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In this research paper I will be discussing how to identify high risk youth and the treatment for drug abuse. First I will cover which teenagers are likely to be at high risk for drug use and abuse. Second I will discuss some of the causes of drug abuse amongst our teenagers. Third I will discuss the symptoms of teenage drug use. Fourth I will discuss preventative measures with high risk teenagers. Last I will talk about the different types of treatment for teenagers who are abusing drugs.

There are teenagers throughout the world that are considered high risk for drug abuse. Some of the teenagers have been labeled as gang members, homeless, and throwaway teenagers. (Newcomb, 1995) Socioeconomic status may also be a variable with our high risk teenagers. The lower the economic status the higher the risk the teenager is to try drugs. According to a report in 2007 up to 50% of youth who used substances, had some sort of mental disorder such as anxiety or depression. (Leslie, 2008)

There are a few other risk factors that have to be taken into consideration. Family risk factors for teenagers is such a huge factor; family conflicts, poor parenting skills, lack of attention, severe parental discipline, and history of alcohol or drug abuse. (Newcomb, 1995) Other risk factors that are more individual would be history of physical or sexual abuse, learning problems, and difficulty with handling impulsive behavior. (Newcomb, 1995)

Some of the causes of this disorder (drug use and abuse) can be broken down into several areas of concerns. The first area would be cultural/ social environment. (Newcomb, 1995) This consists of the availability of substances for a teenager within their community. How extreme is the living conditions for the teenager; meaning is this teenager living in poverty. Teenagers who don’t have access to certain resources are at a higher risk. The community that the teenager resides in can be a cause of drug use. If that individual teenager is custom to seeing drug use, drug selling, or drug addicts this can be a cause of drug use as well. (Newcomb, 1995)

An interpersonal factor is another area that can be a cause of drug use for teenagers. Teenagers who live in a home where there are inconsistent family practices, family conflict, or poor parental supervision typically are at higher risk. (Newcomb, 1995) Where there is family conflict in the home such as arguing and fighting this can be a cause for a teenager to want to use drugs to escape the conflict. If a teenager is in a home were drugs are not frowned upon they could feel its o.k. and are comfortable with using. When a teenager is rejected among its peers this may a reason for a teenager to find new friends whom may be drug users and they will begin to experiment with drugs with these new friends because they feel accepted. (Newcomb, 1995)

Psycho behavioral is an area which deals more with a teenager who has always had problems academically. They have rebellious behavior toward adults such as teachers, school counselors, or administration. They probably started drug use at an early age; as early as eleven years old. They have always looked at drugs as a good thing. (Newcomb, 1995)

Lack of communication is a cause of drug use that many people, mainly parents don’t consider. When parents and community leaders don’t discuss drug use with teenagers this leads to many teenagers being ignorant about the effects of drug use. (Accornero, Crum, & Storr, 2007) Many teenagers who participate in high-level sports may feel the competition is a lot of pressure and this can cause drug use as well. (Accornero et al., 2007)

There are many symptoms and warning signs of drug use with teenagers. Many of the symptoms are noticeable and some are not. Some of the symptoms of an individual who may be smoking marijuana could be: reddened whites of the eyes, a larger appetite than normal, not motivated to do anything productive, always happy, or paranoid. (Leslie, 2008) Some teenagers may start out by using over the counter cold medications. Symptoms for cold medicine use would be: sleepiness, a rapid or slow heart rate. (Shiel, 2010)

Symptoms of a teenager using inhalants are: runny nose, confusion, moody, smell of gasoline, or the smell of paint. (Shiel, 2010) Teenagers who are using heroin, morphine, codeine, and other depressant drugs normally show signs of sleepiness, poor coordination, dizzy, or low inhibitions. (Shiel, 2010) Ecstasy is known as the “club drug” and is popular among teenagers. Warning signs that your teenager may be using this drug would be: feverish child who does not sweat, finding lollipops around the house or in their room, the teen may seem to love everyone or is always in an excessive happy mood. (Shiel, 2010)

General behavior changes among teenagers who are using drugs would be grades dropping all of a sudden, parent(s) receiving phone calls of child missing or skipping school regularly, and dropping out of regular school activities. (Leslie, 2010) Some teenagers physical appearance may change; such as their attire, loss of weight, and poor hygiene. A teenager who was once jovial, happy, and easy to get along with may become hostile or easily agitated. They may become more secretive such as coming in and going straight to their bedroom without speaking. Locking their bedroom door when they leave the house and simply some parents may feel their child just doesn’t seem like their normal selves. As you can see there are so many warning signs and symptoms of drug use.

