Health Policy And The Social Determinants

wellness Policy And The Social De experi affable conditioninantsINEQUALITIES IN MENTAL HEALTHIntroduction and definitions psychic wellness is described by the World Health Organization (WHO) asa state of well- be in which the individual realizes his or her own abilities, fuel cope with the normal seekes of conduct, can deform productively and fruitfully, and is able to make a contribution to his or her community (WHO 2001a, p.1).According to NHS website every year in the UK, much than 250,000 plurality ar admitted to psychiatric hospitals and over 4,000 peck commit self-destruction(http//www.nhs.uk/conditions/ noetic- wellness/P develops/Introduction.aspx , accessed 20-4-2010) noetic health disparity is a long standing line that has been tackled for decades by epidemiologists, sociologists and health professionals.And because this business has twain strong social and health aspect there is no unified accession to identification and resolution.From Sociologists viewpo int inequality with affable health is a occupation that has two main explanations people are poor because they have mentally distemper that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to get hold of in the etiology such(prenominal) as genetic factors, diet, and hormonal disturbance which interact with personality perturbations or emotional state to produce mental indisposition.The problem of inequality is not altogether few serious mental illness but we can expand the definition of mental health inequality to take everyday feelings which is considered by United Kingdom Department of Health to be public health indicatorHow people feel is not an elusive or abstract concept, but a significant public health indicator as significant as grade of smoking, obesity and physical military action ( kind offbeat Impact Assessment ,200 9)The table below gives examples of those factors that promote or reduce opportunities for good mental health (DOH 2001)MENTAL HEALTH antifertility FACTORSINTERNAL PROTECTIVE FACTORSEXTERNAL PROTECTIVE FACTORSEMOTIONAL RESILIENCEphysical healthself-importance esteem/positive sense of self dexterity to screw conflict office to learnCITIZENSHIPa positive feel of early bondingpositive beget of attachmentability to make, maintain and break relationshipscommunication skillsfeeling of tolerationEMOTIONAL RESILIENCEbasic needs met food, warmth, shelterCITIZENSHIPsocietal or community validationsupportive social networkpositive voice models dateHEALTHY STRUCTURESpositive educational experiencessafe and secure environment in which to livesupportive political infrastructurelive within 4th dimension of peace treaty (absence of conflict)MENTAL HEALTH DEMOTING/VULNERABILITY FACTORSINTERNAL VULNERABLE FACTORSEXTERNAL VULNERABLE FACTORSEMOTIONAL RESILIENCEcongenital illness, infirmity or disabilitylack of self esteem and social statusfeeling of helplessnessproblems with sexuality or sexual orientationCITIZENSHIPpoor quality of relationshipsfeeling of isolationfeeling of institutionalisationexperience of dissonance, conflict, or alienationEMOTIONAL RESILIENCEneeds not being met hunger, cold, firmlessness/poor housing conditions etc.experience separation and lossexperience of pace or violencesubstance misusefamily history of psychiatric disorderCITIZENSHIP pagan conflict experience of alienationdiscrimination the negative experience of being stigmatisedlack of autonomythe negative experience of peer pressure un affairHEALTHY STRUCTURESvalue systemseffects of povertynegative physical environmentTable 1 factors that promote or reduce opportunities for good mental healthWhat is the evidence on mental health inequalities?Socio-economic statusCommunity-based epidemiological studies across countries and over time have consistently identified an inverse relationship between Socio-economic status and prevalence rates of schizophrenia .The ratio between the current prevalence (defined as period prevalence up to one-year prevalence) of the disorder among low-SES and superior-SES people was 3.4, whereas the ratio for lifetime prevalence was 2.4 (Saraceno et al,2005), and in Britain, twice as many a(prenominal) suicides occur among people from the most lower SES (Blamey A et al ,2002).There are five hypotheses to explain this relation (Hudson 2005) venture 1 Economic stress. The inverse SES-mental illness correlational statistics is a specic outcome of stressful economic conditions, such as poverty, unemployment, and housing unaffordability.Hypothesis 2 Family fragmentation. The inverse SES-mental illness correlation is a federal agency of the fragmentation of family structure and lack of family supports.Hypothesis 3 Geographic drift. The inverse SES-mental illness correlation results from the movement of individuals from higher to lower SES com munities subsequent to their initial hospitalization.Hypothesis 4 Socioeconomic drift. The inverse SES-mental illness correlation results from declining employment subsequent to initial hospitalization.Hypothesis 5 Intergenerational drift. The inverse SES-mental illness correlation is a forge of declines in community SES levels of hospitalized adolescents between their rst hospitalization and their most recent hospitalization after turning 18AgeIn elderly discipline fetch for psychic Health in England (NIMHE) has reported the following point regarding mental health problems in elderly 3million one-time(a) people in the UK experience symptoms of mental health problemsthe annual economic burden of late onset dementia is 4.3 billion which is greater than that for stroke, cancer and heart disease combineddementia affects 5% of those time-honored over 65 and 20% over 8010-15% of all older people meet the clinical criteria for a diagnosis of depressionthese be are set to increase by a third over the next 15 years(NIMHE, 2009). psychical health problems in elderly very much go unrecognised. Even where they are acknowledged, they are often inadequately or inappropriately managed (DH 2005c).The UK inquiry into mental health and well-being in later life (2006) identified five factors that influence the mental health of older people discrimination (for example, by age or gardening) participation in meaningful activity relationships physical health (including physical capability to undertake everyday tasks) and poverty.in children WHO states, that the development of a child and adolescent mental health form _or_ system of government requires an intelligence of well-being and the prevalence of mental health problems among children and adolescents(child and adolescent mental health policy, 2006)However, there is an evidence that levels of scathe and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases tha t require interventions are around 3-6 per cent of people under 16 years of age (Bird et al.1988 Costello et al. 1988).Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (Zeigler-Dendy,1989).GenderWomen and Mental HealthMental health problems are more common among women than men with higher incidence rates of depressive disorder than men (Palmer, 2003).There are many factors to explain this, starting line Socio-economic factors such as poverty and poor housing conditions cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighbourhoods cause stress and anxiety amongst women , dependency on prescription drugs (for depressive and sleeping disorders) often leads to anxiety.Men and Mental HealthMen tend to be more vulnerable to mental health problems and suicide than ever before due f or a number of reasons includingMen in general are less likely to talk about their problems or feelings or to admit that they have depression.Men are less likely to seek help for mental and emotional health problems.Unemployment has a greater impact on men in general.Some mental disorders are more serious in men for example suicide is the leading cause of death among young men. The rate for young men aged 10-24 years is higher among those from deprived communities compared with those from affluent communities. Men also experience earlier onset of schizophrenia with poorer clinical outcomes (Piccinelli, 1997)Risk groups for mental illness in men include (DHSSPS,2004)Older men they are less willing to use health function because of the perception that these operate are for older women. break men because they have less support available from family , and services designed to meet the needs of this group is particularly. staminate victims of domestic abuse -especially boys in ineleg ant areas.Gay and bisexual men few services are available to help men deal with problems such as homophobic bullying and harassment.Male survivors of sexual abuse lack of co-ordinated support for adult survivors of abuseFathers despite examples of good practice, men have comparatively less access to support services than women, to enable them to cope with the stresses of parenthood.Bereaved men lack of appropriate services specifically targeted at men who have experienced bereavement.Men in hobnailed areas particularly isolated in terms of service access.Young offenders inadequate psychological services in juvenile justice centres despite the high balance wheel of young people entering the juvenile system with a range of mental health problems.Ethnic groupA review by delegation for Health worry Audit and Inspection,( Count me in, 2009) noted that Rates of admission were lower than the national average among the White British, Indian and Chinese groups, and were average for t he Pakistani and Bangladeshi groups. They were higher than average among other minority ethnic groups particularly in the glum Caribbean, Black African, Other Black, White/Black Caribbean Mixed and White/Black African Mixed groups with rates over tierce times higher than average, and nine times higher in the Other Black group.Employment shape and Mental HealthHaving a assembly line helps to maintain better mental health than not having one, but this is not always true as many factors involveFor example, jobs which are unsatisfactory or insecure can be as harmful to health as unemployment (Wilkinson et al , 2003). Anxiety about job security, lack of job control, perceived effort-reward imbalance, negative relationships in the workplace, including bullying and harassment can have negative mental health consequences.According to OSC Health Inequalities suss out (2006) people with a common mental disorder are five times more likely to be unemployed, and if they have work they are more likely to be excluded, people with an identified mental health problem are twice as likely to be on income support and four to five times more likely to be getting invalidity benefits. A person with a diagnosis of a psychotic illness leaves him with exactly a one in four chance of being in employment.Geographic variationStudies result on geographic variation of mental illness are inconsistent , for example Hollie has concluded that In mental health problems there is substantial variation at the household level but with no evidence of postcode unit variation and no association with residential environmental quality or geographical accessibility. It is believed that in common mental disorder the psychosocial environment is more important than the physical environment (Hollie et al, 2007)On the other hand, a recent Swedish study of 4.4 million adults found that the incidence rates of psychosis and depression come up with change magnitude levels of urbanisation (Sundquist K.et al.,2004).Another study by Royal Commission on Environmental Pollution shows that people from densely dwell areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. deep down urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters in London schizophrenia rates are about twice those in Bristol or Nottingham (Royal Commission on Environmental Pollution, 2007a, 2007b). deterrent and Mental HealthDefinition According to Disability Discrimination Act (1995) (DDA)A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activitiesIn the light of this definition we can stress on mental health inequality of three groups of people pot suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental heal th problems. People with both mental health problems and physical disabilities. People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.Disabled people are more likely to experience stress and emotional instability than those who are not disable.a report by the Equality Commission for Northern Ireland (2003) has found that whilst 34% of those who were not disabled had experienced quite a lot or a great