Mental Health in North Ireland
Introduction
Mental Health in Ireland is governed by the Mental Health Act of 2001, which was later enacted in 2006 (Latif & Malik, 2012). The definition terms of mental illness and mental have developed over the years. Literature has concluded that there is a conceptual confusion on using the words (Leighton 2008). Nonetheless, the term mental illness arose in the 1960s to decrease stigmatization (Rowling et al. 2002). There is no joint agreement on how the terms should be used other than they both address an individual’s mental state. Mental health and mental illness are different but related. Reports have established that health focuses on whether an individual is living a holistic lifestyle within the society, such as having a life purpose, interpersonal relationships, and much more. At the same time, the illness is the disease (Ryff and Singer, 1998).
Statistical Assessment of Mental Health in North Ireland
Fundamental Facts were first established in 2007 for purposes of analyzing England’s Adult Psychiatric Morbidity Survey. However, the publication had developed over the years to post 2015 when it became a consistent publication by the Mental Health Foundation. The information elevated to beyond the United Kingdom to Scotland, North Ireland, and Wales. The data is primarily a statistical assessment of mental health in different areas, but this paper shall be centered on the North Ireland statistical assessment.
Department of Health, Social Services and Public Safety (2014) determined that North Ireland has higher mental health cases than England by 25%. Based on the North Ireland Health Survey conducted in 2014/2015, the number of people who depicted symptoms of mental health challenges was recorded as 19%, which was the same as the previous year’s assessment (Bell & Scarlett, 2015). Bell & Scarlett (2015) established that 20% of women and 16% of men who have depicted mental illness signs make women more prone to mental problems on the median. In 2013, the reports indicated similar information. The report suggested that the mental disorder rate was 23.1% with an analysis of specific mental disorders; anxiety was recorded at 14.6%. Mood illnesses were at 9.6%; drug abuse mental conditions were at 3.5% while impulse control mental problems were at 3.4% assessment (Bell & Scarlett, 2015).
Bunting et al. (2013) conducted 12-month cases to determine that 28.8% of these mental cases were severe, 33.4% were manageable, while 37.8% were acute. The reports decided that only 40% of the patients were patients in the previous year (Bunting et al., 2013). Based on the interviews conducted, 78.6% of the patients believed that their treatment as averagely adequate (Bunting et al., 2013).
There was a decline in the number of mental health patients admitted to the mental health program. A study conducted by the Department of Health (2015) revealed a 13.3% decrease, which amounted to 637 patients from 2010/2011, which had 5,268 patients, while 2014/2015 had 4,675 patients. O’Donnell & Taggart (2015) determined that the number of hospital beds in North Ireland in the mental health care program declined by 28.7%, which amounted to 235.3 beds; initially, there were 821.4 beds, but they decreased to 586.0.5 beds.
There was a compulsory admission to mental health facilities of 987 patients between the year 2014/2015 in compliance with the Northern Ireland Mental Health Regulations of 1986. The entries consisted of 54.5% males and 45.5% women (O’Donnell & Taggart, 2015).
Donnelly (2014) reported that the depression cases in North Ireland were much higher than the rest of the United Kingdom. The identified mood and anxiety conditions, bipolar disorder, anxiety, and depression elevated by 20% between 2009 and 2013 (Information Analysis Directorate, 2015).
The amount of public funds placed in the health industry in North Ireland has been the lowest in the United Kingdom between the years of 2011 to 2012. Nonetheless, North Ireland has been reported as having the highest need for health in the United Kingdom. The need for medical care isn’t a precise measurement but there particular elements that should be considered. The Nuffield 2014 report determined that a proper measurement strategy would conclude that England and Wales have fewer mental health needs that North Ireland and Wales (Bevan et al., 2014).
Interventions to Promote Mental Health
Community Interventions
The Community consists of families, schools, social services, workplaces, and institutions, which can help mental health support. The World Health Organization defined mental health as the total physical, psychological and social state of a human being, Community based interventions would aid in addressing mental health inequalities and factors that contribute to the social aspects of mental health.
