MENTAL HEALTH AND SUBSTANCE ABUSE COMBINED (1500 WORDS
7.1 Demonstrate critical appreciation of the interaction between psychosocial aspects and patient presentation.
7.2 Analyse the role of social exclusion and stigma on health and illness.
7.6 Analyse approaches to health promotion and health education and their role in health service structure and organisation.
7.7. Critically explore the role of politics, policy and social construction of health and illness on the provision and access to services.
The purpose of this patch is to explore how homelessness links to mental health and substance abuse and looking at social exclusion and stigma on the those who fall into the category of being homeless. As well as, exploring the role of the paramedic when it comes to health promotion and health education for these people and their access to services. For the purpose of this essay, homelessness refers to a person sleeping rough on the streets.
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Referring to the department of health improvement plan, the cause of homelessness is a complex combination of structural problems and personal factors (GOV.UK, 2014), including but not limited to: the lack of availability of adequate housing, relationship break down, poor health, alcohol and drug abuse, mental health problems, unemployment and lack of social support network (Wright et al, 2006) (REFERENCE). All these factors can be both causes and effect of homelessness and have a spiralling effect from one to another. For example, having a mental illness, if not controlled, could cause someone’s life to spiral into homelessness if they are unable to withhold a job or if they have a relationship which breaks down, may cause them to start abusing drugs and or alcohol. Likewise, if someone becomes homeless for a financial reason, their mental health may deteriorate from the effects of homelessness. Thirty percent of the homeless population whom are accounted for by the homeless services in England have some form of mental health need, which could either have been diagnosed prior to becoming homeless or an effect of becoming a rough sleeper. Hewett et all 2010 (reference) claims that the National Health Service has dismissed homelessness for too long as purely an issue of housing and social care but that there is increasing evidence that long term homeless is strongly also an issue of health.
Homelessness can have detrimental effects on both mental and physical health (Hewett et al REFERENCE) which is reflected by the average life expectancy of the homeless male being forty-seven years of ages and for a homeless woman being forty-three, both being approximately thirty years lower than the national average (Crisis, 2001 REFERENCE.) Homelessness is traumatic, and as such can lead to PTSD. Depression also often develops when people live on the streets, as can other mental illnesses. If someone is vulnerable to mental illness, either from environmental or genetic factors, homelessness is very likely to lead to mental illness
The Advisory Council on the Misuse of Drugs (1998) categorises drug abuse as having a vital role in homelessness. Research shows that two thirds of individuals report increasing problems with substance misuse after becoming homeless (Homeless Link’s SNAP 2012). It is unknown whether this is due to social selection, being a mode of natural selection based on reproductive transactions connected to the development of social behaviour. Or, if it is due to social adaptation, being the adjustment of behaviour to confirm within the social norms and values within the homeless society. When a person is homeless there are many organisations which offer support for finding a place to stay. However, abusing drugs and alcohol can make it more difficult for them to access these services or to seek and accept help and support. This is because some organisations have rules in place that prevent users bring intoxicated with drugs or alcohol when seeking support. Homeless Link is a national charity supporting people and organisations working directly with homeless people (REFERENCE), their aim is to make services more readily available and to campaign for policy change that will hopefully reducing and eventually end homelessness.
Homeless people are one of the most vulnerable and socially excluded group of people in our society and find it difficult to access the help they need (Crisis, 2002 REFERENCE). Most of the homeless population have multiple co-morbidities such as unintentional injuries, chronic pain, hunger, skin problems, infectious diseases and respiratory problems and many more, and therefore often largely require health services. However, some people choose to not seek help due to the way they live. Many rough sleepers carry all their belongings with them and may have a fear of losing them if they go into an accident and emergency department and are admitted, therefore they may decline the help of the ambulance service. Many other services such as hostels and charities require the person seeking help to be clean from drugs and to be sober.
Those in the state of homelessness have twice the amount of common mental health issues compared to the general public. For example, Psychosis is 4-15 times more prevalent in the homeless population (Home link 2013; Crisis 2009). EDIT. The World Health Organisation say that health is a position of physical, mental and social well-being being complete and not only the absence of disease and illness. (WHO REFERNECE “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”) Equally, substance abuse can also cause an individual to spiral into the state of being homeless as it can also be used as a coping mechanism. According to Kemp et al (REFERENCE), drug users are seven times more likely to become homeless compared to non-drug users.
When a person is not coping with their physical health problems and has limited access to services, this may have a detrimental effect on their mental health. Some people may use drugs and or alcohol to subside their side effects from their co-morbidities or to mask their poor mental health which in turn causes more health problems. Homeless Link (REFERENCE) conducted an audit involving over seven hundred homeless people in England which showed that eight out of every ten participants had one or more physical health need and seven out of ten had one or more mental health problem. Because of this, homeless people require tailored health promotion and education. Problems with health, both mental and physical can majorly decrease their quality in life and reduce their ability to routes out of homelessness (Talking Health Inequalities 2003 REFERENCE).
