The meals that are offered should meet the Essence of care standards which state that ‘all patients are entitled to three balanced meals a day including snacks 24hrs a day’. However it also states that “Community and Mental Health services are therefore:- not required to adopt the menu format as set out in the NHS Recipe Book – but are encouraged to do so where this is appropriate”. The Ward Manager mentioned that cutbacks in the food menu and other areas were needed to meet the budget and therefore I was urged to quash hopes of games sessions as funding would be needed for items such as balls etc.
Even though there were clearly many health benefits to the patients undertaking exercise rather than being ‘schooled’ on a balanced diet, the latter was favoured because it was the safer option, but the question was safer for whom? I then went to work on my presentation and used PowerPoint and incorporated the use of flashing images and sounds to gain the attention of the service users (my audience) and also to try and make the session as least boring as I could.
The biggest dilemma I faced however was that of telling the service users that the activity that they had taken their time to choose had been greatly modified if not completely disregarded. During lunch on the day before the proposed ‘new activity’ was to take place I had to announce to the service users the change in structure. Many of them did not respond verbally but I could see by their facial expressions that they were extremely disappointed. I explained to them that it was to safeguard their health and safety and proposed my talk about health talk the following day, I had complete reservations about the attendance of the session.
As expected, almost all of the service users did not show up, with exception of only two, Mrs. E and John. It was apparent that the service users had lost trust in me and were obviously conveying their feelings by refusal to show up. Mrs. E and John only managed to stay stationary for less than five minutes and had begun to fondle each other. The support workers had to pull them apart and I was unable to carry out the rest of my presentation. On Reflection
Looking back at my research project I would not change the way in which I carried it out however I feel it would have been beneficial if I had known the residents for as long as I have known them now. ‘There are also indications that more accurate, detailed information is provided when the researcher has spent time getting to know people and has regular contact with the participants during the research'(Cornwell, 1984). I also did not take into account how much of an impact the organizations policies were going to have on the project.
I would have preferred for the project to have had a positive impact on the service users however I feel that it may have lowered their self esteem even more. Nonetheless McIver (1991) suggests that ‘where an evaluation has explored in some depth the nature of the service individuals receive as well as the impact it has on the recipients, the task of establishing the relationships between these two sets of data is challenging but nonetheless of considerable importance to the future development of policy and provision’.
As services strive more and more to offer an individual service to their users this can complicate attempts to aggregate outcomes, and produce misleading results for the project as a whole. Whilst planning the project and undertaking it there are many issues that I encountered that may need reviewing and others changed completely. Firstly, the main problem was that the organisation did not look at the patients as people and disregarded what they wanted.
The problem many healthcare workers face is that they get stuck in a situation where they routinely treat the patients as a whole and do not take the time to get to know them personally and take heed to their individual likes and interests. The National Service Framework (1999) states ‘All mental health service users on CPA should receive care which optimises engagement’ however one could argue that this was not the case when the Ward manager refused an activity that offered many advantages.
Furthermore The Community Care Act (1990) states that ‘In some cases, resources should not be taken into account, for instance, if a person would be at severe physical risk if a service were not provided’. Even though the service users (especially the heavier ones) may not suffer straightaway, over a period of time they could be at physical risk from not having any exercise. Moreover because research suggests that exercise eases stress and may cause a reduction in low self esteem it could possibly slow the processes of patients becoming more depressed.
“Discrimination against people with mental health problems is rife and extends into the health professions” (Chadda, 2000) and discriminatory behaviour is conveyed by certain members of staff at the unit. The National Occupational Standards state that one of the key purposes of Mental health services is ‘to provide equitable and non-discriminatory services, across all age groups and settings’ however one could argue that the senior members of staff may discriminate against Mrs. E and John because of their expression of their sexuality. It is possible that staff separate Mrs.
E and John for their own benefit rather than for the benefit of the service users themselves because it seems that the more they are not allowed to interact with people of different sex it makes their ‘exhibition of promiscuous behaviour’ even worse. It is apparent that the organisational structure of health and social care services has developed a culture of ‘just do it’ and do not ask questions. This could be because of a number of several factors. The healthcare market has grown dramatically and this is reflected also by the many consumers.
