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Abstract:

Free riders are those who take the same credit of you without exerting efforts. They are present in many groups, but it depends whether they are known early or not. Also many guys tolerate with free riders if they were their friends, but work and friendship are separated things. Every group should have a communication way, where all the group members agree on. And no one says that I did not know or I did not get the message. And this is something we suffered from. And because there are many members in the group and everyone has his own business, everyone should be on time for the meeting. When any group want to choose their topic, they should choose it wisely because wrong choosing will cost them time and effort. Working like a team is better than working like a group, but team work requires discipline, which we lacked. The abilities within the group differ, but you should try to get the maximum from everyone. Interpersonal relationship is the social connection between the group members which grow with time. Positive interpersonal relationship between group members leads the organization forward and to employees’ satisfaction. Organizations know interpersonal relationship effects, so they try to provide the appropriate working climate for it. The managers have influence on employees’ interpersonal relationship and he tries to make it positive of the benefits he can get from it. Group members working together at all times and seeking a common goal is working like a team. To have an effective team you need to work hard and combine the right people together. Team effectiveness is measured by the final outcome and employees’ satisfaction.

Introduction:

Group assignments provide postgraduate students with opportunities to improve their capabilities and demonstrate a professional behaviour. Personally, the group assignment is considered to be a valuable experiment that led me to write this reflective essay. The group assignment had a great impact on my skills as it had lot of benefits. I learned lot required behaviours from working with a diverse group. Group work differs from working individually as it involves an interaction with others that might result in conflict occurrence, misunderstanding and so on. There may be difficult times during group work, but a group member should be wise and help the group to pass those difficult times. I have relied on my diary notes captured after group meetings to write this essay to reflect reality. Although there is a distinction between friendship and work, I prefer to work with friends rather than people that I do not know. Effective cooperation among group members would be required at all times, so they can complete assigned work and deliver it in the best way with highest level of satisfaction.

Free Riding:

Free Riding is the absence of contribution and getting the benefit of that good. This view has been supported in the work of Marwell, Ames (1981). Before the module starts we knew that we had a group assignment and it must contain 4-6 individuals, so we were four friends knowing that we can make a group of friends only, but we have been thinking that if we entered two more participants it will be easier for us as everyone will write less and concentrate more on his points, and that will help us to concentrate on our other assignments also, but what we have been afraid of is that we may have two free riders who will make the work harder. From the first day that we have decided to meet at, we found that 3 of the group members were not there, so we were thinking about free riders and will we accept those free riders in our group because of the friendship we have. I and the present group members decided that this is work and we do not like to work hard and the free riders get the same credit. A personal experiment of being in a group with free riders made us insist of our situation that we do not want free riders in our group, as before the submission date they came with no work in their hand saying that we did not know what to do, so we have decided to work together all the time and to divide the work and everyone do his part, but we have a weekly meeting to ensure that there will be no one free riders. Discovering free riding before the grading is important, but detecting the free riding early is much better for the group to take the corrective action and to work all together and get those free riders involve in the work again (Free riding in group work – Mechanisms and countermeasures, n.d.). Therefore, we decided to meet often so we can ensure that we are all walking on the right side. And we have asked the professor about the grading system and she said if you were the manager and you have free riders in your group, what you would do? And I was thinking of leaving them behind as they will delay our work and make it harder, but if I must have them in my group I will give them specified tasks and ask them often about their progress with an evidence to ensure that they are really working and contributing with the group.

Misunderstanding within the group:

There was a misunderstanding regarding the time at the first meeting, as we have decided to meet at 11 am and then some of the group members changed the meeting time till 3 pm and they have said that we have sent a message on Facebook, but not all of the group members actually got the message, so we ended up blaming each other. I think that happened because we did not have that person who could take the responsibility to tell everyone about the exact time and if the time changed or there was any kind of change in plan, he would tell all the group members. Also, I think the existence of that kind of person in every group is important and will lead to a better performance and satisfaction from all the group members. Because of the misunderstanding, we have delayed our work for one more day as the members who came early had other plans to do at the time of the new group meeting appointment. Consequently, we have decided to have one communication channel for the group and it is doing a group chat on Facebook and everyone contributing in deciding the meeting time, so no one can have any kind of excuse of not attending the meeting.

Meeting time:

When we wanted to choose our meetings time, we were asking all the group members if that time was appropriate for them, because we wanted our meetings to be on time. The thing that happened was that I am there on time, but I had to wait at least an hour and half for the group meeting to start, because the members were always late. I waited and we did our meeting, but I was frustrated because of the late start. I have told them many times to choose the right time that they will be there and they have apologized for their lateness and promised to be on time for the next time. The same lateness behaviour had reoccurred as usual in which late members were acting normal, but the other group members were frustrated and complaining. The other group members had cool nerves and sometimes they have just waited others for an hour and a half to let us complete the work. I think this has affected our group performance, as if we were committed to the meeting time we would have done better in the group assignment.

Improper Subject Selection:

At the first we have choose Bloomberg as our subject because there was a Bloomberg guy who came and talked well about Bloomberg and we all found that the subject is very interesting, so we have decided to write about it. Therefore, we have decided on the points that we are going to talk about and that everyone would come back after 3 days with the information about Bloomberg. Apparently, no one has written a thing when the meeting day came and we were all complaining that there was not much available information. Therefore, our improper selection of the subject has led us to a waste some time.

Team or Group?:

I knew the difference between the team and the group from prof. Sally Sambrook, as she told us that working as group is discussing the points together, distributing the tasks and then everyone do the work individually. In the other hand, working as a team is doing everything together from discussing the points till the end of work. We tried to work as a team because it is more effective and creative than working individually, but the continuous absenteeism and lack of commitment of members in the meetings made it difficult, so we decided to work as a group. In addition, we decided to distribute the tasks in a way that please and satisfy everyone, so we wrote down the tasks and every one chose his favourite task that he would be interested to write about.

Individual differences:

There were individual differences in the abilities of the group members, as when we met to see and assess everyoneaˆ™s work we found that some members of the group have covered their tasks perfectly while other group members made it difficult because we had to modify their work. My point of view is that I do not consider them free riders because they have tried and I could feel that they made an effort on their tasks, but the abilities within the group are different. Moreover, I suppose that their aim is just to pass while other group members who wanted to have a good grade in the assignment. We found the module is interesting and easy, so there is nothing to prevent us from having A* while others saw it impossible, so there were different aims within the group. Members with high ambitions did not get disappointed from others and have worked very hard. These members with all honesty have gained my respect and gave me a lesson for life that I can do everything even if the group members are reflecting discouragement and laziness. If you want anything and you work for it very hard, you will achieve it.

Interpersonal relationship and team effectiveness:
What is an interpersonal relationship?

Interpersonal relationship is a strong social connection between two or more people. There are many types of interpersonal relationships, but what we care about is the organizational interpersonal relationship which is the relationship between individuals working together in the work place. They spend a lot of time in the work and for sure they want to talk and discuss their issues with others rather than working alone all the time and that is a natural part of the working environment. Also, there may be a previous relationship between the individuals before working together and this helps the relationship to expand. We as students knew each other before the group assignment, but within the group work we came closer and worked together for longer hours. I think that I have a stronger relationship with them now, after the group work. I would prefer working with them again rather than working with a new group members that I do not have any kind of relationship with them (Management study guide, [online], n.d.).

Do interpersonal relationships affect the performance of the individuals?

There are many beneficial outcomes for individuals and organizations because of the positive interpersonal relationship at work. Employees can feel job satisfaction and commit to their work because of their positive interpersonal relationship within their workplace. In the other hand, a negative interpersonal relationship could affect the employees and make them upset, and that will lead to lack of commitment towards their work. Obviously, it depends on the individual himself whether he was a social person and like to communicate and interact with the others or he likes to work individually and isolated from the others. A positive interpersonal relationship within the organization will build a supportive and innovative working climate for the employees, which will lead to an increase in the organizational productivity and institutional participation, and that will lead to employees’ satisfaction (Dachner, 2011, Abstract). In our group work there was a positive interpersonal relationship which have made the work easier and more interesting. Furthermore, we were friends and knew each other before the group work, so it helped us a lot. It is interesting to have friends working together and it would form a comfortable working climate which can help to improve the performance and encourage the members to work hard. In the other hand, friendship in the group can make the members lazy; as they know that if they do not do their work; their friends will not leave them behind and will do their work. Our group had agreed from the beginning to isolate friendship from group work because we did not want the group members to keep depending on the others to do their own work. In my opinion, working with group members that I have a positive interpersonal relationship with them is much easier than working with new groups. Also, from my previous experiment of working with members that I do not know, I can say that there is a risk of being in a group with members who do not care about the grades they get, so you find yourself obligated to do their work.

How could the organization build a positive interpersonal relationship?

The variety of the advantages of the positive interpersonal relationship within the organization has encouraged organizations to build, support, and try to form a strong positive interpersonal relationship. The organization attempts to make the coworkers to become friends, because coworkers with friendship help each other more than normal coworkers. Besides, the organization helps the workers to communicate and work together in groups or teams to build a positive interpersonal relationship in order to provide the appropriate working climate for the workers to communicate and interact with each other. Moreover, the theories propose that demographic characteristics affect social relationship between individuals (Dachner, 2011, Antecedents of Interpersonal Relationships at Work). Consequently, organization could form group works with individuals who share the same demographic characteristics. Our assignment group consists of people from India, China, and I am from Kuwait, but it was easy to work with them because we all shared the same goal and were working for the same purpose. I think that it depends on the person himself if he wants to make friends with his group and try to help them with their work or he just want to do his part and leave.

How the management could affect the interpersonal relationship?

Managers want the employees to be friends, help each other, and work together so they can get the most of their performance. Managers could give them the opportunity to socialize and encourage them to be friendly with each other and become friends. There are two influences that managers could have on employees’ interpersonal relationship. The first is direct and it is forming groups and giving them the chance to work together and compete with other groups which can provide a healthy competition for the organization. The second is indirect and it is giving them appropriate working condition, and not to give them a lot of work that they do not have the time to interact with others (Department of Public Health Sciences, 2010) 2.1 interpersonal relationship at work.

A Team in an organizational point of view:

A team in an organizational setting is a group of individuals whose tasks are done by working together, who share outcomes’ responsibility, who consider themselves and are considered by others as a unit inside the organization, who work together at all the times, help each other, and correct each other’s mistakes to increase the efficiency and improve the quality of the teams’ outcome, because they are all sharing the responsibility of the final outcome (Cohen, Bailey, 1997).

As individuals who worked together for the assignment, although we shared the responsibility for the final outcome, we were not working together at all the time. If we worked as a team, it would have been better than working as a group but the conditions hindered us from working together as a team.

Team effectiveness:

Teams with high performance need to be developed and nurtured, as they do not just appear without working hard on them. The development of these teams cannot be guaranteed even with visionary leaders. Because if you want to have a high performance team, you should combine visionary leaders and motivated team members. There are many characteristics that help to build a high performance team such as, having a clear plan and a common goal, utilizing teams’ resources, valuing the differences in the team and trying to get the best from each member, the willingness of the members to give their best for their teams, managing the meetings in the perfect way, and exerting the efforts to achieve the goals. Also there are other things that affect the high performance teams and it is the teams’ size, the abilities and the skills within the team, the way of communication, and the conflict resolution (Cliffs Notes, n.d.). I agree that high performance teams needs co-operative and hardworking members. Also it requires the commitment from the team members, especially in the meetings time, because we suffered a lot from the members who were always late on our meetings.

Measuring the team’s effectiveness:

As the team members work together all the time with shared responsibility of the final outcome, it is hard to evaluate each member’s contribution to the work. The manager wants and sees the final outcome only regardless whoever contributed more to the work. The effectiveness of the team is measured by performance and personal outcomes. Measuring the final product, customer satisfaction, items sold, etc. are all kind of performance outcome measurement. While measuring team members’ commitment and satisfaction and their desire to work with the same team members again is kind of personal outcome measurement. Hence, the grade that we will get in the group essay is the performance outcome, while if I wish to work with the guys that I have worked with again is the personal outcome. In my opinion, our group works both the performance outcome and the personal outcome was excellent.

