This study is a peer review of mental health nursing. We try to cover psychiatric-mental health nursing practice and the main theory, new practice challenges, its theories and changes in the laws according to these studies. This work suggests the need of specialization of modern day nurse in the particular field of mental health. Nurse should have a good knowledge of all social values of the society. This would facilitate in managing the mentally ill patients in much a better way.
In this study we talk about different theories of sociology and try to understand its significance for the mental health nurse. Sociological factors have been studied by different analysts in all ages. These analyses help in understanding the main concept of the work.
What is a Society?
Society is like an “organism”, which is a system of interdependent parts to work for the benefit of the whole. Society constitutes institutions and organizations that work independently for the survival of the society. Human social system comprises of many factors which contributes in developing a good society. These factors are the family, education, economy, politics, religion and culture of an individual. These all should be studied and examined carefully to comprehend the behavior of any society. This would assess the importance of sociology for the larger social system. This is the main concept of the sociological studies to understand how different institutions in a society work collectively. It can help in optimizing the performance of these organizations and regulate the productivity and efficiency of any society. This is the focal idea of macro level sociology and is very successful nowadays. These are said to be the predominant philosophy guides of any society.
Health and illness are complex terms to define, especially according to the culture and behavior of the society. Different societies classify these terms according to their own values. Things which appear abnormal or unacceptable to the society are usually labeled as a disease. Sociological studies show that different environmental, behavioral and political factors contribute in maintaining the health of the society. It is manifested from different studies that social class is an imperative factor in determining the health of the society.
Different studies show that gender disparity is a prominent discriminating factor in health issues of rural societies. Women seek medical advice more often then men, as in case of childbirth, reproduction and mental health but it is evident from different statistics that women have more susceptible to ill health then men. Women are more likely to be prescribed anti depressant drugs due to different mental problems. Peter Sedgwick found that: About 10% of all GPs prescriptions and 20% of annual expenditure goes on tranquillizers, anti- depressants or hypnotic drugs, mainly for women (class handout).
Mental health is an enormous and neglected issue of our society. Different theoretical insights from psychiatrists and sociologists are under study to grow a better society. Why this might be is open to debate and many of the key sociological theories in relation to mental health have in fact as much to say about the prevailing viewpoints within society and within professional bodies towards mental health as they do about those who suffer from mental health related problems. (Cockerham, 1992).
The fundamentals of sociology are that people behave different in groups then they do as individuals. It is a common saying that groups have the lives of their own. Sociologists says that whole is better then the sum of its parts. The focal point in sociological studies is an “invisible hand of order” that guides economic relations, and “social forces” do guide social relations to develop a better society.
There are different theories to understand issue of mental health. Different developmental theories describe different types of changes in the concept of sociology. Two most radical of these theories are social reaction and social constructivism. These have been described according to the dominant medical and social views on mental health of a society and an individual. These differences can be located in broader trends which have occurred within the discipline of sociology itself as a shift in the major theoretical traditions within the discipline, (Delanty, 1999).
Social Reaction theory:
Social reaction theory or the labeling theory helps in defining mental illness and different ways to manage it. This theory emerged in 1960s and helps in evaluating broader critical standards of mental health in the society. It emphasizes on a strong relation between a person, his family, medical professionals and the whole society. This all would help in evaluating the levels of mental health of a person. This theory drew its framework from the symbolic interactionism school of sociology so at its root this theory sought to examine the ways in which roles and actors interacted and played out within the drama of mental illness (Pilgrim and Rogers, 1999).
This theory provokes a twin concept of primary deviance and a secondary deviance. Primary deviance is related to the things which might actually be wrong or actions or circumstances which involve actual rule breaking, (Pilgrim and Rogers, 1999). The most comprehensive study of the phenomenon of primary deviant was the work of Yarrow, Schwartz, Murphy and Deasy (1955).
Secondary deviance is more challenging in the two types of deviance. It has many critical aspects to study in detail. The typical symptoms of secondary deviance are not related to any actual physical happenings or incidence. Hence it is evaluated that the environmental or the social conditions of the individual are the major source of secondary deviance. Sometimes intrinsic factors within the individual itself can trigger this type of mental illness. As Rosenham (1973) states the question of whether to distinguish a sane from the insane is a simple matter of just a fact: do the salient characteristics that lead to diagnoses reside in the patients themselves or in the environments in which observers find them (250).
