INTRODUCTION:

The purpose of this case study is to explore mental health issues and the diagnosis of enduring mental health illness and carry out an assessment based on problem of chosen mental health illness and analyse the development of historical, culture differences and make a distinction between mental health and mental illness by defining schizophrenia in men and women within working class and acknowledgement the current policies and regulation that impacts on mental health illness. Moreover, I will be analytic towards the problemsolving process and it will be identified by using biomedical, psychosocial and social model of health and the relationship between health model and mental health will be explained and identified by looking at the Changes of the landscape management throughout the years.

IMPACT OF SOCIAL DIVISION ON DISEASE PREVELANCE:

Mental health is related with a  condition regard to their psychological, emotional and social wellbeing that is related with cognitive behaviours and their emotions of how their feels, act and endure their psychological pain that could affect their abilities, daily life and unable to balance between life activities and psychological resilience. The Importance of mental illness holds inequalities and prejudice towards the individuals as they describe a person with mental illness as “loony and Nutter (Kinsella 2006). World Health Organisation predicts (WHO) (2003) 400 million people worldwide will suffer from mental illness determined by multiple factors such as social, psychological and biological.  Differences of mental health and illness is best described with some who cannot cope with mental, physical abilities and cognitive behaviour problem and biological illness. Furthermore, poor mental health is associated with social construction on how the individuals interaction with their society and the construction of knowledge that has been fed in their brain which has been divided into two thread strong and weak constructed by brutal and unsentimental facts.

 Schizophrenia is serious and defined as a chronic mental illness that compares a person’s thoughts and behavior. The word schizophrenia is widely misunderstood by the term which commonly known as split personality as the term schizophrenic is wrongly used by the media, indicating a person with contrasting sides as the schizophrenia does not mean split personality but a destruction to personality (Kinsella 2006). Schizophrenia is a deadly chronic killer of disabling mental illness that affects 200 million people world wide about 1% of world population (WHO 2019). The individuals with schizophrenia afflicted with thoughts disorder experience, hallucination, disorganised thinking and prone to false and paranoid beliefs, (National Institute of Clinical Excellent) (NICE 2009). Schizophrenia is socially constructed by the society and the biomedical model plays a role, as there is no answer for the causes of schizophrenia but plenty of treatment. On other hand, Mulvany et al (2001) argues that schizophrenia is linked with social classes as working class are high likely to get by 5% than other groups, although social classes are not identified as  an important risk factor of schizophrenia, however the relation between low socially classes, poverty, social environmental factors plays an important role as developing schizophrenia. The contrast of social conflict theory which argues about social classes within the society which there are divided into two groups, the wealthy and the poor these are socially constructed by the society, and if they tries to oppress each there and fulfil each others duties and roles in their daily life, thats when the contrast of good and bad social conflict reflects as their are demanding and wanted to be in power and those who not in power wanting power (conflict, 2011). Due to the demand of being in power, in UK we have rich are getting richer and poor are getting poorer, Marmoth (2006).

The symptoms of schizophrenia are classified by the DSM5 and should include a general disturbance  for 6 months period before diagnosed, there is two form of symptoms,  positive and negative that includes in behaviour but there might be cognitive symptoms which are harder to understand or detect as the function is already be impaired ( American psychiatric Association 2018) positive symptoms refers to the presence of psychotic behaviour as positive symptoms can be different and often lose touch with the reality (NICE 2009) . Hallucination hearing voices, seeing nonexistence of objects, delusions of false beliefs, thoughts Disorder dysfunctional ways of thinking disorganised thinking and fails to connect the thoughts logically and lastly movement Disorder agitated body movement, repetition of certain motion. Negative symptoms are associated with disruption to normal emotions and behaviours. The negative symptoms can be harder to identify as it can be seen as part of disorders. In addition, the diagnosis will depend on the presence of welldefined featured (Kinsella 2006). Flat Effect of person does not interact or talk or does not move and could normally be talking in monotonous voice, lack of pleasure in everyday life and ability to sustain planned activities and speaks only little or interact a little even when forced to do so. 

