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Unit 20 Health and Social Care Distinction
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A completed coursework unit at Distinction level.
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IntroductionIn this unit, I will be exploring the importance of understanding mental wellbeing and
the various aspects that impact it. As mental wellbeing consists of social, emotional
and psychological wellbeing, I will be investigating each aspect and how they can be
better understood in health and social care. I will also be looking at the various
professionals that will work with individuals to maintain their mental health or support
their recovery from mental health disorders, such as psychiatrists, and how they go
about supporting service-users to promote their overall mental wellbeing.
Furthermore, I will be exploring the impact of mental ill health on society, as well as
on a smaller scale, such as on families and friends of those with mental health
disorders. This unit also requires me to investigate the various treatments available
for those with mental ill health and how they work, as well as their impacts on
service-users, such as longer term consequences that the service-user may
experience. Additionally, I will be investigating the various legislation that underpins
health and social care practice regarding mental wellbeing and how it supports the
promotion of mental wellbeing.
For Learning Aim A, I will be required to understand the different views on the nature
of mental health and the various perspectives held by society. Learning Aim B
focuses on examining how the main forms of mental ill health are classified and the
strengths and limitations surrounding current classification systems in health and
social care. In Learning Aim C, I will examine the impact of mental ill health on
individuals, families, friends and society as well as the treatments used to manage
mental ill health. Learning Aim D requires me to examine the strategies which
promote mental wellbeing as well as the legislation in place to manage the treatment
and management of mental ill health in health and social care.
Learning Aim A | Understand different views on the nature of mental well-being and
mental health
A.P1 | Explain factors that influence mental wellbeing and mental health.
As mental wellbeing has various connotations to each individual, there is no agreed
universal definition. According to the World Health Organisation (WHO), mental
wellbeing may have various definitions, such as: “the notion of happiness or
contentment” or “the absence of disease” or the “absence of negative determinants
in the life of an individual” (World Health Organisation, 2009). Mental wellbeing also
includes cognitive, social, emotional, behavioural, and psychological responses
displayed by an individual in certain situations. Furthermore, the World Health
Organisation also state that mental wellbeing “should be considered as a continuum
and as operating within a spectrum, rather than a state that is present or absent”
(World Health Organisation, 2019) due to its complexity and lack of universal
definition. As mental wellbeing can vary from day to day, it is a dynamic concept.
Mental health is defined as a state of well-being that all individuals have and is
influenced by various factors in an individual's life. If an individual has good mental
health, they are expected to be able to “cope with the normal stresses of life, can
work productively and fruitfully, and are able to make a contribution to their
community” (World Health Organisation, 2014). Similarly to mental wellbeing, mental
health can be seen as being within a spectrum due to having different perceptions
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,L507446 Level 3 Extended Diploma in Health and Social Care 22113
within both society and health and social care settings. At different points in
someone’s life, they may have a different state of mental health due to health
physically changing, as well as the individuals perception of the meaning of mental
health.
An individual's mental health can be negatively affected if they experience stress or
mental illnesses which have different symptoms in each person can impact people’s
lives very differently. Mental illnesses can have a range of severities and symptoms
and each person's experience with a mental illness may be unique. Due to there
being so many types of mental illness and each one having the possibility of
impacting someone differently, it is often difficult to identify when someone is
suffering from a mental illness which can cause challenges within social networks, as
well as within health and social care.
Throughout history, societies perspective on mentally ill individuals has changed
drastically for various reasons including reforms, funding and provision of care. In the
1900s, mentally ill individuals were held in asylums to be kept away from society.
Admissions to asylums were often involuntary as individuals were forced by their
families to stay in the institution and receive treatment for their mental health.
Despite reasons for admissions often being for trivial reasons such as being socially
inept, admissions often lasted for long periods of time due to the individual being
unable to cope in the community without support, and often becoming worse
throughout their stay. Inside asylums, therapy was limited which contributed to the
length of admissions as there was no support for individuals to recover, instead they
were often left to their own devices and subsequently relapsed. Care in psychiatric
institutions before 1948 consisted of straitjackets, intramuscular injections, padded
cells and restraints; treatments were equally brutal and electroconvulsive therapy, as
well as insulin induced comas and frontal lobotomies which were commonly used to
manage the symptoms of those with mental disorders.
In 1948 when the National Health Service started out, it took responsibility for over
100 asylums in the UK and mental health based care was all funded by the
government. In 1950, the Ministry of Health Report highlighted “therapeutic
convulsion treatment, insulin shock treatment and prefrontal leucotomy” (Mental
Health Foundation, 2013) as the most commonly used treatments inside the
hospitals, it also indicated that provisions for outpatient care were almost non-
existent which led to individuals being confined to hospitals almost indefinitely.
Shortly after the creation of the NHS, the Mental Health Act was created in 1959,
allowing for patients to be kept in hospital involuntarily, meaning that even if a patient
wanted to leave, the law stated that they could be kept locked up until deemed safe.
Despite the creation of the NHS and 1959 Mental Health Act aiming to reduce the
amount of individuals inside asylums and allow for more community care, instead it
did the opposite. By the mid 1950s, there were over “150,000” (People's History
NHS, 2018) individuals kept inside and the number was expected to continue to
grow due to their being no adequate community care available.
