Introduction
Many mental health officers and doctors often exclude ethical principles such as beneficence, respect, non-maleficence and justice when mentally ill patients are concerned. The underlying reason for this exclusion is that these doctors consider the mentally ill patients to be people who cannot understand or even appreciate these key ethical principles in the medical practice. Failure to uphold ethical principles in the mentally ill care denies the health provider a chance to emphasize on the person’s cultural values and also a chance to exercise a practice that reflects excellent patient care. Some of the ethical principles that guide psychiatric care include confidentiality, conflict of interest, informed consent, operational challenges and vulnerability. Along with ethical practices in mental health, there have been other barriers such as lack of psychiatric facilities, increased rates of homelessness among the mentally ill patients which raises their vulnerability level to thing like stigma, premature death and even discrimination. While most healthcare sectors continue to address the issue of mental health, they have neglected the construction of healthcare facilities for mental health patients which has increased their homelessness rates, making them vulnerable to things like stigma.
Effects of Less Psychiatric Facilities
When a state or a country has reduced number of psychiatric facilities, there is a concurrent decrease in specialized treatment and rehabilitative services for mentally ill patients including those that are difficult to manage. Psychiatric facilities often provide with metal health patients with a treatment that concentrates on aiding the person go back to their optimal functioning level. This help could range from guiding them through the rehabilitative activities such as group discussions, yoga, social skills and even vocational training to chemotherapies which mainly constitute medications. One of the key functions of the rehabilitative services is that it offers the mentally ill patients with accommodation, meaning it provides housing that protect them from adverse conditions. When their facilities are lacking, couples with an increased rate of mental illness, most of these patients end up living in the streets, a situation that aggravates their condition even further (Creighton et al., 2018). Unequivocally, low number of psychiatric facilities results to reduced number of rehabilitative services such as accommodation to the patients thus worsening their mental health state further.
Psychiatric facilities provide an environment where prospective mental health doctors can access cognitive-behavioral, brief cognitive-behavioral therapy and provider training programs. Psychiatric facilities offer mental health practitioners to understand approaches within which they can offer cognitive-behavioral programs. For instance, they train these doctors that in a primary-care setting, they need to perform rapid assessment of their patients and offer brief treatments while in the community-based settings, they need to offer a wide-range of mental health services. Along with cognitive-behavioral programs, these facilities allow for provider training programs such as bCBT training and support programs that allows the healthcare providers to maximize the sustainability and the efficiency of their care (Creighton et al., 2018). The provider training programs often range from tailored programs to general programs which aim at teaching the recommended ways of handling mental health patients to specific individuals and groups respectively. In the event that there are no reduced facilities in the community, most of the practitioners end up giving community-based care to patients who need individualized care. Consequently, the care only worsens the patient’s problem rather than solving it.
Reduced psychiatric facilities reduce the number of specialized inpatient services that are a prerequisite for mental health patients. Individual-based inpatient care is a key requirement for patient having mental disorders such as anxiety or depression. The services include having the patient sates in the healthcare facility wither overnight or having them stay there at a prolonged period. To provide inpatients services, it means the facility is well-stocked with resources that can cater the basic needs of the patients such as offering them clothing and food and also their specific therapies such as medications and social-based reamendments. When these facilities miss or are reduced in numbers, the number of specialized inpatient facilities are lowered consecutively. This low number often makes patients to live in their homes where issues of stigmatization even from their family members are experienced (Creighton et al., 2018). Generally, reduced number of psychological facilities often make patients remain at their homes, predisposing them to cases of stigmatization even from their family members.
Low number of psychiatric units tend to lower psychiatric telephone consultation services to other beneficial agencies that can offer help to the patient. Jonathan Pecker and other authors found out that psychiatric telephone consultations were common mainly from psychiatric facilities and these phone-based advisory services often helped patients receive the help they had aspired. In their research, they found out that most patients felt that psychiatric telephone consultations from a psychiatric telephone setting maintained their confidentiality and that they gave them individualized attention. While confidentiality and personalized attention are the key benefits of the psychiatric telephone consultations, flexibility, comfort and convenience are also benefitting that most mentally ill patients report based on the telephone conversations emanating from psychological units. However, when these psychiatric healthcare settings are reduced in number, patients find it difficult to get their required care or even to get referred to other settings that would provide their desired care (Creighton et al., 2018). Ultimately, the patient ends up feeling discriminated as no one is available to offer the help they are had ascribed to their condition.
