CRITICAL PERSPECTIVE OF MENTAL HEALTH

Introduction

Mental Health is referred to the psychological, emotional and social well-being of an individual which is required to be efficiently managed as it affects the way a person feel, think and act in the society. The presence of sound mental health influence an individual regarding the way they manage stress and others to develop life choices (Barry et al., 2019). The individuals suffering from schizophrenia are found to experience hindered mental health condition that disrupts their effective cognitive thinking and feelings to lead a normal life. In this context, the current study is going to explore the topic of mental needs of adult schizophrenia patients and the way to respond towards meeting the needs. The population to be focussed in this study would be people who are 20-45 years of age. This is because it is seen that people get affected by schizophrenia in the early adulthood stage that is in the 20s to 30s and it extends to become worse with middle adulthood age (Immonen et al., 2017). The discussion regarding the response to mental needs of adult schizophrenia patients is essential because delay in treatment or lack of response to meet mental needs of adults suffering from individuals makes them become at risk of losing brain volume and face adverse implications for treatment without improvement in health.

Background

In the UK, the statistics mention that 1 in 100 people are found to be at risk of suffering an episode of schizophrenia in their lifetime (livingwithschizophreniauk.org, 2019). It indicates to determine that prevalence of schizophrenia in the UK is 14.5% per 1000 individuals (livingwithschizophreniauk.org, 2019). The figures inform that schizophrenia is not a common mental disorder but it affects considerable number of people in their lifetime which makes it one of the major mental health issues to be considered for discussion. In the study by Jones & Luhrmann (2016), it is mentioned that schizophrenic individuals are prone to develop delusion and hallucination with progressing disease condition. The presence of delusion in schizophrenic individuals makes them show unexplained violent or angry attitude towards others. It leads them to face hindrance in maintaining stable relationship of any form due to which they are often isolated from the society by the individual’s family members and friends (Bortolon et al., 2019). In contrast, the study by Handest et al. (2016) mentioned that delusion and hallucinations in schizophrenic adults affects their sleeping pattern. This is because delusion creates unexplained fear or anxiety among schizophrenic individuals which makes them unable to sleep normally in turn making them feel tired along with lack of motivation to work effectively. Thus, the topic of responding to mental health needs of schizophrenic adults is critical aspect of mental health because the discussion would lead to develop actions that can resolve the hallucinations which are interrupting the normal social and physical well-being of the people.

The presence of hallucination and delusion among the schizophrenic individuals makes them consider as vulnerable individuals in the society who can harm others. It leads to create discriminative attitude towards schizophrenic adults and they face hardship in availing and continuing jobs to boost their career (du Sert et al., 2018). However, the chances of getting harmed by a schizophrenic individual are rare. Thus, the current topic is one of the critical aspects of mental health because discussion to respond to the hindered mental health condition of schizophrenic individuals would create a better future for them to live a happy life with progressing career. In order to explain the response towards mental health needs of adult schizophrenic individuals, the treatment policy guidelines mentioned by the National Health Services (NHS) and National Institute of Health and Care Excellence (NICE) are to be focussed and related in the study. Moreover, the mental health legislation in the UK which are relevant to influence effective response towards the schizophrenia patients are to be discussed. This is to ensure that all the ethical principles and values in responding to schizophrenic individuals are underpinned by policies and practices.

Search Strategy

The electronic search strategy is to be used for researching valid and critical information regarding the topic of study. The electronic search is to be used because it provides opportunity to the researcher in analysing and evaluating wide range of data without geographical constraints from different countries which are effective to support effective argument and comprehension in the study (McGowan et al., 2016). The electronic search is to be performed on platforms such as Goggle Scholar, MEDLINE, CINHAL and PubMed. This is because the platforms provide information and data regarding wide range of mental health issues which are constructed through scientific experiment and research, in turn, assisting to gather logical and valid data. The key terms to be used in searching information for the study are “Mental needs of adult schizophrenia patients”, “Respond to schizophrenia individuals”, “responding to mental needs in schizophrenia” and others.

The inclusion criteria are the characteristics that are considered to be important and must be present in the study. However, the exclusion criteria include characteristics that are to be avoided from using in the study as it leads to create error (Patino & Ferreira, 2018). The inclusion criteria are articles and policies that are related to responding to mental needs of adult schizophrenia patients, published on and after 2016, include primary and secondary information and written in English. The exclusion criteria include articles related to childhood schizophrenia, not written in English, published before 2016 and not fully accessible. The articles published in the past 5 years are to be included and other excluded so that current and relevant information can be gathered. The articles written in English are to be included as the researcher have only knowledge about English. The articles regarding childhood schizophrenia is to be excluded as it is not the topic of interest in the study. The articles containing primary and secondary information are to be included n the study so that statistical information along with descriptive data related to the topic can be gathered.

