Treatment Of Patients With A Dual Diagnosis Social Work Essay Essays

Treatment Of Patients With A Dual Diagnosis Social Work Essay Essays Treatment Of Patients With A Dual Diagnosis Social Work Essay Essay Treatment Of Patients With A Dual Diagnosis Social Work Essay Essay A mental wellness nurses position of the issues environing the intervention of patients with a double diagnosing of psychiatric upset and larning disablements in mainstream mental wellness units. This essay is traveling to research from a mental wellness nurses perspective the issues environing the intervention of patients with a double diagnosing of psychiatric upset and larning disablements in mainstream mental wellness units. Including a treatment around prevalence, proviso of services, entree to services, authorities policy and whether staff in mainstream mental wellness units have the cognition and accomplishments necessary to supply effectual attention for this potentially vulnerable service user group. The modern-day construct of larning disablements focuses on the physical and societal troubles that can happen as a effect of being labelled a individual with a learning disablement and how any damages a individual may hold impact them ( Swain et al, 2004 ) nevertheless it neglects to place the mental wellness issues people with larning disablements on a regular basis and more normally face If people who meet the diagnostic standards for boundary line acquisition disablement are included the prevalence of larning disablements in the UK equates to 12 % of the population or around 8 million people ( Hassiotis et al, 2008 ) It is by and large recognised that people with a larning disablement have a higher rate of psychiatric upset compared with the general population with the prevalence estimated at 40 50 % ( Raghavan and Patel, 2005 ) . In comparing to 10 20 % of the general population ( The Office for National Statistics, 2000 ) Assorted factors have been cited as being conducive towards this exposure including encephalon harm, centripetal damage, chronic physical ailment wellness, epilepsy, repeated loss or separation issues, hapless self-image, get bying mechanisms and societal accomplishments, communicating troubles and household jobs ( Fraser A ; Nolan 1995, Hardy et Al, 2007 ) Mental wellness nurses are specifically trained to handle a diverse group of people including kids and immature people, working age grownups, the aged and new female parents all with mental wellness jobs. Experiences from clinical pattern demonstrate an addition in the figure of people with larning disablements admitted to general acute mental wellness infirmaries and the increasing incidence of complications that can frequently come along with the attention of this group of people. These include jobs with appraisal and intervention, normally stemming from communicating troubles, behavioral issues and barriers to collaborative working between the acquisition disablements and mental wellness squads. They can frequently take to an addition in length of stay in infirmary and inappropriate or unequal attention being delivered. Problems arise for the most portion when a individual with a learning disablement develops a psychiatric upset to the extent that requires acute psychiatric admittance. It is now more common to happen that they are being admitted to general psychiatric beds under the attention of general grownup head-shrinkers and mental wellness nurses, many of whom have had small preparation in the appraisal and intervention of mental unwellness in this group. The communicating troubles people with a learning disablement may confront can do assessment highly complex. Peoples with larning disablements frequently require a longer stay and may besides be vulnerable ( i.e. Abuse and development ) without extra support on the ward. Peoples with a learning disablement may besides hold unusual presentations of common mental upsets due to encephalon hurt or other long standing conditions such as epilepsy taking to trouble in diagnosing and an idiosyncratic response to intervention. Furthermore, people with larning disablements represent a diverse group with a varied scope of complex mental wellness demands, which mainstream staff may experience ill-equipped to run into. Boundary disputes between general grownup and larning disablement services often lead to a decreased quality of attention for people with complex demands Death by Indifference ( Mencap, 2007 ) highlighted alleged attention weaknesss in general infirmaries and primary attention scenes It led to the constitution of an independent authorities enquiry in England. The enquiry unluckily did non widen to mental wellness services It found that there is small grounds refering the quality of attention received by people with larning disablements in these scenes but anecdotal grounds from pattern has indicated that it is sensible to believe mental wellness services face the same sort of jobs as general medical attention. It seems pertinent to undertake these issues head on in order to run into the demands of this client group who have a diverse scope of demands that can cross across all subdivisions of nursing and whose attention can endure as they seem to be on a regular basis forgotten or pushed to the underside of the heap Until 20 old ages ago, people with larning disablements did non usually come into contact with mainstream services. Most people with a learning disablement who had complex demands including mental unwellness, were cared for in specialist mental disability infirmaries, and all medical and psychiatric attention was provided on site. Deinstitutionalisation has transformed their attention and now this group can