Conclusion:

In conclusion working in a group assignment has many advantages and make you learn a lot of things, but everyone should try to get the maximum benefits that he could get. I can say that the group work made me better prepared for the real practical world. Although I had many hard times during the group work, it was interesting and earned me some good friends for lifetime. It was exciting to work with my friends in a group assignment and to help each other trying to get the maximum grade. After reading a lot about the interpersonal relationship and team effectiveness, I realized its importance in the work place and it really affects any organisation, and that is why every organisation is keen on it. Working in a group is totally different from working individually, as working in a group imposes you to respect the group members and their opinions even if these opinions conflict your own opinions, but if you are working alone you are the decision maker. That is the difference that I knew from working in the group assignment and the individual assignment. Finally, working in a group has many benefits that contribute in refining the personality of the participants and often better than the individual work and this is what I had concluded from my personal experiment in the group work.

People suffering from mental illness are often looked differently and do not have equal access to all the opportunities in life. Though, patient’s family and the health care providers can play a fundamental role in the lives of these mentally ill people. Through offering a proficient care with warmth attitude they can certainly bring an optimistic change in them. But, imagine what if these caregivers are the reason of mistreatment with mental patients? This is an ethical issue which I recently came across during my clinicals and therefore decided to explore it in depth. Thus, the following paper is an attempt to analyze this issue by integrating an ethical model, highlight its significance and to discuss the causes, effects on mental health and practical strategies to overcome this immoral issue of mistreatment with mental patients.

On my clinical to psychiatric ward civil hospital I encountered a 60 years old female, married and diagnosed with obsessive-compulsive disorder (OCD). The chief complaints of patient were severe headache and aggressive behavior. Since 20 years patient had history of recurrent depressive illness characterized by weeping spells and low energy. On asking about the support system patient became gloomy and said “I am alone and nobody likes to be with me and care for me”. Further she said that due to her habit of cleaning things again and again her family becomes angry and speaks harshly to her. On spending some time with patient I came to know that how much she loved them but nobody came to meet her since she had got admitted. After taking history of patient that day I also observed that when my patient called the nurse to inquire about the medication timings, nurse replied rudely that “how many times you will ask the same thing again and again. You are mentally ill but please let us remain in good health” and then that staff nurse after making vicious gesture got out of that ward. This incident made patient further depressed. It is an issue which is ethically wrong, as caregivers who should help the patient when they are in true need are abusing them. As the professional code of ethics explains the significance of this ethical issue, which is the base of social morality that “first of all, do no harm”. It also emphasizes that the purpose of nonmaleficence includes not only definite harm but also the risk of harm (Clinical Ethics, 2004). Therefore, an ethical person must be constantly careful about the possible negative consequences of his words and actions with the mental patients. Furthermore, according to the world health organization, In Pakistan we come across upsetting stories about the mistreatment of mentally ill people due to societal hostilities daily (Gadit, 2008). Though, it is difficult to understand why such people are maltreated in Pakistan, an Islamic country where religious teachings are followed. Therefore, to discover the reasons behind this immoral deed, to identify actions to lessen this in society and also to make the caregivers inculcate this thought to support these people in their difficult times, I consider this issue as significant and therefore decided to highlight it in my paper.

As defined by SAVE project of social services that mistreatment is a breach of person’s human and civil rights causing despair. And, this violation can appear once or constantly (SAVE Project, 1995). Mistreatment of elderly person may include physical, psychological or financial exploitation and it can be intended or unintended. Intentional mistreatment involves a purposeful effort to inflict harm such as physical abuse or mauling. On the other hand, unintentional abuse takes place when an unplanned action results in damage, such as ignorance or a lack of desire of the care providers to offer proper care (Jones, Holestege, & Holstege, 1997). As verbalized by my client that at home she was beaten harshly and was always ignored by the caregivers. Moreover, nurse also verbally mistreated the patient and showed lack of desire to care. However, the empirically generated model, which is an ethical model, provided by Fulmer & Malley (1987) gives in depth details of causes and risk factors leading to mistreatment in mental patients. They divided the causal factors of mistreatment into four major categories including physical and mental impairment of the patients, increased strain on caregivers, family history of domestic violence and the societal attitudes. This model elucidates that domestic violence such as abuse and neglect are the behaviors which are learned at home and are passed from one generation to the next. Thus, elder abuse may be a continual phenomenon learned in childhood. Secondly, the stress on caregivers can also lead to mistreatment. Facing behaviors by the elderly mental persons like drug abuse, recurrent falls, incontinence or aggressive behaviors, the caregivers become exhausted and can lash out their resentment on these innocent beings. As happened with my client that due to her habit of cleaning things repeatedly, caregivers always offended and taunted her. Other external stressors such as loss of job, personal illness or low income can also place overwhelming demands on care providers which results in violent behaviors. Furthermore, this model suggests that the ill health of elderly persons in itself is a reason for abuse. Functional impairments lead to dependency on a caregiver for the activities of daily living. As these needs raises, the stress level of caregivers further increases. As faced by my patient, who was always reliant upon her family and husband for daily routine work. This created frustration for the family and at last they left her at psychiatric hospital. Lastly, there are several societal attitudes that contribute to mental person’s maltreatment. Among these attitudes, Stigma is the most common in psychiatric settings. There are many reports affirming that such patients are teased in communities by unkind names (Gadit, 2008). Moreover, according to the World Health Report (2001), stigma and prejudice are the main hindrance faced by the mentally ill today, these abstain them from seeking appropriate care (Rameela, 2004). Besides this, patients are also mistreated in the ward settings by the staffs, as occurred with my client. This is because, persons in institutional care are dependant, extremely fragile or chronically ill. In addition, problems such as low salaries, staff shortages and poor working environment increase the chances of mistreatment. (Lucas & Stevenson, 2006).

As the fundamental duty of all care providers is to perform efforts to improve the quality of life of patients. However, if these caregivers would show such an abusive behavior to the mental patients this will affect their psychological as well as physiological health. As shown in my client who along with psychological symptoms also suffered from insomnia and decreased appetite due to worries of being alone. Besides, as mentioned in literature that, negative behaviors and biases towards those having mental illness is the greatest hurdle to recovery (Chambers et al., 2010). Like, it was observed in my patient who lost all the hopes of being in normal condition as before. This was shown in her verbal comments that “everyone thinks that I am mad and therefore behaves with me in harsh manner and I am sure I will never be fine again”. This shows that how important role the caregivers and their attitude play in the development of mental patients. As very rightly said that “Support has been known to help influence and motivate a behavior change in a positive way” (Clark et al., 2005, p.20). Thus, if there would be lack of support system for these people it would lower their self esteem, intrinsic motivation and leads to decrease self concept (Lowder, 2007). If these mentally un well people are discriminated, this would hinder their ability to assimilate into society and this can lead to social isolation. Also, according to labeling theory, that once public label these people as mentally ill, their presence becomes undesirable in community hence leading them to social seclusion (Lowder, 2007). As happened with my client that when she asked her husband once to meet their relatives, he had beaten her scarcely with wooden stick just because he felt ashamed to take her in family gatherings. This affected her personality immensely and from that onwards she herself remained lonely and isolated. By reflecting upon this we can imagine that how a single dishonest action or altitude of caregivers can massively effect patient’s life. In addition, the interpersonal model of violence in mental health by Chappell and De Martino (2003) also agrees to the point that if patient’s needs and wishes are blocked till great extent, it would intensely affect patient’s mental health hence leading to disturbing effects such as ineffective adherence to treatment schedule and destruction of self (See appendices). Like, my patient tried several times to commit suicide in order to decrease her loneliness and suppress her aggression towards others. This show that it is very significant for caregivers to strengthen the mental health of these people rather than making them more vulnerable to harmful health consequences as conferred above.

After thorough literature search I found out some practical interventions to promote the ways of reducing mistreatment with mental patients. It would be on individual, family, community and government level. At individual level, patients should be granted liberty to take decisions regarding their life and should not be tortured or harmed. This is supported by Human Rights Act (1998) that states “no one shall be subjected to torture or to inhuman or degrading treatment or punishment” (Clinical ethics, 2004, p.24). In addition, the stair case model illuminates intervention strategies concerning abuse prevention in 3 steps which are reluctance, recognition and rebuilding. This includes interventions such as breaking through denial, decreasing social loneliness, sorrow and self blame, providing teaching and advocacy (Loughlin & Duggan, 1998). Health care professionals can integrate these interventions in their care framework. I also attempted to apply this model in my patient’s care. I tried to make my client verbalize her feelings by providing her concrete objects like blank paper and colors. This helped her in verbalizing her internal feelings which were not shared with others since long time. Moreover, throughout my clinical weeks I remained engaged in care through non judgmental speech and body language. As supported by literature that your speech and nature should convey respect and a non-judgmental attitude (Loughlin & Duggan,1998). To lessen social isolation, I involved my client in group occupational therapy and also focused on her hobbies that were, drawing and coloring the religious names. In this way I was able to socialize her to some extent. As supported by literature that, Support groups provide a channel for people with OCD to get emotional support while learning how to manage their condition. Also, this helps victims to lessen the barriers that the memories of abuse place in the way of normal life (Davis, 2008; Child abuse, CPS facts). In addition, abuse creates sense of hopelessness and low self esteem in patients as discussed earlier therefore caregivers should be taught to encourage and praise clients on their little efforts to boost their self concept.

On family level, a good communication and involvement in patient care can be a best defense against mistreatment. Moreover, providing psycho education can also enable family members to remain involved in the care. As, the stress level of caregivers can also be reduced by providing tips of care giving to them and involving in family therapy (Davis, 2008). At community level, social and health workers including community leaders should have responsibility for identifying cases of mistreatment and then organizing interventions to lessen the risk of any future abuse (Loughlin & Duggan, 1998). Moreover, I recommend that the psychological counseling services as well as social gathering area for mental patients should be established in the community, where these people can socialize themselves. On government level, various laws and punishments for the abusers and extensive awareness campaigns on care and destigmatization of mental illness should be arranged (Raj, 2009). Besides, government should also set up monitoring system to ensure that human rights are being followed in all psychiatric facilities (Gadit, 2008). Lastly, I recommend that with the help of mass media cases of abuse with mental patients should be reported so that the strategies should be planned on local and national level to minimize the risk of any future abuse.

It was a good learning experience for me to write a scholarly paper. I have learnt the importance of promoting mental health without abusive and negative attitude. Moreover, faculty facilitation and literature review helped me to learn and integrate all concepts related to the issue which will help me in my future clinical settings.

In conclusion, the above provided evidences are overwhelming that the mistreatment with mental patients is the disobedience of human rights as strongly proved by human rights declaration that “All human beings are born free and equal in dignity and rights.” (UDHR, 2006, p.2). In addition, the paper also discussed the causes and consequences of this immoral issue of mistreatment with mental patients. Now, it’s the duty of caregivers to adhere to the strategies provided above, in order to offer a competent care with encouraging attitude and bring a positive change in the lives of these people.

Topic:

Read the report A study on girls in gangs by Hong Kong Federation of Youth and evaluate the possible explanations offered by Merton’s strains towards anomie theory.

After reading the report A Study on Girls in Gang by Hong Kong Federation of Youth , to a large extent I disagree to Merton’s strain towards anomie theory.

Let’s begin with the definition of Girls in Gang. Firstly, Girls in Gang means those girls are not contribute in any triad or serious criminal cases like murder, but they mainly committed in physical violence, stealing from shop or strangers, dishonesty to use their phone or bullying some people that they do it for fun. Secondly, they aged from 10 to 17 years old. Thirdly, gang members are or above 3 people.(Chu Yiu Kong, An Analysis of Youth Gangs in Tin Shui Wai in Hong Kong) Moreover, there are 5 types of structure in gangs. They are autonomous which is girl-dominant, auxiliary which is also girl-dominant but also rely on boy gangs, mixed which included girls and boys, independent group which is not control by anyone, satellite group which is girl-dominant, rely on boy gangs but independent. But what we know is, auxiliary and satellite are the main structures which were more common in Hong Kong society, and the decision-making are mainly from the boys.

According to the theory of Structural Functionalism, the society is co-related. The social relationship extending over time and form stable patterns of interaction, then these structures in turn constituted social institutions when time’s gone. Therefore the social problem happens when function of an institution is not being performed properly, results from the malfunctioning. Also, from Merton’s theory,’ deviant behavior and social disorganization were separate and distinct; tended to see each as causing the other.’ (Merton, 1938)

In the case of Girls in Gangs, there is malfunction in the social relationship of their family, which cannot achieve prerequisite of socialization in order to inherit values, social norms, customs or ideologies by the society. That means their relationship cannot engage those girls in such a way that we find appropriate and acceptable. At the same time, their family cannot give out as the role of the family does such as give them love and belonging, financial support. Thus, girls may easily accept the deviant behaviors such as join gang to satisfy their needs.