Now that I have discussed the risk, causes, and symptoms; I will now discuss some preventative measures. Not very many preventative programs have been completed among teenagers who are emerging into adulthood. This would be teenagers from the ages of 16 to 19 of age. Some of the preventative programs out there for teenagers consist of helping teenagers change their drug use motivations, teach them new communications skills, how to have self-control, and job seeking skills. For 17 and 18 year olds these programs may work on showing them how to make good decisions, and how to obtain new environmental resources. (Pumpuang, Skara, & Sussman, 2006)

One preventative program that could be used within the schools would be providing resources to teenagers who normally wouldn’t have access to these. Some of these resources would be providing transportation to and from drug counseling services within their community. Providing job training for students who may be struggling academically and helping them find a trade or skill that they would enjoy would be motivation for them to avoid using drugs. Some of these teenagers have never been introduced to recreational activities by their parents; by providing them with these different recreational activities this will give them something to do besides hanging out and doing drugs. (Pumpuang et al., 2006) Also providing drug prevention classes within the middle and high schools would be an opportunity for teenagers to communicate and learn more about the consequences of drug use. Research has shown that school-based prevention programs have had long-term success especially with current teenage drug users. (Pumpuang et al., 2006)

Telephone drug prevention education is becoming more popular. Some researchers suggest using the telephone prevention in conjunction with the school-based programs. (Pumuang et al., 2006) Telephone education is a great tool for teenagers to use when trying to find out about social-environmental resources in their communities.

There is a group of social workers who are trying to start a social service telephone program (SSRTP) that youth can use to get information that will help them within their surrounding community. (Pumuang et al., 2006) This program will consist of four elements: Mastery, attachment, cue, and hope. This will be known as the MACH model; which will help with early intervention for teenagers who are transitioning into adulthood. (Pumuang et al., 2006) In the mastery stage individuals would be able to receive educational lessons that would help them to master a skill and feel a sense of autonomy. They would show them how to plan and receive assistance as they transition to live by themselves. In the attachment stage they would receive information on jobs, continuing education, how to use public transportation, and how to access free or low cost counseling services. These teenagers who are getting ready to live on their own will need these services so that they will have healthy development and a sense of knowing there is resources out there for them to be successful. (Pumuang et al., 2006) The third stage is the cue stage. This stage gives awareness to participants that there are programs that will direct them to learning more about the risk of drug use/abuse. The last stage is the hope stage; this stage gives teenagers a positive outlook on their current circumstance. This allows teenagers to have the knowledge to know that there are so many other options out their besides drugs. (Pumuang is et al., 2006)

There are many different types of preventative programs out there. One program that is popular in the Santa Barbara area is ADAP Teen coalition. This program is headed up by teenagers who work together to reduce the amount of underage teenagers who use drugs and drink alcohol. This program has been around for over six years. They consider themselves to be more about the community and using community resources. They look at how the environment effects teenagers’ decisions, they look at solutions on public policy when dealing with underage drug use, and they study how culture, social, and political factors play an important role. (2009)

There are also two programs that are headed up in Portland, OR. These preventative programs teach teen athletes other alternatives to steroids, sports supplements, alcohol, and other drugs. (Bradley, 2010) This program has won several achievement awards. This is the first program and the only program in the world that has effectively reduced the need of using drugs that promote athletic performance. This program provides mentors to teenage athletes throughout the high schools. (Bradley, 2010)

As we know with teenage drug use delinquent behavior comes along. Many teenagers who are using substances find themselves in trouble with the law. The juvenile system has become a haven for many of these teenagers who have numerous challenges with drug and alcohol abuse, mental health issues, and lack of resources for other assistance. (Nissen, 2006) The juvenile system is trying to come up with new ways to effectively treat these juvenile delinquents. Many teenagers who need assistance rarely ever receive it, studies show less than 10% will receive proper assistance. (Nissen, 2006) Only 36% of the juvenile justice centers offer drug abuse treatment. Many teenagers who are in juvenile detention centers come from different walks of life; this makes it tough when trying to do assessment and matching. Many juvenile detention centers will use family involvement in treatment. They have found that this is the key to long-term success with these teenagers. They work with these families while the teenager is in custody and once they are released they help the family find the resources so they can receive proper treatment. (Nissen, 2006)

Many family practitioners do not test youth for drug use. There are many screening assessments out there that can be used with teenagers. One of these is called the HEADSS assessment; this is a mnemonic that forms the basis for a psychosocial assessment. (Leslie, 2008) GAPS is another assessment it stands for Guidelines for adolescent prevention services. CRAFT is an assessment tool that identifies substance use, which has been known to be successful with teenagers. (Leslie, 2008)

In the past there have not been very many successful treatment programs for teenagers. Many of these programs went for an abstinence-based approach; meaning don’t use alcohol or drugs period. (Leslie, 2008) Evidence has shown that these programs have not been successful. There is a rise of harm-reduction treatment programs that have been successful. This program accepts teenage drug and alcohol use but shows the long term effect of drug and alcohol use. These programs aim to reduce the risks that are related to drug abuse. (Leslie, 2008)

Treatment also depends on the types of drugs that the individual teenager is using. There are short-term substance abuse treatment programs specifically for teenagers. Many of the programs will last less than six months. There are residential therapy centers that are designed for teenagers to stay in a facility for three to six weeks. They will detox and hopefully overcome their addictions. After the residential program has ended the teenager will begin to do go to twelve step meetings. There is also medication therapy; these medications will help the teenager overcome their addictions. These medications will help with withdrawal symptoms and craving which normally cause teenagers to relapse. (Shiel, 2010) There are also long term substance abuse treatment programs. These programs will last more than six months; typically these programs are designed for teenagers who are using opiates, or have been addicted for a long time. Therapeutic communities are a residential drug abuse treatment. Typically a teenager will stay here for six to twelve months. (Shiel, 2010)

As we can see there are so many factors that go into drug abuse and high risk teenagers. There is still so much research and work to be done to effectively prevent and treat these teenagers. There have been strides in our juvenile detention centers with teenagers who have been court mandated. Many of these teenagers will receive he treatment that is needed, but what happens when the teenager is released back into their environment. More community involvement is needed when working with teenagers who lack the resources to get the counseling and treatment that is necessary for them to recover from drug abuse. Hopefully we will see more community involvement and more research done on treatment for teenage drug abuse.