In 1961, Minister of Health Enoch Powell, gave a speech highlighting the same aims
as the creation of the NHS and Mental Health Act: the movement towards outpatient
care instead of inpatient care for individuals with mental illness. Powell presented the
solution as twofold: “on the one hand, moving the treatment of mental illness to the
wards and wings of general hospitals; on the other, developing new services in the
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community supported by an expanding social work profession” (People's History
NHS, 2018) which promoted a fundamental transformation to mental health services
across England, a transformation which was made easier due to medication being
used as a more readily available treatment of mental disorders.
Even though Powells ideas showed promise, the change was slow and only a few
mental health hospitals had closed by 1970. However, from the 1980s change began
to be evident within society and there was a “60% fall in mental hospital beds from
1987 to 2010” (People's History NHS, 2018). Powell, as well as many others, pushed
forwards the idea of community based care for individuals with mental disorders,
however cuts in NHS funding resulted in hugely disappointing outpatient care. Due to
the lack of outpatient care, there were numerous high profile incidents involving
community care patients, whereby other services such as the Police often had to
become involved to promote the preservation of life and keep society safe.
In 1990, the NHS and Community Care Act provided “a backdrop for
multidisciplinary community mental health teams and the care programme approach,
which gave some patients an assessment, a care plan and a key worker” (People's
History NHS, 2018), despite the reform showing promise, implementation was
inconsistent and often unsuccessful. Labour Governments identified the
inconsistencies within mental health care and therefore implemented a programme
which aimed to modernise “mental health services between 2000 and 2010”
(People's History NHS, 2018). Provision of the programme was overseen by the
National Institute of Mental Health and was backed by significant new money that
had been accumulated since the end of the recession.
Since the various reforms and legislations created in the late 20th century, provision
of mental health services has overall continued to improve primarily due to the
control gained over services, as well as the large increase in funding for mental
health services. Despite there still being negative perspectives towards individuals
with mental illnesses, they have changed
significantly since the 1900s due to various
factors including campaigns leading to raised
awareness and better provision of mental health
care both outpatient and inpatient.
Media attention has heavily contributed to the
shift in perspectives on mental health due to the
raised awareness of information regarding
mental health including promoting the truths and
fighting the myths surrounding the topic. In
2016, Rhydderch et al conducted a study investigating the attitudes and attention on
mental health in newspapers. Primarily the study focused on stigmatising language
used in articles relating to mental health and found a “significant decrease in the
proportion containing ‘danger to others” (Sykes. E, 2016), demonstrating the
evidently changed perspectives on mentally ill individuals within the media. As the
researcher chose the most popular newspapers in England, it is likely that the
opinions stigmatising mental illness would have been widespread which would have
heavily influenced perspectives relating to mental health within society.
Campaigns run in the UK by mental health charities have also influenced the shift in
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perspective. In 2018, Time to Change launched their ‘Ask Twice’ campaign, urging
people to ask their friends twice if they’re okay. Primarily the campaign aims to raise
awareness of how common mental disorders are and reduce the stigma to allow
individuals that are struggling to seek support. The campaign was created after a
national survey identified that over 2000 respondents saw the question ‘How are
you?’ as a meaningless exchange; other results from the survey found that 52% of
individuals didn’t properly answer the question due to not wanting to burden people.
Time to Change are in the process of running a five year campaign titled ‘In Your
Corner’ which aims to encourage individuals “to be more open and supportive of the
1 in 4 people living with a mental health problem in any given year” (Time to Change,
2018).
Since Time to Change started in 2007, millions of people across England have been
reached with the various messages being shared by the charity. In a national survey
conducted the Time to Change there was an “overall attitude trend between 2008
and 2016 was positive with a 9.6% change - that's an estimated 4.1m people with
improved attitudes” (Time to Change, 2018) which demonstrates the evident shift in
societies perspectives on mental health and mental illness.
Mental capital is a concept defined as “the totality of an individual's cognitive and
emotional resources” (GOV.UK, 2008), it includes an individual's cognitive abilities,
efficiency of learning and emotional intelligence. Throughout life, mental capital can
alter and is often thought in terms of trajectory which rises in early years, plateaus in
middle years, and begins to decline as
an individual becomes older. Various
factors can influence an individual's
mental capital over their lifetime as they
begin to have new experiences due to
their age, for example a twenty year olds
mental trajectory will be affected by a
job, but the mental capital of a three year
old would not be affected by a job since
they would not have one.
Due to the prevalence of poor mental
capital within the UK, Professor Cooper
of Lancaster University was appointed
the “lead scientist on the Mental Capital
and Wellbeing Foresight project,
commissioned by the UK Government Office for Science to inform its vision and
future policy” (Lancaster University, 2016). The project aimed to address the key
challenges identified by the government as likely to have a major impact on working
patterns within the next 40 years. The programme generated key recommendations
which identified a simple ‘five-a-day’ programme of social and personal tasks to
promote better mental wellbeing and mental capital in the daily lives of individuals.
Five actions that were identified included: connecting with others, being active,
taking notice of your surroundings, continuing learning and giving to the community.
The five actions identified were published on a postcard set that was used by
organisations throughout the world since publication.
Primary interventions are put in place to prevent mental health problems from
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