Refer to Merton’s theory of strains towards anomie society, separate deviance into cultural structure and social structure. First, anomie means the low level of moral regulation which regard as normlessness, on the one hand, it is about when we are free to act and not constrained by social norms. Second, cultural structures means a hierarchy of shared values that govern our behaviors and provide us with cultural goal like achievement on education or career, material comfort of wealth. On the other hand, ‘social structure means institutional norms which define and regulate the acceptable mode of reaching these goals.'(Merton, 1938) In other words, is to provide legitimate means by which members can pursue their goals. From his theory, there are five types of adaptations to achieve either cultural goals or social means. To a large extent, I agree to the conformity adaptations, but small extent agree to the ritualism adaptations, the innovation adaptation, the rebellion adaptations and the retreatism adaptation did applicable to the case of girls join gangs in Hong Kong. The reasons are as of the following.

The report of ‘ A study on Girls in Gangs’ have shown that the several reasons of the girls join gangs because of emotional attachment and protection. As most of the interviewees responded that they were lack of affiliation, which they do not have a good or even lack of relationship with their family, school or working place. In order to fulfill their mental needs or emotional attachment, they joined gangs to achieve the conformity with other people in order to lower the loneliness. Besides, girls in gangs will be named as ‘ah-so’, English means either sister-in-law or girlfriend, or ‘ka -mui’, in English means little sister, both names did not have a direct relationship, but somehow they can get protection from the gangs because of what their fake relationship is simply as same as the real family. This structure represents that the girl participating in gangs is trying to achieve their cultural goal and they do have social means which is join gangs . Thus, the girls participate in gangs does regard as an conformity adaptations since they have their cultural goals and social means.

According to the report,” A study on Girls in Gangs”, the two interviewees told that they were pleasant and happy because of they can enjoy free entertainment when they join gangs. (18 years old, student) They will go to sing karaoke, dancing or go to mainland sometimes, depend on where the gangs go, and the girls in gangs do not need to pay any money, which for boys to show their gentleness and power. (16 years old, employee). From the research, it presents the girls do have cultural goal which is free entertainment regard as use the social means, but they use the same means which do not have any new goals or new means. In addition, the society was also assume the goal as materialism or material comfort, when they did not achieve their goals in legitimacy means, so they will reject the mean. Therefore, the ritualism adaptation which refers as no goals but with means cannot apply in this case.

Nonetheless, the report ” A study on Girls in Gangs”, One of the interviewees said that she joins gang because of her boyfriend is one of the members in gangs.(16, student)Furthermore, from what she has said, girls join gangs may seem to have a new goal which is find a boyfriend and maintain a stable love relationship with their partner, but it is also talk about they need emotional attachment, love and belonging by the mean. Thus, rebellion adaptation which have new goals and new means, and innovation adaptation which have goals and new means are not applicable in girls join gangs in Hong Kong, because they do not have the new goals and new means.

The above report data’s also presented some of the girls know that when they need to leave the gang. The report shown that girls join gangs which they think they were smart enough to protect themselves, and they know what they are doing, they always did something for aim.(18, employee) This shows that they are not as what retreatlism adaptation means have no goals and no means to do some deviant behavior, and what Merton regards as true deviant. Therefore, retreatlism adaptation cannot apply in this case, as the girls join gangs for goals.

In our life, different countries or places may bring a different social structure. Compare to America, Hong Kong is rarely have serious criminal cases, and the girls in gangs which were totally different. Merton’s theory can explain why rates of deviant behavior are higher in some sectors of the society than in others. ‘American culture is characterized by great emphasis on the accumulation of wealth as a success symbol without a corresponding emphasis on using legitimate means to match toward their goal.'(Marshall B. Clinard, 1964) Refer to the theory, it told that in America society, if the one who want to achieve goals of being wealthy, they can use any means leaned success, even illegal or criminal should be accepted by the theory. Thus, American are more focus on wealth, and do not care all other things such as relationship, love, caring, academic, and they may not facing the same problems of Hong Kong girls in gangs which was lack of affiliation or facing failure. Then, compare to the case of Hong Kong girls in gangs, mainly concerned about the emotional attachment and conformity, join gangs seek as an instruments to achieve their conformity, they may have goals but they do not have any new means. So in this way, Merton’s theory may not be appropriate to apply on the girls join gangs in Hong Kong society which is more applicable on American society.

Last but not least, Hong Kong girls join gangs should be regarding something they want like affiliation to achieve with means, which is Hong Kong girls join gangs were trying to gain conformity by satisfy their emotional attachment, love and belonging. So conformity adaptation of the Merton’s theory is the only one can apply and suit on the girls join gangs in Hong Kong. On the other hand, girls in gang of Hong Kong society need to fulfill their need with means, but not with new goals or new means, so other adaptation of the Merton’s theory may not be the best to apply in Girls in Gangs of Hong Kong society. Therefore, to a large extent I disagree to Merton’s strain towards anomie theory.

Reference Readings

Chu, Yiu Kong (2005)”An analysis of Youth Gangs in Tin Shui Wai in Hong Kong” in Hong Kong Journal of Social Sciences NO.29 Spring/Summer 2005.
Clinard, Marshall B.(1995) “Robert Merton: Anomie and Social Structure” in Earl Eubington and Martin S. Weinberg ed. The study of Social Problems – Seven Perspectives, London : Oxford University Press.
Haralambos, Michael and Holborn, Martin (2000) Sociology – Themes and Perspectives ,London Collins.
Mok, James and Chan Shui-ching(2008) A study on Girls in Gangs, Hong Kong : Research Centre, Hong Kong Federation of Youth Group.

On any given night in Australia it is estimated that over 100,000 people are homeless and living without essential human rights. (MHCA, 2009. p.5) While the reasons for people’s homelessness are varying, the abuse of alcohol, drugs and other harmful substances can exacerbate the situation and lead to further problems. The use of harmful substances by many homeless people is often seen as “functional”, this meaning that the use of these substances is helping them cope with their situation, and provide them with a sense of belonging in the Australian street culture. While many of the homeless people may start using ‘soft drugs’ , this often opens the gateway to harder substances to which they can come completely reliant upon. The prevalence of heroin use in the homeless community is ten times higher than the general Australian community. (Australian National Council on Drugs, 2008) (Johnson & Chamberlin, 2008, p.347)

Australia’s homeless population, exhibit higher rates of emotional and physical health issues, anxiety, poor nutrition and difficulties in maintaining relationships (Lady Bowen Trust).

1 in 200 Australians in today’s society don’t have access to adequate housing and employment. It is estimated that 75 percent of this homeless population is suffering from some kind of mental illness, (MHCA, 2009, p.5) and that at least forty three percent engaged in substance abuse. (Johnson & Chamberlin, 2008, p.347)

A safe and secure environment is essential to physical and mental health. Mental health symptoms can often be worsened by unstable housing and social isolation. Homelessness significantly affects a person’s ability to successfully maintain employment and relationships.

When referring to mental illness, generally speaking it is an illness that has some kind of influence and effect on how a person, thinks, feels and acts. (MHCA, 2009, p.10) These can include mental health issues such as depression, anxiety personality disorders, schizophrenia and stress disorders. It is estimated that 1 in 5 people will experience a mental illness of varying degrees at some point in their lives. (MHCA, 2009, p.10) Although the exact cause of many mental illnesses are unknown, along with biological factors it is believed that environmental factors, stressful and abusing situations, substance or drug abuse and negative thought patterns all contribute to a person’s mental health.

Domestic violence, mental health, unemployment and substance abuse are among the leading causes of homelessness in Australia, along with critical shortages of affordable housing. However it is important to note that there are many contributing factors to a person becoming homeless such as family breakdown, sexual assault, gambling, mental illness, financial difficulties and social isolisation and broader social processes. (Homelessness Australia, 2010)

Having a mental illness reduces a person’s quality of life; the symptoms can make it difficult for individuals to cope with the daily demands of work and home life. In some cases this can lead to people becoming socially isolated, and even losing their jobs. This loss of employment often means people are no longer able to afford housing and a lack of social support can mean these people may become homeless. The unemployed are also less likely to receive medical treatment for symptoms of mental illness. If they do seek treatment of these illnesses they then face the problems of being able to pay for expensive prescriptions. (www.informahealthcare.com)

The current economic climate has also placed increased stress on individuals and there has been “a spike in Medicare claims for mental health consultations due to unemployment” (Dragon, 2009).

Studies have shown that homeless people have a higher prevalence of mental illness and substance abuse, with a Melbourne study showing 30 percent of homeless people surveyed had mental health issues and 43 percent suffered substance abuse issues. (MHCA, 2009, p.14)

Substance abuse is also linked to homelessness, unemployment and mental illness, as substance abuse can take hold and damage a person’s quality of life. Substance abuse begins to interfere with a individuals work and social life and this commonly leads to the destruction of relationships and loss of employment. Rather than this slide from positive relationships and employment being instant, many people tend to slide into homelessness as a result of their substance abuse. As they begin to come more dependent on these substances the transition becomes more rapid. ((Johnson & Chamberlin, 2008, p.348)

Having a mental illness can increase a person’s likelihood of abusing drugs, which may in the short term make the symptoms of their mental illness feel better, while other people’s drug use can trigger the symptoms of mental illness. (MHCA, 2009, p.22) The link can also be made in terms of unemployment and homelessness, if a person is unemployed they can experience financial difficulties that can result in being homeless, alternatively if a person is homeless it becomes difficult to gain employment and break the cycle.

The relationship between homelessness and substance abuse is well researched and documented; there is debate however on the direction of this relationship, and whether substance abuse is the cause or consequence of an individual becoming homeless.

The focus of substance abuse as a consequence of homelessness is the social adaption model. Entering into homelessness often exposes individuals to a subculture where substance abuse is accepted and common place. This model also identifies that many people start to abuse substances as a method of coping with their situation, which can often be very stressful, uncertain and traumatic. (Johnson & Chamberlin, 2008, p.343)

Johnson and Chamberlain (2008, p.350) report that thirty four percent of individuals have engaged in substance abuse before becoming homeless, while sixty six percent first start abusing substances after becoming homeless.es as they struggle to pay for their addiction. Loss of employment then leads individuals looking for alternative income which can often lead to ‘bad loans’ and illegal behaviours. (Johnson & Chamberlin, 2008, p.p347-350)

The social selection approach focuses on substance abuse as a cause of homelessness rather than a consequence. Substance abuse can be a leading factor into homelessness, as when a person becomes addicted to harmful substances they tend to start self damaging behaviours which affect social and work relationships. As their substance abuse increases, this often leads to financial difficulties and destruction of social networks.

Psychological trauma and post traumatic stress disorder have been found to be contributing factors for many of the homeless population.

There is no specific way in which each of these social detriments of health contributes to each other. For example, mental health issues may contribute or lead to people becoming homeless, while for others their mental health issues may be a result of being homeless or compounded by it. (MHCA, 2009, p.22)

The homeless population can face discrimination when trying to find and apply for housing, especially when they have experienced a mental illness. (DHA, 2005) Many landlords are something about having people with a mental illness in their accommodation, due to the negative stigma that is attached with mental illness.

Having a mental illness or past substance abuse problem can also follow a person and impact upon their lives even after they have overcome these issues. As in today’s society many jobs and housing applications require police, credit and background checks. (MHCA, 2009, p.18)

Webster (2007) reports that drug abusers with mental illnesses are likely to experience high rates of employment difficulties. Stating that individuals with mental illnesses have fewer work-related skills, poor interpersonal skills, impulse control and poor time management, therefore having less success in the workforce than individuals without mental illness and substance abuse issues. (Webster et al., 2007)

Webster (2007) also reports that employment is a key factor in breaking the cycle of drug abuse, as employment occupies time, increases self esteem, promotes a sense of belonging and responsibility and provides structure. (Webster et al., 2007)

In Australian society a quarter of the homeless population are children aged between 12 and 18, as these children age and mature they are at a higher risk of unemployment and being stuck in a vicious cycle of homelessness, unemployment, substance abuse and mental illness. (Graham, 2010, p.24)

Children are more likely to face unemployment if they are from low socioeconomic status, left school early leading to low literacy and numeracy skills, are indigenous, live with one or more unemployed person, or live in remote areas. (Graham, 2010, p.20)

A longitudinal study of Australian youth with mental health issues found that they did not suffer from mental health issues prior to unemployment. This shows the importance of employment and the effect that unemployment can have. (Graham, 2010, p.23)

In 1991, Fischer & Breakey developed three pathways into homelessness. The first being social selection which involves “a breakdown in the capacity for living independently due to mental illness. The second pathway details socioeconomic adversity in which a person experiences unemployment, low levels of education and declining income. The third pathway described involves the inability to develop “socially normative roles and support systems”. (Kim & Ford, 2010, p.40)

The sociological imagination uses a sociological approach to analysing issues such as homelessness, substance abuse, unemployment and mental illness. This approach analyses associations of public issues and personal problems by looking at the Historical, structural, critical and cultural factors which contribute to a person experiencing issues such as homelessness. A better understanding of the causes can be found and thus leading to a better understanding of how to return to normal societal function and reducing the risk of relapse into past behaviours. . (Germov, 2009, p.7).