Critical Perspective

The value-based practice is referred to the approach of supporting decision-making in the clinical filed that provide practical skills and techniques for eliciting individual values and creating negotiation with the available evidence (Moss, Seifert & O’Sullivan, 2016). One of the value-based practices in schizophrenia is person-centred psychopathology. This is because in this approach the health professionals and schizophrenic adults both involved in discussing their mental health needs and develop mutual decision in receiving care to overcome the identified issues (Henriksen & Nilsson, 2017). The person-centred pathology is one of the initial responses to be made for assessing mental health needs of schizophrenic adults. This is because the approach allows the schizophrenic individuals in explaining the extent of their hallucinations and delusion along with level of loss of emotion and agitation reaction to the people and environment in their surroundings. It helps the healthcare professional also to understand the level of mental health deterioration of the schizophrenic individuals and the exact treatment response that would be most effective for their health (Henriksen & Nilsson, 2017). The NICE guidelines also support the psychopathology of schizophrenia patients to be made to understand the nature of mental health needs and response required for the specific mental health needs (NICE, 2019).

In adult schizophrenia patients, the key positive mental health need is resolving instances of delusion and hallucination which are interfering to create hindrances for them in leading their everyday life (Ueda, Maruo & Sumiyoshi, 2018). This is because delusion and hallucination lead adults to show bizarre behaviour and ideas in the society which are not acceptable under norms and customs. The negative mental health symptoms in adult schizophrenic individuals are loss of emotion, withdrawal from society and others (Marder & Galderisi, 2017). According to NHS and NICE treatment guidelines, the antipsychotic medication is to be provided as response to the positive (resolving hallucination and delusion) and negative (resolving loss of emotion, stress, anxiety, others) mental health need in adult schizophrenic patients. This is because antipsychotic medication blocks the increased subcortical release of dopamine in the brain of schizophrenic patients which is the key chemical in the brain that is responsible in causing the hallucinations and mood disorder (NHS, 2019; NICE, 2019). The antipsychotic medication provided to schizophrenic individuals includes risperidone, aripipraxole, olanzapine and others (Cheng et al., 2019).

In the study by Kumar et al. (2017), short-term efficacy and side-effects of risperidone and aripipraxole are compared to determine which of these antipsychotic medications provides greater response in managing hallucination in schizophrenic individuals. The results in the study are gathered through follow-up process of health analysis of adult schizophrenia patients for 8-12 weeks. It revealed that both aripipraxole and risperidone show effective improvement in positive symptoms such as hallucination, delusion and others along with negative mental health symptoms such as loss of emotion, anxiety and others in adult schizophrenia patients. There was no statistically significant difference found in the values of improved impact of the two medications on mental health of the schizophrenic individuals. However, the extra pyramidal symptom of drug induction was found more common in schizophrenic patients treated with risperidone compared to aripiprazole. Moreover, Aripiprazole expressed less weight gain as side-effect on the patients (Kumar et al., 2017). The facts lead to inform that aripiprazole is equally effective as risperidone on patients with schizophrenia but aripiprazole express more satisfaction on use among the patients. Thus, to respond to mental health needs of hallucination and delusion in adult schizophrenia patients, the use of aripiprazole is to be made as it provides greater patient satisfaction (Kumar et al., 2017).

In adult schizophrenia patients, it is found that few may show treatment resistance presence of schizophrenia. This means that the individuals tend to show lack of response in improvement of their mental health needs such as hallucination and delusion irrespective of the persistence responsive use of more than 2 trials of antipsychotic medication in adequate dose and duration (Howes et al., 2017). In this condition, the response to be made is change in use of antipsychotic medication. In the study by Kumar et al. (2017a), comparison between the effect of clozapine and quetiapine in responding to treatment-resistance schizophrenia is discussed. For this purpose, 53 patients for 14 weeks are analysed in groups. The results revealed that group who were provided clozapine expressed significant greater reduction in score of Positive and Negative Syndrome scale (mean difference=14.45) compared to those who were provided quetiapine (mean difference=4.15).

The fact mentioned by Kumar et al. (2017a) is also supported by the study of Molins et al. (2016) where it is also mentioned that colzapine is the first-line effective medication for responding to treatment-resistant schizophrenic patients. Therefore, colzapine as pharmacological response is to be used for managing mental health needs in treatment-resistant adult schizophrenic individuals. However, the study by Molins et al. (2016) mentions that colzapine is not provided as first-response to mental health needs of the schizophrenia patients. This is because of its various side-effects and requirement of extent follow-up of blood work requirement in normal schizophrenic patients. Moreover, it is mentioned by NHS guidelines that the patients are to be informed about the side-effects and way antipsychotic medications are to work for their condition by the health professionals while using them as response to resolve positive and negative symptoms of the disease (NHS, 2019). This is because it would help the patients to make informed decision and assist the health professionals towards providing person-centred care. It is evident as in the process the patient’s opinions regarding medication use are to be kept in the centre while planning care response for them to treat their health condition (NMC, 2018). Thus, by following the actions in responding to mental health needs of the schizophrenia patients it would also help to abide by the ethical principle of autonomy. This is because providing patients with information regarding medication and care they can avail for schizophrenia it would allow them to make their own care decisions (Ali et al., 2017).

