Evaluating Mental Health Policy Health And Social Care Essay

Evaluating cordial health Policy wellness And Social C be testifyMental ill health during early stupefyhood, or perinatal amiable malady, is a salutary state- aided health issue with potentially serious consequences for womens disembodied spirit-long intellectual health and the health and soundbeing of their children and families (Hayes, et al, 2001). Although difficult to estimate, there atomic number 18 in any case economic and br other(a)ly costs associated with the cognitive and doingsal electric shock of postpartum imprint. As of 2008, the home(a) economic burden of this condition to public services is estimated at 35.7 million per annum. The mean estimated cost for agnatic finagle in the comm building blocky for those with postpartum falloff is 55% higher than for those with surface (Petrou et al, 2002). It send packing also herald the onset of long- experimental condition genial health problems for the match and is associated with increased risk of m aternal suicide (Oates, 2003). Postnatal drop-off has also been linked with low in fathers and with high rates of family breakdown (Ballard, 1994). at that place is also march that children born to deject mothers do less well educationally, experience higher levels of conductal problems and ar more likely to rise psychogenic problems in later life (Oates, 2002).Social alimentation is a flexible concept so b track that its meaning faecal matter considerably be assumed, or bent to resistent purposes, rather than overtly go to to. This produces problems in researching societal score got since the implicit in(p) assumptions or theoretical frame travels of the work are not always class. Postnatal opinion has been associated with a overleap of social tin (Bebbington, 1998). The risk of PND has been engraft to increase when the level of social relief is low or absent (Morse et al 2000 Pederson 1999). Beck (1992) states that social support not only provides concret e inspection and repair, but dope aid the mother wound uply by hindering the reciprocal experience of rumination. in that location are third common forms of postpartum affecti iodines the baby blues, postpartum (or postpartum) depressive disorder and puerperal psychosis, each of which differs in its prevalence, clinical presentation, and screwment. Postnatal depression is the most common complication of childbearing (Wisner, et al 2002), affecting 10-15% of women (Cooper et al, 2008). According to the National constitute for clinical Evidence ( adequate, 2007) postnatal depression (hereafter also known as PND) has been defined as non-psychotic depression occurring during the first 3 months interest the take in of a baby. The 10th revision of the International Statistical Classification of Diseases and relate health Problems (ICD-10) defines the perinatal current as commencing at 22 correct weeks (154 age) of gestation and ending s reddening completed days after gestate (WHO, 1992). In the tetradth edition of the Diagnostic Statistical Manual (DSM-IV), the American Psychiatric Association makes no mention of perinatal amiable illness although postnatal depression is included, but only if the mother is diagnosed within four weeks of the take over (American Psychiatric Organisation, 1994).The interest and motivation for exploring the topic of postnatal depression is due to professional experience of working in this field. This sermon seeks to look the variety of approaches for treating PND, focussing on the role of social support. Current national insurance policy and frameworks ordain be examined, together with current let of interventions.Evaluating Mental Health PolicyThere have been some an(prenominal) discussions almost whether depression during the early postnatal occlusion is all quantitatively or qualitatively different from depression at other measures (Stoppard, 2000) and has been the focus of ofttimes policy and research since the 1960s (Brockington, 1998). In 2004, the National Institute for Clinical Evidence ( comely) asked the National Collaborating Centre for Mental Health (NCCMH) to develop a clinical turn tailline on the treatment and management of psychic health problems in the antepartum and postnatal period (NCCMH, 2004). Before this, the Department of Health create a 10 year agenda for improving psychical health care in England, known as the National receipts Framework for Mental Health (NSF, 1999) which set priorities for the way that services were to be provided. The NSF proposed protocols to be implemented for the management of postnatal depression, concern disorders and those needing referral to psychological therapies. The NSF recognize the role of Health Visitors with training who could use routine contact with naked mothers to identify PND and treat its milder forms. Furthermore, the NSF related to actions to reduce suicides, by ensuring that staff would be competen t to assess the risk of suicide among individuals at greatest risk. This streamer was relevant to Health Visitors, as maternal suicide was cited as the largest induce of maternal death in the first postnatal year.Subsequent policy statements and guidance have since been supplemented to the