What would be the benefits and drawbacks for Bronwyn, whose story was featured in Unit 2, of being assessed as having a psychiatric disorder?

What is mental distress? Mental distress is when someone experiences changes in their thoughts and feelings. Their behavior will be significantly different, both in themselves, and how they behave around others. This greatly interferes with their home life, work life, social life and their relationships they have with others. Examples of mental distress would be anxiety disorder, depression and schizophrenia. (Ethomed, 2003)

The diagnosing of mental distress can mean different things for different people. It must always be dealt with in a sensitive matter. No doctor can ever be certain as to how the individual may act when informed. The diagnosis itself must never overshadow the person, their qualities and personality, or their unique life experiences. (The Open University, 2008, p. 104) (a)

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(Bowers, 1998) tell us, that those who experience problems such as anxiety or depression may not actually appear different, to those who are not experiencing mental distress. With regards to Bronwyn and the mental distress she is experiencing, this could well be the case. To everyone else, and the outside world, things may seem that everything is fine with her. However, Bronwyn is experiencing mental distress on a daily basis, in all aspects of her life.

From listening to the audio (The Open University, 2008) (b) it appears that she is having a constant battle with herself; all of the time. Whether it is the state of the kitchen floor she is talking to herself about, or where the keys to the house are; she is anxiously trying to work out, as to how things have gotten the way they are. In one breath she blames herself for the state of the kitchen floor, because she has let things slip since she had the flu. However, in the next breath she is asking why the kids or Rob don’t help her around the house, or cleans the kitchen floor themselves. Rob and the kids clearly do not notice that Bronwyn is experiencing mental distress.

Because of the way Bronwyn is feeling it would probably be best to seek professional help. She could start by telling the kids and Rob, exactly how she is feeling. By doing this her anxiety and stress levels, will drop a little. Her next step would be to contact her GP. The GP is an excellent first point of contact for someone who is suffering from mental distress. The GP will decide what the best treatment is and if required, can make arrangements for the patient should they need further intervention. Help can be in the way of counselling, or the patient may need referred to a psychiatrist for more intense treatment and/or therapy (Action on Depression, 2013)

If Bronwyn was diagnosed this could lead on to both positive and, negative impacts. In the audio she talks of ‘the old me’. She is not certain of where the old she has gone. From a positive aspect this could mean Bronwyn could have a treatment plan tailored to her needs allowing her to get well. Bronwyn will start to feel like her old self again.

There are many different ways that Bronwyn can be treated. Treatment can depend on a number of factors. One of the most important factors will always be how Bronwyn wishes to proceed. This will ensure Bronwyn always feel empowered. This is an important aspect of her recovery process. Bronwyn may be happy to be treated with medication alone. This would be known as the medical approach. If the medication on its own is not helping and further intervention is required, the GP can refer Bronwyn for Cognitive Behavioral Therapy (CBT for short) (NHS Choices, 2013).

CBT involves talking to someone who is specially trained. They then teach the person (Bronwyn) how to change the way they think, and feel. This could be very beneficial for Bronwyn. With the CBT, Bronwyn will then be shown new ways of coping with particular situations, i.e., situations that can make her anxious, worried, or leave her feeling depressed. Doing both the CBT and taking medication is known as the biomedical approach. Another approach to treatment that could be used is the psychological approach. The psychological approach would be the CBT on its own. No medication is used at all. It could also be another type of person-centered therapy, i.e., it would focus on helping Bronwyn realise her full potential (The Open University, 2008, p. 113) (c)

The biggest positive impact for Bronwyn is that she will get well. It can take some time, but following a treatment plan, and sticking with it does normally have a good outcome, and the person (Bronwyn) will feel better. Other positive impacts of being diagnosed for Bronwyn would mean that she would have full understanding of her illness. This will then lead on to finding out what can be done to help her. Having proper access to the health and social care system is available once a formal diagnosis has been made. It means Bronwyn will be able to get access to those who can help her. Without a diagnosis getting an appointment with the likes of a psychiatrist or psychologist is close to impossible. Appointments like these are done by referral only (The Open University, 2008, p. 52) (d)

A drawback to Bronwyn’s diagnoses could be issues surrounding stigma and labelling. Stigma and labelling can take many different forms. Goffman (1968) speaks of three types of stigmatised identity. These are Abominations of the Body, i.e. Physical deformities or Blemishes of individual character, i.e., Alcoholism or homosexuality, and Tribal identity, i.e. religion or social class. The first two are directly related to users of health and social care, which in this case, would be Bronwyn. Goffman refers to non-stigmatised people as ‘normal’; therefore, having a stigmatised identity can have many implications. This could leave Bronwyn wide open to labelled insults such as lunatic or crazy woman. In turn it could lead to Bronwyn being stereotyped, or having generalised assumptions made about her character, and/or her abilities. (Goffman, cited in K217, Chapter 5, p.10) This could have negative impact on Bronwyn’s self-esteem, and she may be left feeling even more useless, or worthless, than she already does.