The inadequacy of psychiatric facilities often results to low number of specialized forensic centers that offer the intensive care that is necessary to promote the healing of patients that present high risk to the society. Forensic mental health facilities are imperative in offering mental health care to patients who are referred by organizations such as courts, the police, community correctional facilities and even prisons. These individuals are those that commit crimes that are motivated by their mental health conditions, meaning they need to be treated differently compared to those lacking mental health problems. When such facilities are in low numbers, most of the mentally ill offenders end up feeling depressed, some of them committing suicide while in prison or even in the cells. In addition to suicide, their hostility levels are increased as they lack guidance on how to handle some mental health conditions such as stress, depression or even anxiety (Creighton et al., 2018). Generally, psychiatric services provide services that help mentally ill offenders control their health state to avoid more problems.
The insufficiency of psychiatric facilities often inhibits research, evaluation and training of mental health doctors in any given country or state. Psychiatric facilities provide potential menta health doctors with a chance to conduct research on fields such as the biopsychosocial factors which integrate social, psychological and biological functioning of the mentally ill patients. Additionally, these facilities allow these potential doctors to learn the trends and the social determinants of population mental health and how they can be modified to provide effective care to such patients. On evaluation, these facilities allow scientists to analyze the data available for mental health patients either on a local, regional or global basis, preparing them on them on the treatment specifies that different patients might require. In the event that there are low psychiatric facilities, the number of doctors trained is lowered meaning the doctor-patient ratio is reduced. Reduced doctor patient ratio prevents individuals from getting personalized care, which end up deteriorating their health (Creighton et al., 2018). Generally, low number of psychological facilities results to low number of doctors catering for specific number of patients thus poor healthcare services offered to mental health victims.
The Homelessness State of Mentally Ill Patients
Causes of Homelessness
The presence of insufficient incomes among the mentally ill patients is the leading cause of homelessness among these individuals. One of the key recommendations for the mentally ill patients is to find jobs that pose less tress int their lives. Such jobs include works like dog-walking where their individual spend most of their time with dogs or even horticulture where the individual works as a professional landscaper. Low pay transits to poor lives of the mentally ill patient such as failing to afford a good place to live. For instance, it is not rare to find a person working in a horticultural farm living almost next to the farm since living the city is more expensive than living beside a farm. In the case of those living next to the farm, they might get displaced when the farm owner wants to expand their land, meaning this person has to look for another place to reside (Creighton et al., 2018). Generally, low wages make mentally ill patient fail to afford permanent residencies.
Lack of jobs due to the mental condition of person has increased the homelessness state of mentally ill patients. The relationship between mental health and unemployment is a two-way thing where unemployment could result to mental health challenges while mental health problems could result to unemployment. This discussion focuses on the latter where the presence of mental conditions such as schizophrenia, depression and even anxiety could make a patient miss a certain occupational opportunity despite them meeting the required skills and knowledge. Most organizations require people who can handle work-based stress effectively besides meeting the required skills set. According to most organizations, mentally ill patients are incapable of handling this type of stress thus they tend to reject their applications. Principally, good mental health influences the employability of people as those who can handle work pressures such as handling many tasks have higher chances of getting jobs than those with poor mental health. With increased unemployment, these people fail to afford basic facilities such as shelter, meaning they end up living in the streets (Creighton et al., 2018). Unequivocally, mentally ill patients are highly unemployed, denying them a chance to afford proper housing.
