Treatment Of Persons With Mental Illness example essay topic

The past thirty years have seen great changes in the treatments available for people with mental illness. Advances in neuroleptic medications, better understanding of the neurobiological aspects of mental illness and more effective styles of psychosocial intervention have all improved the services available for the mentally ill. However, the last three decades have also been a period in which several obstacles to the access of care have made the treatment of persons with mental illness more difficult. Although designed to protect those who suffer from mental illness, changes in policy and law have created difficulties in delivering services to involuntary clients and assisting them to control their illnesses. People with severe mental illness require a variety of interventions in order to successfully manage their conditions. Basic needs such as housing, vocational training, and financial assistance are all areas which, although perhaps taken for granted by many, can be of great difficulty for someone with a mental illness.

People may require varying degrees of assistance in these areas as well as with managing interpersonal relations and other spheres of social and emotional functioning (Hersh berg & Posner, 1992). Most people with mental illness can benefit greatly from the use of antipsychotic medications. In the past, many of the drugs offered to mentally ill people to control their psychoses, such as h aldol and stela zine, would sometimes produce side effects almost as debilitating as the illness itself. However, in recent years, advances in the field of neuroleptic medications have produced new drugs which are far more effective than their predecessors and which cause far fewer negative side effects. It can be argued that without a medical control of sever mental illness through medication, assisting clients to function adequately for extended periods of time can be an almost impossible task (Isaac & Armat, 1992; Torrey, 1995). Although established to protect the people's rights and put a stop to past abuses, current laws and policy can prove to be difficult hurdles to overcome when working with persons with mental illness.

Since the 1960's, deinstitutionalization and changes in rights protection have greatly altered the face of psychiatric care. Before these changes, many people were unnecessarily hospitalised for lengthy periods and subject to poor treatment, over medication and in some cases to questionable medical procedures (Torrey, 1995). In response to the situation, survivors of the previous institutional system, their families and civil rights groups fought for the protection of patients and succeeded in having laws and medical practices changed. These protections are crucial in order to avoid a return to past abusive practices. They do, however, necessitate that professionals working with people with metal illness be creative in working within the constraints of the existing laws. Under normal circumstances, people are not required to accept any form of treatment for their illness.

It is common for psychiatric patients to refuse medical and psychosocial intervention. The very nature of many mental illnesses may lead the person to believe that they are not actually ill but in fact well and living in a sick world. In many cases, after a short hospitalizations, patients are discharged into the community and have the choice as to whether or not to continue treatment. Sometimes, when people are under the effects of medication and feeling relatively well, they believe that they are no longer are sick and cease following their medication programs and other aspects of their follow up. Sometimes the effects are devastating. The fact that a surprisingly large portion of the homeless population are in fact people who have dropped out of treatment programs for mental illness and their being homeless is a consequence, direct or otherwise, of their dropping out is a frightening and concrete example of the possible outcome of treatment refusal.

(Torrey, 1997; Torrey, 1988). With such clients, it is often necessary to be creative in order to convince them to follow their treatments. Abramson (1989) uses the term paternalistic beneficence to describe actions taken to serve the best interests on the client while depriving the person to some degree of their right of choice. While this may take the form of outright decision making for the client, other more subtle forms of paternalistic beneficence are possible. Some clients may seek certain services while refusing others. In some cases, withholding desired services and only providing them if the client complies to certain conditions may be justifiable.

In the case of people who are mentally ill and homeless, material assistance such as budgeting or assistance in finding housing might be given on the condition that the client agrees to be followed by a physician. Although it may sound unethical to suggest refusing services, it may be justifiable if the end result is that the client gets the treatment they need. Also, in the case of the mentally ill, certain services may be useless if not accompanied by medical follow up. For example, assisting a person to find an apartment when they accept no other support and are incapable of maintaining the living arrangement for any length of time due to their untreated illness might not be productive and turn out to be only a temporary arrangement and a frustrating, confusing failure for the client. A number of other strategies can also be used.

If necessary, legal procedure is available to oblige clients to follow treatment plans and for forced hospitalisation. However, although a court order may bring about the care a person needs, it is a last resort and is often only enough to have a person evaluated by a psychiatrist or hospitalised for a short period but can not force people to take their medication. In some cases, people with metal illness are required to do so but usually only when the criminal justice system is involved and following a treatment plan is part of the person's probation or parole terms. Torrey (1995) suggests the implication of family members whenever possible. By using the family's influence, as well as having them present throughout the helping process to reassure their loved one of the positive outcomes of treatment, convincing the client to accept the help needed may be facilitated. When the family is involved, time must be taken to educate them on aspects of the illness and possible outcomes.

However, Isaac and Armat (1992) suggest that without some sort of mandatory adherence to taking medication for clients, treatment plans can not be truly successful. They describe a number of successful programs which use public legal authority in a system similar to a public curatorship of a person's treatment plan. The authors note that without such measures to keep clients on their medication, community services can not be entirely successful. Torrey (1997) suggests that similar programs might be needed to reach the hard to treat clients who are presently not receiving any sort of treatment.

This refers to those who have been hospitalised several times, usually by way of court order, then released only to again stop taking their medication and retreat from view until the next court order. Simply hospitalising and re-hospitalising these people is not necessarily beneficial and is extremely costly. Although mandatory adherence to treatment is not the answer for all clients, it may be an effective response for some who have a tendency to drop out of treatment. While some regions of the USA have such programs, Quebec only forces adherence to treatment through its legal system as a condition of probation or parole when the person's untreated illness has lead to criminal acts. It is sometimes suggested that the current laws do too much to protect clients rights and impede assisting them (Torrey, 1997). Although treatment is sometimes made difficult, the protection is essential.

Without it, clients would be dis empowered and possibly rendered unable to play an active part in their treatment plan. Whenever possible, clients should be able to have at least some choice in what services they do or do not receive. Having the choice bestows a sense of responsibility upon the client and improves chances of long term adherence to a plan of service (Torrey, 1995). By providing incentives and assistance to make those choices, clients may have their needs met while at the same time playing an active part in determining the outcome of their illness. For those clients who can not be reached in this way, a more flexible and creative legal tool is needed as suggested by Isaac and Armat (1992). However, there is no one response to dealing with clients who might not adhere to treatment plans and the legal system is not the answer for all.

What is needed and can assist in almost all cases is a general flexibility as well as creativity and tolerance, all of which are at times lacking in our system. Not only must health and social services be less rigid but also the legal system. If all players can adopt a mentality suited to this population, treatment might be better provided to more people without threatening the protections of human rights as they presently exist.