populate in the community and entree mainstream wellness services, irrespective of the grade of their disablements. This procedure has been guided by the rule of standardization since the early 1970s, which is a doctrine that remains influential today. Standardization represents a cardinal statement of human rights saying that forms of life and mundane life which are every bit near as possible to the regular fortunes of society should be made available to all mentally sick and larning handicapped people ( Nirje, 1976 ) . Closely associated with the principal of standardization is the construct of mainstreaming, which advocates the usage of criterion instead than specialised services, for illustration, schools, Employment and wellness attention it is now a steadfastly established rule and characteristics to a great extent in authorities policy which supports the usage of mainstream services and the question of the acquisition disabled population back into society but besides recognises the demand in some instances for specializer services. ( The Department of Health, 1992 ) stated that: wherever possible people with larning disablements should be enabled to utilize ordinary wellness services every bit good as specialist appraisal and intervention services . Advocates of standardization by and large back up the mainstream attack ; they may reason that specialized services lead to labelling, stigmatization and negative professional attitudes. The statement for this attack at first glimpse appears sound and is supported widely by literature. It is, for illustration, current policy in the UK and USA. However, in pattern mainstream community mental wellness and inmate squads have found it progressively hard to run into the demands of people with larning disablements and psychiatric upsets ( US Public Health Service, 2002 ) . Each of the four United kingdom states has its ain policy construction turn toing how the demands of people with larning disablements should be met in a mental wellness environment. England s policy is set out in the undermentioned studies. Valuing Peoples: A new scheme for larning disablement in the twenty-first century ( Department of wellness, 2001 ) , Health Services for Peoples with Learning Disabilities ( Department of Health, 1992 ) and Mental Health: National Service Framework, ( Department of Health, 1999 ) , The common subjects and issues that underpin this policy construction, include: advancing collaborative working between mainstream mental wellness services and specialist acquisition disablement services ; leting people with larning disablements to entree mainstream mental wellness services wherever possible but making little specializer inmate services for those whose demands can non be met by mainstream services, implementing a changing function for specializer larnin g disablement services to supplying support and facilitation for mainstream services including supplying mainstream mental wellness and attention staff with equal preparation on the demands of people with learning disablement ; using a attention programme attack for people with learning disablement and mental wellness jobs and making mental wellness publicity stuffs which are made accessible for people with a learning disablement. Advice is available to assist care suppliers and staff support people with larning disablements in accessing mainstream mental wellness attention scenes ( Hardy et al, 2006 ) . The Green light toolkit ( Foundation for People with larning disablements et Al, 2004 ) is one illustration of a counsel papers that demonstrates how policy construction and specific policies are being implemented in pattern. It is used throughout England as an audit tool to mensurate how the National Service Framework for mental wellness ( Department of Health, 1999 ) is being implemented for people with learning disablements. The toolkit provides a gilded criterion that can be used by local mainstream mental wellness services to mensurate services against. It offers a traffic visible radiation hiting system and provides counsel on how services can be improved, covering countries such as local partnerships, planning, accessing services, attention planning and work force planning. After a green light toolkit a ppraisal, each local country should develop an betterment program from the action points identified and have a clip frame to implement the necessary alterations. Anecdotal grounds from observations in pattern suggest that the green light tool kit is still being used in pattern today but similar countries for betterment are identified clip and clip once more such as entree to wellness promotional stuffs in apprehensible formats. This would propose that although appraisals of services are being undertaken the results of these appraisals and action points are non being carried frontward into pattern. The Disability Rights Commission ( Disability rights committee, 2006 ) supports this position by stating that old counsel paperss intended to assist people with larning disablements gain entree to mainstream wellness services have had limited consequence. A working group from the royal montage of head-shrinkers ( Royal College of Psychiatrists, 1996 ) acknowledged that enabling people with larning disablements to entree mainstream mental wellness services can be a complex and demanding undertaking necessitating input from specializers in the psychopathology of larning disablement. To react to this statement they have advocated two rules for the mental wellness nursing of people with larning disablements: joint working between mental wellness and larning disablement squads with the usage of Mainstream psychiatric installations at every possible