Communities That Care (CTC)
This is a community strategy that focuses on the prevention of mental health disorders. The system addresses mental health challenges in children between the school grades 6-9 on violence, suicide, anxiety, and depression, all of which are mental health conditions. The system has five phases, the first being the community stakeholders, which consist of the parties mentioned above, such as families and institutions (the University of Washington Centre for Communities That Care). The second phase is the development of the community partnership, which pertains to the community stakeholders’ communication to work together. The third phase is creating a community profile that pinpoints the mental health risk and the means of protection such as substance abuse. The fourth phase is establishing the community policy, which provides a platform of adherence, such as children’s supervision. The fifth phase is implementing the community policies and evaluating the success of this action plan.
The CTC strategy has been implemented in different areas and has shown excellent results. Therefore, the system could be implemented in North Ireland in the management of mental healthcare. For instance, the Community Youth Development Study, centered around the CTC, consisted of 24 communities in Kansas, Oregon, Pennsylvania, Colorado, Utah, Illinois, and Washington [Fagan et al., 2009]. The study established that CTC is better than a controlled community. The information obtained from the study was that students were less likely to get involved in drug abuse, violence, and delinquency, which are centered around mental health.
Therapeutic Interventions
The Use of Humor
Humor has been identified as a therapeutic intervention for mental health patients. Reports have determined that social workers could benefit from using humor in mental health care (Wiggins &Mccreaddi,2008). Mental healthcare involves treating patients that are not very cooperative in some cases due to their mental states such as paranoia, anxiety, and erratic behavior. Humor could be applicable in managing such patients to create a happier environment, thus increasing the likelihood of cooperation. Therapeutic intervention decreases embarrassment, depression, and anxiety, all of which are symptoms of mental health conditions (Wiggins &Mccreaddi, 2008). Humour creates an environment where a patient can cope with mental health issues such as panic attacks or anxiety from post-traumatic stress disorder. The technique allows for open communication between the social worker, therapist, and the patient by lightening the mood (Gonot-Schoupinsky & Garip., 2018). However, there is a distinction between direct and indirect humor. The medical field recommends the use of indirect humor rather than direct humor. The risk with direct humor is that the patient is centered on telling jokes that a mental health patient may perceive in the wrong light, such as being mocking. On the other hand, indirect humor is primarily focused on fostering interpersonal relationships between the patient and the social worker (Gonot-Schoupinsky & Garip., 2018). Moreover, humor should be made professionally to provide for mental healthcare(Wiggins &Mccreaddi, 2008).
Mindfulness
Mindfulness is a therapeutic intervention developed by Day &Horton-Deutsch 2(004a) for the management of mental health diseases. The technique was centered on the effect of mindfulness in psychotherapy by concentrating on the emotions and thoughts of addicts to prevent relapse incidences (Day &Horton-Deutsch, 2004a). Consequently, mindfulness assists patient that struggle with substance abuse which is typically associated with mental health challenges such as management of anxiety and depression (Day &Horton-Deutsch, 2004a).
Mindfulness creates an environment where the patient can talk about the issues that contribute to their mental health challenges, such as the things that trigger their post-traumatic stress disorder (Sinanan, 2015). The technique focuses on ensuring that the patient feels heard and that the social worker can meet the mental health patient’s expectations to achieve the patient’s treatment (Day &Horton-Deutsch, 2004a). Therefore, the approach will identify the mental health issue that the patient is suffering from, such as depression, anxiety, or post-traumatic stress disorder.
The technique relies on compassion and empathy during mental health patients’ management, thus facilitating the recovery process (Lima-Basto et al., 2010). The final result of the technique is the patient’s recovery by providing a platform for the patients’ recovery by developing a safe space for conversations (Lima-Basto et al., 2010).
Mindfulness provides a platform for social workers to obtain informed consent from the patient, especially when the patient has been institutionalized. The technique allows for the communication with the patient to understand whether the patient understands the reason for their confinement and that they shall cooperate to ensure that they get better (Nursing and Midwifery Council, n.d).
Narrative Approach
Narrative therapy was created by Michael White and David Epsotone (White & Epston, 1990). A narrative approach is a form of therapeutic intervention that enables a patient that suffers from mental health issues to distinguish themselves from the problem (Wolter et al., 2006). Therefore, the therapist would help the patient identify the fragile matters in their lives that trigger their behavior (Biggs & Hilton- Byre, 2016). The technique allows the patient to believe that they can decrease the challenges they experienced in their lives (Biggs & Hilton- Byre, 2016). A patient would then begin to have the capabilities of not allowing the issues to take over their lives (Wolter et al., 2006). One has undergone their personal life story, which contributes to the individual (Wolter et al., 2006). The approach relies on this perception of personal information by making the patient the narrator of their narrative (Biggs & Hilton- Byre, 2016). The isolation of the patient’s challenges from decreases self-defense, which would encourage their behavior. Consequently, the therapy sessions would be geared towards problem solving rather than creating a defense mechanism (Biggs & Hilton- Byre, 2016).