Persistent research and investigations provokes major criticisms regarding this theory. But this theory is still very popular with the same levels of relevance. In the case of Rosenham’s study it was found that the label of deviant though at first an uncomfortable and disturbing experience did not persist for a great length of time with the pseudo-patients in the experiment, (Pilgrim and Rogers, 1999).
Labeling theory with all the present criticisms gives distinctive values between physical disorders, primary deviance and subsequent reaction from society which leads to secondary deviance. Indeed lay perceptions to mental illness have been demonstrated only marginally to relate to the images associated with medical diagnosis, (Pilgrim and Rogers, 1999:18).
A French theorist wrote in his book of “Birth of the Clinic” that insanity in a person comes from the classificatory concepts of medical knowledge. The objectification of insanity occurred after as well as in tandem with the development of psychiatric knowledge, the insane developed as a problematic group which in turn led to strategies being developed to manage them, (Foucault, 1976).
Both these theories are analogous to determine the critical role of an individual in the society in case of mental illness. Social constructivists mainly focus on the mental health related to social environment. It does this through utilizing the theoretical framework of discourses, thus the subjectivity of being mad is defined through the objectifying process of psychiatric or medical knowledge generally (Pilgrim and Rogers, 1999).
Foucault’s works are considered to be the best viewpoints related to the mental health and the role of a society in that state. Foucault’s work is in particular concerned with how the shifting conceptions of what madness meant to society led to the development of a discrete set of knowledge which pathologise mental states according to a classificatory system related to madness and what were the strategies which developed as a result of this knowledge towards the control and management of the insane (Foucault, 1972, 1976).
The theoretical framework of the Foucault Book evaluates the errors in the psychiatric practice and psychiatric study and the way to handle such patients. This study has no prevailing principles to analyze the mentally ill patient. While the critique may be justifiable in saying that the social constructivist theories can be distinctly vague about resistances to the all powerful discourses which they describe and analyze. Similarly the ability to formulate social policies arising out of the critique may similarly be limited (Rogers and Pilgrim, 2001: 175). A secondary point and one which we have already made in relation to labeling theory is that perhaps social constructivism deconstructs too much certain incidences of mental illness, perhaps there are some illnesses which in their etiological sense reveal themselves to be indeed physical manifestations of what we might actually be able to call a disorder (Zinberg, 1970).
Role of a Mental Health Nurse:
Department of Health 1998-2000 has reformed the rules for the mental health nurse and made significant changes in the last fifty years piece of legislation. According to these rules the mental health nurse should be well trained and specialized in that particular field. They should be semi- autonomous workers and are quite competent to impart effective healthcare services in all aspects. Due to these evolutionary reforms in the schooling of the mental health nurse they becomes more professional and efficient They need to be trained out of the normal curriculum to be specialized in this field and be able to handle a mentally ill patient appropriately.
The mental health nurse should have psychiatric knowledge at specific degree to deal with their mentally ill patient. It should be the part of their schooling and experience. Their curriculum must have to be broadened in the perspective of sociology to deal with mental illnesses. They should have good knowledge of sociology, politics, religion, and economics. The Government has declared mental health as being one of its top three priorities in the Health Service partly, it could be argued, because of the general sense of lack of progress that is felt by the healthcare professionals throughout the service (Department of Health 1999b).
Reforms in Mental Health Act for Nurses:
Chan(2002) has discussed the legislations for the Mental Health Act with its reforms in 1998. Chan states that the way a society deals with the mentally ill, is the reflection of the society. The White Paper “Reforming the Mental Health” encapsulates this very important point. It revolves around the whole concept of the Paternalistic State in deciding what a patient’s “best interests” are, and these are also influenced by considerations of risk assessment and possible legal liabilities. Chan states these reforms as “who’s best interest”.
Nurse has to face ethical and moral issues in their day to day practice. Chan also focus his study on the free will of the mentally ill patients. Mental health act highlights the ethical dimensions of decision making for the health care professionals. The current guidelines of Mental Health Act states that the patient cannot be restrained against their will unless “they pose a danger to themselves or to others”. Nurses face ethical intricacy in dealing with the mentally poor patient. It is the part of their education to deal such patients and make solid decisions in management. In this respect this Act recognizes – some would argue, for the first time – that the mental health nurse has a social responsibility as well as the hitherto medical one.
Mental health nurse plays a imperative role in the whole process of treating and managing the mentally ill patients. Such patients have developed a strong association with the relevant nurse. So the mental health nurse are in better position to make any decision in regard to ethical, practical and professional position of the patient.