deal of stress in the last 12 months prior to the survey, the percentage rose to 52% for disabled people. Experiences of depression within the last 12 months were higher among women who were disabled (44%) than men (34%).ConclusionInequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address distinguishable kinds of mental health Inequalities a ssociated with it.Question 2 word count (2000)Tackling inequalities in mental healthIntroductionMental illness, among other disorders, is widely considered as a significant determinant of both health and social outcomes and many studies have spotted mental health disorders as both consequence and cause of inequalities and social exclusion.Mental health diseases have two distinct characteristics as a public health problem outgrowth very high rates of prevalence secondly onset is usually at a much younger age than for other health problem , Mental health diseases effects all areas of peoples lives personal relationships, employment, income and educational performance. (Friedli and Parsonage , 2007 McDaid , 2007)Who is at risk for mental health problems?Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs.A review of recen t evidences on mental health inequalities can help to define the large groups at risk People living in institutional settings such as charge homes or those in secure kick or subject to detention. People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless. People with physical and/or mental illness, people misusing drugs, people with alcoholic drink problems, people who are victims of violence and abuse.children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children, People from groups who experience discrimination.Key policiesThese policies can be long term policies focusing on deep change over long period or short term seeking fast results such as health promotion.Long term aimsInequalities in mental health are not only about equality of access, but also about quality of access.In the year 2009 Mental Health Foundation has publi shed a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities ,2009)This report mentioned four priorities for action1-Social, cultural and economic conditions that support family lifeThis can be done by reduce child poverty , parenting skills training and high quality preschool education , increasing access to safe places for children to play, especially outdoors, inter-agency partnerships to reduce violence and sexual abuse.2- Education that helps children both economically and emotionally byschools health promoting programs, involving teachers, pupils, parents and supporting parents to improve the home learning environment (HLE)support social, sports and creative achievements, as well as academic performance3- Reduce unemployment and poverty levels and promote and protect mental health bySupporting efforts to improve pay, work conditions and job security.Facilitate early referral to workplace based support for employees with psychiatric symptoms or personal crises to prevent employment breakdown.4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.However, these strategies take long time to be effective, that means the need for more rapid actions or short term aims.Short term aims Mental health promotionTo take a shit an effective strategy to promotion for health equality the following points should be achieved Comprehensive Mental Health promotion is not only the responsibility of health services alone other sectors of society should join that effort. Based on evidence Based on the needs of the local communities, and with the conformity of these communities. Subject to evaluation The strategy should be subject to critical evaluation and can be changed when necessary.A good example of such strategy is the Mental health national evidence based standards which have been i ssued by The National Service Framework for Mental Health (DOH 1999). The purpose of these standards is to deal with mental health discrimination and social exclusion associated with mental health problems. And that can be achieved by promotionpromote mental health for the whole society, working with individuals and communities give notice discrimination against individuals and groups with mental health problems, and take steps towards better promotion for their social inclusion.Tackling inequalities for special risk groupsThe Suicide measure strategyOne of the scoop out example is the strategy based on work by (DOH 2002) and The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals1. To reduce the risk in key high-risk group.2. To promote mental well-being in the wider population.3. To reduce the availability and lethality of suicide methods.4. To improve the reporting of suicide behavior in the media.5. To promote research on suicide and suicide prevention.6. To improve monitoring of progress towards the target for reducing suicide.Women and Mental Health PreventingThe results of UK-based survey (Williams, 2002) shows that mental health services for womenDo not meet womens mental health needs.Can replicate inequalities.Can be unsafe for women.Can be insensitive to the effects of gender and other social inequalities, such as race, class and ageHowever, in their response to a survey conducted in England and Wales, women said that they wanted services that Keep them feel safe. Promote empowerment, choice and self-determination. Place importance on the underlying causes and context of their distress in addition to their symptoms. Addressee important issues relating to their roles as mothers, the need for safe accommodation and access to education, training and work opportunities. Value their strengths, abilities and potential f or recovery.