Abstract:

The term Social Problems is a misnomer and is an admission of the fact that the actual nature and constitution of the situation has not been deliberated at depth. When senior people see that the rules and behavioural patterns they have held so dear are getting challenged they term it as creation of problems.

Criticising the social order that is emerging is the easiest way to admit defeat. The brave and sensible way is to accept the challenges and find ways and means of retaining the value system – may be with certain modifications – that has been followed for generations. In this way the young generation can adjust to the social changes and yet remain healthy and flourish in life.

Introduction:

The present day health issues are very closely related to the current social set up and coming into existence of a new set of social norms and values. While most of the social norms and values are traceable to and intimately related to the economic factors yet there is a trend of getting carried away by foreign cultures and their different social bearings. The pressure on the present day youth for being economically successful is very high and this gives a peculiar dimension to these ‘youngsters’ way of life which is enormously different to the type of pressures felt by the previous generations.

While on one hand parents expect their children to become successful – which is a decent way of saying that they earn pots and pots of money – on the other the boys and girls are expected to follow the same set of social rules which has been followed by the ‘elders’ for generations. Thus the social problems have many causes but one significant reason is the inability of the older generations to accept and adjust to the changes in the society which is inevitable.

The main problem that surfaced is that previous generation weighed the social structure of today by the norms and values that were taught to them quite a few decades back. The ground reality has changed rapidly and the senior generations are still getting guided by the rules of the game of yesteryears. The world is changing faster than it ever did before and the changes are not only very wide and rapid but are also very deep penetrating. Thus the changes are in effect causing social ‘evils’ as seen by the previous outlook but in reality the developments of the world is going on for centuries and what is being called as social problems is a manifestation of the inability to change and adjust to the new life order.

Discussion:

As stated in the introduction above, it is evident that there is need to face the societal changes that are coming up every day. In order to examine the situation in depth, three generation of society were interviewed to get to the bottom of the problem. The first were the generation of grandparents – who learned their ways of life some fifty to sixty years back.

The next set consisted of parents i.e. father and mother group of today’s youngsters and they learned what they believe to be correct social norms some twenty-five to thirty year back. The final subset consisted of growing boys and girls of today and consisted of college and university students. These are the people who are bearing the brunt of the social problems which in turn is having a serious effect on their health.

The first set of people consisting of grandparents carried fixed and set ideas about what the societal norms and beliefs are supposed to be. They saw no reason for changing those norms and beliefs. The behavioral norms were very strictly defined and centered around simple living and high thinking with very little emphasis and importance – if any at all – being paid to the economic progress and well being.

They had lived their life in a very definite way and firmly believed that what was good for them is also god for their grandchildren today. Above all, their firm belief that ‘one size fits all’ concept as far as social behavior is concerned was much too firm for accommodating any updating necessitated by the present day life style. This brought about the severe view of the present day social interactions and the resultant problems. They knew that they had lived their life and were in no mood to accommodate or even tolerate the changing pattern of social values and norms. The best thing is that – in fact it should be called the worst thing – is that his set of people failed to see the few very good aspects of the changing patterns of social behavior. They invariably were quick to point out the drawbacks without for a moment acknowledging the good and beneficial aspects of the emerging new social order.

The second set of people who were interviewed represented the parents. This group had its own problems. They fully appreciated the beneficial aspects of the change but were hesitant to admit the same since it clashed with what they were taught as the ideal way of social behavior. They too saw the problems of the present social setups and behavioral patterns but at the same time knew that there is no stopping of the changes coming about.

Further they saw the new order did bring new problems but at the same time it encouraged the democratic institutions so very necessary for the well being of the future generations. They wanted to break away from the traditional social order and get into the flow of development of the new order. However, they had reached an age where they were unable to be adventurous and were cautious about accepting the changes.

This gave rise to a very unbalanced state since while in their heart of hearts they knew that what was seen as social problems were more of aberrations of their viewing the outcomes than causing difficulties for the new generations.

Yes, they wanted their children to bag high-pay job offers but at the same time wanted their children to stick to the ‘five prayers a day’ schedule despite the demands of their job conditions. This kind of situation is prevalent not only in the Middle East but such situation also exists in most of the emerging economies like Brazil, India, China, Pakistan etc.

This group, like the previous group of grandparents, also quickly saw the social problems – but with a difference. This group simultaneously tried to find a solution which would accommodate the social change and at the same time keep a balance with the past so that the health (both mental as well as physical) hazards were contained. This is a very healthy indicator of the changes in social order being slowly accepted and though it is a slow process but it is a sure process. The present social norms have taken centuries to develop; it is very likely that the new social order will take some time to settle down.

The last group consisted of the people of the below twenty-five age group. The first priority for this group was a better and more comfortable way of life. They valued democracy in all walks of life. They carried no negative feelings for the age old systems and gave full credit to the social order which has seen their predecessors to reach the current state.