The narrative approach does not advocate for labeling the parient’s conditions because it creates a barrier that hinders the shine of the patient’s dominant voice (McNamee & Gergen, 1992). The primary voice is essential in determining the patient’s perception of their family, workplace, school, community, and much more, contributing to their mental health (Biggs & Hilton- Byre, 2016).
The social worker shall be concentrate on the repetitive narration of the story to evaluate whether the patient has positively changed their perception (White & Epston, 1990). The social worker shall be keen to pinpoint any aspects of the narration that indicate recrimination and self-abuse, leading to mental health symptoms such as anxiety and depression (White & Epston, 1990). This approach aims to guide the patient on changing their lives for the better (Hoyt 2000).
There are specific steps that a social worker could use in the achievement of narrative therapy (Biggs & Hilton- Byre, 2016). However, the mental health patient should not know that the narrative approach is being applied in the recovery process (Biggs & Hilton- Byre, 2016). If a patient becomes aware of this application, it will cause the patient not to cooperate with the therapist (Biggs & Hilton- Byre, 2016). The approach requires the therapist to view the patient as a person who can reach the point of clarity, which would be the separation of the issues (Monk, 1997).
Firstly, the therapist should help the patient isolate the patient’s problems, which causes them anxiety or depression. The therapist must inquire for more information from the patient to isolate the events that have created a negative perception of their lives (Biggs & Hilton- Byre, 2016).
Secondly, the therapist must pick out the external factors that influence their perception, such as depression cases where there is an abuser (Biggs & Hilton- Byre, 2016). The identification would trigger change because it would aid in the patient’s separation from the issue (Biggs & Hilton- Byre, 2016).
Thirdly, the therapist must encourage cooperation with the patient to fight against the patient’s issues (Biggs & Hilton- Byre, 2016). The patient should perceive that their counselor is on their side against the patient’s problem (Biggs & Hilton- Byre, 2016).
Fourthly, the counselor should identify an alternative story that the patient should have, which would ignite a positive perception of their lives (Biggs & Hilton- Byre, 2016). This action would involve convincing the patient of a better personal narrative that would be healthier for their mental health (Biggs & Hilton- Byre, 2016).
Fifthly, the counselor should guide the patient to create a better personal story (Biggs & Hilton- Byre, 2016). This stage would involve the patient discovering the impact of their negative perception and the need for change (Biggs & Hilton- Byre, 2016).
Sixthly, the patient becomes accepting of the new personal story, and it is entirely evident in the manner the patient provides a personal narrative (Biggs & Hilton- Byre, 2016).
Lastly, the patient must communicate this personal narrative to the people in their lives (Biggs & Hilton- Byre, 2016). This stage will require the people in the patient’s life to become accepting their new perception (Biggs & Hilton- Byre, 2016)
Psychodynamic Approach
This strategy involves isolating unconscious factors that contribute to the patient’s behavior (Substance Abuse and Mental Health Services Administration, 1999). This approach’s essence is the cause of self- awareness and understating of the impact past incidences have on a patient’s behavior today. The system aims to enable the patient to isolate unresolved issues and how these problems affect their lives (Substance Abuse and Mental Health Services Administration, 1999). For instance, one of these past issues could include being brought up in abusive households, participation in the war, and sexual assault history (Substance Abuse and Mental Health Services Administration, 1999).
The psychodynamic approach is one of the oldest therapy interventions (Substance Abuse and Mental Health Services Administration, 1999). Therefore, it is an approach that has worked for years, but there are still other approaches that have developed as well.
There are various features of the approach that differentiate it from other systems based on the processes and techniques (Shedler, 2010). The method involves analyzing the patient’s emotions and how they should guide the patient in talking about their feelings (Shedler, 2010). The aim is to provide a platform for the patient to express emotions that they never conveyed in the past due to suppressing their feelings (Shedler, 2010). The approach encourages the patient to acknowledge the thoughts and emotions that cause negative emotions such as anger, sadness, and fear, which trigger mental health conditions such as anxiety and depression.