framework, including the National Institute of Clinical Evidence (NICE, 2007) guidelines for antenatal and postnatal amiable health (NICE-CG45, 2007). The NICE guidance identifies the need for excited and social support for unsanded mothers, whilst the National Service Framework puzzles to drive home a high quality standardized service. In 2007, the in-depth guidance was print where the standards for postnatal psychological health needs were summarized asAll professionals knotted in the care of women immediately pursual childbirth need to be able to distinguish normal emotional and psychological changes from significant genial health problems, and to refer women for support according to their needsAll professionals instanter involved in the care of each charr who has been identified as at risk of a recurrence of a severe mental illness pastime the birth, including the family, are familiar with her relapse signsEach woman who has been identified as at risk of a recurrence of a severe mental illness has a written plan of concord multi-disciplinary interventions and actions to be takenThe Department of Health issued guidance in 2009, called the good Child Programme pregnancy and the first pentad years of life and is an update to the National Service Framework for Children, Young People and motherhood Services (2004). The programme speech patternes the NICE guidelines, including the need for the woman to be asked nice and appropriate questions to help identify depression. Additionally, the programme states the need for parent-infant groups, baby massage, auditory sense visits, cognitive behavioural therapy and interpersonal therapy.In February 2011, the Go vernment published its new Mental Health strategy No Health without Mental Health which acknowledges that mental health is a public health issue that needs co-operation from many different agencies, including education, social care, housing, employment and welfare.According to NICE (2007), unlike psychosocial and psychological treatments are recommended for the management of depression in the postnatal periodSocial support can be defined in legal injury of sources of support (e.g. spouse, friends and relatives, support groups), or in terms of the type of support received, (e.g. informational support, emotional support, practical support).Non-directive counselling an empathic and non-judgemental approach, listening rather than directing but offering non-verbal encouragement. This approach is usually offered by health visitors.Self-help strategies channelize self helpComputerized cognitive behavioural therapy (C-CBT)ExerciseBrief psychological treatmentStructured psychological tr eatmentCognitive behavioural therapyinterpersonal therapyNICE guidelines clearly state that PND services are subject to local variation due to locally existing services. To ensure the stampive provision of high quality clinical services, it is essential that there is a clear referral and management protocol for services with a well defined pathway. Furthermore, NICE guidance states that services should develop clinical ne iirks to improve access for women to specializer perinatal mental health services.In a report published in March 2011 by the Patients Association, it was found that 64% of Primary anxiety Trusts (PCTs) do not have a specific strategy in place when commissioning services specific to PND. World Class mission (www.icn.csip.org.uk) clearly states that PCTs should have services that accurately reflect the needs of the local population. The report also shows that 44% of PCTs are failing to implement the NICE guidance due to not being part of a clinical nedeucerk o r not having a stretch forth clinician for perinatal mental health.Is there a problem?What is it?Why does it need to be figure out?What is your hypothesis (hunch)?Who pass on value from your investigation?In what sense will they benefit?In what sense will my contribution add to what is already known?How in general terms are you going to bring in the problem, e.g., collect data, analyse data?By what methods? E.g., a case knowledge approach.What are the constraints or limitations of the study?Methodology (The title of this oratory is postnatal depression and the role of social support from a womens rightist perspective.A systematic literature check out was conductedThe search methods used for the literature re ken were as followsDatabases searched included MEDLINE, CINAHL, DAWSONERA, PsychLit, EBCOHOST, CENTRAL and DARE. make books as listed in the References.Published articles in hard copy journals.Key terms were postnatal depression, postpartum depression, closing off, soci al support, stigma, mental illnessThe searches were designed to be as inclusive as possibleThe searches were limit to articles between 1985 and 2011.An sum totalal google search was conductedOverall, a total of ( ) abstracts were identified by the literature searches, over ( ) papers were assessed resulting in the final reference list of ( ) papers.Methodological limitationsEthical limitationsThe overall aim of this study is to visualize postnatal depression and the objectives are as follows explore the different sources of social support for new mothers in the year interest childbirthTo