The amount of structure and agency an individual holds in situations of homelessness, drug abuse, unemployment and mental illness is also important to note. The structure agency debate explores the amount of control a individual has over their behaviour and how much influence the social structure to which they belong plays. (Germov, 2009, p.7). Children that have grown up in an environment which is socioeconomically disadvantaged, high levels of drug abuse and unemployment, and poor work ethic, are more likely to follow in this pattern than children that have been brought up in higher socioeconomic conditions and have been instilled with a strong work ethic.

Sue is 17 years of age and has been living away from home for two years, having left her family home due to conflict and violence with parents and physical assault between siblings. In the past two years Sue has lived a typically transient lifestyle, residing in crisis accommodation, various boarding arrangements and in an accommodation program to assist young people who are homeless and in need of specialist support. Sue has lived independently in a small unit as well as with a number of friends in their accommodation and in squats.

Over the past two years Sue has engaged in self-harming behaviour and been violent and aggressive towards peers, herself and family, which has on occasion resulted in ‘cautions’ from the legal system. Sue has also engaged in petty theft, auto-theft and ‘break and enters’, all resulting in legal ‘cautions’. Sue uses alcohol, marijuana and amphetamines and has been diagnosed with depression resulting in anti-depressants being prescribed

(Mission Australia, 2005).

In December 2008, the Australian Government released a “White Paper on Homelessness: The Road Home: A National Approach to Reducing Homelessness”. This paper recognises that maintaining the current approach to homelessness will see the homeless population of Australia significantly increase in the coming years. The paper takes a holistic view and aims to find solutions in address the varying needs of the homeless population, for example employment needs, education and training, health and social support. This report has three main initiative areas. They are to ensure that services intervene early to stop people becoming homeless, making services more connected and responsive across a range of areas not limited to housing, such as health and economic and social participation and strategies to assist people who become homeless to move quickly through the crisis system to stable housing, and providing the support they need so that they do not re-enter homelessness. Through the implementation on many straggles under these initiatives and 1.2 billion dollars in funding the Australian Government aims to have a fifty percent reduction in homelessness by 2020. (MHCA, 2009, pp.12-13)

Today’s society has negative stigma and labelling associated with homelessness. Due to this attributes, the skills they poses, their personality, past achievements are often disregarded and overrun by the fact they are homeless. (Mission Australia, 2005)

As homelessness is not a ‘social norm’, it can be seen is deviant behaviour. With the rise of the medical model of health, importance is placed on the individual receiving treatment in order to restore health and conformity. (Roach Anleu, 2010, pp.242-260)

Under the ‘therapeutic model deviant individuals which can include the homeless, mentally ill, drug and alcohol abusers and those experiencing ‘adjustment problems’ require psychiatric intervention, with little emphasis in the social and environmental conditions that contribute to these issues. (Roach Anleu, 2010, pp.242-260)

Homelessness, unemployment, drug use and mental illness are all intricately connected in today’s society. These social determinants of health all coexist and can each weigh largely upon another. These linkages can lead to a viscous cycle which can be hard to break.

Conclusion

What was discussed

Reaffirm argument

http://www.health.qld.gov.au/research_information/social_determinants.asp

This research paper is going to look at the social work profession and specifically deal with mental health social work. In researching on the subject, I will use books and articles to get secondary information and at the same time carry out an interview with two social workers that are involved with mental health patients and clients. One of the social workers has a bachelor’s degree in social work while the other one holds a master’s degree in social work. Carrying out the interview will require posing a few questions which are listed below.

What is the social work profession in general all about?

What other or extra duties are social workers expected to perform?

How many categories of social workers are there in the profession?

What does a mental health worker specialize in?

What is the connection between a mental health social worker and a substance abuse social worker?

What are the services that one would expect to get when visiting a mental health social worker?

Give me a short briefing of the nature of your work as a social worker?

How is your work related to the outside and regular work environment?

What are the challenges that most mental health workers face in their jobs?

What requirements does one need to get into this profession?

Are there any exceptions for entry-level jobs in small agencies or community work?

Is there a specific amount of field experience required beforehand seeing as one gets to handle clients directly?

What other qualifications does one need apart from the educational and professional ones?

Are there any personal skills advantageous to this profession?

Is there any advancement opportunities in the mental health social work profession and what are they?

Essay

Social work is a profession which is most suitable for individuals who have a strong urge and desire to help improve the lives of other people. Therefore, social workers are the professionals who help people in coping with their day to day lives and solving their personal, family and relationship problems. In additions, there is another group of social workers that helps the clients in dealing with disabilities and life threatening or fatal diseases as well as social problems such as drug abuse and unemployment. As a result, they also end up being involved in the conducting of research, advocating for improved services and involvement in the planning and/or policy development. Basically, most of the social workers concentrate in supplying their services to a particular population or in operating in a specific background. Social workers are generally involved in different areas of practice according to one’s preference. These categories are mental health, elderly, education, political, medical or slums dwellers. If they have the right State mandated license, these workers are referred to as licensed clinical social workers in spite of whichever setting they are in.

Mental health social workers, who are often paired up with the substance abuse social workers, are the ones who treat people affected with mental illness or substance abuse problems. The reason why mental and substance abuse social workers are paired up is because more often than not, substance abuse leads to addiction and most experts concur that addiction is a brain disease. The services offered by these social workers include individual and group therapy, crisis intervention, outreach, social rehabilitation and outreach programs. In addition, they help in planning for supportive services so as to make it easier for the clients when they leave the in-patient facilities to rejoin the community and also provide services to help the family members of their clients cope with the situation.

Although most mental health workers are flexible to work in whichever setting that they are comfortable with, they usually spend most of their time in an office or a residential facility. Some of them work in outpatient facilities whereby the patients come for the treatment and medicine then leave while others work in inpatient facilities whereby the clients reside within the facility until they are well enough to go back home. In regard to the normal work environment, there are a few mental health workers who work in employee-assistance programs in which case they help people cope with job-related pressures or with personal problems that may affect the quality of their work production. Several other workers are involved in private practice where they get employed directly by a particular client. Workers may also travel locally to visit their clients, meet with service providers and attend meetings.

Even though most of the mental social workers are greatly satisfied after offering their services, the job can sometimes be very challenging. Social work, and especially in the mental health specialty, does not have a lot of professionals. Due to this, there is a regular understaffing and build up of large case load in some of the agencies thus leading to too much pressure on the available workers. Full time social work requires one to work a standard 40-hour week but due to the nature of the job, one is at times obligated to work during the evenings and weekends meeting with clients, attending community meetings and handling emergencies. Moreover, in the working with some patients especially in the mental health institutions can prove to be challenging and at times impossible. This is especially when dealing with a chronically ill patient who is unwilling to co-operate and is difficult to handle and manage. In such a case, external help might be required to calm down such a patient and acts such as man-handling and injecting them with sedatives have to be executed so as to return things back to normality. (Golightley, 159)

Just like any other profession, social workers also have minimum requirements so as to be permitted full entry into the occupation. Although some positions necessitate one to have an advanced degree, the most common minimum requirement is on average a bachelor’s degree in social work (BSW) which is sufficient for entry into the field. However there are a few exceptions whereby a major in psychology, sociology or related fields can qualify one for some entry-level jobs in small community agencies. On the other hand, a master’s degree in social work (MSW) is characteristically vital for one to get positions in both the health and teaching fields as well as in clinical work. Furthermore, for teaching position in colleges or universities, one would need a doctorate in social work (DSW or PhD). A certified bachelor’s degree program requires a minimum of 400 hours of supervised field experience while a master’s degree program includes a minimum of 900 hours of supervised field instruction. This prepares the graduates for employment in their chosen field of specialty and helps them continue developing the skills required to execute clinical assessments, handle and supervise large case loads as well as explore new ways of using social services that are helpful to the clients.

In addition to the educational qualifications, all states have licensing, certification or registration requirements regarding the use of professional titles. Most of the states call for 2 years of supervised clinical experience for any social worker to be given a license. However, one does not only need professional and educational qualifications to successfully practice a socially and emotionally challenging career of mental health social work. One also needs to have certain personal skills and traits. First and foremost, a mental health social worker should be objective and at the same time sensitive to other people and the problems they are dealing with. It is also helpful to both the social worker and the client to possess calm temperament, quiet disposition and be very patient. A social worker should also be emotionally mature, be able to manage responsibilities and to maintain good working relations with both clients and coworkers. In terms of advancement, a mental health worker can progress to become a supervisor of other workers, a program manager or an executive director of a mental health institution. In the case where one has reached a retiring age or is unable to work in a health institution, there are other career options such as teaching, consulting, researching or going into private practice.

In conclusion, despite the social work profession and most especially the area of mental health not being as popular as other careers such as medicine or law, it is just as important in the community as the others. Mental health social workers contribute greatly to the community in undertaking a task that most people do not have the heart, disposition or courage to do. If more people were to delve into the profession, the community and the families dealing with mental illnesses would benefit significantly.

NAME : Kerril Sommerville.

LOCATION : Monmouth Medical Center, Long Branch, New Jersey.

PHONE : +1 800 732-922-7300

EMAIL : [email protected]

Mental Health is thus the emotional and spiritual resilience, which enables us to enjoy life and to survive pain and disappointment and sadness. It is a positive sense of well-being and an underlying belief on our own and others dignity and worth. Recent transnational and national policies on mental health adopt a broader view than the traditional psychiatric model. This approach is directed at promoting good mental health, preventing mental ill health and ensuring early intervention when mental health problems occur. It involves looking beyond prevention, to the relationship between mental well-being and physical health; behavioural problems; child abuse; violence and drug and alcohol abuse. In promotion and prevention policies such social determinants as living and working conditions; homelessness; poverty, social networks and support, unemployment and risk taking behaviour are included. In effect it means addressing the mental health impact of public policies, programmes and plans like:

Combating homelessness

Preventing ghettos and marginalisation

Promoting equity

Providing safe water, sanitation and shelter

Taking care of families with children and their needs

Enhancing accessible environments

There have been two big changes in mental health services in recent years. The first was the introduction of care in the community. This was meant to enable mental health service users to live in their own homes and neighbourhoods with suitable support instead of going into or staying in hospital. The second is the development of the mental health service survivor’s movement. This has made it possible for service users to speak for themselves, say what they want and to try and improve the way they are treated.

What are the main issues facing this special population, particularly around access, quality, and cost-effective care?

Considerable emphasis was given throughout need to rebalance mental health policy to give a higher priority to promotion and, where possible, prevention. Like public health policy more generally, mental health suffers from the emphasis given to acute, hospital-based care, which continues to receive most of the resources and attention.

The notion of empowerment receives a great deal of lip service, but deep-seated issues of power and professional status are at stake and should not be ignored. Bringing service users and their families into hitherto closed decision-making practices and arenas can be threatening for professionals and disempowering for the users and families. The process should be transparent and designed to benefit everyone concerned.

No single model of care is perfect, although some are clearly more attractive and effective than others. Different countries have different models to offer, and they should embrace diversity as an advantage. Countries should be open to and invest in innovation and change, and search for new ways to tackle familiar problems.

There is a need for better information about developments in the Region and for comparative data on European countries where appropriate. Collecting them may be a task for public health observatories, for which a European movement now exists.

The need for and importance of learning within and more particularly between countries in the Region was stressed. Well-placed and -equipped to undertake the task of education and to help countries transform knowledge into action.

The great bulk of mental disorders are high prevalence disorders such as depression, anxiety, alcohol related disorders and somatiform disorders. These have evidence based treatments.

Developments in services should not be stalled by the fact that there are still many unanswered questions. There are plenty of opportunities for true innovation in the primary care metal health arena.

The general practice workforce has an important role in managing these disorders but cannot do it alone.

Especially in rural areas extra resources need to be spent in provision of accessible services that are evidence based. This needs to encompass the full range of services from specialist psychiatrist services through to support groups, self help manuals and computer based programs.