Yet when any of the social behavioral patterns got into the way of their achieving the goal they so cherished they did not hesitate to set aside the existing social norms. They were ready to burn the midnight lamp if that meant getting higher grades which would translate into their landing better jobs. Yes this was a potential health hazard but it also promised attainment of their dream goals. These groups wanted to make it big and for achieving this they were ready to take on with a ‘no-holds-barred’ situation.

Good health is basic pre- requisite of good life. Without having good heath one will lose the very capacity for any human pursuit – from the grossest to the subtlest. He will not be able to enjoy the fruits of his toil. Health does not mean absence of diseases but it implies the possession and cultivation of a physically fit, morally strong and mentally alert individual who is able to meet the physical demands of life pursuits with full vigour and enthusiasm.

The present day society seeks comforts, conveniences and freedom from drudgeries and wants to avoid working on monotonous, back-breaking and tedious chores from dawn to dusk – except out of compulsion. They prefer freedom from all hindrances and choose democratic way of life. Democracy for them is not just a merely form of government but it is a foundational societal value and hence they prefer a democratic society. In such a preferred democratic society values of freedom, equality, respect for the individual, collective decision making and the right to dissent should be inbuilt into the social arrangements and transactions. The young people with a democratic bent of mind respected the rights and freedoms of other people.

They treated people at the level of equality and were tolerant of the views and opinions which were different from their own. When they were invested with authority they would use it with care and that too for the common benefit of people. Instead of imposing their views on others they would look for a consensus solution for making any collective decision. While the first group (grandparents) stood out by their intolerant attitude, this group of young citizens were endowed with refined, liberal and humanistic values.

Though the members of the first group found the young people as creators of all trouble and labelled them as ‘rebels’ the younger generation were accepting their new found status of that of a rebel with alarming ease and comfort.

They knew that if they stuck to the ways of the senior citizens then the possibilities of their realising their dreams of making it big would never materialise. There is ample historical evidence which go to prove that change – be it social, economic, technological or even environment – are all here to stay. Either one makes himself capable to adjust to the change or the process of change will eliminate them for good.

Now, SOCIETY is an organisation for cooperative working to ensure human development, through production and distribution of sharable social goods. Society is made up of various constituents like individuals, different classes and groups, social, economic institutions and many more. In UAE and other Middle East countries the individual goals and the collective goals are often in conflict with each other.

Yet the main objective of any developing and healthy society is to ensure human development which is not restricted to social, political, economic issues but also the development of the members on a total basis which would include health, formality and above all the value system of life.

As stated earlier, one of the major aim of any society is to ensure production and distribution of sharable social goods like roads, transportation, water, electricity, health care and a host of other facilities. Opportunities and means of gainful employment, jobs, career and other rightful and legitimate means of seeking personal economic betterment are also to be treated as part of sharable social goods.

Thus, the social changes taking place in every country and in every society aim at providing better opportunities and means of gainful employment and suitable jobs to the members of the society. There is no harm if the young people of today seek better standards of living and are prepared to dissociate themselves from the social norms which prevent their advancement in life.

Conclusion:

To sum up the entire picture it is necessary to understand that the so called Social problems are the result of the failure to appreciate the wisdom behind each and every change that is taking place in the world around.

Older people who have lived their lives may conveniently call such changes as resulting in problems causing health hazards but such changes are for ‘GREATER GOOD’ and hence should be accepted if not welcomed. The budding Engineer or Manager or Professor faces an uphill task and shying away from sharing the gains available today is certainly not wise. Though the severe challenges may prove to be a health hazard in the short run but over time people will learn to cope with it and emerge the winner.

Thus finding faults with the social problems is the weak person’s way of handling the changes taking place in the milieu. A strong and healthy individual will take the bull by its horns and will certainly succeed in controlling the social changes to his advantage.

INEQUALITIES IN MENTAL HEALTHIntroduction and definitions:

Mental health is described by the World Health Organization (WHO) as:

“a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO 2001a, p.1).

According to NHS website every year in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide

(http://www.nhs.uk/conditions/mental-health/Pages/Introduction.aspx , accessed 20-4-2010)

Mental health inequality is a long standing problem that has been tackled for decades by epidemiologists, sociologists and health professionals.

And because this problem has both strong social and health aspect there is no unified approach to identification and resolution.

From Sociologists viewpoint inequality with mental health is a problem that has two main explanations: people are poor because they have mentally illness that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to involve in the etiology such as genetic factors, diet, and hormonal disturbance which interact with personality disorders or emotional state to produce mental illness.

The problem of inequality is not only about serious mental illness but we can expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be public health indicator:

“How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity” (Mental Well-being Impact Assessment ,2009)

The table below gives examples of those factors that promote or reduce opportunities for good mental health (DOH 2001):

MENTAL HEALTH – PROTECTIVE FACTORS
INTERNAL PROTECTIVE FACTORS
EXTERNAL PROTECTIVE FACTORS
EMOTIONAL RESILIENCE

physical health

self esteem/positive sense of self

ability to manage conflict

ability to learn

CITIZENSHIP

a positive experience of early bonding

positive experience of attachment

ability to make, maintain and break relationships

communication skills

feeling of acceptance

EMOTIONAL RESILIENCE

basic needs met – food, warmth, shelter

CITIZENSHIP

societal or community validation

supportive social network

positive role models

employment

HEALTHY STRUCTURES

positive educational experiences

safe and secure environment in which to live

supportive political infrastructure

live within time of peace (absence of conflict)