evaluate the effectiveness of different setsTo examine the evidence of expertness of social supportTo consider the findings in singing to policy and practice interventions and guidance of perinatal mental healthTheoretical Perspective beer maker (2000) states that opening is a set of interrelated abstract propositions about merciful affairs and the social world. firearm much of the researc h on postnatal depression has been subjective, it may provide a political and ideological cargo to supporting the victimisation of health services specifically targeted at womens health needs. Such a political process is consistent with the drive of womens liberationist concerns that the health care system has failed to distinguish the busy needs of women (Najman, et al, 2000). This dissertation will attempt to look at the role of social support role from a feminist perspective.According to Busfield (1996), feminism is a philosophy suggesting that women have been systematically disadvantaged. Durrheim (1999) argues that feminist theorists aim to change this by look into the situations and understanding the experiences of women in society and in doing so, provide a demote world for women. Feminist research is opposed to patriarchal societies, which attempt to understand the world in order to control and exploit its resources. Feminists also tell apart the male point of view a s objective, logical, task-orientated and instrumental. It reflects a male emphasis on individual competition, on dominating and controlling the environment (Neuman, 1997). Further, by examining postnatal depression through a feminist lens, the mechanism of social structure that contributes to the pressure to find motherhood a perfect, happy time can be addressed.Postnatal depression has been inform and studied since 1858 (Richards, 1990). In the nineteenth century, psychiatricalal disorders due to pregnancy and childbirth were common copious to account for 10% of all asylum admissions (Marland, 2003). Allen (1986) states that writer Chesler (1972) assumes that psychiatry sees women as madder than men and is perhaps rooted in the historical context of use of womens psycho-pathology being linked with femininity (Showalter, 1987).Taylor (1996), suggests that the dominant discourse surrounding postnatal depression overlooks the social construction of gender order and conventional gendered strength dynamics. Furthermore, she stresses that the media play a role in blaming mothers, questioning appropriate behaviour and the choice of self-identity outside of motherhood. The structure of families in modern society creates problems of isolation and alienation (Taylor, 1996) as we move outside from the traditional nuclear family building block and loss of close extended family ties.Over the past decade, self-help, recovery, and support groups that channelize upon the discourse of feminism have gained increasing importance as sources of emotional support and settings in which women seek to redefine the female self.Models of mental illnessPostnatal depression is conceptualized as a malady or illness and research efforts have been devoted to describing, predicting, preventing, and treating it (Cox Holden, 1994). Researchers have also endeavoured to uncover the underlying factors associated or correlated with postnatal depression, including biological variables much(prenominal) as horm unrivalleds, other biochemicals, genetic factors psychological characteristics much(prenominal) as personality traits, self-esteem, preceding(prenominal) psychiatric history, family history, attitudes towards children, deficiencies in self-control, attribution style, social skills a range of social variables, for precedent an unplanned pregnancy, method of feeding the baby, type of delivery, obstetric complications, infant temperament, previous experience with babies, marital relationship, social support, stressful life events, employment status, and socio-demographic characteristics such as social class, age, education, income, parity (OHara Zekoski, 1988).Mental illness can be difficult for people to understand or empathise with. Similarly, even mental health professionals can have difficulties in understanding what is going on for the patient, as there is no one diagnostic test that can be performed on the brain in an attempt to provide a simple answe r or treatment. The effects of mental illness are made apparent in actions, qualityings and thoughts, and thereof a model or group of linked theories is used to explain the cause and predict the trounce source of treatment. Doctors helping people with mental illness have models to guide them in both diagnosis and treatment. Most models of mental illnesses will directly acknowledge a combination of biological, psychological and social factors. Different models will, merely, switch in which factors they rate as the most grave. When advising a patient, a revive tries to look at which interventions are likely to work best for that particular patient, taking into account the patients symptoms and circumstances. Models are the basis of every scientific belief.The health check model and behavioural model of psychiatric illness differ in their assumptions about the nature of