The presence of systemic failures is also a contributor of why most mental health patients lack proper housing. One of the systemic failures is stalling in the identification and delivery of support to people who are predisposed to becoming homeless. For instance, most correctional services fail to acknowledge that most mentally ill patients are often on the verge of becoming unhoused. If the correctional services acknowledged that the mentally ill patients are at high risk of living in the streets, reforms would be underway to provide permanent housing to these individuals thus reducing the number of homeless individuals. However, this is not the case as most correctional services blame it on the mentally ill patients, who in real sense cannot afford the city’s rent prices. The same scenario is experienced in healthcare settings where mentally ill patients are accorded with rooms that are congested or ones that lack proper spacing, making them contemplate living alone in the streets (Creighton et al., 2018). Generally, systemic failures in the identification of contributors of homelessness tend to increase the number of unhoused mentally ill individuals.
Consequences of Homelessness
Lack of permanent homes among the mentally ill persons denies these individuals social security which deepen the problems related to their living conditions. People who have permanent physical address have the ability to receive notifications including letters and mails from the government offices. Some of the things that the government can email via a mail include financial aid. The mentally ill who live in the streets miss out governmental opportunities such as grants which can have pivotal role in reducing some of their problems such as paying for their mental healthcare. Additionally, the government can establish programs which can only be communicated to the people via email box. Without a permanent address, these individuals lack those opportunities, some of which may be providing the exact care that a patient needs. A permanent address helps a person enjoy civil rights such as education, rights to vote and even fair trial (Creighton et al., 2018). Those individuals who are mentally ill and who lack permanent residencies often tend to miss out these rights and, in most cases, they are subjects to impartial hearing in courts and other unfair treatments.
Homelessness often slumps the mental conditions of the mentally ill patients especially if their condition is a recent case. Mental health conditions can vary from those that were acquired to those that have been newly acquired. For instance, a person can be born with schizophrenia while for some, schizophrenia can develop along the way. The latter group is the most susceptible to deterioration of their mental health conditions. These individuals often end up getting laid off their works, which raises their stress levels. One of the consequences of the newly developed mental condition is that it tends to depress the victims especially when there is an apparent change. Homeless persons who get laid off their job show high stress levels when they remember the lucrative lives they had before developing the condition. These thoughts make their mental health state jump from being trivial to a complicated case such as dementia and Alzheimer’s (Creighton et al., 2018). Unequivocally, homelessness among those who develop mental illnesses while having a magnificent life can deteriorate their conditions by adding other problems like stress and depression.
Homelessness increases malnutritional risks among the mentally ill patients, inhibiting their recovery phases. Living in a good house which has everything that one needs, including the nutritional requirements indicates the presence of good mental health for such residents. Good nutrition is imperative in the prevention, evolution and management of mental health problems such anxiety or even schizophrenia. One of the contributive roles of nutrition in proper mental health is that it provides nutrients such as folate, zinc and iron that are responsible for regulating the mood, anxiety and feelings of individuals. When these nutrients are in low concentration in the food, the person is predisposed to the developments of mental conditions such as attention deficit. Increased health stress on the person’s body exposes them to the development of other conditions such as schizophrenia as the body is not getting the required nutrients in the right way as it should (Creighton et al., 2018). Unequivocally, poor nutrition among the homelessness prevents from recovering and in most cases worsens their conditions as it introduces new problems such as depression and stomach upsets.
Homelessness exposes the mentally ill individuals to substance abuse leading to addiction which later further affect their mental capabilities. About 33% of the homelessness people living in the streets of the US battle mental with most of them reporting cases of bipolar disorder and severe anxiety. Homeless individuals who are also victims of mental health are often the victims of assault such as sexual abuse. Since these individuals are suffering from the flashbacks of the assault cases, they tend to seek comfort from drugs and other harmful substances. Those people who are suffering from mental health may also find it difficult to cope with the doctor’s medications especially while living in the streets thus they seek harmful substances such as cannabis to self-medicate their condition. Psychiatrists attending to such individuals need to perform a co-occurring disorder diagnosis to rule out substance abuse and the underlying mental condition (Creighton et al., 2018). Generally, homelessness makes people living with mental conditions to turn to drugs as they find it difficult to follow the doctor’s prescription, causing them to become addicted to substance abuse.