chance every bit good as emphasizing that commissariats for specializer services are still to be available if needed. The independent authorities enquiry instigated by Death by Indifference ( Mencap, 2007 ) , while non widening to mental wellness services, promoted research into the experiences reported by people with larning disablements of acute mental wellness units. This provides a assorted image. The negative experiences are similar to concerns expressed by other patients. These include: deficiency of control and information ; larceny of belongings ; intimidating multi disciplinary meetings ; hapless nutrient and hapless attention. However the presence of larning disablements may change their significance for illustration, service users with larning disablements may happen it harder to understand information about their admittance and intervention, unless it is shared in a format which is appropriate to their cognitive and communicating accomplishments. Psychotropic medicine may farther impair already hapless cognitive operation and may stand for an extra restriction on persons capacity to und erstand and take an active portion in their intervention. Relatives and paid carers are likely to hold a much more important and long-standing function in back uping the service user than would be the instance with other grownups with mental wellness jobs, Often a individual with a acquisition disablement has specific modus operandis that merely person near like a carer would cognize and following these modus operandis can do nursing them much easier. this is something to which mainstream services in peculiar seem to pay small attending. Not emphasizing engagement with carers in peculiar with a client from this group can take to either a deficiency of support for carers or carers experiencing pushed away by services and left without a function which in itself can take to the presentation of depression and low temper in the carer. ( Scior and Longo, 2005 ) Finally, the hazard that marks and symptoms of mental wellness jobs will be misattributed to a individual s acquisition disableme nt ( diagnostic overshadowing ) is specific to this group. These issues need to be considered by practicians nevertheless, grounds indicates that healthcare professionals frequently lack the cognition, accomplishments and experience necessary to run into the health care needs of people with learning disablements. ( Fraser, 1999 ) The Royal College of Nursing ( Royal College of Nursing, 2008 ) commented that the recent development of an outlook of the mainstream mental wellness services to react to the demands of the bulk of people with larning disablements and co-morbid mental unwellness has frequently proved an unrealistic end for the mental wellness nurse. It has been proven that particular expertness and preparation every bit good as the usage of specialist mental wellness squads are required for the appraisal, diagnosing and intervention of mental unwellness in the acquisition handicapped population. Although it is theoretically possible to develop staff in mainstream scenes, the little figure of instances gives small chance for staff in the assorted subjects to derive the necessary accomplishments. Additionally, mainstream mental wellness staff frequently feel that caring for this group of vulnerable people is non portion of their function, and the resources of big mental wellness services are already stretched ( Day, 1988 ) . The support deductions that arose from such a monolithic displacement in service duty that came out of the execution of the mainstreaming attack neer seem to hold been adequately addressed ( Bouras et al, 1995 ) Collaborative working between professional groups in health care is critical across the board for bettering criterions of attention for patients and their carers ( Pollard,2004 ) . In relation to this professional competitions between mental wellness and larning disablements squads are common and the apprehension of each other s function is hapless taking to chiefly uneffective collaborative working ( Bouras et al, 1995 ) There has besides been no evident or unequivocal dialogue between the two service squads in the UK to develop clear local operational policies or service understandings and merely obscure definitions of who is entitled to entree which service exist, which can sometimes take to a patient having inappropriate intervention, being bounced between services or, in rare instances, even being denied attention wholly as neither squad is willing to take duty for that patients attention. Distinguishing between psychiatric upsets and behavioral issues in people with larning disablements is non ever a straightforward procedure. Both empirical and conceptual issues associating to the nature of such behavioral upsets question both the cogency and dependability of a diagnosing of mental unwellness in a individual who has a learning disablement ( Krose et Al, 2000 ) This raises the inquiry what does a nurse dainty foremost? As with double diagnosing of a drug dependence and mental unwellness, in many instances the drug job needs to be tackled foremost before the full extent of the mental unwellness can be seen ( Drake,2007 ) .However, with a learning disablement this is non a possibility as a acquisition disablement is a long standing status that can non be treated. The inquiry is hence, is the behavior being exhibited by a patient due to their mental wellness jobs or the learning disablement? When a individual with a acquisition disablement requires admittance to hospital due to a psychiatric unwellness, the first aim is to hold on whether the general or learning disablement head-shrinker acts as the responsible clinician. The