Symonds (1998) studies the sociological and philosophical aspects of the mental health reforms. He states that “We have touched upon the ethics of assessment “dangerousness” in a patient and the degree to which that allows a society to restrain them”. Symonds study evaluates that dangerousness of the patient state is an important factor in decision making. The relevant mental health nurse assists in such stage of decision making. Grounds (2001) produced a very illuminating abstract of the recent mental health reforms which is beyond the scope of this study but it underlines the need of our hypothetical mental health nurse to be fully apprised of the climate of change in the area.
Modern Mental Health Nurse:
The focal point of this study is to appraise the role of modern mental health nurse and to organize their services. Johnson et al (2001) provide an incisive insight into the current structure and functions of an Inner London Authority and then compare them with the provisions across the country as a whole. This article examines the sociological, political and the economic feature factors that are relevant to this issue. He spend a lot more time describing the evolution of the mental health service from Institution-based provision of the 60’s and 70’s to the comprehensive community-based services that are the mainstay of our current mechanism for the caring of mentally unwell.
Another important factor to mention is that the mentally ill patients are the socially excluded segments of the society. The whole topic of social exclusion is taken further by Repper and Perkins (2003). All mental health nurses should keep this in mind while managing such patients. Liaison Mental Health Services (LMHS) are very important but has overlooked the aspect of the treatment of the modern nursing system. Callaghan et al. (2003) reviewed the role of this “Cinderella service” and its contribution for the welfare of many mainstream ill patients. They mention its economic value in the current provision of the A&E departments of out DGH’s. The sociological impact of these services is assessed, emphasizing the value of the LMHS in helping clients to access mental health provision and the benefit for the community in both economic and social terms. The economical conditions of the patient are also a very eminent factor in their treatment.
Modern day nurse having a good knowledge of socioeconomic values can better help in decision making for the patient benefits. Usher and his colleagues (all mental health nurses) have constructed an excellent piece of work on the issue (2001), their particular exploration centered on the economics (and the ethics) of PRN prescribing which they found to be frequently ineffective, sub-optimal and wasteful. Given the fact that, in the field of mental health, drug prescribing is frequently a mental health nurse’s fairly autonomous role, the link between better understanding and enhanced performance could not be clearer.
Pinikahana (2003) wrote a thought provoking paper on the value of sociology for the modern-day mental health nurse and worked on the arguments on both sides of the debate. Pinikahana provocatively quotes Sharpe who argued that there is no need for the modern nurse to understand sociology as they have to operate within tight sociological confines that are already defined by modern practice. Edwards et al. (2000) looked at the wastage of this resource through stress and burn-out. One could argue that this point encapsulates elements of all three of our germinal issues for our mental health nurse.
Sociological study is hence of key importance in the modern day mental health nursing. Rogers and Pilgrim (1993, 2001) have produced an excellent series of books looking at this issue (and many others). Any modern appreciation for complete role of the mental health nurse would be unfinished without the understanding of the concepts of social responsibility. The title of this piece asks us to consider the enhancement of the role of the mental health nurse. We feel that it would be reasonable to argue that sociology is actually both pivotal and vital essential for this profession.
According to the sociological studies there are different levels of mental health services. Economical and social status of the patient is the important factors to determinate the level of mental health service provided. Drukker et a. quantified the issue in their recent paper (2004) . They discovered that the consumption of the mental health services was highest in neighborhoods that had the highest levels of informal social control and lowest in areas of socio-economic deprivation. Given the fact that higher levels of social control tend to be associated with higher degrees of contact, this is in further an evidence for the need of our hypothetical mental health nurse to be aware of sociological issues.
Sociologically mental health nurse should have notable political levels in the public. Davis (2002) consider this question in great detail going as far as to describe the politics of the nursing profession in general as immature in its views but equally acclaim to help bringing the profession out of the era of political neglect that it had been through in the past. We do not suppose to pass comment on the issue as there are clearly two sides to the argument but our hypothetical mental health nurse would be well advised to be politically aware in the current climate within the limits of the profession.
This study facilitates in establishing the significance of specialized mental health nurse in the society. They should be specialized in their specific field of mental health. They should have a good knowledge of social, political, religious, cultural and economic values of the society. We worked out on numerous studies in which we try to weigh up the noteworthy position of mental health nurse in decision making. They can help the doctor in treating different problems of the patient’s. Modern reforms in the Mental Health Act strongly advocate the importance of specialized training for the mental health nurse. They should be so highly trained in mental health care that they can work as autonomous settings.