MENTAL HEALTH – DEMOTING/VULNERABILITY FACTORS
INTERNAL VULNERABLE FACTORS
EXTERNAL VULNERABLE FACTORS
EMOTIONAL RESILIENCE

congenital illness, infirmity or disability

lack of self esteem and social status

feeling of helplessness

problems with sexuality or sexual orientation

CITIZENSHIP

poor quality of relationships

feeling of isolation

feeling of institutionalisation

experience of dissonance, conflict, or alienation

EMOTIONAL RESILIENCE

needs not being met – hunger, cold, homelessness/poor housing conditions etc.

experience separation and loss

experience of abuse or violence

substance misuse

family history of psychiatric disorder

CITIZENSHIP

cultural conflict – experience of alienation

discrimination – the negative experience of being stigmatised

lack of autonomy

the negative experience of peer pressure unemployment

HEALTHY STRUCTURES

value systems

effects of poverty

negative physical environment

Table 1: factors that promote or reduce opportunities for good mental health
What is the evidence on mental health inequalities?
Socio-economic status:

Community-based epidemiological studies across countries and over time have consistently identified an inverse relationship between Socio-economic status and prevalence rates of schizophrenia .The ratio between the current prevalence (defined as period prevalence up to one-year prevalence) of the disorder among low-SES and high-SES people was 3.4, whereas the ratio for lifetime prevalence was 2.4? (Saraceno et al,2005), and in Britain, twice as many suicides occur among people from the most lower SES (Blamey A et al ,2002).

There are five hypotheses to explain this relation (Hudson 2005):

Hypothesis 1: Economic stress. The inverse SES-mental illness correlation is a speci¬?c outcome of stressful economic conditions, such as poverty, unemployment, and housing unaffordability.

Hypothesis 2: Family fragmentation. The inverse SES-mental illness correlation is a function of the fragmentation of family structure and lack of family supports.

Hypothesis 3: Geographic drift. The inverse SES-mental illness correlation results from the movement of individuals from higher to lower SES communities subsequent to their initial hospitalization.

Hypothesis 4: Socioeconomic drift. The inverse SES-mental illness correlation results from declining employment subsequent to initial hospitalization.

Hypothesis 5: Intergenerational drift. The inverse SES-mental illness correlation is a function of declines in community SES levels of hospitalized adolescents between their ¬?rst hospitalization and their most recent hospitalization after turning 18

Age:
In elderly:

National Institute for Mental Health in England (NIMHE) has reported the following point regarding mental health problems in elderly :

3million older people in the UK experience symptoms of mental health problems

the annual economic burden of late onset dementia is ?4.3 billion which is greater than that for stroke, cancer and heart disease combined

dementia affects 5% of those aged over 65 and 20% over 80

10-15% of all older people meet the clinical criteria for a diagnosis of depression

these numbers are set to increase by a third over the next 15 years

(NIMHE, 2009).

Mental health problems in elderly often go unrecognised. Even where they are acknowledged, they are often inadequately or inappropriately managed (DH 2005c).

The UK inquiry into mental health and well-being in later life (2006) identified five factors that influence the mental health of older people: discrimination (for example, by age or culture); participation in meaningful activity; relationships; physical health (including physical capability to undertake everyday tasks); and poverty.

in children :

WHO states, that the aˆzdevelopment of a child and adolescent mental health policy requires an understanding of well-being and the prevalence of mental health problems among children and adolescents”(child and adolescent mental health policy, 2006)

However, there is an evidence that levels of distress and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3-6 per cent of people under 16 years of age (Bird et al.1988; Costello et al. 1988).

Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (Zeigler-Dendy,1989).

Gender:
Women and Mental Health

Mental health problems are more common among women than men with higher incidence rates of depressive disorder than men (Palmer, 2003).

There are many factors to explain this, first: Socio-economic factors such as poverty and poor housing conditions cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighbourhoods cause stress and anxiety amongst women , dependency on prescription drugs (for depressive and sleeping disorders) often leads to anxiety.

Men and Mental Health

Men tend to be more vulnerable to mental health problems and suicide than ever before due for a number of reasons including:

Men in general are less likely to talk about their problems or feelings or to admit that they have depression.

Men are less likely to seek help for mental and emotional health problems.

Unemployment has a greater impact on men in general.

Some mental disorders are more serious in men for example suicide is the leading cause of death among young men. The rate for young men aged 10-24 years is higher among those from deprived communities compared with those from affluent communities. Men also experience earlier onset of schizophrenia with poorer clinical outcomes (Piccinelli, 1997)

Risk groups for mental illness in men include (DHSSPS,2004):

Older men: they are less willing to use health services because of the perception that these services are for older women.

Divorced men – because they have less support available from family , and services designed to meet the needs of this group is particularly.

Male victims of domestic abuse -especially boys in rural areas.

Gay and bisexual men – few services are available to help men deal with problems such as homophobic bullying and harassment.

Male survivors of sexual abuse – lack of co-ordinated support for adult survivors of abuse

Fathers – despite examples of good practice, men have comparatively less access to support services than women, to enable them to cope with the stresses of parenthood.

Bereaved men – lack of appropriate services specifically targeted at men who have experienced bereavement.

