IntroductionMental health difficulties are reported globally to affect 1 in 4 individuals (World Health Organisation (WHO), 2013). Figures in Scotland are similar, where 32% of individuals surveyed in 2013 self-reported having one or more mental health conditions (Scottish Government, 2014). Scotland currently has a wide range of policies and legislation in place to protect those with mental health difficulties, extending from policies designed to reduce stigma and discrimination, to policies designed to support those who are at the risk of suicide.This assignment will discuss the ramifications of living with schizophrenia and cannabis dependency in an individual called Stuart. There will also be a discussion on the legislative and policy framework in Scotland within which support for people with mental health needs is set.CaseStudyThis casestudy will focus on an individual, who will referred to as Stuart. This is notthe service users real name, but thispaper will follow the Nursing and Midwifery Councils (NMC) Code of Conduct,5.1 (2015), stating that a patients right to privacy and confidentiality mustbe upheld at all times Stuart is a 50- year-old divorcee .He is an electricianby trade. Currently unemployed. He has three children and an ex-wife.Stuart has adiagnosis of schizophrenia. Schizophrenia is a long-term and debilitatingcondition which is characterised by symptoms such as delusions, hallucinations,low affect, and cognitive difficulties (American Psychological Association(APA), 2013). It is diagnosed using the DSM-5 diagnostic criteria, whichinclude delusions, hallucinations, negative symptoms, disorganised/catatonicbehaviour, and disorganised speech (APA, 2013).Theexperience of voice hearing should not be confused with the normal inner voicethat we all have in our minds when we are in good health. Voices caused bypsychosis are profoundly different. They are as real as hearing a person in thesame room speaking ( and indeed research carried out by scientists has shownthat the parts of the brain that are activated by hearing real speech, i.e. fordetecting speech and generating language, are also active when voice hearershear the voices coming from inside their heads( Reveley, 2006).In additionto schizophrenia, he struggles with substance dependency and has been smokingcannabis since he was 9 years old. Cannabis is the most widely used psychoactivesubstance in the world (United Nations Office on Drugs and Crime, 2016). It isestimated that 10% of cannabis users develop a cannabis use disorder. This canbe diagnosed when a persons cannabis use impairs their functioning in everydayactivities, such as driving, over a year long period (APA, 2013). Cannabis use hashigh morbidity with disorders such as schizophrenia, and some experts believethat there is a casual link between early cannabis use and schizophrenia (Hartzet al.,2014).HistoryStuart wasraised in dysfunctional family. He rarely saw his father who had been physicallyabusive towards Stuarts mother. He was also an alcoholic. Stuarts father diedat the age of 42 from liver disease. Stuarts relationship with his mother isstrained. He blames her for allowing him to witness the domestic violence as achild.When yougrow up in a dysfunctional family, you experience trauma and pain from yourparents actions, words, and attitudes (Boyd, 1992).Because of this trauma youexperienced, you grew up changed, different from other children, missingimportant parts of necessary parenting that prepare you for adulthood, missingparts of your childhood when you were forced into unnatural roles within yourfamily (Boyd, 1992).Impact ofConditionsCannabis useis associated with lower educational attainment and the increased use of otherdrugs (MacLeod et al., 2004). There is mixed evidence for the link betweencannabis and impaired neurological functioning. There is some suggestion thatany impairment in function is not permanent and resolves when use is stopped(Schreiner and Dunn, 2012).Schizophreniaimpacts negatively on both physical and psychological health. Research suggeststhat patients with schizophrenia often have health problems due to low levelsof exercise, poor diets, and other drug use (McNamee et al., 2013). The socialeffects are also considerable. Individuals typically avoid social interactionsand become isolated as their relationship with family and friends disintegrate(Castle and Buckley, 2015). In addition, they can experience significantdevelopmental difficulties, with their ability to work impaired as a result(Lauriello and Palanti, 2012). When Stuarts delusions are most extreme,Stuart finds that he cannot leave the house, which is difficult for his childrento cope with. This is likely to negatively impact on his chances of recovery asfamily support is important for recovery (Mueser and Gingerich, 2006).Therecontinues to be a stigma around mental illness (Thompson, 2007). This isparticularly true in Scotland where stigma and discrimination have beenidentified as a widespread concern (The Mental Health Foundation, 2016). Stuart wasfired from his workplace for his number of absences. He believes the realreason was that he had mental health problems. This negatively impacted on hisemotional wellbeing at the time, and he began to experience self-stigma and lowmood. He experienced discrimination when he went to the job centre to seekemployment. He revealed that he was a regular cannabis user and felt that hiscase worker judged him, and did not offer him any viable training or employmentoffers as a result.TwoContrasting ApproachesTwoapproaches to mental health which have widely influenced perceptions have beenthe biomedical model and the anti-psychiatry model. The biomedical model viewsillness as an aberration to be treated (Thompson, 2007). Mental illnesses arediagnosed based on observable behaviours. This is also known as the labellingtheory (Thompson, 2007). The biomedical view continues to be the prevailingview of mental illness in the Western world. An opposing view of mental illnesscomes from the anti-psychiatry movement. This movement has maintained a stancethat mental illness should be viewed as a sane reaction to the insanity of themodern world (Thompson, 2007).Psychiatristssuch as Laing contended that psychotic episodes were instead expressions ofextreme stress on the part of the individual in response to societalexpectations (Thompson, 2007).PrecipitatingFactorsStuart hasrecently heard that his ex-wife is moving away with their children. This hasbeen a huge setback for Stuart, who is likely to feel even more isolated than before.Legislativeand Policy FrameworkScotland hasa strong legislative and policy framework in