HISTORICAL BACKGROUND:

Dr Emile Kraepolin identified the history open with an overview of Schizophrenia in 1887 as discrete mental illness in less than 100 years old in 1887 and he described as dementia praecox. Before the discovery of schizophrenia in early 1550s  people would discriminate men and women as spiritually they thought their were possessed by an evil spirit and to release the spirit they gave importance to the traditional and culture and the social construction was build to exclude those people with schizophrenia from their society, but later on the medical model took over to attributes mental abnormalities and medical treatment such as psycosurgery as they drill into an human skull to comfort the theory of their belief about an mandatory divine punishment or demonic possession from God due to neglecting religious duties and angering the God.  During 1700s in UK they were many therapeutic landscape of asylum institution that was build either private and public butbefore the built of institution  people with mental illness or disabilities were looked after their families, but on the announcement of asylum the rich people would send their relatives to be cared for with discretion and those with now income tax working class couldnt afford therefore they had to rely on local parishes or send those with mental illness to workhouses or prison, but those that goes to these institution would suffer society isolation, neglect and abuse, even faced death. As per investigation of mental illness asylum it was discovered that patients were left uncured or face other physical and mental issue while they were there as due to treatment people there were left as dead zombies and made their situation worse than the cure, therefore all these institution were forced to shut down and those with mental illness were left with families to look after without any support. Fortunately, birth of NHS in 1948 help those with mental illness with polices and regulation and protect them from harm and it removed any health inequalities between rich and poor.

The diagnosis of Schizophrenia leads to judgemental and disadvantageous to internalise about the negative attitude and stereotype as it play an important role in men and womens life as it led to problematic life, ability to capitalise with equal opportunity as everyone. but with men it its more of effecting their manhood as they dont seek for help, doesnt show or talk about it as they like to keep burden under their mind, which leads to the prevalence rate of men in suicide cases. Liberalisation of schizophrenic created an negative perception and discrimination  socially towards them as it prevents them from inhibit towards employment  and good life, thus they will lead to poor quality of life, (WHO 2007). Negative attitude towards schizophrenia and the media overgeneralisation by worsened the situation, therefore men and women with schizophrenia acts dangerous and violent due to stigmatised but stigma divided into two category of selfstigma and social stigma which created an impact on their daily life by being taunt socially and low esteem personally, (Buizza 2007.)

THEORETICAL APPROACHES:

 The model  of looking glass self is self conceptual model of social, psychological concept of interrelationship between self from out of society and interpersonal interaction perception of society norms ( Cooley 1902). The looking glass self is a vital step in socialisation to meet the demands of society, as social experience contains an impact on schizophrenic person. Moreover, in this modern era the demand of technology is changing how people at forming their identities such as social media influence both men and women to act normal by feeding statements, photos and emojis as their are trying to distinguish the fact of being normal and trying to fit into the society.  Implicit personality theory refers to when an individual uses when creating impressions based on a limited amount of initial intelligence about an unknowing the diagnosis of their condition and   illness. Implicit personality theory also refers to judgements individuals make about someone based on their physical characteristic or personality, For example, when somebody knows one or more thing about particular person and knowledge to assume other things about that individual and decided to socially isolate the individuals due to their mental illness, for instance, assuming an individual with eyeglass is smart. (R. Smith and M, Mackie, 2007).  Furthermore, implicit personality theorist acknowledges that if we look at person in an energetic style, we declare that strength is linked to intelligence, and if another individual is energetic, then we understand that they are clever too. Moreover, implicit personality theory also refers to a set of assumptions that a person creates, often unconsciously about the difference between personality attributes, for example if we see someone with good professional development carer we assume that this person is intelligent and smart therefore its socially constructed that we people in our society with good professionals career, so they do not feel burden the society with their needs. 

Men and women with schizophrenia is labelled and have stigma attached from the society norms and whats acceptable in society, being stigmatised for schizophrenic is an instigation by society as the coping strategies of labelling is adopted by schizophrenic as they are socially withdrawn and reticent (Link at al 1997), means that people were locked in asylum, abandoned houses or killed being a threat to the society. The individuals that are withdrawing from the society is mostly men as to securing their selfesteem and feelings of isolation and rejections; they would keep it within them to prove their manhood. The individuals experiences of social rejection and stigmatise on self conceptual is identified as negative impact from society due to labelling the individuals shows the felling of rejection and neglect are persistence and for long term as the society is impacting the individuals physically, emotionally and mentally tortures to satisfy their social construction of being perfect and meeting the society needs, as this would result them from social exclusion, unemployment, underemployment, poverty and inadequate housing, (WHO 2013) .