Further development though Divisions needs to be done in a measured way and needs to engage Divisions and their members and meet their agendas firstly.

2. What are some public policies that would support the needs of this special population?

Both theoretically and methodologically, health research has recently increasingly focussed on cohesion in communities and societies, people’s integrative needs and action models that promote integration. The level of benefits such as income support is low. Because of this it is crucial for mental health service users who are eligible to secure disability benefits. Although these benefits are important to maintain people’s quality of life, they are generally difficult to get and may be difficult to keep. Mental health services are provided by health and social services through care management and the care programme approach. Underfunding and problems of coordination mean that the support service users receive is often inadequate, inappropriate and unreliable.

Unlike most other social care service users, mental health service users/survivors are liable to have their rights restricted and may be subject to legally sanctioned detention, compulsory treatment and control over their lives and opportunities. The government says that care in the community has failed. Present proposals for mental health policy and practice place a special emphasis on the danger and risk from mental health service users and the importance of safeguarding public safety. Provisions for more compulsory treatment, including the extension of compulsion to people living in the community and locking up people labelled as having personality disorder that have not been convicted of any offence, are planned.

Clearly, no one policy or program will be sufficient to meet all the needs of those who choose to parent, but a combination of services that fill in the gaps left by modern-day changes to traditional care giving networks can make a significant difference in the lives of individuals and families and lead to improved public health measures. Home visitation programs, if implemented correctly, can be one effective piece of this pie. Service users have so far had little or no say in the government’s proposed changes. They fear that these will result in their rights being further restricted and being subjected against their will to damaging treatments. They fear that because of this, many service users will try and avoid mental health services at any cost and be denied any support. They fear that government mental health policy will increase rather than reduce social exclusion as it is meant to.

An abusive, compelling and dominating behavior in a dating relationship among the teenage youngsters is termed as dating violence. Students susceptible to dating violence suffer greatly in terms of their academic performance, social and extra-curricular activities. They may show poor results and isolate themselves from colleagues and friends. They may show lack of interest in extra-curricular activities. All these activities are results of poor mental health. Such students have a profound effect on their psyche due to being exposed to some kind of in-home violence in their childhood. They exhibit anger management disorders and have a history of aggressive or fighting attitude. An even greater consequence of dating violence may be suicides (Maryland School Mental Health Alliance).

Background

There may be several categories in dating violence like sexual, emotional, psychological or electronic. Physical violence may involve pushing, beating or grabbing one’s partner. Psychological violence comprises of controlling behaviors like preventing him or her to involve with other people while electronic violence is the name-calling or bullying through texting.

A latest survey has revealed that psychological and physical abuse is a common aspect of dating among the American youngsters. Among 1400 seventh grade students being interviewed by the researchers showed that about 37% of 11-14 year olds had been susceptible to some type of psychological violence while almost one sixth had experienced physical violence during an on-going relationship. About three-fourth of students had a boyfriend or a girlfriend during their middle school. The survey provided a number of conditions related to dating violence. Among the students being surveyed, there was a large number who believed that it is fine to hit one’s girlfriend. A moderate number of them had undergone sexual harassment through physical or verbal means by touching in a wrong way or by joking (Dating Violence Common by 7th Grade).

However, teenage dating violence is not restricted to westernized and industrialized countries. A study carried out on international level revealed that dating violence extended among males and females was high in all the countries under study. Dating violence was studied through a number of variables like assaulting a partner, depression, injury and sexual coercion. The behavioral acts that were reported in the study were hitting partner, pulling his/her arm or hair, using weapons to harm, burning him/her on purpose, forcing him/her on doing sex when he/she does not intend to do so etc. The rate of physical assault was higher in Asia, while it was significantly lower in New Zealand and Australia while victims of sexual coercion were greater in Canada and the United States (Chang et al.)
Significance of Mental Health

Mental health is a state of efficient performance of brain contributing to productive activities, healthy relationships with people and adaptability to changes and dealing with challenges in a better way. Mental disorders are considered to be health conditions that are attributed by mood swings related to stress or decreased functioning of brain. Mental disorders may lead to diverse complication which includes pain, disability or death. Mental illness is a broader term encompassing all the identifiable mental disorders.

Mental disorders are a major contributor towards disability. The disease burden because of mental illness is the greatest among all diseases. National Institute of Mental Health (NIMH) has reported that approximately 13 million American adults suffer from serious deliberating mental illnesses. Mental disorders contribute to 25% loss of life time through disability and premature mortality and in Canada and United States; they are leading cause of disability. Suicide is the 11th most dominant cause of death in America where it takes away almost 30,000 Americans.

There is a strong correlation between mental and physical health. A good mind leads to good health. Ability of people to engage in health promoting activities reduces as a result of mental illnesses like depression and anxiety (Mental Health and Mental Disorders).

Thus, it is really important to deal with mental health problems arising as a result of dating violence because in severe cases it may lead one to self-harm or even suicidal attempts. Aggression personality disorders are a common phenomenon with the victims of dating violence which involves increased expression of anger, anti-social behavior and self-harm personality disorder etc. About 20% of suicidal persons have a history of violence. Other than that, the victims of dating violence are more likely towards the use of drugs, alcohol and smoking which further deteriorates mental health. Also, there is a trend of using laxatives, dieting pills, fasting and binge eating for weight management among such individuals which lead to eating disorders. Also there is an increased risk of getting infected with sexually transmitted diseases like HIV because the individuals may fear the use of condom because of the violent partner and unprotected sex may lead to such diseases (Teen dating violence). Thus, to alleviate such symptoms and personality disorders among such people and other health associated risks, a mental health policy is demanded.

Mental Health Policies Followed around the world

A number of school and community based programs are operating. Most common are the primary prevention programs that aim at preventing abuse before it starts. The program emphasizes upon providing clear knowledge and suitable behaviors regarding the dating abuse. Its curriculum is based upon increasing awareness of dating violence, fighting violence beliefs, encourage help seeking and skill development in order to improve the communication strategies and management of conflicts (Teen dating violence-awareness and prevention). Such initiatives may lead to improvement of mental health.

Other than program initiatives, there has been a limited reporting in the legal arena for reforms of legislative and judicial nature in dating violence. Only a small number of teen victims knock the door of law to seek legal remedies like protection orders against dating partners who are abusive. The local anti-violence non-profit organization “Between Friends” in Chicago is striving to offer counseling, legal aid and health-care awareness within the city to fight domestic violence (U.S. high schools unequipped). Novel ways are devised by the White House and Vice president’s office in order to prevent dating violence at the initial stages by providing assistance to young men for ending up violence. The Office of Adolescent Health’s Pregnancy Assistance fund grants aims at improving services for the pregnant teens that are experiencing or at the stake of sexual or any other type of violence (Teen dating violence-awareness and prevention).

Safe dates is a curriculum designed for high school and middle school students which is organized in a set of 10 sessions, each of which is almost of 50 minutes. This curriculum gives definitions on caring and sound relationships and also provides information on the dating abuse regarding its causes and effects. It teaches the students how to assist a friend who has an abusive dating partner. It describes the methods in which gender stereotypes affect dating relationships and explains in what ways sexual assault can be prevented. The curriculum comprises of a play on dating violence, poster presentation, and source material for parents and a general outline for teachers (Teen dating violence as a public health issue).

My mental health policy proposal

In my understanding, a mental health policy should first of all address the psychology of the middle and high school students. There should be a compulsory subject on issues related to dating violence. The teachers should observe the students keenly. If the psychological problems are observed in some students, they should be provided counseling in the school.

Parents should also play an important role in dealing with dating violence. They should develop a strong bonding with the children so that they could share what is going on in their life. Also, the parents can then help them coping with their particular situations through their own life’s experiences.

The peers are most aware of dating violence. So the peer groups should be educated about the negative and ill effects of it so that they can assist their friend who is experiencing it.

The legislative body on part of dating violence should become more active and efficient in resolving the dating violence cases and there should be a system of penalties and punishment to those who commit this crime.

Conclusion

Dating violence is a serious and wide spread problem worldwide. Other than violating the human rights, it affects the physical, sexual, reproductive, mental, emotional and social welfare of individuals and families. Physical injury, abortion, sexually transmitted infections, mental disorders like aggression, anxiety and depression are the immediate and long term health effects associated with sating violence. Other than that, use of illicit drugs and smoking are very frequent among the victims of dating violence. A number of initiatives are being under taken by the U.S. government in order to eradicate this issue from the general population. The most important is the mental health policy that aims at improving the mental health of the susceptible individuals that in turn improves their physical health. With a healthy psychology, they can deal with life in a suitable way and serve their country as effective citizens.

There have been on-going public and professional concerns about the issue of domestic violence in the world. This interest has resulted in a growing body of research evidence which examine the prevalence and correlates of this type of violence (Archer, 2002; Fagan & Browne, 1994; Johnson & Ferraro, 2000).

The most common form of violence against women is domestic violence, or the violence against women in families. Research consistently demonstrates that a woman is more likely to be injured, raped or killed by a current or former partner than by any other persons. Men may kick, bite, slap, punch or try to strangle their wives or partners; they may burn them or throw acid on their faces; they may beat or rape them, with either their body parts or sharp objects and they may use deadly weapons to stab or shoot them. At times, women are seriously injured, and in some cases they are killed or die, as a result of their injuries (United Nations Economic and Social Council, 1996).

The assaults are intended to injure women’s psychological health and bodies, which usually include humiliation and physical violence. Just like torture, the assaults are unpredictable and bear little relation to women’s own behaviour. Moreover, the assaults may continue for weeks, and even years. Some women may believe that they deserve the beatings because of some wrong actions on their parts, while others refrain from speaking about the abuse because they fear that their partner will further harm them in reprisal for revealing the “family secrets” or they may simply be ashamed of their situation (United Nations Economic and Social Council, Report of the Special Reporters on violence against women, E/CN.4/1996/53, February 1996).

Physical and sexual violence against women is an enormous problem throughout the world. The perpetrators are typically males close to women, such as their intimate partners and family members. Violence puts women at risk for both short- and long-term sequel which involves their physical, psychological, and social well-being. The prevalence of violence involving women is alarming and it constitutes a serious health problem. No woman is safe from domestic violence, no matter what country or culture she lives in. According to the latest UN report, one in three women is raped, beaten, or abused during her lifetime. The occasion of today’s world “Eliminate Violence against Women’s Day” focuses on Iran, where abuse largely goes unreported and – officially at least – unrecognized.

Some researchers have argued that violence is equally a problem for both sexes (Gelles, 1974; Straus, Gelles and Steinmetz, 1980; both cited in Dwyer, 1996). However, as Bograd (1988) points out, this argument ignores the disproportionate rate of male violence against women and that most documented female violence is committed in self-defence. Moreover, it also ignores the structural supports for male violence against women. There is abundant evidence which suggests that violence, against women by their husbands or partners, is a historical and current norm (i.e. Dobash and Dobash, 1988; Geller, 1992; Gordon, 1998).

Some of the criticisms of cognitive behavioural therapies are that they tend to ignore social and political factors which affect clients (Enns, 1997). People who are homeless, battered, or poor may not have the financial resources or social support to use some cognitive and behavioural methods. Cognitive-behaviour therapy views that behaviour is primarily determined by what that person thinks. Cognitive-behaviour therapy works on the premise that thoughts of low self-worth are incorrect and due to faulty learning. In addition, the aim of therapy is to get rid of the faulty concepts which influence negative thinking. Furthermore, cognitive behavioural therapies may not attend to client’s cultural assumptions about rationality which are rather implicit in such therapies.

To make cognitive and behavioural therapies more compatible with the feminist therapy, Worell and Remer (2003) suggested changing labels that stress the pathology of people, focusing on feeling, and integrating ideas about gender-role socialization, rather than using negative or pathological labels such as distortion, irrationality, or faulty thinking. Worell and Remer (2003) suggest that clients explore ideas, based on the gender-role generalizations which appear to be distorted or irrational. For example, rather than labelling the thought that “women’s place is in the home” as irrational, the therapist should explore the actual rewards and punishments for living out this stereotyped belief. By focusing on anger, particularly angry ones which arise as a result of gender-role limitations or discrimination, women can be helped to feel independent and gain control over their lives. Therefore, helping women with their social-role issues, gender-role and power analysis can be helpful in exploring ways of dealing with societal pressures which interfere with women’s development. This is supported by Wyche (2001) who believes that cognitive and behaviour therapies are particularly relevant for women of colour because they focus on the present, providing clients with methods to use in handling the current problems.