Vulnerability of Mental Health Patients and Types of Care Needed
Vulnerability among Mental Health Patients
One of the causative factors of disabilities is mental illnesses, meaning these victims are vulnerable to mental health disorders. Disability entails the interference with activities of one’s whole systems relative to the immediate environment. On the other hand, mental illness entails a partial or complete disorder of the minds that impairs the body from performing its designed activities such as self-care, education or even participating in the social life. Some of the disorders that have been associated with causing disabilities include schizophrenia, bipolar disorder and obsessive-compulsive disorder (OCD). The degree of disability caused y a particular mental health condition depends on its severity with some conditions such as schizophrenia resulting to a wide range of disabilities among the mental health patients. Other mental health conditions that are related to the causation of the disabilities include alcohol-based stress and bipolar conditions (Creighton et al., 2018). Generally, those individuals living with mental illnesses are on the risk of developing disabilities such as loss of communicative functions since these disorders impact the core areas of their body.
Mental health patients are vulnerable to premature mortality which generally reduces their life spans. People living with mental health conditions have their life expectancy reduced by about 10 to 25 years (Creighton et al., 2018. However, this reduction in life expectancy depends on the type of mental illness that a person is suffering from as those suffering from schizophrenia have their mortality rates twice as many as those of the general population. Disabilities and deaths are proportional to the type of mental illnesses that the individual is suffering from. In the schizophrenia case, a person becomes disabled especially in the performance of personal roles such as hygiene and even nutrition. Most of the schizophrenic individuals may skip meals unknowingly while others may soil themselves with acknowledging it (Creighton et al., 2018. Unequivocally, this results to increased number of deaths thus shortened life spans. Additionally, mental health conditions increase the rate of suicides thus most of the individuals contemplate killing themselves especially when the stress levels surpass certain thresholds.
Mental health conditions increase the vulnerability of the victims to stigma and discrimination in the society. Mental health stigma entails the societal disapproval of an individual especially when people in the society shame a person living with a mental condition or one who wants aid for emotional distress. Typically, mental health stigma can emanate from friends, family, colleagues or even the society in general. Such individuals may end up politicizing stigma, preventing people from seeking support from psychiatrists and other mental health patients. Discrimination can be associated with stereotypes that can range from simplified to generalized perceptions of the patients, where in most cases these stereotypes on hold inaccurate, offensive and negative thoughts. These stereotypes allow people to judge quickly about other individuals on the basis of how the appear, propagating such definitions to all the people in that group. One excellent of a stereotype that is prevalent among the mental health patients is considering those with depression lazy and those suffering from anxiety as cowards (Creighton et al., 2018). Generally, mental illnesses predispose people to stigma and discrimination through creation of stereotypes that demean the victims.
Mental illness often exposes the victims to the menace of social exclusion due to various reasons. Menta health conditions can cause social exclusion among the patients especially due to lack of financial resources and due to the effects of the disease like low self-esteem and reduced social interactions. The lack of financial services which is a categorizing factor for the mentally patients can make them excluded from the social functions including entertainment spots and even social settings such as hotels. For instance, it is rare for someone suffering from mental health problem to be allowed entrance into a place with many people who are not suffering as them, mainly because they cannot afford this social place. When families take one of their members to rehabilitation center, they rarely consider them in other social functions, meaning the person is forgotten (Creighton et al., 2018). In other social settings, a mental health patent especially the one suffering from anxiety or depression, they may be disallowed from presenting vital points as they are considered to have low self-esteem.
Care Required by Mental Health Patients
One of the needs required by mental health patients is housing and accommodation support. As discussed earlier, homelessness predisposes the mentally ill patients to harmful substance abuse and even to other illnesses, meaning solving the housing issue can solve a great deal of the problems that these patients suffer. One of the ways of providing housing services include establishing community rehabilitation centers where the health sector can bult at least two such centers in every county in the US. Another method is establishing the doorway program which helps homelessness or those who are on the verge of becoming homeless. This program accords mental health patients with a safe and stable housing, allowing them to have ample time to health and recover from the mental health condition. Lastly, the government can provide home and community which develops a person’s home to allow them to heal comfortably at their own home settings, avoiding the need to move to rehabilitation centers (Creighton et al., 2018). Generally, by establishing housing programs and services, people with mental health problems will have some of their problems recessed.