 Traditionally people schizophrenia has been perceived negatively by the society and to improve the stigma and discrimination, mental health act was introduced past over years now. The purpose of the ACT is to safeguard people, decrease dangerous treatment such as electroconvulsive without consent. Throughout the years the improved of the mental health act past 40 years have significant changes have occurred such as the way people perceived Schizophrenia in society, all these possible changes were made due to legislation and polices action taken by the government over 40 years therefore theyre is more awareness for mental health, more funds and fundamental flaws of the medical model. The legislation of mental health act have been introduced to help men and women with mental illness and to stable their social life such as employment and life, but later the ACT was modified in 2007 by assessing the individuals and acknowledging a framework to meet their needs and provide health professionals with sense of power in term of treating and protecting the safety of individual and public safety. As time passes in 2015, a social care act was introduced to provide the individuals with mental illness with legal rights especially to those who are from working class or lowincome family as they have social barriers and these could be rents, expenses for food, employability or having housing issues.

The treatment of the Schizophrenia is carried from medical treatment to therapeutic and related with cognitive behaviour therapies, (Nelson 1998). But schizophrenia is seem to be challenging to treat as the individual does want to have any input of engaging but the want the treatment, but there is not much treatment that involves doing but medication is the key element of treatment as they would prescribe anti depressing, anti anxiety, antipsychotic medicines, other than that there is only psychological therapies that could help to ease the mind and the circumstances. The biomedical treatment of Schizophrenia was not available until 1950s and due to these treatment is a rare of hope and desperation of selfneed for those that affected by Schizophrenia and the treatment were ruthless and inhuman and despicable of humanity. Schizophrenia was immutable as the psychologist had numerous of biomedical surgery fails and operation of the treatment that was forced on people and these treatment were antipsychotic drug, chlorpromazine, high body temperature by injecting with sulphur and oil, were forced to stay in crowded lunatic asylum and another special treatment that were received  was purgative, blood letting and rebalance in brain after their had electrocution or electroshock and prefrontal leucotomy which is a process of removing parts from their brain. During that epoch these treatment was famous and believable but rather those operation and surgeries were seen as fatal due to peoples death, side affect in their organs and mentally, physically and emotionally disturbed by the treatment, surrounding due to which 80% declared that their situation and schizophrenia has expansion to an extent where they thought about suicidal attempts, (public health England 2017), selfharm, anguish and desperation for freedom. The establishment of biomedical model is very advanced now, but for schizophrenia only the treatment and the medicine is helpful these help them to cope with recovery, stress, inner pressure and the situation but the medicine that is provided to these with schizophrenia such as antidepressant and psychotic drugs are very harmful substances to our body and the affect it create to our body is neurological damage and tardive dyskinesia due to which you cant control certain movement in the body, Scheff (1999). 

UK MENTAL HEALTH POLICY AND ITS IMPACT:

Community development based alternatives used for hospital care is a longstanding strategy used in UK. Census had been done which enhanced the primary and secondary health care policies but for aged population the provision of better health care services is still a great challenge due to their long run treatment and the increased cost applied to them. More progressively than past three years major developments in the mental health sectors had made. This transformed the more than other health care parts. Such models introduced in which large institutions, to provide longterm care than acute term care, have transformed small institutions. These institutions provide community based health care by the help of multi based mental health care teams. These teams provide support at home as well as in the hospital for acute treatment. For a long term treatment small residential units have been developed, to provide best possible service to patients. From initially used models it has been shown that some patients require more support than provided by such teams. Some changes in the community has been generated by the presence of such individuals so there is somewhat different behavior of people towards such patients. This enhanced coordination model have profoundly increased the development of facilitating environment and betterment in care provision (Helen Gilburt, 2014).

                Mental health services’ transformation started from back 1980’s and onwards and consist of three distinct phases. Deinstitutionalization done rapidly, models of comprehensive care, diversified provision of service with local needs fulfillment. In the first phase deinstitutionalization occur. Till 18th century care of mentally disturbed or ill patients is family or community responsibility but at the end of 20th there is a shift in this perspective occur and the way of people’s care towards mental problems shift. In the second phase some models for enhancing community care were developed and in third phase further development was made and innovation for new needs were made strategically (Helen Gilburt, 2014). The phase of deinstitutionalization has replicated in UK and some other countries which resulted in researches done internationally and also initiated cross comparative research for providing information about processes of learning transformation occurred in the whole world. Patient experience was intended to be improved by the by this deinstitutionalization, other than this several other benefits were also attached with this strategy. Moreover, the construction of hospitals was geared up for the provision of extended social and health care in the community. This strategy include the movement of health care teams in the community as well as the residential care has been initiated for patients who have severe diseased condition and cannot live in the community without support. Staff training and development were set up for better provision of services. Security payment from society were utilized for provision of long term residential care to patients some other funding strategies were made to help these patients and to evolutionalize the health care system (Editors of The Kings Fund, 2020).