the illness and the appropriate treatment (ref), however many practicing psychiatrists use features from b oth in the bio-psycho-social model (ref). Psychological models such as the learning theory, personal construct theory and psychoanalytic theory differ in the time-scale over which they try to produce explanations of behaviour.A biological model of mental illness is based on the presumption that the illness has a tangible cause and hence requires a physical treatment. This model suggests that mental illness is caused by chemicals, genetics or hormonal imbalances and such, a biological intervention or treatment would be drugs to reverse the chemical imbalance.A psychological model says that disruption or dysfunction in psychological processes lead to mental illness. Furthermore, personal experiences, social and environmental factors are important contributors to psychological disoblige. Taking anti-depressant music would not be treating the cause of the problems hence treatment would be in the form of therapy such as psychoanalysis and cognitive behaviour therapy.There are twai n social models of mental illness the labelling theory states that behaviours disliked by society are denominate as symptoms of a psychiatric illness. Labelling a person as having a disease, particularly mental illness is to become that illness, for instance shes mental and it is therefore easy to understand the concept of blame and stigma surrounding mental illness. Society believes that we can and should be able to control our psyche and emotions and therefrom the descent into mental crisis should be avoidable and controllable. Labelling, therefore, questions the very existence of mental illness and helps to maintain the imbalance of power between men and women (Taylor, 1996). Labelling a gendered illness provides society with a more palatable acceptance of the disease and its options for treatment. Szasz (1962) examined the concepts of stigma in mental illness and criticised the ways in which psychiatry made assumptions about those labelled as mentally ill.Another theory is tha t social situations can lead to a mental illness. For instance destitution leads to situations that a person cannot control, which can lead the person to develop anxiety. rough researchers suggest that the availability of medical care and expectations of quality of life following the birth of a baby (Thurtle, 1995) lead to postnatal depression.Feminist sociologists have looked at the impact of social factors on womens mental illness from three different perspectives societal causes, medical causes and the mother herself (Taylor, 1996). A typical feminist approach would be to question whether a historically patriarchal tradition, viz. medicine, can realistically address the experiences and needs of women.Medical perspectives consider that womens sadness and discontent is framed in psychiatric terms and are therefore treated accordingly. The medical model has been the dominant theoretical perspective of postnatal depression and according to a feminist perspective this disempowers womens individual experiences. While feminist researchers have criticized the medical model for the way it blames individual mothers for their difficulties, mothers themselves relish that the medical label and status, and the hormonal explanation, have the opposite effect of evacuant them from blame and responsibility because the depression is something which is happening to them, their bodies and is therefore beyond their control. It is calm for some to know that they were not going mad but experiencing a medically recognized problem, shared by other mothers, and for which they were neither creditworthy nor to blame. Oakley (ref) suggests that pregnancy and childbirth are constituted as a disease by the medical profession.In an article written for the British diary of General Practice, Richards (ref) questioned whether giving the diagnosis of postnatal depression to tired, overwhelmed women, simply allows them to deed of conveyance sickness benefit. Considerable effort has been put into research into the causes of postnatal depression from a biological or hormonal reason however Richards (1990) believes that no consistent relationship has been found.Dalton (1989) claims that there are endocrinology reasons for depression after childbirth, and that this could be treated by diet or hormonal treatment. However Oakley (1980) criticizes this view from a feminist perspective, believing this emphasizes women as reproducers. Despite Daltons (1989) opinion that postnatal depression is caused by hormones, she does believe that social and psychological support could benefit the mother.Kitzinger (2006) believes that many women are wrongly labelled as suffering from postnatal depression because they are unhappy after the birth, when in fact their distress is the result of a medically managed but traumatic birth. Kitzinger (2006) argues that the failure of the gestation period services to give humane care can be ignore when the focus is placed on the mothers performa nce during childbirth. There are many theoretical perspectives that seek to explain the notion of postnatal depression and this dissertation will be focussing on the