Even though it can be difficult to access, there is help available people who are homeless and are suffering from. In many cities, there are organisations how send people out to the streets to meet the homeless where they are, providing them with information to help connect the mentally ill homeless to resources which could provide hep for them. However, obviously this cannot help every mentally ill homeless person as they might be in the wrong place at the wrong time and not see these people or they may also choose to decline the help and support for their own reasons, including the fear of losing their belongings. Many also say that they prefer to stay away from homeless shelters and so on so that they can stay away from others who are using and abusing drugs and alcohol, to prevent themselves from getting into any fights.
The homeless population have the same rights to health services and health promotion as the rest of the population. However, health promotions targeted at the general population may not always be suitable or accessible to them. This therefore disadvantages them further (Tackling Health Inequalities 2003 REFERENCE) for example the campaign Choosing Health: making healthy choices. This campaign focuses on sexual health, obesity, smoking and alcohol consumption. The general population whom have adequate housing and have their basic needs being met can focus and improve on the above healthier choices. However, for someone who is homeless, they would be more focused on their basic needs being met such as food and a roof to sleep under.
As a paramedic, there is as a responsibility to ensure all patients receive the same quality of care and that access to services is equal regardless of the patient’s background. Access to mental health services for homeless people can be improved via front line healthcare staff having a wide spread awareness of help and support available for. For example, non-clinical settings where they can talk to other people and meet other people in a similar situation to themselves which are available may be easier for them to access. According to St Mungo’s 2012 REFERENCE, the governments mental health strategy identifies addressing the mental health needs of homeless people as a priority for action.
PATCH 3 – END OF LIFE (750 WORDS)
The Importance of Breaking Bad News to the Relatives of a Patient Who is Deceased.
7.3 Analyse the cause and effects of loss and adjustment on the individual and the role of the paramedic in supporting the patient/family.
7.4. Recognise individual difference including culture, gender and anti-discriminatory practice.
The purpose of this patch is to explore the role of the paramedic when breaking bad news to the relatives of a patient who is deceased. As a Paramedic, communicating bad news to relatives and friends of patients is something that is thought to be difficult and emotive (Pilbery and Lethbridge, 2015). How this conversation is approached may have lasting impact on the receivers (Reid, et al, 2011) and the situation they are in could impact on how they are able to process bad news. Consequently, the receiver’s reactions may be unexpected due to a few factors including denial, shock or anger, so it is vital that paramedics remain professional and provide a patient centred approach in order to prevent discrimination and uphold their professional regulators standards of conduct, performance and ethics (Health and Care Professions Council, 2016).
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When a patient dies, the healthcare professional has a duty of care to their next of kin, extended to other relatives whom are on scene with the patient (Buckman, 1992). Supporting the family after their loss of their relative is thought to be a very difficult task by many health care professionals. (REFERENCE?) However, it is necessary to ensure that every conversation when communicating this bad news is conclusive and consoling (Kurer and Zekri, 2008). Different people will react to the news that their loved one is deceased in different ways. For instance, sudden death may be extremely distressing and shocking. Whereas, anticipated death, in the case of patients who are terminally ill may have a calmer response from relatives (Samuel, 2018). The initial conversation is the first stage of the grieving process. Typical displays of grief include denial, anger, shock, guilt and sorrow (Pattison, 2008). Cultural factors may also impact on the grieving behaviours of relatives, such as inconsolable wailing or tearing of their own clothing (REFERENCE?) Under these circumstances, the way in which people can comprehend the news of their deceased relative may differ (REFERENCE?). Paramedics are not expected to have full knowledge of all cultural and religious beliefs; however, it is expected for them to work in an anti-discriminatory mindset being respectful and non-judgemental of all beliefs (Blaber, 2012).
A study conducted by Jurkovich et al. (2000) investigated which elements of breaking bad news were most important to relatives of the deceased patient. Across an eighteen-month period, fifty-four family members of forty-eight patients took part in a survey which graded importance when receiving bad news. The most significant features of delivering bad news were judged to be attitude of the news giver, clarity of the message, privacy and the news givers ability to answer questions. Every single conversation with relatives regarding their deceased loved one should meet and exceed these features. (REFERENCE?). The attitude of the news giver and clarity of the message and the ability to answer questions are all things that health care professionals have control over and adapt depending on the receiver and how much they would like to know. However, privacy for the setting the conversation may be a little difficult and may need vetting prior to the conversation starting. For example, a gentleman in his eighty’s had a cardiac arrest at his own home but on arrival of the ambulance crew, there was obvious recognition of life extinct. This gentleman was not diagnosed as being in the final stages of life and therefore it was an unexpected. The call handler had already dispatched the police prior to crew arrival and therefore the police arrived almost at the same time as the first ambulance crew. For this reason, their home was very busy with five members of staff from the ambulance service and two policemen. The paramedic first on scene, had to let this gentlemen’s family members know that was had deceased, because of the business they ensured that they took the family members into a room and prewarned all other emergency services staff on scene to not enter that room to ensure privacy and respect for the family members. If this was not done, it may have been very disturbing and more upsetting for his family members if they could not have that privacy.
Breaking bad news should be tailored to the situation and the relatives involved (McLauchlan, 1990); the amount of information sought by the relatives regarding their loved one will likely differ from family to family. The healthcare professional breaking the news should be able to answer all the relative’s questions with poise and respect.