Statistics (2000) show that there has been a dramatic increase in the number of people being referred to psychiatric services since the 1940s – particularly men and young people. Furthermore ‘65% more are being referred to psychiatric hospitals for the first time’. This obviously has an impact on the healthcare sector as a whole because the Government has had to up funding over the years to cope with the demand for care services. This is in turn puts pressure on the many NHS funded hospitals and psychiatric units to keep up standards and not go over their budgets.
This is reflected in the way the ward manager runs the unit and may give reason to as to why she refused the recreational activity chosen by the service users because of factors such as the funding to buy equipment, the time and effort in doing the risk assessments for each and every patient who takes part and also the allocation of staff. Care vs control is also a major issue as I found it hard to interview some patients because of the medication that they had received which made them drowsy and rarely alert.
The nursing staff may sometimes give medication to the patients before the allocated time ‘so that they don’t act up’ or when they are being aggressive than usual. Healthcare workers need to take into account that it may be possible for the service user may be upset about something and may be lashing out just as ‘normal’ people do. Conclusion There are a number of factors which work together to strengthen the case for giving greater priority to evaluation in the planning and delivery of services for people with mental health problems.
“The inclusion of users’ perspectives in the evaluation of mental health is increasingly seen as a way of giving a marginalized group more of a voice”( White and McCollam,1999). However this is much easier in theory than it is in practice. Many psychiatric patients continue to need long-term care in institutions in the public and private sector, despite the development of community facilities. Long-stay psychiatric institutions vary in size, level of security, facilities and type of care provided.
Patients are usually regarded as long-stay if they are in an institution for more than a year. Inevitably, many long-stay in-patients experience limitations to their freedom, personal choice and activity, usually compounded by a low income and relative isolation from the community.
References Bryman A. (2001). Social research methods. Oxford: Oxford University Press. Chadda, D. (2000) Discrimination rife against mental health patients. British Medical Journal, 320,1163 Cornwell, J 1984.
Hard -earned lives:Accounts of health and illness from East London. London:Tavistock Gibson , C, 1998, Journal of Psychiatric ; Mental Health Nursing,5,(6), pp. 469-477 Hillsdon, M. , Thorogood, M. ; Foster, C. (1999) A systematic review of strategies to promote physical activity. In Benefits and Hazards of Exercise (ed. D. MacAuley), pp. 25-26. London: BMJ Publications http://www. indymedia. org. uk/en/2006/10/352537. html http://www. statistics. gov. uk/downloads/theme_health/PMA-AdultFollowup. pdf.
Jamison, K. R. 1996. An Unquiet Mind: A Memoir of Moods and Madness. New York: Vintage Books McIver, S (1991). Obtaining the views of users of Mental Health Services. London. King’s fund centre. Meltzer, H. , Gill, B. , Petticrew, M. , et al (1996) Economic Activity and Social Functioning of Residents with Psychiatric Disorders (OPCS Surveys of Psychiatric Morbidity in Great Britain, Report 6). London: HMSO National Service Frameworks for Mental Health, Modern Standards and Service Models (1999) Peat, J., Mellis, C. , Williams, K. and Xuan W. (2002), Health Science Research: A Handbook of Quantitative Methods, London: Sage Rubin, H. J. , & Rubin, I. S. 2005, Analyzing Coded Data.
In Qualitative Interviewing: The Art of Hearing Data, second edition, pp. 224-245. Thousand Oaks, CA: Sage Souminen T and Leino-Kilpi H (1997) Research in intensive care nursing. Journal of Clinical Nursing 6, 69-76. Tilbury, D. (2002) Working with Mental Illness: A community-based approach, Basingstoke, Palgrave MacMillan.
UKCC, Guidelines to Mental Health and Learning Disabilities Nursing, 1998 White, J and McCollam . A, 1999. Evaluation of Social work services for people with Mental health problems. In Mental health and Social work, pp. 190-215. Jessica Kingsley.