1.2 Statement of the Problem

Violence by intimate partners has been recognized throughout the world as a significant health problem. For instance, the World Health Organization (WHO) focuses on violence against women as a priority health issue. Violence by intimate partners refers to any behaviour within an intimate partnership which causes physical, psychological, or sexual harm to those in the relationship.

Violence against women is a manifestation of historically unequal power relations between men and women (Declaration on the Elimination of Violence Against Women, 1993). According to this Declaration fear is the biggest outcome of violence against women. Fear from violence is a big obstacle of women’s independence and results in women to continue seeking the men’s support, and in many instances this support results in the vulnerability and dependency of women, and is the main obstacle in the empowerment of women’s potentials, which can bring about the development of their capacities and to use their energy in the improvement of society.

Violence and abuse across the world are a common phenomenon and are not specific to a particular society, culture or mentality. Women in any given country and society are in one way or another subjected to violence in the private (home) environment or public (social) environment. In view of the irreversible consequences of violence for both the human, social and family structure of society, and for women themselves. This issue must become extra sensitive in the world. In fact, gender-based violence against women is the violation of their human rights and fundamental freedoms, the denial of their spiritual and physical integrity and an insult to their dignity. Violence against women is an obstacle of access to equal objectives, development and peace. The term “violence against women” is associated to any violent act that is gender-based that results in physical, mental and sexual hurt and suffering.

The main reason for the separation of men and women is mental abuse. Mental abuse is an abusive behaviour which hurts and damages the woman’s honour, dignity and self-confidence. This type of abuse results the loss of perception, loss of self-confidence, various types of depression, woman’s failure in managing the family, greed at the work environment, the reconstruction of violent behaviour in children, woman’s dysfunction in the family, turning to sedatives, alcohol, drugs, fortune-telling (Mehrangiz Kar 2000).

Violence against women in Iran takes place in a number of ways: 1 – Honour killing; 2 – Self-immolation; 3 – Domestic violence; 4 – Prostitution; 5 – Human trafficking, women and children in particular.

Violence reduces the self-confidence of women in the family. Women, who are abused, usually become depressed, secluded, and withdrawn people. Depression is also one of the most fundamental psychological problems in women who are in domestic violence. (Enayat, Halimeh,2006).

Standards for counselling practice was developed in response to reports from women who were dissatisfied with the counselling they received after experiencing domestic violence, and concerns raised by workers in women’s domestic violence services (Inner South Domestic Violence Service in Melbourne). According to the Welfare Organization of Iran (2006), the rate of mental illness among women victimized by domestic violence is significantly higher than among other women having hospital contact. It was noted that while an established network existed for domestic violence crisis and support services were designed specifically to meet the needs of women, counselling services tended to be generalized, with only a few practitioners specializing in the area. Furthermore, there has been no study to show counsellors which treatment for the mental health treatment of women who experienced domestic violence is better than the others (WBO, 2006).

Family laws in Iran, create inequality between men and women, and these laws do not have the capacity to protect women who live with violent men, and violence has turned into a power tool for men.

As the country progresses into an industrial nation, more academically qualified professionals are in great demand in Iran. Women who have experienced domestic violence are subjected to considerable amount of problems concerning mental health related to domestic violence. In a study by A. A. Noorbala, conducted at the Tehran University of Medical Sciences, the prevalence of mental disorders was shown to be 21.3% in the rural areas, and this was 20.9% in the urban areas.

According to an old Iranian saying, “Women should sacrifice themselves and tolerate.” This shows that many women, if not most women, are involved in domestic violence. It happens in private life and a legal complaint can destroy the life of a woman. In other words, parts of the population have the perception that abuse is done in order to keep with the traditions of the society and out of love. Women, who are victims of domestic violence, perceived that their husbands’ jealous reactions which turn into violence are a sign of their love and attention to them.

In a very traditional and religious setting in which many [in Iran] live, their understanding of religion and the interpretation given to them throughout the centuries is that a man can beat his wife. They believe that it is a religious command and the commentators, who have portrayed Islam in this light as a violent religion, have also contributed to the growth of this kind of culture. The police and judicial system are of little help. If a battered woman calls the police, it is unlikely that they will intervene. Ironically, the traditional attitude towards marital conflict in Iran inclines people to mediate between the couple. In many cases, the woman is usually sent back to her violent home. In the Iranian judicial system, there has been no law established to prevent domestic violence. On the contrary, there are many indicators which encourage violence against women in families in the Iranian Islamic penal code. Some authors estimate that the number of intimate relationships with violent husbands is about 20 to 30 percent (Stark & Flitcraft, 1988; Straus & Gelles, 1986). Broken bones, miscarriages, broken families, death, and some mental health disorders are some of the consequences of battering in intimate relationships. Each year, over one million women seek medical care due to battering (Nadelson & Sauzier, 1989). Victims also experience nightmares and somatic consequences, while children who witness abuse may be symptomatic, displaying a high number of somatic, psychological and behavioural problems (Nadelson & Sauzier, 1989). In addition to psychological scarring for victims, children, and batterers, there are broader societal repercussions of domestic violence. Williams-White (1989) state that “the structural, cultural, and social characteristics of our society continue to perpetuate the victimization of women at all levels.” In a way, violence within familial relationships reflects and helps maintain violence and oppression it widely in culture. Jennings (1987:195) explains this by stating that violent husbands not only contribute to maintaining the level of violence in society, they also reflect “a direct manifestation of socially learned sex-role behaviours.” Moreover, the prevalence of battering has crossed race, ethnicity, and socioeconomic status (Hotaling & Sugarman, 1986). Maltreatment of violence can lead to more violence (Walker, 1984). In systems which do not change, future generations may continue to resort to violence to solve problems. In addition, in many of those systems, violence may become more severe with time. For this reason, it is therefore necessary to work on treating the consequences of violence. However, to date, funding for mental health interventions is still limited, and it often only supports short-term treatment which will not adequately address the long-term symptoms.

In view of the special treatment for the mental health of women, counseling centres and support houses for women can reduce the mental health problem of abused women and also reduce the domestic violence statistics.

At the Welfare Organization’s Counselling Centres in Iran, women who are victimized by domestic violence are treated by social workers and counsellors utilizing the cognitive behaviour therapy. Based on the above discussion, this study also analyzed the comparison of the treatments given to women who have experienced domestic violence, using four different therapies, namely combination therapy (cognitive behaviour therapy and feminist therapy) with cognitive behaviour therapy, feminist therapy and social work skills.

1.3 Objectives of the Study
1.3.1 General Objective

In general, this study was carried out to:

Examine the influence of four different mental health treatments given to women who have experienced domestic violence;

Empirically investigate the outcomes of the mental health treatments given to victimized women under combination therapy comprising of (CBT and Feminism), CBT, Feminism therapy and social work skills.

1.3.2 Specific Objectives

This study was undertaken specifically to:

Examine the effects of the combination of therapies comprising of cognitive-behavioural-feminist on the mental health of the women who have experienced domestic violence;

Examine the effects of the cognitive behaviour therapy on the mental health of the women who have experienced domestic violence;

Examine the effects of the feminism therapy on the mental health of the women who have experienced domestic violence;

Examine the effects of the social work on the mental health of the women who have experienced domestic violence.

1.4 Hypotheses
The following hypotheses are postulated in the current study:

There is a significant difference in the improvement of the mental health of the women who underwent the treatment using a combination of different therapies (cognitive, behaviour, feminism therapy) and those who were treated using only social work skills.

There is a significant difference in the improvement of the mental health of the women who underwent the treatment using the cognitive behaviour therapy and those who were treated using only social work skills

There is a significant difference in the improvements of the mental health of the women who underwent the treatment using the feminism therapy and those who were treated using only social work skills.

There is a significant difference between the combination of therapies (cognitive, behaviour therapy), feminism therapy and social work skills.

1.5 Significance of the Study

Violence can shatter a woman’s life in many ways. Being a victim of violence is widely recognized as a cause for mental health problems, including post-traumatic stress disorder, depression, anxiety, and panic attacks. Being abused also plays a major role in developing or worsening substance abuse problems. For many women who are affected by violence, their first abuse usually occurred in their childhood or adolescence. Victimized women as children’s mothers frequently end up losing custody of their own children due to allegations of abuse or neglect, and over 50% of child abuse and neglect cases involve parental alcohol and drug abuse.

In addition to institutionalized violence against women in Iran, the majority of the women and young girls are facing domestic violence at home at the time when they are still living with their parents. In most cases, it is the father and the other elder male members in the family are among those who first commit the aggression against the women and young girls. According to the latest statistics, two out of every three Iranian women have experienced discrimination and domestic violence from the father or the other male members of their family. For the vast majority of the Iranian women, married life marks the beginning of horror, pain, and humiliation, i.e. being the victim of their husbands and sometimes the other family members. Moreover, eighty one out of 100 married women have experienced domestic violence in the first year of their marriage (Mehrangiz Kar 2000). Even women with outstanding jobs and prestigious social standings are subject to this violation. In most of the cases, this abuse leaves permanent physical and psychological damages for the rest of their lives. Ironically, without saying even a word and with much pain and yet no support, crimes against women have gone unnoticed. Ninety out of 100 women suffer from a severe case of depression, from which they ultimately commit suicide and 71% of those women experience nervous breakdowns. (Mehrangiz Kar 2000). Their methods of suicide include setting themselves ablaze. For them, this is the only way of escaping from segregation and humiliation. For instance in Ilam (a city in Iran), 15 girls set themselves ablaze each month, fighting against oppression or depression (Welfare Organization of Iran, 2005). Looking at how serious this problem has become, it is therefore the responsibility of everyone to fight the oppression against women. Female victims need to believe that they should not be blamed on whatever happens to them. An active participation in the Welfare Organization of Iran to defend the women’s rights and opposition to the Iranian Islamic fundamentalism is the least one can do to help end the pain and suffering of the victims of violence in both private and public spheres. Violence against women, in human and brutal punishments, such as stoning and complete elimination of the women from the political and social arenas represent some aspects of the modus operandi of fundamentalists leading to institutionalized violence. This also means that the struggle for equality, safety and security cannot be separated from the fight against fundamentalism in Iran.

This study made use of the theoretical framework, combining the cognitive-behaviour theory and feminist theory for the mental health of the women who have been victimized by domestic violence. The present study could provide knowledge on the different types of mental health treatments adopted by counsellors at various counselling centres throughout the country. This research also examined the quality of the treatment by combining two therapies (cognitive-behaviour therapy and feminist therapy).

Armed with this knowledge, the leaders of the Welfare Organizations, the society, families and counsellors can benefit from the consequences of change in the women’s mental health. The suggested theoretical framework would provide a better understanding of the women’s mental health and their performance in the society.

In summery, battered and abused women need a wide range of responses, flexible services, and supportive policies to enhance their safety and self-sufficiency and to restore their self-esteem and welfare. These might include mental and physical health evaluation and referral; relocation services; confidential advocacy, shelter, and other domestic violence support services; educational and vocational training; legal representation concerning divorce, custody and protective orders; evaluation of immigration status and ethnic or cultural issues; and the effective enforcement of criminal laws and court orders to help free them from their partners’ control and to keep them and their children safe.

We know that women who have suffered abuse are more likely to suffer posttraumatic stress disorder (PTSD), depression, and somatization than those who have never experienced abuse; the more extensive the abuse, the greater the risk of mental health disorder.

Women’s mental health treatment is an important area to consider for research because (1) girls and women as a group are exposed to more traumatic stressors than boys and men; (2) the mental health of women may be severely affected, resulting not only in immediate psychological symptoms, but also lifetime risk for self-destructive or suicidal behaviour, anxiety and panic attacks, eating disorders, substance abuse, somatization disorder, and sexual adjustment disorders; and (3) psychologists are not regularly trained to work specifically with trauma survivors, which can reduce the effectiveness of the treatment survivors receive.

Currently there are 22 crisis intervention centres (women’s crisis intervention centre) across the country (Iran), and women can stay in these centres between 6 to 8 months.

As violence causes psychological pressures and uncontrolled stresses on and ultimately depression in women generally, this study was intended to find a better and useful treatment in the attempt to improve the treatment for the mental health of the women who have become the victims of domestic violence. The present study would also provide further knowledge and understanding on the three different types of the treatments used, namely the Cognitive-behaviour therapy (CBT), Feminist therapy and the combination of the two treatments. The results of this study would therefore contribute the theoretical development and practice in counselling.

1.6 Operational Definition of Terms
1.6.1 Domestic violence

“Domestic violence is a pattern of coercive behaviour, which includes physical, sexual, economic, emotional and/or psychological abuse, exerted by an intimate partner over another with the goal of establishing and maintaining power and control.”