Establishing effective communication between the mental health patient and the doctor is imperative for proper prognosis. It is always crucial for medical providers to have good communication between themselves and their patients both in the interhospital and intrahospital settings. One of the benefits of good patient-doctor communication on the doctor is that it saves on costs, it protects one’s patients and increases the day-to-day operating efficiencies of the hospital. On the other hand, patients enjoy easy access to their medical histories, which lowers the rate of medical error. Additionally, effective communication can help the health provider to make accurate diagnosis especially when the patient presents with a wide range of symptoms (Creighton et al., 2018). An effective communication needs to be timely, clear and discrete and one which allows individual patients to acknowledge their health statuses and needs.
Mental health patients require interventions that integrate both psychotherapy and medications. Medical personnel handling mentally ill patients need to offer psychotherapy which is a form of treatment that explores feelings, thoughts, behaviors and even seeks to boos a person’s health. One of the widely used psychotherapy treatments is the application of the cognitive behavioral therapy (CBT), which aid the medical practitioner identify the negative beliefs surrounding a given mental condition. After this identification, the health provider replaces them with positive behaviors thus improving the prognosis of the patient. Additionally, medications should be integrated for the care to be effective and these medications could include antidepressants and even antipsychotics. Examples of medications that are prescribed for mentally ill patients include selective serotonin reuptake inhibitors (SSRIs) which help to treat diseases such as bipolar disorder (Creighton et al., 2018). Unequivocally, a combination of medication and psychotherapy could result to proper management of the mental illness condition.
Medically unwell patients with psychiatric comorbidity benefit from psychiatric treatment. This is the idea behind C-l psychiatry, whose advantages may be proved using a value matrix that considers treatment outcomes in medically unwell patients with psychiatric comorbidity, as well as cost savings by combining specialist psychiatric care with routine medical treatment. Principally, hospital inpatients, cost–benefit issues of consultation psychiatry service delivery have been demonstrated, with primarily US studies showing a trend toward shorter hospital stays and lower treatment costs in medical patients after a psychiatric liaison service was established, compared to control groups under such treatment program. Taking care of our mental health can also help us avoid or combat the mental health issues that can arise as a result of a chronic physical illness. It can prevent the beginning or return of a physical or mental ailment in some situations. For example, good stress management can reduce the risk of heart disease (Creighton et al., 2018). Generally, combining psychiatric care with routine medical checkup is a way of saving the cost of treatment for the individuals suffering from mental health since the care offered is personal-centered.
Along with care, mental health patients need employment opportunities to help them cover their bills. A mental health patient can be tasked with a librarian task or even as a postal services administrator. As a librarian, the person will have ample time interacting with readers as they look up books for them. This interaction reduces the feeling of stigmatization or even discrimination. In the postal services center, the individual can develop many relationships with their neighbor as they deliver mail, creating a feeling of love which they can harness to improve their condition (Creighton et al., 2018). Generally, offering employment opportunities to the mentally ill patients can prove to be therapeutic besides giving them money for their expenditure.
Conclusion
Inconclusively, there are important ethical practices in the field of mental health that are ignored y doctors including confidentiality and informed consent. This ignorance affects deteriorates the conditions of the patients. Additionally, there are other problems like reduced psychiatric facilities which poses a challenge to accommodation and even the offering of services to the individuals. Other problems associated with mental illnesses is homelessness which propagates problems such as drug abuse and even malnutrition. These problems could be alleviated by offering the mentally ill patients a care that solves most of their underlying problems like housing which could be through establishment of accommodation programs. Additionally, there are approaches that could be integrated in healthcare setting provide individuals suffering from mental health with cost-friendly care such as the C-I psychiatry which results to shorter hospital durations. Reduced costs could improve the health seeking behavior of the mental health victims. Generally, every government should look into the issues of mental health as it is commonly ignored, leading to increased morbidity of the patients.
Reference
Creighton, G., Oliffe, J. L., Ferlatte, O., Bottorff, J., Broom, A., & Jenkins, E. K. (2018). Photovoice ethics: Critical reflections from men’s mental health research. Qualitative health research, 28(3), 446-455.