Another drawback for Bronwyn would be that of social exclusion. This means Bronwyn may be left feeling excluded from services in her local community and from society in general. Bronwyn has already expressed in the audio, how this is happening to her now. The local shop has closed down and her friend that worked there has gone away. She now has no one to chat to as she seen the shopkeeper as a friend. This leaves her feeling very down, and very lonely. Another example of social exclusion with regards to Bronwyn would be that of the threat, of her local hospital facing closure. When she arrived at the hospital to see her son she noticed the protest that was being held outside, to save the hospital from closure. If the hospital closed and Bronwyn was diagnosed, where would she go for help? She may be left to travel some distance to receive treatment (The Open University, 2008, p. 53) (e)

Another negative impact of a diagnosis for Bronwyn could be losing her job. The mum’s that she is a child-minder for, may feel, that due to her anxiety and depression she is incapable of looking after their children. This is not true of course, however, society and the media both show those suffering from mental distress are either deluded, or violent. (Walsh, 2009) shows us a number of ways how the mass media misrepresents mental distress. He tells us how there is a connection between the negative media portrayal of mental illness, and the government responses to mental health issues. Those who have never suffered from poor mental health or have never watched a family member/friend suffer will no doubt have different thoughts or opinions on what poor mental health actually is. This it would seem is largely to do with lack of understanding. How are people supposed to know what the truth is, if the media very rarely shows or tells people the truth?

The K225 course model shows how social, environmental, economic and political (SEEP) elements can shape people’s experiences of mental health and distress, and their implications for ethical and value-based practice. Bronwyn’s social contacts have been limited for a number of reasons. These include lack of money, and depending on a very undependable bus service. The environmental aspect for Bronwyn is the lack of amenities in her area, and the fact that she has to travel a long way just to get to the shop. The economic downturn impact on Bronwyn and her family is due to her inability to work at the minute, leaving her with no income. Her husband lost his job due to economic inactivity also. This has left him in long term unemployment and unable to find another job. From a political aspect Bronwyn tells us on the audio DVD (The Open University, 2008) that since the local coal mine pit had closed things had changed in her area over time. (The Open University, 2008, p. 26)(f)

Things that could be done to help Bronwyn using the SEEP model as a basis could be, for Bronwyn to go out into her community, and find good social support. If Bronwyn was able to find herself a healthy environment i.e., a safe place; be that at home, or outside in the community, she will start to feel more positive and build some confidence. This would be a stepping stone to her feeling better. Economically, at the minute, Bronwyn’s hands are quite literally tied, however, should she be formally diagnosed and receive treatment she should be able to return work, which in turn will leave her better off financially. Politically Bronwyn could maybe contact her local politician and ask them to intervene in the area. They could maybe put in a play park for the children, or set about getting a better, more reliable bus service in operation.

For Bronwyn to decide whether to get diagnosed or not, she could ask herself how she copes on a daily basis? Does she feel that she is coping well? Does she feel she could cope better than she does now? Does she feel she could do with more help? The answers to these questions are important, as ability to function on a normal day-to-day basis is a large factor in determining if an individual needs professional help and support (The Open University, 2008, p. 114) (g)

From going over the K225 course material it seems that being diagnosed is much better than not getting diagnosed. Yes there are cons; however, there are pros and cons to every situation in life, and overall, it is about making the right decision at that time; regardless as to whether negative issues may come or not. A formal diagnosis to Bronwyn will not only make her feel like her old self, but will also allow her to grow in strength and stability, which then allows her to deal with any negative issues, should she face any.

References

Action on Depression (2013) About Anxiety and Depression [Online], Available at http://www.actionondepression.org/information/depression/anxiety-and-depression (Accessed 26 November 2013)

Bowers, L. (1998) The Social Nature of Mental Illness, Milton Keynes, The Open University

Ethomed (2003) Mental Distress Information [Online], Available at http://ethnomed.org/patient-education/mental-health/mental-english-rev.pdf (Accessed 26th November 2013)

Goffman, E. (1968) ‘Who are you? Identity in health and social care’, [Online] Available at http://learn2.open.ac.uk/mod/oucontent/view.php?id=136352&section=1.2 (Accessed 1 December 2013)

NHS Choices (2013) Cognitive Behavioural Therapy [Online], Available at http://www.nhs.uk/conditions/Cognitive-behavioural-therapy/Pages/Introduction.aspx (Accessed 20 November 2013)

The Open University (2008) (a) Exploring Perspectives: Diverse Perspectives on Mental Health, Milton Keynes, The Open University

The Open University (2008) (b) ‘DVD 1: An untimely death on Passchendaele Ward’ [DVD], K225 Diverse Perspectives on Mental Health. Milton Keynes, The Open University

The Open University (2008) (c) Exploring Perspectives: Diverse Perspectives on Mental Health, Milton Keynes, The Open University

The Open University (2008) (d) Exploring Perspectives: Diverse Perspectives on Mental Health, Milton Keynes, The Open University

The Open University (2008) (e) Exploring Perspectives: Diverse Perspectives on Mental Health, Milton Keynes, The Open University

The Open University (2008) (f) ‘DVD 1: An untimely death on Passchendaele Ward’ [DVD], K225 Diverse Perspectives on Mental Health. Milton Keynes, The Open University

The Open University (2008) (g) Exploring Perspectives: Diverse Perspectives on Mental Health, Milton Keynes, The Open University

Walsh, M. (2009) ‘(Mis) representing Mental Distress’, in The Open University (2009) Mental Health Still Matters, Hampshire, Palgrave Macmillan

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