1.6.2 Mental health

a state of mind characterized by emotional well-being, relative freedom from anxiety and disabling symptoms, and a capacity to establish constructive relationships and cope with the ordinary demands and stresses of life. Mental Health is the balance between all aspects of life – social, physical, spiritual and emotional. It impacts on how we manage our surroundings and make choices in our lives – clearly it is an integral part of our overall health. In this study, mental health refers to the score which the client gets from the SCL-90-R test.

1.6.3 Cognitive behaviour Therapy (CBT)

A set of principles and procedures that assume that cognitive processes affect behaviour and conversely that behaviour affects cognitive processes. It emphasizes a here-and-now process without emphasizing causation. (D.Meichenbaum) .A treatment approach that helps clients examines and changes the relationship consequences, thoughts, feelings, behaviours and resultant consequences. It incorporates a number of diverse intervention (for example, cognitive restructuring procedures, problem solving, coping skills interventions, stress inoculation training, and self instructional training.

1.6.4 Feminist Therapy

A philosophical and practical approach with certain assumptions; for example, strategies are needed, and therapists must be aware of personal, gender-biased value system in relation to appropriate behaviour. Feminist therapists promote se4lf-awareness, self-affirmation, and personal integration, outcomes that may conflict with the societal norms that were the original source of dysfunctional behaviour patterns of women.

Promoting the mental health of older people is becoming an activity of increasing importance. In the incoming decades, there will be an increasing the number of older people. There will be fewer young people and young adults. In the year 2050, 30 percent of the people will be older than 65 years of age, while 11 percent of the people will be 80 years old and above. The word old age has no agreed upon definition. In most countries, people retire at an age of 60 to 65 years. This is considered the age when one becomes an older person. According to the European commission, there are three age groups that older people can be divided into. The first group is older workers from the age of 55 to 64. The second group is older people from the age of 65 to 79 years while the third group is 80 years and above. These older age groups are the most diverse in terms of education, attitudes, family background, social background, hobbies, preferences and political attachments.

Mental health in later life – models and issues

There are six main factors that influence mental health. These are financial security, life span experiences, structural factors such as housing, employment, social support and individual coping skills. The mental health of older people as well as their well-being issues in older people are unique and have a greater relevance to them. Retirement is an issue that has great relevance to people who are 60 to 80 years age. As much as it means relief from responsibilities, retirement also mean a loss of status, less social relationships and a reduced role in life. This age group also suffers from health and physical deterioration, changing the environment from moving their home, loss of financial stability and a loss of sense of belonging.

People who are 80 years and above increasingly lose their friends, family members and spouses. They use their sense of purpose in life and their functional ability deteriorates. These people constantly deal with bereavement, death and the fact that their own life is ending. Not all of those older people are the same. They have different values, life experiences, health, economic status and culture. When planning the promotion of the mental health for older people, all of these factors should be put into consideration.

Continuity through the life course

A person’s continuity through life gives them a positive history filled with experiences. This continuity gives a person a set of values that guides their behaviour. When working with older people who have mental health needs, the strategies used should have a psychosocial and sociological perspective that can support the older people during their transition. Much of the work with older people relies on the continuity through their life. Every person has an internal and external self. In order for one to have a happy and successful old age, one needs to be supported in managing their life with a certain general framework. When it comes to the internal self, people should be allowed to make decisions like they have always done it, maintain their integrity and their self esteem. In the external self, people need to reciprocal relationships, continue in positive roles, preserve social support and compensate for mental and physical losses. Disruption of the internal and external elements is likely to heighten the unhappiness and poor self images of people.

Having links in the past, being meaningfully active, feeling embedded within society and having the ability to continue living a life that coincides with one’s personal beliefs can all contribute to living a successful and happy old age. No underestimation should be made when it comes to the significance of having social relationships and maintaining good mental health for the older people. Important factors that can prevent the risk of depression and social isolation in older people are intimate relationships, reciprocal relationships, quality of ties and the presence of a confidante. These factors should be available both at the community and in care homes.

Ageism

In society today, there exists a negative and depreciating attitude towards older people. While ageism affects all age groups, it is found to be more profound with older people. Ageism exists in politics, consumerism, media, voluntary life, crime, design, civic life and many other area of life. Age discrimination is an abuse of human rights that causes personal hardship and suffering and economic and cultural problems. It is therefore necessary for politicians to ensure that a change in human rights is implemented for the sake of older people. There must be no tolerance whatsoever to any kind of discrimination. In promoting mental health, it is especially important to ensure that age equality is promoted. Older people have the right to fully participate in the political, social, economic and cultural decision making processes of their societies. To promote respect and understanding between the young and older people, intergenerational activities can be used. Employees who serve the public should also be trained and educated on how to respect and value the older people that they have direct contact with.

In a recent survey carried out by (reference), it was found that 29 percent of people had suffered age discrimination when compared to other kinds of discrimination. This survey also found that by the age of 55 years, age discrimination was twice as likely to have been experiences as opposed to other forms of discrimination. Moreover, it is believed by 30 percent of people that there is more age discrimination today than there was five years ago, and this trend is likely to get worse. This survey also found out that the demographic shift towards a society with older people than younger people will make life worse in terms of education, security, health, living standards and jobs. In fact, one of the respondents from this surveys said that they viewed those who were 70 years old and above to be incapable and incompetent.

On 1st October, 2006, a new law that was enforced by the Employment Equality Regulations came into effect in England, Scotland and Wales. This law protects people from age discrimination in employment, adult employment and training for people from all age groups. However, this new regulation does not provide protection from age discrimination in health care. It is therefore important for carers and social workers to describe their beliefs and values clearly and on a concise manner. Knowing one’s values is an important guide while caring for the older people. To create a common shared vision between the carers and the social workers, it is important that an exercise to clarify their values be carried out. This practice will give the carers and social workers a shared vision and purpose.

Promoting mental health and well being – what might be involved in practice

When working with older people, promoting their mental health should be seen as a part of everyday work and not as a special project. Since the older person might stay in the residential facility for a relatively short time, the activities dome to promote mental health should be both short term and long term. There are seven principles in promoting the mental health of oder people. The first principal is that the target group should be defined and how, when and where they can be reached is identified. The second principal is that the older people should be involved in developing a plan, implementing and evaluating the programmes and opportunities. The third principal is that the health and social needs for the older people should be addressed. The fourth principle is that the older people should be empowered and motivated to take initiatives to ensure their own health and wellbeing. The fifth principle is that barriers that affect the capacity of older people to participate in society should be identified. These barriers are social, economic and political in nature. After identifying these barriers, interventions should be done to overcome them. The sixth principle is that respect should be given to the independence and autonomy of older people. The last principle is that holistic and multi-faced interventions should be made to consider the mental, social and physical needs of older people. The relationship between these needs should also be considered.

Several opportunities for involvement in activities that are meaningful for older people should be provided. Creative activities that older people can participate in are museums, arts, performances, libraries and other cultural events. The personal and social realisation of the older people can be fostered by lifelong learning programmes. Volunteering and community development initiative that older people can participate in can offer an additional form of beneficial participation. This participation will increase the mental health of the older person who is volunteering as well as the people receiving the services.

Healthy lifestyle choices among older people should also be promoted. To have a good quality life, one must have good health. Having good physical health depends on a variety of factors. These factors include lifestyle, genetic makeup, choices, environmental factors and socioeconomic factors. Despite their daily activities being restricted by having a limiting long term illness, many older people consider themselves to be in good health. Adopting a healthy lifestyle can prevent or delay many of the chronic conditions that are found to affect people in their old age. A healthy lifestyle can be adopted by exercise, reducing alcohol intake, eating a balanced healthy diet and avoiding smoking. Aids and adaptations can be provided to help people keep mobile. Positive mental health can be promoted by providing encouragement, information and opportunities for older people to make healthy choices in their lifestyle.

Physical actuivity and exercising opportunities should be provided. By exercising, a person has better physical health, increased psychological benefits, increased mental wellbeing and better functional ability. By engaging in different types of exercise, a person has different benefits to their mood, stress, self-esteem, sleep and alleviating or preventing the symptoms of anxiety and depression. Safe and healthy outdoor and indoor environments should be adopted for older people’s participation.

An important measure in supporting the mental health in older people is enhancing their participation in the community. Older people should be enabled in engaging in the social activities at the wider community or at their residences. Ensuring the social participation of older people can be done by providing them with opportunities for participating in lifelong learning and political, cultural and economic decision making of their community.

Secure and positive relationships that older people have with their relatives, friends or neighbours should be strengthened. These relationships are important because they contribute to good mental health of older people. The wellbeing of an older person can also be positively influenced by having a pet. Access to activities such as spiritual belief and faith communities should be ensured and recognised as important. The good mental health of older people is also ensured by having a satisfying sexual life. Poor mental health is risked when older people are isolated from society. For some older people, it is a positive experience for them to live alone because it means autonomy, self-support and independence for them. However, other people might find living alone to be a lonely experience especially if getting out of their home is difficult. Therefore, the community should organise befriending programmes that help older people in their everyday lives. Feelings of isolation and loneliness can be avoided by different kinds of clubs, social networks and recreation centres. Isolation can further be avoided by recognising the knowledge and skills contributed by older people and the provision of opportunities where the older people can share their skills with people from other age groups.

Independent and safe living opportunities should be provided. Many older people want to live in their own homes for as long as they can because it provides them with feelings of autonomy band independence. These feelings can be enhanced by providing equipment that can facilitate mobility and communication in the support of smart home establishment solutions. Independent living can be enabled by providing domiciliary services such as home help, home adaptation assistance and providing adequate amenities through assistance with home improvements. Older people who have been victims of violence should be supported and any violence or abuse that affects older people should be tackled. In supporting them, the older people will be able to cope with the resulting psychological and physical ill effects.

Appropriate social and health services should be provided. It is evident among older people that general health and mental health are strongly interrelated. Mental ill health is risked by poverty and poor physical health. It is therefore important that a social and health care system be provided. This care system will give easy access to psychiatric help, high quality primary and specialty health services, necessary social services, transport services and other benefits. To afford decent housing, travel, heating, occasional treats and social activities, older people want to have enough money. These activities help older people to fully participate in their families and communities. To maintain an increase in their income, older people should join individual retirement schemes that allows them to continue working even later in life.

Mental well-being and carers

Traditionally, it has been the role of some family members to provide care for older people at home. However, in this day and age, the social framework all over the world is changing. Caring for an older person, a person with disabilities and for a child in the family is a usual way of life even in the most developed information society-type society. In the European Union, millions of people are seen taking care of their partners or relatives. It is common to find that an elderly person is in charge of taking care of a frail older person. Nowadays, frail wives are taken care of by their husbands and vice versa. The experience of taking care of a spouse, child or a close friend is rewarding and mentally positive. The carer finds that their life has purpose and is more meaningful.

On the other hand, being a care giver has psychological, financial, physical and social strains that may lead to feelings of loneliness and social isolation. Cares are at a high risk of developing psychological and physical ill health that shows that the carers need opportunities for respite and more effective social, financial and practical support. Those carers taking care of older people with dementia are likely to be burdened and have high levels of stress, depression and fatigue. Family caregivers should also be targeted when promoting mental health activities for older people to ensure that the carers’ needs are met as well.

Conclusion

We are all affected by wellbeing and mental health in later life. The reasons why we should pay attention to issues surrounding mental health in old age are economic, social and humanitarian in nature. Each one of us benefits from good mental health and wellbeing in later life because we are ensured that we will be able to lead long healthy lives that are fulfilling and enjoyable. Good mental health promotion for older people is a means by which we can maximise older people’s valuable contribution to economy and society. The costs that arise from poor mental health care are minimised at the same time.

Social workers have been working for a long time with older people in promoting mental health. The mental social work profession is founded on the skills of mental social work. The work of social workers has been to stop disintegrating forces in families, individuals and social groups. Society needs the work done by social workers to continue because these disintegrating forces are still around us. A social worker is able to take up the challenge and help in promoting mental health in older people.