Men in rural areas – particularly isolated in terms of service access.

Young offenders – inadequate psychological services in juvenile justice centres despite the high proportion of young people entering the juvenile system with a range of mental health problems.

Ethnic group:

A review by Commission for Healthcare Audit and Inspection,( Count me in, 2009) noted that “Rates of admission were lower than the national average among the White British, Indian and Chinese groups, and were average for the Pakistani and Bangladeshi groups. They were higher than average among other minority ethnic groups – particularly in the Black Caribbean, Black African, Other Black, White/Black Caribbean Mixed and White/Black African Mixed groups – with rates over three times higher than average, and nine times higher in the Other Black group.”

Employment Status and Mental Health

Having a job helps to maintain better mental health than not having one, but this is not always true as many factors involve

For example, jobs which are unsatisfactory or insecure can be as harmful to health as unemployment (Wilkinson et al , 2003). Anxiety about job security, lack of job control, perceived effort-reward imbalance, negative relationships in the workplace, including bullying and harassment can have negative mental health consequences.

According to OSC Health Inequalities Review (2006) people with a common mental disorder are five times more likely to be unemployed, and if they have work they are more likely to be excluded, people with an identified mental health problem are twice as likely to be on income support and four to five times more likely to be getting invalidity benefits. A person with a diagnosis of a psychotic illness leaves him with only a one in four chance of being in employment.

Geographic variation:

Studies result on geographic variation of mental illness are inconsistent , for example Hollie has concluded that “In mental health problems there is substantial variation at the household level but with no evidence of postcode unit variation and no association with residential environmental quality or geographical accessibility. It is believed that in common mental disorder the psychosocial environment is more important than the physical environment” (Hollie et al, 2007)

On the other hand, a recent Swedish study of 4.4 million adults found that the incidence rates of psychosis and depression rose with increasing levels of urbanisation (Sundquist K.et al.,2004).

Another study by Royal Commission on Environmental Pollution shows that people from densely populated areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters; in London schizophrenia rates are about twice those in Bristol or Nottingham (Royal Commission on Environmental Pollution, 2007a, 2007b).

Disability and Mental Health:

Definition: According to Disability Discrimination Act (1995) (DDA)

‘A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activities’

In the light of this definition we can focus on mental health inequality of three groups of people:

aˆ? People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems.

aˆ? People with both mental health problems and physical disabilities.

aˆ? People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.

Disabled people are more likely to experience stress and emotional instability than those who are not disabled.

a report by the Equality Commission for Northern Ireland (2003) has found that whilst 34% of those who were not disabled had experienced quite a lot or a great deal of stress in the last 12 months prior to the survey, the percentage rose to 52% for disabled people. Experiences of depression within the last 12 months were higher among women who were disabled (44%) than men (34%).

Conclusion:

Inequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address different kinds of mental health Inequalities associated with it.

Question 2 : word count (2000)

Tackling inequalities in mental health
Introduction:

Mental illness, among other disorders, is widely considered as a significant determinant of both health and social outcomes and many studies have spotted mental health disorders as both consequence and cause of inequalities and social exclusion.

Mental health diseases have two distinct characteristics as a public health problem: first very high rates of prevalence; secondly : onset is usually at a much younger age than for other health problem , Mental health diseases effects all areas of people’s lives : personal relationships, employment, income and educational performance. (Friedli and Parsonage , 2007; McDaid , 2007)

Who is at risk for mental health problems?

Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs.

A review of recent evidences on mental health inequalities can help to define the large groups at risk:

aˆ? People living in institutional settings: such as care homes or those in secure care or subject to detention.

aˆ? People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless.

aˆ? People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse.

aˆ?children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children,

aˆ? People from groups who experience discrimination.

Key policies:

These policies can be long term policies focusing on deep change over long period or short term seeking fast results such as health promotion.

Long term aims:

Inequalities in mental health are not only about equality of access, but also about quality of access.

In the year 2009 Mental Health Foundation has published a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities ,2009)

This report mentioned four priorities for action:

1-Social, cultural and economic conditions that support family life:

This can be done by reduce child poverty , parenting skills training and high quality preschool education , increasing access to safe places for children to play, especially outdoors, inter-agency partnerships to reduce violence and sexual abuse.

2- Education that helps children both economically and emotionally by:

schools health promoting programs, involving teachers, pupils, parents and supporting parents to improve the home learning environment (HLE)

support social, sports and creative achievements, as well as academic performance

3- Reduce unemployment and poverty levels and promote and protect mental health by:

Supporting efforts to improve pay, work conditions and job security.

Facilitate early referral to workplace based support for employees with psychiatric symptoms or personal crises to prevent employment breakdown.

4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.

However, these strategies take long time to be effective, that means the need for more rapid actions or short term aims.

Short term aims: Mental health promotion:

To build an effective strategy to promotion for health equality the following points should be achieved:

aˆ? Comprehensive: Mental Health promotion is not only the responsibility of health services alone; other sectors of society should join that effort.

aˆ? Based on evidence

aˆ? Based on the needs of the local communities, and with the agreement of these communities.

aˆ? Subject to evaluation: The strategy should be subject to critical evaluation and can be changed when necessary.