(DH, 2002a)These points are important to build a need-based action plan for better equality in health services.Men and Mental Health PreventingThe Equal Minds conference workshop which had special focus on men and mental health listed five service design features targeted at mens mental health and well-being (equal minds, 2005) Accessibility and flexibility of services regarding time, location. For example, destine places familiar for men, Men Only sessions run by male staff, make use of some activities, such as sport and physical activity platforms. holistic approach, works on the person as a whole, not just on mental health. Early intervention to prevent anxieties and concerns build up, especially in stress and anger management. Trust and confidence are important to solve problems of identity and role that can underlay mens anxieties and self-perceptions or lack of self-esteem.Ethnicity and Mental Health PreventingThe main problem in this field was the barriers to ac cess services. Barriers include Language. Stereotyping. Lack of awareness or understandings of mental illness.The report Inside Outside (Sashidharan, 2003) which addresses mental health services for people from black and minority ethnic communities in England and Wales. Suggest that patients from all minority ethnic groups are more likely than white majority patients To follow aversive pathways into medical specialist mental health care. To be admitted compulsorily (there are differences also between ethnic groups at all ages). To be misdiagnosed. To be prescribed drugs and Electroconvulsive therapy (ECT), more than talking therapies. To have higher readmission rates and stay for longer periods in hospital. To be admitted to secure care/forensic environments. Their social care and psychological needs are less likely to be addressee within the care planning process. To have worse outcomes.A strategic approach in Ethnicity and Mental HealthIn England and Wales a framework have been developed for action for delivering race equality in mental health (DH, 2003b)The framework focuses on three building blocks which are essential to improved outcomes and experiences of people from black and minority ethnic communities Information of better quality and more intelligently used. run which are more appropriate and responsive. Increased community engagementIn other words any approach should take in consider both quality of health services and the socio-economic disadvantages experienced by people from ethnic communities.Some suggested steps for this approach may includeProviding interpretation and translation services beside mental health service to insure highest possible quality.Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in expression of mental distress.Developing assessment and diagnostic tools that can better assess patients from different backgrounds and ethnicities.Ensuring that services understand and respect spiritual requirements for different cultures.Ensuring access equality to culturally appropriate services including, counseling, psychotherapy and advocacy.Addressing common problem for people from black and minority communities, such as housing, employment, welfare benefits, and child-care.Disability and Mental Healthpeople with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special avocation regarding mental health services , they are liable for what Rogers and Pilgrim (2003) described inequalities created by service provision.Mental health services for disable people should be customized to their needs, some recommendations for such services may includePromotion for mental health, well-being and living with disability.Early intervention for people who show symptoms for possible mental illness.personalised care based on individuals needs and wish esStigma work for better social inclusion and tackling stigma and discrimination associated with some disabilities.Elderly and mental healthIn order to achieve better equality for this group, policy makers should insure better access to mental health services on the first place.In the year 2005 the Department of Health published a report titled Securing Better Mental Health for Older Adults to launch a new programme to bring together mental health and older peoples policy in order to improve services for older people with mental health problems.The National Directors for older people and mental health promoted the dual principles of Delivering non-discriminatory mental health and care services available on the basis of need, not age and Holistic, person-centred older peoples health and care services which address mental as well as physical health needsHere, it is essential to emphasis the importance of specialist mental health service for older adults.Sexual Orientation and Mental H ealthIn this group health promotion plays a great role to address the mental problems associated with sexual orientation.PACE organization has drawn up a set of practice guidelines for working with lesbian, gay and bisexual people in mental health services (PACE guideline.2006).The guidelines suggest promoting services and resources specifically for LGB people, including services such counselling and advocacy provided by LGB organisations.In response to these guidelines and studies about LGB such as (McNair et al, 2001). Mental health services for LGB people shouldReflect upon the homophobia and heterosexism that LGBT people may experience within mental health services.Enhance awareness of LGBT people problems, and the forms of discrimination and social exclusion they may face.Consider the nature of a culturally competent for LGBT peoplePreventing in Mental Health Problemspeople with mental health problem are in need for resilience factors that enable them to recover from mental dis tress and to fight the effects of discrimination and stigma, we can epithet some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive accepting communities (Dunn, 1999).Examples for these services can be found in report on Mental Health and Social Exclusion which has been published by Social Exclusion Unit. The report included a 27-point Action Plan aimed at tackling stigma and discrimination, focusing on the role of health and social care in addressing problems of social exclusion, unemployment, and supporting families and community participation through ensuring access to goods and services such as housing, financial advice and transport (SEU,2004).Beyond this report, it is important that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic ap proach that aim prevention on the long run.ConclusionIt is essential to coiffe the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for reducing inequalities in mental health within primary care, and the primary care organization studied is not conducive to addressing inequalities in mental health. (Craig, 2009).For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.