The interventions require observing the patterns and themes that lead to a specific patient (Shedler, 2010). For instance, the conditions that cause the patient to have outbursts and violence due to their mental illness. The pattern would provide information on the traumatic incidence that the patient experience, such as the previous history of sexual abuse (Hall & Hall, 2011).
The method involves analyzing whether the patient is trapped in the past incidences (Shedler, 2010). This analysis will provide information on the patient’s present behavior. Therefore, the therapist would understand how to guide the patient to heal and live in the present. For instance, the therapist would understand the patient’s historical events to suffer from the post-traumatic stress disorder.
The method requires the development of strong relationships between the counselor and the patient. This relationship’s creation is essential for the therapy sessions’ success because it requires open communication (Shedler, 2010). The patient must view the therapist in a positive light. Furthermore, the patient’s personality will play a massive factor in the interpersonal relationship with the counselor. A patient with anger issues will be very hostile towards the therapist; therefore, the therapist’s personality should be considered when allocated to the patient.
Social Workers in Northern Ireland
Legislation on Social Work
The Health and Social Care Professionals Act of 2005 provided a platform for establishing the Social Workers Registration Board in 2010. The Board was one of the 12 initial boards appointed by the Minister for Health and Children. Health and Social Care Professionals Council, established in the year 2012, is the body with the duty of public protection by providing standards in the social care profession. The council investigates professional ethics, training, and expectations amongst social care and other health professionals. Furthermore, the Social Workers Registration Board has the duty of determining whether an individual is qualified as a social worker. The Board also creates compulsory professional ethics and standards for social workers.
Additionally, as of the year 2013, all social workers in Northern Ireland must be registered to work and use the title. The registration criteria must be observed, and the social worker must commit to compliance with the Code of Professional Conduct and Ethics for Social Workers. The registration allows other people to confirm whether the person is an actual social worker to reduce misrepresentation chances.
Social Work Assessment
Social workers have the role of assessing the patient. A proper social assessment would look into the patient’s practical and emotional state—the social worker analyses the patient holistically, including analyzing the patient within the society. The role also requires cooperation with other stakeholders such as the family, colleagues, friends, teachers of the patient to provide an informed assessment. The information enables the social worker to have a proper comprehension of the patient present psycho-social status, thus developing a care plan that would be best suited for the patient and lead to a better quality of life (Roberts & Ottens, 2005).
Challenges
Financial Decline
A severe economic downfall took place in Northern Ireland between the late 1990s to the 2000s. The event affected several professions, which was inclusive of social workers. There was a decline in health care funds and a rise in the demand for social workers, which causes social workers to work more with less pay. Newly admitted social workers would have to experience a significantly lower salary than others fewer opportunities. Furthermore, the budget cut caused a lack of academic training compared to the past year, and managers had more obligations. For example, the managers were expected to ensure that social workers should ensure that policies and standards are met.
Heath and Security Executive social workers had to deal with a significant reorganization to establish distinct family and children departments. Additionally, other social workers were separated into different departments, including hospitals, mental health, and primary care. There were concerns that the National Standardized Assessment Framework does not inhibit therapeutic interventions with patients, interpersonal relationships. Social workers were worried that the needs of the patient could be overlooked due to these assessment frameworks.
Employment Challenges
The employment of social workers has been an issue for years. The challenge arose from the need for more training to meet the people’s needs in the past, which led to an overflow of social workers, making it challenging to receive employment due to the field’s over-saturation. Furthermore, the state of employment opportunities is evolving. The elevation of arrears in work pertains to children and families. Nonetheless, there is a shift in concentration from hiring more social workers in health care facilities to placing social workers in the Community, such as providing mental health services. There is a positive ideology in the placement of social workers in the Community because it facilitates patients living within the Community.
Conclusion
In conclusion, mental health is an integral part of human beings, and there is a need for a proper assessment to ensure that a majority of people live their best lives. Northern Ireland is one of the States with an enormous amount of health cases meaning that the Government should aim to put measures that would promote its decrease. There are mental health interventions that would help patients that have a mental illness, thus encouraging recovery. Social workers are essential in addressing mental health. However, these social workers in Northern Ireland experience challenges that may discourage people from partaking in the profession, yet there is a vast need for social workers. Mental illness is not selective; it can affect everyone in society, given different circumstances. Therefore, mental healthcare should be one of the critical areas of focus in any State, especially in cases where mental illness is vast in society, such as in Northern Ireland.