admittance of a individual with larning disablement frequently happens as a last resort in response to an exigency that can non be managed elsewhere such as in the community or via the usage or reprieve services. The community larning disablement squad should be able to offer some preparation to nursing staff or even transport out specific pieces of work straight with the patient. The allotment of a named nurse is highly of import and, if available, person with particular accomplishments or involvement should be appointed in order to develop a more effectual curative confederation with the patient. The increased exposure of people with larning disablements to mistreat even during admittance should be considered and protection from this possible hazard given. This may necessitate to be in the signifier of separation from high-risk patients or an increased degree of nursing observation such as is policy with under 18s admitted to adult acute psychiatric units. In all instances, the importance of coaction with the acquisition disablement squad should be stressed. This becomes peculiarly of import during discharge planning. In the scenario of an admittance under a Mental Health Section, people with learning disablement and mental wellness jobs are entitled to all the commissariats of the Care Programme Approach and Section 117 after-care. It is besides indispensable that mental wellness nurses have a good working cognition of mental wellness jurisprudence and statute law. Experiences from clinical pattern have demonstrated that frequently mental wellness statute law is misused or disregarded for people with co morbid acquisition disablements which denies them the precautions and protection of the jurisprudence that statute law such as the mental wellness act was designed to set in topographic point ( Mental Health Act, 1983 ) . The relevant statute law should be applied to this group of people if and when it is appropriate to make so and the same classs of detainment used as for other persons sing mental sick wellness. Although it is of import to observe that a individual with a learning disablement can still be sectioned if it is deemed they behave abnormally sharply or earnestly irresponsibly, without any marks of mental unwellness it is hence of import to find that that there be existent mental wellness jobs presen t if a individual is admitted under subdivision to a mainstream mental wellness infirmary. Assessment is a specific portion of the nursing procedure where mental wellness nurses can fight when covering with people with larning disablements For illustration, The Mental State Examination, which constitutes an indispensable constituent of the preparation procedure and is indispensable for measuring hazard and explicating a intervention program, may be debatable. This could be for a figure of grounds, including high rates of conformity or an avidity to delight in certain interview state of affairss ( Sigelman et al, 1982 ) . Moss argues that people with learning disablements are besides less likely to kick or near members of staff to inquire for aid which may farther perplex the Assessment and hazard direction procedure. ( Moss,1999 ) Simple linguistic communication and direct oppugning including communicating and in depth treatment with carers could be a manner to get the better of this trouble. Higher degrees of nursing observation may besides be utile, non merely in guarant ing a individual s safety on the ward but besides in giving critical information sing a individual s mental province ( Appleby,1999 ) ( Gibson, 2007 ) highlighted some cardinal factors that nurses without specialist preparation may happen complicate effectual appraisal and intercession The two chief factors that affect mental wellness nurses are: rational deformation, which may ensue from cognitive shortages in countries such as memory and concentration which can do comprehension and communicating of ideas and feelings hard ; and Cognitive decomposition, which can happen in state of affairss where the individual is overwhelmed by the anxiousness of the demands being placed on them, ensuing in an inability to soldierly ideas and bizarre behavior Communication is cardinal to doing a sound and accurate appraisal. It is estimated that upwards of 50 % of people with larning disablements have important communicating troubles ( Matson, 1998 ) A nurse demands to turn to the peculiar communicating demands of each person as each will change in their abilities, This is another point in which collaborative working becomes really of import as if the individual is involved with a acquisition disablements squad, that squad may be able to supply the nurse with accurate information about the degrees of a individual s communicating and how best to pull off these issues. Many of the jobs in relation to direction of people with larning disablement by mental wellness nurses relate to the deficiency of cognition accomplishments and preparation ( Lennox A ; Chaplin, 1995 ) . Evidence suggests that qualified nurses on a regular basis feel out of their deepness and unsupported when covering with this client group and observations in pattern indicate a certain sum of turning away tactics from mental wellness nurses when it comes to volunteering for the named nurse axial rotation which could be due to a deficiency of assurance in this country. The current pre-registration nurse instruction programme for mental wellness nurses was originally validated by the English National Board ( English National Board,2000 ) , and the course of study follows the Nursing and Midwifery Councils Fitness For Practice Guidelines ( United Kingdom Central Council for Nursing, Midwifery and Health