Protection of Vulnerable People: Safeguarding those with Mental Illness

Introduction

Individuals with mental health conditions may suffer from neglect and abuse as a result of their condition (Taylor, 2006).Hence, the National Health Service (NHS) in the UK places emphasis on safeguarding these individuals and recognising them as a ‘vulnerable’ group.The Department of Health (2000) states that the act of ‘safeguarding’ is synonymous with protecting those who are more exposed to abuse and neglect.

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The main aim of this essay is to discuss safeguarding patients suffering from mental illness. The first part of this essay discusses vulnerability in this group. Factors that influence vulnerability and how these impact the health and wellbeing of these individuals will also be explored. The second part discusses multidisciplinary and multiagency interventions to protect and safeguard those with mental health conditions. The third part examines the safeguarding laws and policies that support and inform the work of a multi-disciplinary team. This will then be followed by a reflection of the findings of this essay and how these influence practice of a student nurse. Finally, a conclusion that summarises the key points raised in this essay will be done.

Vulnerability of patients with mental health conditions
Watkins (2008) observes that the limited ability individuals with mental health conditions to express themselves increase the risk of abuse. For example, patients might express their fears and anxiety through aggressive behaviour (RCN, 2008). When patients are placed in a new environment, such as a hospital setting, they might be unable to articulate their feelings and become anxious. This is aggravated when they could not see their family members or when nurses take over their families in providing for their care (RCN, 2008). McDonnell (2011) explains that is not uncommon for these patients to become defensive and aggressive when surrounded with ‘strangers’.

Second, patients with mental illness often suffer from stigmatisation, discrimination and isolation (Lubkin and Larsen, 2011; Moran et al., 2013; Mestdagh and Hansen, 2014). Moran et al. (2013) states that isolation could aggravate the patient’s mental health condition since loss of social support increases risk of depression. Stigmatisation, on the other hand, increases vulnerability since patients might not access appropriate healthcare services due to negative perceptions of patients with mental illness (Mestdagh and Hansen, 2014). Individuals with a history of mental illness could also experience discrimination at work or when applying for employment (Lubkin and Larsen, 2011). All these factors influence the health and wellbeing of those with mental health condition. Lack of social support and inability of an individual to find an employment increase the risk of depression (Lubkin and Larsen, 2011). It is widely established (Cocker et al., 2014; Lubkin and Larsen, 2011) that chronic depression is strongly associated with poor health outcomes such as development of cardiovascular diseases, hypertension, obesity, type 2 diabetes mellitus and other chronic conditions. Importantly, depression has been associated with poor adherence to medications or a care plan (Grenard et al., 2011). Hence, vulnerable individuals such as those with mental health conditions could suffer poorer health as a result of discrimination, stigmatisation and isolation.

Multi-disciplinary and multiagency interventions to protect and safeguard those with mental health conditions
A blended approach in caring for vulnerable individuals with mental health conditions has been promoted in the NHS (Transition Pathway, 2005). Different groups of healthcare professionals are involved in safeguarding those with mental health conditions. For instance, occupational therapists help patients engage in occupations that help restore meaning in their lives. On the other hand, therapists provide different types of counseling to assist individuals cope with their condition. For example, these therapists offer cognitive behavioural counseling or family therapy to help patients with their thought process or engage family members in the support and management of the individual (Gehart, 2012). Drawing from different literature, mental health nurses could also use current evidence to help inform care plans that are specific for the needs of a vulnerable individual.

Meanwhile, a focus is made on patient-centred care (Transition Pathway, 2005) This means that vulnerable individuals participate in healthcare decisions regarding their health. Health and social care team members provide the needed support as they help students arrive at an informed decision. Today, there are many types of therapies and interventions for individuals with mental health condition. Watkins (2008) observes that each individual is unique and hence, blended approach and choices are necessary to create a healthcare plan specific for the individual. The chronic nature of mental health conditions also requires prolonged support and care from different healthcare team members. Similarly, multiple agencies have to coordinate care for each person. Many vulnerable individuals with mental health condition have to transition from supported care to independent living. Further, transition from adolescence to adulthood for vulnerable individuals could be a specially challenging time. The Department of Health (2011a) has provided the Pathways to getting a Life white paper to help health and social care practitioners coordinate care for those with mental health condition transition to independent living.