Stitching – (750 words)
7.5 Show awareness of own beliefs and their effects on others.
This module has been extremely insightful. From this module I have learnt how important it is to widen my knowledge base from mainly practical paramedic skills to also current issues within paramedic practice. As a paramedic, I have responsibilities to care for all of my patients and their relatives ensuring that they receive the best care possible. I am unable to do this if I am unaware of how people feel and am only focusing on their physical needs. This essay has really enabled me to think about psychological and mental needs and what patients may require.
Prior to this work, my perceptions around people not helping themselves with addiction and trying to find somewhere to stay whilst being homeless were extremely narrow minded, I assumed that access to services were widely available and were being offered to much of the homeless population. However, the research suggests that this isn’t happening and that there are many reasons why someone who is homeless cannot receive the help and support that they may need to support them with their mental and physical health, as well as trying to find them somewhere to sleep. Homelessness is a national problem, which will take a long time to stop. But what I have learnt is providing these people with adequate housing, will not fix homelessness as whole. For those who are addicted to drugs or alcohol, they need that problem to be fixed to enable them to withhold a job and relationships. For those who have mental health needs, they need to be met for them to be able to have control over the life. From this new understanding, I feel more passionate about supporting homeless patients that we come across and making them aware of services and organisations that can support them in a variety of ways. To further advance my knowledge of this, I now want to go on to find out about local organisations and what they do to support these people and what their aims are.
The end of life patch was very close to my heart, recently my family have been the family receiving the bad news from a health care professional and were not happy with the way in which it was done. This wasn’t touched on in the patch, however, I learnt a lot from this experience from the perspective of a healthcare professional and have learnt not what to do when I am the person communicating to the relatives of their deceased loved one. From researching and writing for this patch I learnt how little support there is for healthcare professionals when it comes to being advised on how to break bad news. Many articles state that is though to be a difficult task by many and give a broad step by step process, however, from my experience and from this patch I have learnt it is much more than that. As a healthcare professional you need to be able o connect with the people you are communicating with and not only talk to them but also to listen to what they must ask and talk about.
From these separate patches, I realised that mental health comes into all of them. Research shows a strong link between mental health and substance abuse within the homeless population and I’m sure that extends further than that. And the end of life patch had a strong connection to the mental health of the relatives. Up until this point, I have been very focused on physical health problems and conditions and have realised I will not be the best paramedic I can be if I do not widen my perception of paramedic practice. Prior to researching and writing this essay, I have been concerned about being called to a patient who is suffering from a mental health problem whilst on placement and that is because I have had little experience with this myself. However, after this module I do believe that I would be more confident communicating with someone who is suffering with poor mental health and has really sparked an interest in learning more about how to communicate with someone who is feeling suicidal, and how to prevent someone from attempting suicide in that moment. But from research that I have already done, I believe that this isn’t something that can be done from reading and is something that you must pick up on, on the way.
- Blaber, A. (2012). Foundations for paramedic practice. Maidenhead: Open University Press, pp.33-37.
- Buckman, R. (1992). How To Break Bad News. United States of America: The John Hopkins University Press, pp.12-14.
- GOV.UK. (2014). Department of Health Improvement Plan: April 2014. [online] Available at: https://www.gov.uk/government/publications/department-of-health-improvement-plan-april-2014 [Accessed 5 Jan. 2020].
- Jurkovich, G., Pierce, B., Pananen, L., Rivara, F., Carolyn and Fernandez (2000). Giving Bad News. Journal of Trauma Nursing, [online] 7(3), p.69. Available at: https://journals.lww.com/jtrauma/Giving_Bad_News__The_Family_Perspective.9.aspx [Accessed 4 Dec. 2019].
- Kurer, M. and Zekri, J. (2008). Breaking Bad News: Can We Get It Right?. Libyan Journal of Medicine, [online] 3(4), pp.200-203. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074315/ [Accessed 5 Dec. 2019].
- McLauchlan, C. (1990). ABC of major trauma. Handling distressed relatives and breaking bad news. BMJ, [online] 301(6761), pp.1145-1149. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1664280/pdf/bmj00206-0041.pdf [Accessed 4 Dec. 2019].
- Pattison, N. (2008). Caring for patients after death. Nursing Standard, [online] 22(51), pp.48-56. Available at: https://www.deepdyve.com/lp/royal-college-of-nursing-rcn/caring-for-patients-after-death-QK9J2rT7ED [Accessed 24 Nov. 2019].
- Pilbery, R. and Lethbridge, K. (2015). Ambulance Care Essentials . [S.l.]: Class Professional, pp 100-107
- Reid, M., McDowell, J. and Hoskins, R. (2011). Breaking news of death to relatives. Nursing Times, [online] (107), pp.1-4. Available at: https://cdn.ps.emap.com/wp-content/uploads/sites/3/2011/02/080211Breaking-news-of-death-to-relatives-.pdf [Accessed 4 Dec. 2019].
- Samuel, J. (2018). Grief works : stories of life, death and surviving. 2nd ed. UK: Penguin, pp.10-14.
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