Visiting,1999 ) , which states that pupils set abouting pre-registration programmes must hold certain other fortes included. However, larning disablement, as either a practical or theoretical constituent of the subdivision programme, is non one of them. With authorities policy ( Department of Health, 2001 ) saying that people with larning disablements should wherever possible entree generic services, there would look to be the demand for a more specific and in-depth attack to larning disablement instruction for all pupils throughout their pre-registration instruction. Experiences from local preregistration nurse instruction show that presently nursing instruction provides a 12- month common foundation programme for nurses who intend to develop in all countries of nursing including Adult, Mental wellness, Midwifery, kid and learning disablement nursing. Although non required by the NM, Learning disablement theory is taught but arrangements in this country are non common. After common foundation period of preparation, pupil nurse instruction in mental wellness has little or no farther chances to derive learning disablement experience. Comparisons with larning disablements mental wellness can be made to both kid and adolescent mental wellness, every bit good as to older people s psychopathology in that they are both specialist groups with their ain issues and mental wellness nurses are expected to analyze these client groups in item during their subdivision preparation in order to go familiar with the complexnesss of this type of mental wellness nursing. As these countries are compulsory fortes in order to run into the demands of making as a mental wellness nurse ( English National Board, 2000 ) and, coupled with the authorities s policy for people with larning disablements to entree generic mental wellness services, it would look indispensable that mental wellness nurses address the forte of people who have larning disablements and extra mental wellness jobs during their pre-registration instruction as they do with other specific patient groups. Many senior mental wellness nurses have received no larning disablement preparation at all. This deficiency of preparation may ensue in jobs with communicating and apprehension, every bit good as negative attitudes toward people with learning disablement. On the impudent side, nurses in larning disablement have likewise limited preparation in the country of mental wellness, although there are freshly available post-registration classs. One such class gives an experient nurse from either ramify a six month endorsement to the other nursing subject which is backed up by 2 faculties of theory. Anecdotal grounds gained from talking to a mental wellness nurse who has late completed this class has shown that general nursing accomplishments that every nurse should be competent in upon making can be transferred across the board to other subdivisions of nursing. The feeling of this nurse is that presently, mental wellness mainstream services see merely those with mild or marginal learning disa blements coming into the service and the appraisal and intervention procedure for these people is non much different to that of non larning handicapped people. Currently specializer services provide the bulk of attention for the patients with more complex demands. ( Scior and Longo, 2005 ) In decision the grounds presented in this essay suggests a figure of issues that need to be addressed if mental wellness nurses are to run into the demands of their clients with a carbon monoxide morbid larning disablement efficaciously. There are: pre and Post enrollment preparation for mental wellness nurses, collaborative working between the mental wellness and larning disablement squads and proviso and entree to services. It seems that specializer larning disablement in-patient units with a mental wellness focal point offer a more positive experience for the patient than mainstream mental wellness units, and hence should be developed farther ( Scior and Longo, 2005 ) . However, realistically mainstream services are extremely likely to go on to supply attention for this group, if merely because of the resource restrictions in specializer services and the fact that 30 % of NHS trusts provide no specializer admittance installations ( Bailey A ; Cooper, 1997 ) . There seems a demand now for major alterations to be made to the constructions and daily patterns in these services. Such alterations should include enterprises to advance more positive attitudes and behavior towards persons with acquisition disablements through preparation and regular input from specializer larning disablements services. Closer attending must be paid to the demand to do information about diagnosing and interventions accessible, in media such as cusps utilizing simple linguistic communication pictures and audio information ( Forster et al, 2001 ) and the demand for stronger engagement of and co-operation with service users regular carers. Current pattern experience has shown nevertheless that in the most portion mental wellness services in this country merely seem to come into contact with patients who have a boundary line or mild learning disablement as there is a big supply of specializer beds. Currently merely in rare instances would mainstream mental wellness units be acknowledging a individual with terrible or profound acquisition disablements whereby little changes to pattern and movable nursing accomplishments would non be plenty to give that patient the best attention available. Referances Appleby L ( 1999 ) National Confidential Inquiry into Suicide and Homicide by Peoples with Mental Illness. 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