One of the challenges when providing multidisciplinary and multi-agency care for vulnerable individuals is allowing patients to exercise autonomy while maintaining their safety. The Nursing and Midwifery Councils’ (NMC, 2008) code of conduct stresses the importance of respecting patient autonomy when making healthcare decisions. However, patient autonomy might be difficult to observe especially if choices of the patients could lead to poor health outcomes. On the other hand, patients are also encouraged to participate in healthcare decisions. While this is considered as best practice, some patients might be reluctant to participate in healthcare decisions (De Las Cuevas and Penate, 2014; Goggins et al., 2014; Hajizadeh et al., 2014). This might be due to poor levels of knowledge regarding their condition (Goggins et al., 2014) or inability to participate in healthcare decisions (De Las Cuevas and Penate, 2014). The former could be addressed through patient education while the latter through representation of a family member.

Meanwhile, social care has an integral role in helping vulnerable individuals not only transition to independent living but also in assisting them find suitable employment. The partnership between health and social care ensures that individuals receive sufficient support when they return to their communities.

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Hence, empowering patients to take care of their own needs and to manage their condition prevents exacerbation of the condition or development of complications.

Safeguarding laws and policies

The policy ‘No Health without Mental Health’ (Department of Health, 2011b) acts as a guide for different healthcare professionals, social care workers and other stakeholders when providing care for individuals with mental health conditions. Specifically, this policy states that equitable treatment should be provided for vulnerable groups. This suggests that treatment and services should not only be patient-centred but also responsive to the immediate and long-term needs of the vulnerable individual. However, equitable mental health treatment for different groups of patients still remains a challenge in the NHS.

For instance, Nzira and Williams (2008) argue that all individuals, regardless of their race or ethnicity, should enjoy equality in choice of their care providers and process. However, analysis of recent literature (Cantor-Graae and Selten, 2005; Kirkbride et al., 2008; Marmot, 2010) suggest that individuals from the black and minority ethnic groups do not enjoy the same ‘equality’ promoted in the Department of Health’s (2011b) policy. Incidence of mental health conditions is still higher in the black and minority ethnic group compared to the general white population in the UK. Further, this group also experiences social exclusion as a result of poor housing opportunities. There is evidence that poor housing and homelessness have been associated with poorer mental health (Pattereson et al., 2013). Hence, individuals with mental health conditions who happen to belong to the black and minority ethnic groups tend to have poorer health outcomes compared to their white counterparts (Kirkbride et al., 2008).

Apart from evaluating the impact of the ‘No Health without Mental Health’ policy on vulnerable groups, it is also essential to investigate current legislations that safeguard those with mental health conditions. The Equality Act (UK Legislation, 2010) and the Mental Health Act 2007 (UK Legislation, 2007) both promote the rights of mental health patients. The first Act supports equality in the workplace. For instance, the Act states that employers are generally not allowed to ask about the disability of an individual before a job is offered. Although this does not exempt employers from asking questions on the health and background of future employees when absolutely necessary, this shows that equality is observed in the workplace. Meanwhile, the Mental Health Act 2007 (UK Legislation, 2007) introduces changes to the previous Mental Health Act 1983 (UK Legislation, 1983). This time, definition for mental health professionals is broadened to include different healthcare professionals who are involved in the care of patients even without their consent. It should be noted that patients who pose a significant threat to others and to their own selves are admitted, detained and treated in hospital settings under this Act.

Refection

On reflection, this essay helped me realised the importance of increasing my knowledge on the needs of vulnerable patients with mental health conditions and the factors that promote their vulnerability. Healthcare professionals, particularly nurses, serve in the forefront of care. As leaders of care, I will facilitate the care and management of vulnerable patients in the future. This is only possible if I am aware on how cultural differences, stigmatisation, discrimination and isolation influence the trajectory of their condition. I realised that all these factors are crucial in promoting inequalities in healthcare. If I fail to address these factors, I will not be able to provide quality care to my patients.

This essay also helps me appreciate the value of working in multidisciplinary teams and being aware of the roles of each team member. Since mental health conditions are complex, a blended approach is necessary to address individual needs. Vulnerability of an individual is increased when team members fail to consider and address the holistic needs of a patient. In my current and future practice, I should be aware of how I could contribute to effective team collaboration in order to reduce patient vulnerability.

There is also a need to be aware of different safeguarding laws and policies for mental health patients. This will help me use these laws and policies to lobby for the rights of my patients. The Nursing and Midwifery Council (NMC, 2008) stresses the importance of patient safety and providing only quality care. Patient safety is observed when policies and laws on safeguarding are used to the fullest. On reflection, I should continue to become acquainted with different policies and legislations on safeguarding to ensure that the rights of my patients are protected. Specifically, this will help me find appropriate programmes or care pathways for my patients. On reflection, I should provide patient education to help patients make informed decisions regarding their care. This will not only empower my patients but also help them self-manage their own conditions.