A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service Framework for Mental Health (DOH 1999). The purpose of these standards is to deal with mental health discrimination and social exclusion associated with mental health problems. And that can be achieved by promotion:

promote mental health for the whole society, working with individuals and communities

Stop discrimination against individuals and groups with mental health problems, and take steps towards better promotion for their social inclusion.

Tackling inequalities for special risk groups:
The Suicide prevention strategy:

One of the best example is the strategy based on work by (DOH 2002) and The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals:

1. To reduce the risk in key high-risk group.

2. To promote mental well-being in the wider population.

3. To reduce the availability and lethality of suicide methods.

4. To improve the reporting of suicide behavior in the media.

5. To promote research on suicide and suicide prevention.

6. To improve monitoring of progress towards the target for reducing suicide.

Women and Mental Health: Preventing:

The results of UK-based survey (Williams, 2002) shows that mental health services for women:

Do not meet women’s mental health needs.

Can replicate inequalities.

Can be unsafe for women.

Can be insensitive to the effects of gender and other social inequalities, such as race, class and age

However, in their response to a survey conducted in England and Wales, women said that they wanted services that:

aˆ? Keep them feel safe.

aˆ? Promote empowerment, choice and self-determination.

aˆ? Place importance on the underlying causes and context of their distress in addition to their symptoms.

aˆ? Addressee important issues relating to their roles as mothers, the need for safe accommodation and access to education, training and work opportunities.

aˆ? Value their strengths, abilities and potential for recovery.

(DH, 2002a)

These points are important to build a need-based action plan for better equality in health services.

Men and Mental Health: Preventing:

The Equal Minds conference workshop which had special focus on men and mental health listed five service design features targeted at men’s mental health and well-being (equal minds, 2005):

aˆ? Accessibility and flexibility of services regarding time, location. For example, Select places familiar for men, ‘Men Only’ sessions run by male staff, make use of some activities, such as sport and physical activity programmes.

aˆ? Holistic approach, works on the person as a whole, not just on mental health.

aˆ? Early intervention to prevent anxieties and concerns build up, especially in stress and anger management.

aˆ? Trust and confidence are important to solve problems of identity and role that can underlay men’s anxieties and self-perceptions or lack of self-esteem.

Ethnicity and Mental Health: Preventing:

The main problem in this field was the barriers to access services. Barriers include:

aˆ? Language.

aˆ? Stereotyping.

aˆ? Lack of awareness or understandings of mental illness.

The report Inside Outside (Sashidharan, 2003) which addresses mental health services for people from black and minority ethnic communities in England and Wales. Suggest that patients from all minority ethnic groups are more likely than white majority patients:

aˆ? To follow aversive pathways into specialist mental health care.

aˆ? To be admitted compulsorily (there are differences also between ethnic groups at all ages).

aˆ? To be misdiagnosed.

aˆ? To be prescribed drugs and Electroconvulsive therapy (ECT), more than talking therapies.

aˆ? To have higher readmission rates and stay for longer periods in hospital.

aˆ? To be admitted to secure care/forensic environments.

aˆ? Their social care and psychological needs are less likely to be addressee within the care planning process.

aˆ? To have worse outcomes.

A strategic approach in Ethnicity and Mental Health:

In England and Wales a framework have been developed for action for ‘delivering race equality’ in mental health (DH, 2003b)

The framework focuses on three ‘building blocks’ which are essential to improved outcomes and experiences of people from black and minority ethnic communities:

aˆ? Information of better quality and more intelligently used.

aˆ? Services which are more appropriate and responsive.

aˆ? Increased community engagement

In other words any approach should take in consider both quality of health services and the socio-economic disadvantages experienced by people from ethnic communities.

Some suggested steps for this approach may include:

Providing interpretation and translation services beside mental health service to insure highest possible quality.

Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in expression of mental distress.

Developing assessment and diagnostic tools that can better assess patients from different backgrounds and ethnicities.

Ensuring that services understand and respect spiritual requirements for different cultures.

Ensuring access equality to culturally appropriate services including, counseling, psychotherapy and advocacy.

Addressing common problem for people from black and minority communities, such as housing, employment, welfare benefits, and child-care.

Disability and Mental Health:

people with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they are liable for what Rogers and Pilgrim (2003) described :’inequalities created by service provision’.

Mental health services for disable people should be customized to their needs, some recommendations for such services may include:

Promotion for mental health, well-being and living with disability.

Early intervention: for people who show symptoms for possible mental illness.

Personalised care based on individuals’ needs and wishes

Stigma: work for better social inclusion and tackling stigma and discrimination associated with some disabilities.

Elderly and mental health:

In order to achieve better equality for this group, policy makers should insure better access to mental health services on the first place.

In the year 2005 the Department of Health published a report titled “Securing Better Mental Health for Older Adults to launch a new programme to bring together mental health and older people’s policy in order to improve services for older people with mental health problems.

The National Directors for older people and mental health promoted the dual principles of:

aˆ? Delivering non-discriminatory mental health and care services available on the basis of need, not age and

aˆ? Holistic, person-centred older people’s health and care services which address mental as well as physical health needs

Here, it is essential to emphasis the importance of specialist mental health service for older adults.

Sexual Orientation and Mental Health:

In this group health promotion plays a great role to address the mental problems associated with sexual orientation.

PACE organization has drawn up a set of practice guidelines for working with lesbian, gay and bisexual people in mental health services (PACE guideline.2006).

