdom, United States, Canada, Australia and New Zealand apart from those in Middle East, Africa and reciprocal ohm East Asia. It seems that soon we shall become a psychiatrists exporting region like our neighbour India thus causing further deepening of the problem related to the already lively scarcity of psychiatrists. 5 Also, at the same time it is vitally important to abolish the feudal psychiatry which fortunately is being eroded by young generation of psychiatrists. There is also acute shortage of allied mental health professionals. In view of poverty, low health budget, high cost of medicines there is huge economic burden on the patients. 6 The hospitals also dont follow the intake/admission criteria, no separate unit for subspecialties, no appropriate long stay units, no exit/discharge criteria, no rehabilitation services, no exchange of information between psychiatrists and family practitioners, no proper advertisement of available services, no concept of day centers, day hospitals, ill developed community services, no central registry of patients and set policy for management systems in the psychiatric set ups and finally no internal referral system.As far as research is conc erned, there is still low representation in local accredited journals and very low in international journals. 7 Though there has been an increase in lay and scientific write-ups recently but it is still far from satisfactory state. Papers are produced for promotions and that too are for the sake of papers, subject field of keeping up standards are ignored. The Journal of Clinical Psychiatry published regularly from Lahore once upon a time disappeared eventually. The first journal of Pakistan Psychiatric party called JPPS was published in the year 2003, which was blocked politically and was not reproduced again. .It appears that still we are far behind in achieving the standards and in order to improve the existing scenario some steps are essential. In order to bring improvement in psychiatric education, it is important to pay emphasis on the subject of behavioral sciences, design an appropriate undergraduate training program in line with one of the international modules, inculcation of research interest among medical students, either launch of a se parate paper of psychiatry or at least 25% of weightage in the paper of medicine, at postgraduate level more structured training program with exposure to subspecialties, designing a postgraduate curriculum and module, introduction of audit of training and performance, provision of higher specialist training at the level of specialist registrar, private-public partnership in provision of services, mobilization of more resources for mental health and maintaining of records. There is a need for development of research shade especially in the areas of need assessment is also necessary. Along with these efforts the medical fraternity can force the government to allocate a higher budget, reduce poverty, bring social justice and harmony, improving political scenario.It is also advisable to create better incentives for the mental health professionals in order to avert brain drain. Efforts for providing a conducive environment to the public to help in promoting sound mental as well as physi cal health are imperative. literature ReviewAnxiety and depressive disorders are common in all regions of the world.1 They constitute a substantial proportion of the global burden of disease, and are communicate to form the second most common cause of disability by 2020.2 This increased importance of non-communicable diseases such as anxiety and depressive disorders presents a particular take exception for low income countries, where infectious diseases and malnutrition are still rife and where only a low percentage of gross domestic product is allocated to health services.3 These disorders are also important because of their economic consequences. 4 With an estimated population of 152 million, Pakistan is the sixth most populous country in the world. It is projected that, by 2050, the population will have increased to make it the fourth most populous country.5 There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders. We th erefore conducted a systematic review as no such work existed to our knowledge.Our main questions were (a) what the estimated prevalence of anxiety and depressive disorders is in Pakistan and how this compares with estimates from other low income countries (b) what the associated social, psychological, and biological factors are and (c) what evidence exists for effectiveness of treatment or prevention in this population.Prevalence of anxiety and depressive disordersthe prevalence of anxiety and depressive disorders estimated in the studies. The overall mean prevalence in men and women in the six studies of random community samples (n = 2658) was 33.62%, with the point prevalence varying from 28.8% to 66% for women (overall mean 45.5%) and from 10% to 33% for men (overall mean 21.7%). Women aged 15-49 were studied in a paper with 28.8% prevalence, while young men with a mean age of 18 participated in a nurture reporting 33% prevalence. Only one study reported adjusted prevalence wit h 95% confidence intervals.For those presenting to traditional or faith healers (n = 511), the prevalence of anxiety and depressive disorders among men varied from 2.65% to 27%, and among women from 11.5 % to 52%.Three studies looked at total psychiatric morbidity in primary care (n = 774). One described women in a rural area, with a prevalence of 50%, while another described 18% prevalence for men and 42.2% for women in an urban area. The third study, with a prevalence of 38.4%, did not specify participants sex.Of those presenting to psychiatric outpatients (n = 2430), the prevalence varied between 32% and 66.3%. There were two studies on psychiatric inpatients, one reported a prevalence of depressive illness of 37% (n = 2620), while the other reported 19.1% (n = 177).Comparison with other low income countriesUsing stringent criteria, Harding et al reported an overall frequency of anxiety and depression of 13.9% in four developing countries.9 Community studies from Africa have repo rted prevalences of 24% in rural Uganda and 20%-24% in rural South Africa. Among patients attending primary care, the prevalence varied from 8% to 29%. Patients attending primary care in India showed prevalences between 21% and 57%.In relation to risk factors, Abas and Broadhead found a significant association with formal employment, below average income, overcrowding, and certificate of secondary education in urban Zimbabwe.In the same study, they also found a significant association with humiliation or entrapment and with death or other l