Conclusion

This essay explores the concept of vulnerability and focuses on patients with mental health condition as a representative of the vulnerable group. These patients have additional challenges since mental illness is still strongly associated with discrimination, isolation and stigmatisation. Ethnic background also plays a role in their access to appropriate health and social care services. Those belonging to the black and minority ethnic groups have higher incidence of mental illness and less access to healthcare services compared to their white counterparts. The care pathway for vulnerable groups is supported by different health and social care agencies. Multidisciplinary and multi-agency team working are necessary to provide support to vulnerable groups. This essay demonstrates the importance of coordinating care and using a blended approach. Patient-centred care is highly promoted in the NHS since it is essential to design a care plan specific to the healthcare needs of an individual. Finally, this essay shows the importance of becoming acquainted with different policies and legislations on safeguarding. Knowledge on these policies and laws will help nurses exercise patient safety and quality care. Nurses will be able to identify appropriate health and social care services for each mental health service user.

References:

Cantor-Graae, E. & Selten, J. (2005) ‘Schizophrenia and migration: a meta-analysis and review’, American Journal of Psychiatry, 162, pp. 12-24.

Cocker, F., Nicholson, J., Graves, N., Oldenburg, B., Palmer, A., Martin, A., Scott, J., Venn, A. & Sanderson, K. (2014) ‘Depression in working adults: comparing the costs and health outcomes of working when il’, PLoS One, 9(9): e105430 [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25181469 (Accessed: 3 November, 2014).

De Las Cuevas, C. & Penate, W. (2014) ‘To what extent psychiatric patients feel involved in decision making about their mental health careRelationships with socio-demographic, clinical, and psychological variables’, Acta Neuropsychiatrica [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25288200 (Accessed: 3 November, 2014).

Department of Health (2000) No secrets: Guidance on developing and implementing multi-agency policies and procedures to protect vulnerable adults from abuse. London: Department of Health.

Department of Health (2011a) Pathways to getting a life [Online]. Available from http://www.ndti.org.uk/uploads/files/2011-Pathways-to-getting-a-life.pdf (Accessed: 3 November, 2014).

Department of Health (2011b) No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages, London: Department of Health.

Gehart, D. (2012) ‘The mental health recovery movement and family therapy, part 1: consumer-led reform of services to persons diagnosed with severe mental illness’, Journal of Marital and Family Therapy, 38(3), pp. 429-442.

Goggins, K., Wallston, K., Nwosu, S., Schildcrout, J., Castel, L. & Kripalani, S. (2014) ‘Health literacy, numeracy, and other characteristics associated with hospitalized patients’ preferences for involvement in decision making’, Journal of Health Communication, 19(2), pp. 29-43.

Grenard, J., Munjas, B., Adams, J., Suttorp, M., Maglione, M., McGlynn, E. & Gellad, W. (2011) ‘Depression and medication adherence int eh treatment of chronic diseases in the United States: a meta-analsyis’, Journal of Internal Medicine, 26(10), pp. 1175-1182.

Hajizadeh, N., Uhler, L. & Perez Figueroa, R. (2014) ‘Understanding patients’ and doctors’ attitudes about shared decision making for advance care planning’, Health Expectations [Online]. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25336141 (Accessed: 3 November, 2014).
Kirkbride, J., Barker, D., Cowden, F., Stamps, R., Yang, M., Jones, P. & Coid, J. (2008) ‘Psychoses, ethnicity and socio-economic status’, British Journal of Psychiatry, 193(1), pp. 18-24.
Lubkin, I. & Larsen, P. (2011) Chronic illness: impact and intervention, London: Jones & Bartlett Publishers.

Marmot, M. (2010) Fair Society, Healthy Lives: Strategic Review of health inequalities in England post-2010 [Online]. Available at: www.marmotreview.org (Accessed: 3 November, 2014).

McDonnell, A. (2011) Managing aggressive behaviour in care settings: Understanding and applying Low Arousal Approaches. Australia: John Wiley & Sons.

Mestdagh, A. & Hansen, B. (2014) ‘Stigma in patients with schizophrenia receiving community mental health care: a review of qualitative studies’, Social Psychiatry and Psychiatric Epidemiology, 49(1), pp. 79-87.

Moran, G., Russinova, S, Gidugu, V. & Gagne, C. (2013) ‘Challenges experienced by paid peer providers in mental health recovery: a qualitative study’, Community Mental Health Nursing, 49(3), pp. 281-291.

Patterson, M., Rezansoff, S., Currie, L. & Somers, J. (2013) ‘Trajectories of recovery among homeless adults with mental illness who participated in a randomised controlled trial of housing first: A longitudinal, narrative analysis’, British Medical Journal Open, 3(9):e003442. doi: 10.1136/bmjopen-2013-003442.

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Watkins, P. (2008) Mental health practice: A guide to compassionate care. London: Elsevier Health Sciences.

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