feminist perspective in a later chapter.Chapter 2 Postnatal DepressionThe postnatal period is well known as an increased time of risk for the development of serious mood disorders. Many women tactile property exhausted, not just from the physical efforts from giving birth, but the emotional effects of adjusting to their new role as a mother. Although this dissertation is concentrating on postnatal depression, there are two other important conditions that can be diagnosed after the birth, which will be briefly mentioned as followsBaby bluesBaby blues is the term used to describe temporary feelings of tearfulness and lack of concentration either immediately following the birth or within a some days, sometimes coinciding with the mothers milk coming in. These feelings may come as a shock to the mother, as she may have e xpected to feel joy and elation. This condition is very common in up to 80% of new mothers, so is considered as normal, but generally passes after about ten days. There is no treatment for the baby blues, however practical and emotional support in these first few days would be helpful.Puerperal psychosisPuerperal psychosis is a terrifying and rare complication following the birth affecting between one in 500 and one in 1000 mothers. The symptoms are hallucinations and delusions and frequently the mother believes that the baby is evil, she hears voices and can be confused. The word psychosis is simply a medical term, which means, according to the lexiconany severe mental disorder in which contact with naturalism is lost or highly distortedThe common treatment is anti-psychotic medication however the mother may have to be admitted to a psychiatric unit for observation.Symptoms of PNDThe onset of postnatal depression can be slow and difficult to distinguish either from the normal em otional sensitivity of late childbirth, or because the mother is hesitant to disclose her true feelings. Many women feel that they may not need support or that they can manage on their own, whereas others may think there is a stigma attached to admitting feeling depressed. Some of the identifying symptoms of postnatal depression can be physical, however the majority are emotional and affect the everyday life of the mother. In order for a diagnosis to be made, at least five of the following symptoms have to be present for at least two continuous weeksFeeling unable to cope, loss of confidence, feeling inadequate scare attacks, excessive anxiety and obsessions about the baby, routines and cleaningNegative thoughts, irrational thoughts, depressed moodFeeling little/no love for the child, delayed/no bonding with the babyNot enjoying motherhood and wondering what is wrong with them because of itNo interest or pleasure in anything, boredom, things seeming pointless suicidal thoughtsCons tantly needing reassuranceFear that if they asked for help their baby would be taken awayFeeling a burden to family and friendsEverything seeming negative, unable to remember unconditional times/thingsThings getting out of proportion, being thrown by even small thingsTiredness, lethargyLoss of appetite, weight lossLoss of interest in sex, loss of libidoRisk factorsThere is considerable discussion surrounding the cause of postnatal depression (Richards, 1990). In a report written by OHara and Zekosi (1996), their findings led to the certainty that PND reflects the coincidental occurrence of the puerperium and depression, rather than reflecting a causal relation between childbearing and depression. However, Kumar et al, (1984) found that childbearing in itself has a damaging effect on the mental health of women. Martin et al (2001) conducted a comparison of women in a psychiatric mother and baby unit and concluded that puerperal depression has a distinct biological aetiology. This conflicts with Richards (1990) conclusion that there is no link.According to Harlow (2003), any mother can be affected by postnatal depression, with no relation to age, social class, cultural background or educational status. However, research studies have consistently shown that the following risk factors are strong predictors of PNDPoor quality social supportAn unstable or unsupportive relationshipDepression or anxiety in pregnancyPrevious history of sexual abuse upstart stressful life eventsLabour/birth traumaIn addition to many factors on the mothers side, there may be a relation between the behaviour of the infant that has an effect on maternal depression. In a study of 188 first time mothers, neonatal irritability and unfortunate motor function was found to predict postnatal depression (Murray et al. 1996). There are few studies on the role of infant factors in the aetiology of postnatal depression, but it is possible that the babies react to parental mood and depression and vice versa.PrevalenceAccording to Cox (1993) the incidence of women developing postnatal depression in the UK is between 10-12%. However, a study conducted in 2002, found that 27% of mothers aged between 15-44 years of age were found to be suffering from postnatal depression, of which half of them had contacted their GP within 4 months of the birth (Kaye, 2002). The rate of prevalence has varied due to different criteria (e.g, general