One adult in six in the UK suffers from one or more forms of mental illness at any time. Incidence of mental ailments can as such be considered as prevalent as asthma (Ray et al, 2008, p 2 to 13). Mental ailments range from very common conditions like depression to ailments like schizophrenia, which affect less than 1% of the population. Mental ailments cost the nation approximately 77 billion GBP every year in terms of expenses on health and social care (Ray et al, 2008, p 2 to 13). Such ailments are not really well understood even today and often frighten people and stigmatise people with such ailments (Sheppard, 2002, p 779 to 797). Individuals with long term mental health issues are likely to face discrimination and social exclusion, phenomena that can lead to unemployment or underemployment, poverty, inadequate housing, social isolation and stigmatisation (Sheppard, 2002, p 779 to 797). Whilst UK society is progressively coming to terms with and accept modern day phenomena like homosexuality and same sex marriages, people continue to be very apprehensive about mental disorders and often associate such conditions with lunacy and the need for isolation and detention of people with severe and long term mental health conditions (Angermeyer & Matschinger, 2003, p 304 to 309).

Legislation and social policy towards mentally ill people has however evolved substantially over the course of the 20th century and more so in the last 25 years. I am placed in a residential unit that houses people that both sexes who are over 16 and have mental health issues. This assignment focuses on mental health law and policy in the UK and the various ways in which Ii am using my knowledge and understanding of these issues to inform my practice.

Mental Health Legislation in UK

Poor mental health continues to have substantial economic and personal impact in the UK. Stigma and discrimination increase such impacts (Angermeyer & Matschinger, 2003, p 304 to 309). Social research has consistently found the presence of extremely negative attitudes towards individuals with mental health issues (Angermeyer & Matschinger, 2003, p 304 to 309). There persists the view that such people represent dangers to their communities, perceptions which are also on occasion reinforced by the media. Such negative attitudes do not occur only in the media and the general public but also among mental health workers and professionals (Angermeyer & Matschinger, 2003, p 304 to 309). Such elements increase social distancing, cause social exclusion and reduce the probability of such individuals to gain employment or access social and health care services (Angermeyer & Matschinger, 2003, p 304 to 309).

Whilst discriminatory attitudes towards the mentally ill still exists in substantial measure and adversely affect the life chances and social exclusion of such people, it also needs to be recognised that substantial progress has been made over the course of the 20th century and especially in the last 25 years to improve the physical, mental, economic and social conditions of such people (Mind.Org, 2010, p 1). Such changes have basically been brought about through changes in legislation and in social policy (Mind.Org, 2010, p 1).

People with mental illnesses have traditionally been perceived negatively by society, with attitudes towards them varying from being harmless nuisances to violence prone and dangerous individuals (Mind.Org, 2010, p 1). Families with members with mental illnesses have often tried to hide such conditions for fear of social stigmatisation and the state, right until the end of the 19th century, was comfortable with locking such people up in “lunatic” asylums (Mind.Org, 2010, p 1). The Madhouse Act 1774 led to the creation of a commission with authority to give licences to premises for accommodating lunatics (Mind.Org, 2010, p 1). Succeeding legislation gave mental hospitals the authority to detain people with mental ailments (Mind.Org, 2010, p 1).

The Lunacy Act 1890 was repealed with the passing of the Mental Health Act 1959. The Mental Health Act 1959 strengthened the Mental Treatment Act 1930 and allowed most psychiatric admissions to happen on a voluntary basis (Mind.Org, 2010, p 1). The Act aimed at providing informal treatment for most individuals with mental ailments, even as it created a legal framework for detention of certain people (Mind.Org, 2010, p 1). The recommendations made in the Percy Report led to decisions on compulsory detention of mentally ill persons changing from judicial to administrative prerogatives (Mind.Org, 2010, p 1). The 1959 Act however did not clarify whether legal detention orders for people with mental disorders authorised hospitals to treat such people without their consent (Mind.Org, 2010, p 1). The passing of the Mental Health Act 1983 provided a range of safeguards for people in hospitals. The act also imposed a duty on the district health authorities and social service departments to provide after care services to the people discharged from hospital (Mind.Org, 2010, p 1). The Mental Health Act 1983 covered the assessment, treatment and the rights of people with mental health conditions and specified that people could be detained only if the strict criteria specified in the act were met (Mind.Org, 2010, p 1).

The Mental Health Act 2007 aimed to modernise the Mental Health Act 1983 and incorporated changes that widened the definition of mental disorder and gave greater say to patients about who their nearest relatives were (Ray et al, 2008, p 2 to 13). The act also decreased the situations where electroconvulsive therapy could be given without permission, gave detained patients rights to independent mental health advocates, gave 16 and 17 year olds rights to agree or refuse admission to hospital without such decisions being superseded by parents and introduced supervised community treatment (Ray et al, 2008, p 2 to 13). The amendment of the Mental Health Act was followed by the publication of a code of practice that provides guidance to health care professionals on the interpretation of the law on a regular basis (Ray et al, 2008, p 2 to 13). The code of practice has five important additions to guiding principles, which deal with purpose, least restriction, participation, and effectiveness, efficiency and equity (Ray et al, 2008, p 2 to 13). The code importantly states that the specific needs of patients need to be recognised and patients should be involved to the greatest possible extent in the planning of their treatment (Ray et al, 2008, p 2 to 13).

Whilst The Mental Health Act 1983, as amended in 2007, constitutes the most important mental health legislation in the country, the rights of people with mental health ailments is also governed by other acts like The Mental Capacity Act 2005, The Disability Discrimination Act 1995, The Health and Social Care Act 2008, The Care Standards Act 2007, The Mental Health (Patients in the Community) Act 1995, The Carers (Recognition and Services) Act 1996 and The Community Care (Direct Payment) Act 1996. All of these acts by way of certain provisions provide for the rights and entitlements of young and old individuals with mental ailments (Mind.Org, 2010, p 1).

Progressive legislation in areas of mental health has been accompanied by changes in social care policy for people with such ailments (Brand et al, 2008, p 3 to 7). The beginning of social work in the area of mental health commenced with the engagement of a social worker by the Tavistock Clinic in 1920 (Brand et al, 2008, p 3 to 7). Whilst social work in the area of mental health was subdued until the 1950s, it subsequently assumed larger dimensions and led to the realisation of the utility of non medical social interventions for treatment of medical health issues (Brand et al, 2008, p 3 to 7). The publication of the Beverage Report in 1942 was instrumental in altering government policy and shifting the treatment of people with mental disorders from hospitals to the community (Brand et al, 2008, p 3 to 7).

The 1950s saw the establishment of day hospitals, greater flexibility in provisioning of psychiatric services and reduction in hospital beds (Brand et al, 2008, p 3 to 7). The introduction of advanced drugs, the establishment of therapeutic bodies and development of greater outpatient services led to the decrease of numbers of psychiatric inpatients from 1955 (Brand et al, 2008, p 3 to 7). Much of such decrease was prompted by the introduction of social rehabilitation and resettlement methods, introduction of anti psychotic medication and availability of welfare benefits (Brand et al, 2008, p 3 to 7).Intensive debate and discussion in the media and among the community on the need to improve the conditions of people with mental health issues led to the introduction of specific programmes like the Care Programme Approach (CPA) in 1991 and other government initiatives (Ray et al, 2008, p 2 to 13). The guidance on “Modernising Mental Health Services” stressed upon the need for providing care at all times of the day and night and access to a comprehensive array of services (Ray et al, 2008, p 2 to 13).The introduction of the “National Service Framework for Mental Health” in 1999 elaborated the national standards for mental health, their objectives, how they were to be developed and delivered and the methods for measuring performance in different parts of the country (Sheppard, 2002, p 779 to 797).Social workers are now playing important roles in the treatment of people with mental health disorders and their greater inclusion in the community (Brand et al, 2008, p 3 to 7. Social work theory and practice has always espoused the use of the social model for dealing with people with mental health problems and have contributed to the development of a range of approaches that are holistic, empowering and community based in approach (Brand et al, 2008, p 3 to 7.Apart from being responsible for the introduction of numerous new person centred and community oriented approaches dealing with mental health issues, mental health legislation, by way of The Mental Health Acts of 1983 and 2007 empowered appropriately trained social workers with a range of powers for assessment and intervention of people with mental health disorders (Ray et al, 2008, p 2 to 13).

Application of Disability Knowledge in Practice Setting

I am currently placed for my social work practice in a residential unit for people with mental health problems, who are furthermore homeless, more than 16 years of age, and fall under the purview of the Care Programme Approach (CPA). The CPA, which was introduced in 1991 for people with mental illnesses, requires health authorities, along with social service departments, to make specific arrangements for the care and medical treatment of people in the community with mental ailments (Care Programmeaˆ¦, 2010, p 1). The CPA requires that all individuals who receive treatment, care and support from mental health services should receive high quality care, which should furthermore be based upon individual assessment of their choices and needs. The needs of service users and their carers should essentially be central to delivery of services (Care Programmeaˆ¦, 2010, p 1).

Mentally ill and homeless people are liable to pose special challenges to health and social care workers.

“The majority of those who suffer major mental illness live in impoverished circumstances somewhere along the continuum of poverty. Homelessness, however defined, is the extreme and most marginalised end of this continuum, and it is here that we find disproportionate numbers of the mentally ill.” (Timms, 1996, P 159)

It is very possible that the levels of cooperation and motivation of the mentally ill, who are also homeless, could be lesser than that of other patients (Net Industries, 2010, p 1). Whilst their limited resources often result in difficulties in their obtaining transportation to treatment centres, such people often forget to keep appointments or take their medications. Frequently unkempt in dress and appearance, their engagement in drug abuse can render them unresponsive and unruly (Net Industries, 2010, p 1).

My practice setting provides specialised and supported residences for people with severe and long lasting mental health problems. Each resident has his or her own bedroom and is required to share the use of kitchens and bathrooms. Some of the residents have histories of multiple admissions in hospitals, combined with lack of compliance with medication and disengagement with services. Some of them also have histories of alcohol and substance abuse.

Our organisation provides residents with a helpful and supportive environment for the carrying out of comprehensive assessment of needs (Timms, 1996, p 158 to 165). Assessments and care plans of our residents need to consider a range of requirements. These include assessing the requirements of parents with regard to physical health, housing, vocation and employment, dual diagnosis, history of abuse and violence, carers and medication (Timms, 1996, p 158 to 165). Assessment and care plans for such users need to essentially address risk management and plan for crises and contingencies (Timms, 1996, p 158 to 165).

I, along with the other staff of the residential unit, work with mental health services for carrying out of detailed need assessments and for helping residents in development of independent living skills. My academic training and my knowledge of legislation and policy, whilst substantial, has not really provided me with the wherewithal to meet the practical challenges of my current position. It is still not widely recognised that social and economic disadvantages can lead to mental health problems (Timms, 1996, p 158 to 165). It is clear from my interaction with the residents that many of them come from disturbed and abused backgrounds and feel insecure about the social exclusion and stigma attached with mental ailments. They often have a multiplicity of needs that includes dual diagnosis as well as physical and mental health issues. I have to constantly refresh my knowledge of anti-oppressive and anti-discriminatory theory and ensure that personalised, cultural and socialised biases do not affect my responses towards the inmates of the residential unit and that I am able to help them with their social service needs.

My work includes involvement and help in assessments, assisting residents in finding educational agencies that can help them in improving their skills and earning ability, arranging for medical appointments and counselling sessions in line with their intervention requirements, making them aware of their various social services benefits and entitlements, and helping them to access such benefits. I am aware of the need to adopt a person-centred approach, and take care to ascertain the needs of service users as also their opinions on what they feel is best for them before I make suggestions. I try to adopt a uniformly cheerful and cooperative approach that is based upon respect and helpfulness in my routine interaction with them and strive to ensure that my responses are free of condescension and patronage.

I find that some members of the health and social care professions, despite such significant progress in legislation and policy, approach the mental health and other problems of our residents in traditional and bureaucratic ways, (much in the manner of Dominelli’s portrayal of the current state of social services), and appear to be constrained by resources as well as entrenched attitudes (Dominelli, 2004, p 18 to 95). I am doing my best to ensure that the opinions of the residents are taken into account in the satisfaction of their needs, that they are helped to overcome their mental health issues, and are made more self sufficient to look after their needs.

Conclusion

Significant changes have occurred in the last 40 years in the ways in which disabled people are perceived in society. Whilst many of these changes are outcomes of legislative and policy action by UK governments, the growing awareness of (a) the relevance of the social model, and (b) the fundamental flaws of the medical model, in dealing with disabled people has driven both legislative and policy changes.

Social workers, with their commitment towards bringing about of social inclusion of excluded and disadvantaged segments of society, their specialised education and training, and the resources and authority at their disposal, are particularly well placed to bring about attitudinal changes among the members of health and social services, as well as among members of the community. My practice experience has convinced me that much more will have to be done in the application of legislative provisions and social policy at the ground level, especially so by the people responsible for delivery of social and health care, before the disabled can truly be integrated into mainstream society.