PERSON CENTERED CARE

These strategies working in in UK have focused the cultural issues and thus introduced provision of cultural sensitive activities. For this they consider the patient’s cultural norms, their values, religion, faith and norms of community. This has helped in mental as well as physical wellbeing of patient. In this policy they also took care of diet of the patient, as diet incorporate so much response in the success of treatment of the disease. In this act they also worked on training the volunteers to ensure provision of good services keeping care of their customs and traditions. Act also enforced the formation of services that are accessible. As most of the patients are unable to speak English as they are unaware of it so the better way to have a successful session is to make it interactive. This act also include the implementation of strategy of the movement of health care teams in the community as well as the residential care has been initiated for patients who have severe diseased condition and cannot live in the community without support. Some activities which include education were also be introduced to shift the learning ability to “try something new” strategy. The older people along with peers participate in this strategy and service providers were intended to introduce some new strategies. (Bi, 2012)

BIOPSYCHOLOGICAL MODELS AND ITS IMPACT ON DISEASE PREVELANCE:

Biomedical plays an important factor with schizophrenia it also contrast with that social and sociological factors. A survey was conducted in between November and December 2011 by the UK Council for Psychotherapy and the British Psychoanalytic Council which reported that 97% of the personnel were downgraded, 63% have cuts in their psychotherapy while 48% people are those with decreased commissioned psychotherapy and 68% are those with complexities in their cases. This decline in the therapy are not suggested by IAPT, so NHS has taken charge and replace the therapies with other type of therapies. These changes helped more than half of the cases in which decreased therapy rate was found. This has also turned the people towards the utilization of therapies intended for their health betterment and cure. Several different forms of therapy were introduced which can be easily chosen based on suitability by diversified group of patients. (Editors, 2013)

Biopsychosocial model includes both philosophy of clinical care and its practice. It is a path through which a practioner comes to know about how patient is suffering from disease and how he affected by several factors. In circle of bio psychosocial model a contribution which is necessary for the scientific clinical method were made with some clarifications which include relation of the health’s physical and mental complexities, linear approximations were used to temper the circular causality while treatment, increased participation of practioner and patients. Such practices also include active trust cultivation, determination of emotional style which best suits the curiosity empathically, calibration of self to decrease biased behaviors etc. (Francesc BorrellCarrió, 2004)

CONCLUSION:

In evaluation, a deterministic approach is scientific, through the uses of scientific methods, treatment were used to help those with schizophrenia, but as the landscape of management changes throughout the years we have developed numerous of treatment, medicine, therapies and involved the help of community to ensure the safety of individuals and public, but in this modern era the polices does not justify the the action as it not consistence with the legal system.

References

  1. Bi, S., 2012. Engaging faith and BME communities. Fit as a Fiddle by Age UK, July .
  2. Editors of The Kings Fund, 2020. Case study 1: Deinstitutionalisation in UK mental health services. The Kings Fund.
  3. Editors, 2013. We still need to talk A report on access to talking therapies. [Online]
    Available at: https://www.mind.org.uk/media/494424/westillneedtotalk_report.pdf
    [Accessed 7 April 2020].
  4. Editors, A., n.d. Diagnostic and Statistical Manual of Mental Disorders. American Psychatric Association.
  5. Francesc BorrellCarrió, A. L. S., 2004. The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. NCBI, November, Volume 2(Issue 6), p. Pages 576–582.
  6. Helen Gilburt, E. P. B. A., 2014. Service transformation Lessons from mental health. The King’s Fund, pp. Pages 110.
  7. Kinsella, C & Kinsella, C, (2006) Introducing Mental Health, A practical Guide, ed Jessica Kingsley: London
  8. McNally, Kieran (2016) Palgrave Studies in the Theory and History of Psychology: A critical history of schizophrenia, 9781137456816: p263
  9. NHS, 2019. [Online]
    Available at: https://www.nhs.uk/conditions/schizophrenia/diagnosis/
    [Accessed 7 April 2020].
  10. int, 2019. Schizophrenia. [Online]
    Available at: https://www.who.int/newsroom/factsheets/detail/schizophrenia
    [Accessed 2020].

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