place to support people withmental health needs. The Mental Health (Care and Treatment) (Scotland) Act 2003provides the backdrop to policies such as Delivering for Mental Health(Scottish Government, 2006), Towards a Mentally Flourishing Scotland (ScottishGovernment, 2009 b), and Mental Health Strategy for Scotland: 2012-2015(Scottish Government, 2012). In addition to these, there have been accompanyingdevelopments such as the See Me programme which aimed to reduce stigma aroundmental health (Scottish Executive, 2002), and the Suicide Prevention Strategy(2013-16) which was developed to target suicide rates (Scottish Government,2013). The Mental Health Division was set up in 2003 by the Scottish Executiveand has been responsible for some of the above policies (The Mental HealthFoundation, 2016). The impact of the Division and the Mental Health (Care andTreatment) (Scotland) Act 2003 will be discussed here, and their relevance tothe care that can be provided for Stuart explored.TheMental Health (Care and Treatment) (Scotland) Act 2003The MentalHealth (Care and Treatment ) (Scotland) Act 2003 set out provision as to howand where individuals could receive treatment, and how they could be treatedwithout their consent should that be necessary. It also set out the rights ofindividuals when receiving treatment. The background to this legislation wasthe growing awareness in Scotland in the 1990s that the previous legislation,the 1984 Mental Health (Scotland) Act, was outdated. New legislation wasrequired that reflected the changing landscape of mental health, with itsgreater focus on human rights and on supporting individuals in community, asopposed to hospital-based care (The Mental Health Foundation, 2016). The Actwas an ambitious piece of legislation, and was recognised as one of the mostforward-looking pieces of legislation in the world at the time. Of particularimportance was its emphasis on the human rights of those with mental healthillnesses. It was informed by the Millan Principles (Millan, 2001). Theseincluded an emphasis on participation and non-discrimination. Advancestatements relate to the principle of participation and mean that an individualcan produce a written statement when they are well which specifies how theywould want to be treated when they are unwell from mental health perspective,and are unable to make decisions for themselves, Stuart has produced an advancestatement which specifies that he is to be administered anti-psychoticmedication If he is too unwell to make that decision for himself. Advancestatements are useful in forming a therapeutic alliance between thepractitioner and the patient (Mental Welfare Commission for Scotland, 2014).The McManus Review(Scottish Government, 2009 a) assessed the Acts progress and found that theimplementation of the Act was proceeding well, but that areas for improvementremained. The review highlighted areas such as the limited use of advancestatements, and take up of independent advocacy services.MentalHealth DivisionThe secondimportant development that I will discuss is the Mental Health Division and thepolicies that this body has been responsible for. The Mental Health Divisionwas established by the Scottish Executive in 2003, and its aim was to improvethe quality of mental health provision in Scotland. It has been responsible forpolicies such as Delivering for Mental Health (Scottish Government, 2006),Towards a Mentally Flourishing Scotland: Policy and Action Plan (2009-2011)(Scottish Government 2009b), and the Mental Health Strategy for Scotland : 2012-2015(Scottish Government,2012). The Delivering for Mental Health policy set outhealth improvement, efficiency, access and treatment (HEAT) targets which wereto be achieved within a certain timeframe. The HEAT targets relevant to mentalhealth included decreasing the number of antidepressants the population wastaking, reducing psychiatric readmissions, and decreasing suicide rates.Of relevanceto the present case study is the publication of the Mental Health Strategy forScotland: 2012-2015. This policy aimed to improve the treatment optionsavailable for people with mental health needs and their carers. The MentalHealth Strategy however, has been criticised by professionals and service userslike, for trying to address too many areas for placing less emphasis on healthpromotion and prevention than previous (The Mental Health Foundation, 2016).Gaps inService ProvisionAn areawhere there are some gaps in service provision is in the provision of crisissupport for individuals with mental health difficulties. Crisis provision isdesigned to provide support to individuals with or without prior diagnoses ofmental health conditions in instances of acute distress as an alternative tohospitalisation (The Mental Health Foundation, 2016, p.88).Another areawhere further funding is required is around the evaluation of policies (TheMental Health Foundation, 2016). Most mental health evaluation focuses onmeasuring hard outcomes such as patient waiting times, the number ofpsychiatric admissions, and the take up of services (The Scottish Government,2006b).ConclusionsIn Scotland,there is a strong legislative framework to support individuals with mental healthconcerns. However there continues to be gaps in service provision with respectto measuring progress, and the delivery of crisis services. In this way,Scotland is not unlike other developed countries, however greater efforts mustbe made to address these gaps. In addition, service users such as Stuartcontinue to experience stigma and discrimination in daily life and this doesnot appear to have lessened greatly in Scotland since the publication of theSandra Grant Report (Scottish Executive, 2004)ReferencesAmerican Psychological Association (APA), (2013).Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).Arlington, VA: American Psychiatric Association.Boyd, G.A., (1992) .When You Grow Up In A Dysfunctional Family. Available at: http://www.mudrashram.com [ Accessed on 5 September 2017]Castle, D.J. and Buckley, P.F., (2015).Schizophrenia. Oxford, UK: OUP Oxford.Hartz, S.M., Pato, C.N., Medeiros, H., Cavazos-Rehg, J.L., Sobell, J.A., Knowles, J.A . Genomic Psychiatry Cohort, C., (2014). Comorbidity of severe psychotic disorders with measures of substance use. JAMA Psychiatry, 71 (3), pp.248-254.Lauriello, J. and Pallanti, S., (2012). Clinical manual for treatment of schizophrenia. 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Geneva, Switzerland : WHO Document Production Service.Get Help With Your AssignmentIf you need assistance with writing your assignment, our professional assignment writing service is here to help!Find out more