The NICE guidelines regarding adult schizophrenia mentions that the therapeutic response for the mental health needs raised by the health issue is implication of cognitive behavioural therapy (CBT) (NICE, 2019). The CBT is mainly referred as the talk therapy which assists to manage mental problems by changing the way individuals think and express regarding situations (NICE, 2019). The CBT works as active therapeutic response for adult schizophrenic individuals in regarding their mental health needs of hallucination and delusion because the therapy aims to identify the hindered thinking patterns that are causing the rise of the need. The therapist then try to focus on the reason of unwanted behaviour and feelings to learn what changes are required in making the thinking more realistic which is required for enhancing the health of the adult schizophrenic patients (Jauhar, Laws & McKenna, 2019). The use of cognitive behaviour therapy (CBT) for allowing it to works as response to mental health needs of schizophrenia patients, the therapist develop collaborative relationship with the patient where they develop shared understanding of the mental health problem faced by the patients. After understanding the facts, personal techniques and strategies are taught to the schizophrenic individuals regarding the way they can cope with their symptoms of hallucination and delusion along with stress and anxiety to led a healthy life (Lee, 2019).

The effective collaboration through mutual understanding in delivering CBT as response to adult schizophrenic individuals is important. This is because it creates environment of promoting the health of the schizophrenic individuals through co-productive activities of patients and therapist (Lee, 2019). In addition, it also leads to ensure ethical principle of beneficence is followed in the care practice of schizophrenia patients where actions are taken for their health benefits thro0ugh co-production (Lee, 2019). This is evident from the study of Rizk et al. (2016) where the key aim was to determine the impact of CBT along with treatment as usual on adult schizophrenic patients. For this purpose, 40 patients are analysed and separated into groups in which one received only usual treatment whereas the other group included treatment with CBT combined with usual medication intervention. The results from pre-assessment and post-assessment revealed that CBT for auditory hallucination in patients made them express reduced positive scores of Positive And Negative Symptoms (PANSS) (−18.31% less positive score). Moreover, the group with CBT and usual care expressed more significant reduction of delusion and hallucination along with stress and anxiety compared the group that received only usual treatment for the disease. Thus, the study mentioned that use of CBT as therapeutic response along with usual treatment is more effective step for adult schizophrenic individuals who are trying to cope with positive and negative mental health symptoms of the disease. The facts are also supported by the study of Dina et al. (2018) where it is mentioned that use of CBT is more effective therapeutic response for schizophrenic patients compared to usual treatment in helping them overcome mental health needs.

The use of electroconvulsive therapy (ECT) and Electro-acupuncture is made as response to meet mental health needs of delusion, racing thought and hallucinations in acute or severe adult schizophrenic individuals in the hospital. This is because they are the easier and efficient way to relive the patients of the mental health needs to resolve anxiety or suicidal intension (Kim et al., 2017). In this responsive treatment, electrodes are found to be attached to the person’s scalp who is provided general anaesthesia so that the person does not feel pain. The electricity passes into brain to create controlled seizure to manage the increase release of dopamine as the neurotransmitters that control the mood and thinking of the individuals (Sinclair et al., 2019). The facts can be proved through the study of Jia et al. (2017) which determined the augmented impact of electroconvulsive therapy (ECT) and Electro-acupuncture as response on managing psychotic symptoms of severe schizophrenia patients. The results in the study revealed that groups who were provided ECT express 90.1% response rate and group that were provided ECT and EA provided 64% response rate in reducing positive and negative mental symptoms related with schizophrenia.

The NICE guidelines mention that arts therapies are to be provided as response under the supervision of registered art therapist in Health and Care Professional Council to help them cope with mental health needs of overcoming hallucination and delusion (NICE, 2019). This is because arts therapies assist the adult schizophrenic individuals to express their emotions and feeling to their family and friends without using unnecessary words that are not understood by them to assist schizophrenic adults in overcoming the psychotic symptoms. Moreover, it assists the schizophrenic adults to experience a satisfying aesthetic form that could help them to calm their mind and understand what is causing them to hallucinate. It also creates understanding feeling among the adult schizophrenic individuals which emerged out of the creative process to show them better way of coping of mental health needs of hallucinations and delusion (Van Lith, 2016). The study by Ruiz, Aceituno & Rada (2017) was performed to determine the impact of art therapy on mental functioning of schizophrenia patients. The results revealed that there is no clarified evidence able to be gathered that proves art therapy to be effective in clinical improvement of mental health of schizophrenic adults. Moreover, less certainty is also seen in regard to the study about the acceptance of the art therapy as response by the schizophrenic patients to overcome their mental health issues. Thus, the use of art therapy though been mentioned as an effective response by NICE to help meeting mental health needs of adult schizophrenic patients but its authenticity and validity of use is still questionable.