practitioners or psychiatrists diagnosis, self-report questionnaire, clinical interview), different study designs and different time intervals (from few days up to several years) used. OHara (1987) suggested that the symptoms of postnatal depression can be eased and diminished within one to six months, but sometimes depression can become chronic. Thus, it should be acknowledged that without effective treatment postnatal depressive symptoms may continue for as long as one to two years.The sixth report of the confidential enquiries into maternal death s in the UK, Why Mothers Die, describe suicide as the most common cause of maternal death for women in the first year after childbirth. According to the Confidential Enquiries announce for Mothers and Child Health (Lewis, 2004) the number of suicides by women during the perinatal period has declined from 29 in 1997-1999 to 21 known suicides in 2000-2002. Depression can lead to more deaths from suicide each year than there are deaths from road accidents.According to Gregoire et al (1996), if postnatal depression is left untreated, 25% of women will continue to suffer one year after delivery and one in twenty-one women will still have postnatal depression two years later (Lumley et al, 2003). The statistics also show that women with untreated PND are at least 300 times more likely to suffer again in subsequent pregnancies (Hamilton et al, 1992).DetectionThere are a number of rating scales used to measure and detect postnatal depression. In many countries, health visitors screen for PND using the Edinburgh Postnatal Depression casing (EPDS), which is a 10-item self-reporting screening instrument to aid the detection of post-natal depression (Cox et al. 1987 Murray and Carothers 1990 Warner et al. 1996 Wickberg and Hwang 1996b). This is designed to assess the mother at 6-8 weeks after the birth by the Health Visitor at home (appendix). A threshold score of 12 has been used as an indication that correctly identifies at least 80% of mothers with major depression (Cox et al. 1987 Harris et al. 1989 Murray and Carothers 1990).The NICE guidelines recommend the use of the Whooley questions (appendix) as a simple screening method to detect postnatal depression. This screening proficiency is used by health visitors at the initial contact and offers the luck to screen without a formal assessment.However, the EPDS and Whooley questions are not diagnostic tools in their self, and should always be used in conjunction with a clinical evaluation if necessary.Consequences of postnatal depressionDifferent mechanisms have been proposed to explain the effect of postnatal depression to childs psychopathology (Murray and Cooper 1997). Whiffen (1989) suggests that infant temperament and behaviour is related to postnatal depression, both as a consequence and a cause of it. Mothers with chronic depression have infants with more behavioural problems such as sleeping and eating problems and temper tantrums (Campbell et al. 1997), and severity of depressive symptoms associates with compromised cognitive and concomitant security (Lyons-Ruth et al. 1986). A second effect might be the maternal interactional and parenting style, secondary to maternal depression. Mothers with postnatal depression may be emotionally unavailable for their infants and they may withdraw from interaction situations. In addition, they may respond in an inappropriate or unpredicted or even unreceptive manner to their child.Paternal postnatal depression is rarely reported or studied, but esti mated rates of paternal depression have varied from 4 to 13% (Ballard et al. 1994, Areias et al. 1996) in the early postpartum period.Treatment and barIf postnatal depression is left untreated, it can persist for many months with unfavorable consequences for mothers, children and families (Josefsson et al, 2001). There is the possibility of short and long-term consequences for the babys cognitive, social and emotional development. demoralise mothers make more negative and fewer positive responses to their babies and the infants learn a style of interaction that transfers to their subsequent interactions with other people (Field, et al 1988). perennial term adverse influenceshave been demonstrated on childrens language development, IQ and social development (Coghill et al . 1986 Sharp et al . 1995 Murray et al. 1996 1999).Typically, mothers with postnatal depression go through silent suffering. Effectivetreatments are available, but help is often not actively sought. Small and hi s group (1994)found out that only one third of depressed mothers sought professional help. However,these mothers often advised other depressed mothers to find someone to talk to.However, the evidence for the effectiveness of interventions to prevent postnatal depression is conflicting. Stuart, et al, (2003) suggested that early intervention, even in the antenatal period is an effective way of tackling postnatal depression. Midwives counselling, given support and explanations about the childbirth prior to labour provided a better postnatal mental health of the mothers (Lavender and Walkinshaw 1998). The statistical power of existing studies is, however, very limited (Lawrie 2000). The provision