In adult schizophrenic individuals, there is risk of ideation of suicide and self-harm due to positive and negative mental symptoms of the disease. It is evident from the study of Jakhar et al. (2017) which was performed to determine the extent of suicidal intention and self-harm among adult schizophrenia patients. For the purpose, the study executed evaluation of 270 individuals suffering from schizophrenia. The results reveal that 22.59% of them have risk of causing self-harm and 10% has already attempted to suicide once. According to the NHS guidelines, referral of the schizophrenic individuals are to be made to psychotherapist who are showing mental health needs of protecting them from performing self-harm and suicide (NHS, 2019). This is because the therapist would implement suitable psychotherapy to help them overcome the intensions.

Conclusion

The above discussion mentions that adult schizophrenic individuals mainly expresses positive mental health symptoms such as delusion, hallucination and dislocated thinking along with negative mental health symptoms such as loss of emotion, anxiety agitation and others. According to NICE and NHS guidelines, the initial response in regard to the mental health needs of schizophrenic adults is performing person-centred psychopathology. Thereafter, the pharmacological response of offering antipsychotic medication to the adult schizophrenic individuals is to be made. In treatment –resistant schizophrenic individuals, the use of colzapine as response is to be made. In regard to therapeutic response for mental health needs of adults schizophrenic individuals, the use of CBT and art therapies are to be made. This is because they provide opportunity to analyse the level of psychotic condition of the patients and according provide care assistance. However, the impact of art therapy as response to mental health needs of schizophrenic individuals is still not fully proved.

Reflection

In order to provide critical reflection of the learning achieved in the module, the Rolfe’s Reflective Model is to be used. This is because the model provides easier and systematic of executing and presenting reflection regarding learning in practice (Skinner & Mitchell, 2016). The three stages of Rolfe’s model are:

What?

The module led me to learn that schizophrenia is one of the non-common critical health issues which is hindering mental health of the individuals and effective discussion is to be made for the responses to be executed in resolving the mental health needs for schizophrenia. It led me to learn the way electronic search is to be organised for gathering effective evidence regarding the study topic. Moreover, it led me to develop understanding of the way facts are to be critically presented. This is evident throughout the module I was gradually able to understand how to prove each point discussed with alternative evidence from different authors so as to formulate a critical evidence-based research. The module helped me to develop knowledge about the key therapeutic and pharmacological response to be made for adult schizophrenia patients so that their mental health needs are resolved. However, I feel that during the execution of the module I was unable to learn regarding the way large information is to be presented in short-sentences and in compact concepts. This is evident as I feel in some places within the module I framed large sentences that could be presented in more compact way. Moreover, I feel that after the execution of the module, I lacked concept have the way specific responses are to be made to separately overcome positive mental health needs and negative mental health needs of schizophrenic adults.

So What?

The enhanced knowledge of way to execute electronic search is essential as it helps me to determine the structured way in which research is to be performed on the database to gather potential information in the study. Moreover, the knowledge of effective strategy is essential to help individuals understand the way key concepts from the study topics are to be raised for gathering accurate results (Skinner & Mitchell, 2016). The improved knowledge of the way gathered evidence is to be presented critically is important. This is because it led me to understand the way each objective data are to be weighted from all side to present a well-augmented data. The enhanced knowledge of the responses to be made to meet mental health needs of schizophrenia adults is effective learning from the module. This is because it led me to identify which therapeutic response or pharmacological response is to be made to help schizophrenia adults to meet various psychological problems faced due to the disease. However, inability to gather knowledge about the separate responses to be made for positive mental health symptoms and negative mental health symptoms in schizophrenia patients is not a good activity. This is because it led me to remain unaware of specific care response to be made for schizophrenia patients who is showing deteriorated psychotic symptoms of either positive or negative nature. Further, inability to present data in a compact way led to create missing of other potential data which could be mentioned within the word count.

Now What?

In future, I am going to execute further research by use of electronic search to determine the spate responses to be made to overcome positive and negative mental health symptoms in schizophrenia separately. Moreover, I will involve in academic writing skill training to learn regarding the way more information can be presented in a compact way within the study so that the study can be presented with enriched data.

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