The guidelines suggest promoting services and resources specifically for LGB people, including services such counselling and advocacy provided by LGB organisations.

In response to these guidelines and studies about LGB such as (McNair et al, 2001). Mental health services for LGB people should:

Reflect upon the homophobia and heterosexism that LGBT people may experience within mental health services.

Enhance awareness of LGBT people problems, and the forms of discrimination and social exclusion they may face.

Consider the nature of a ‘culturally competent’ for LGBT people

Preventing in Mental Health Problems:

people with mental health problem are in need for “resilience factors” that enable them to recover from mental distress and to fight the effects of discrimination and stigma, we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive ‘accepting communities’ (Dunn, 1999).

Examples for these services can be found in “report on Mental Health and Social Exclusion” which has been published by Social Exclusion Unit. The report included a 27-point Action Plan aimed at tackling stigma and discrimination, focusing on the role of health and social care in addressing problems of social exclusion, unemployment, and supporting families and community participation through ensuring access to goods and services such as housing, financial advice and transport (SEU,2004).

Beyond this report, it is important that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic approach that aim prevention on the long run.

Conclusion:

It is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for reducing inequalities in mental health within primary care, and the primary care organization studied is not conducive to addressing inequalities in mental health. (Craig, 2009).

For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.

For the purpose of this essay I will write a critical analysis of a case study assessing the health needs of a child within a family. The case study is of a two parent family of a two year old girl. The family had transferred from another area. Their daughter was born prematurely at thirty one weeks. She didn’t offer eye contact and had no voluntary speech. Full permission has been obtained to use the information in the case study. I used firstly Orems nursing model to assess the family’s needs. Then a more appropriate framework Family Health Needs Assessment.

The model is a behavioural model. Behavioural models are based on the hierarchy of human needs by Maslow (1993). The hierarchy starts at the bottom of a pyramid with essential needs, when these are met the person progresses up the pyramid until full potential is achieved (Maslow, 1993). Orem’s model is based on societies need for the client to be self caring (Henderson, 1990).

Orem’s (2001) model has a continuum of self care abilities, the aim being to move along this continuum to self care or adapt to a diminishing self care in terminal or chronic ill cases.

Orem (2001) states that the family and significant others in a person’s life must be involved in their self care. It is a model which values individual responsibility, prevention and health education as key aspects of nursing intervention (Aggleton and Chalmers 2000).

Orem lists the following key factors that influence health;

1. Adequate intake of air water and food.

2, Adequate excretion of waste.

3. A balance between activity and rest both mentally and physically.

4. Social interaction and solitude should be optimised.

5. The prevention or avoidance of hazards and danger.

6. The feeling of being and behaving normally leading to stress reduction.

By being able to carry out self care in these areas the person fulfils what Orem (2001) calls their Universal Self Care Demands. If there is illness injury or disease the individual has self care demands in three extra areas (Orem, 2001). These are known as the Health Deviation Self Care Demands.

i Structure.

ii. Functioning.

iii. Behaviour.

Orem uses the Nursing Process starting with assessment of the family in order to discover their individual problems which are defined in terms of self care deficits (Orem, 2001). The first stage of Orem’s model identifies both the demands for and the ability to achieve, self care in an individual (Aggleton and Chalmers, 2000). I assessed the family the parents both worked dad is a chef and mum is a carer in a nursing home they are both supported by grandparents who lived across the street. Both were fit and well. The two year old daughter was causing her mother concern in that she was not speaking it was difficult to get her attention with very little eye contact. Using Orem’s list I asked questions about each of the six activities. The problems identified were related to the two year olds behaviour of pacing around the room not speaking no eye contact and slapping her hands one on top of the other.

After gathering information I had to decide why there was a self care deficit. This was difficult using Orem’s which states the self care deficit should be linked to a lack of knowledge or of skills to a lack of motivation to achieve self care (Aggleton and Chalmers, 2000). These don’t seem to apply to a two year old cared for by her parents. But clearly her behaviour was a cause for concern.

I had now completed a good deal of paperwork a fault recognised by Fawcett et al (2004) in many instances it has led to nursing models being a “bureaucratic chore” (Fawcett et al,2004). A checklist method and standard care plans would have allowed for a quick assessment of the Universal self care demands (Kitson, 2001).

The next stage is to plan and set goals (Salvage and Kershaw, 1990). The long term goal for each client would be the restoration of a balance between self care ability and self care needs (Salvage and Kershaw, 1990).

The implementation of the care plan may involve activities to meet self care demands (Pearson et al, 2004). In addition members of the family, or significant others, may provide some care. Orem (2001) has identified six broad ways in which assistance can be given to implement a care plan.

1.Doing for or acting for another

2.Guiding and directing another.

3.Providing physical support.

4.Providing psychological support.

5.Providing an environment which supports development.

6.Teaching another.

However each of these methods of helping requires compliance (Pearson et al 2004). Orem’s model demands that clients and their families are willing and able to adopt certain roles achieve self care (Aggleton and Chalmers 2000).

3) Evaluation

Orem (2001) has suggested that the evaluation of care given should be measured in terms of the clients or families performance of self care.

Using Orem we should set out goals in terms of what the family will achieve (Pearson et al, 2004). It was difficult to set goals babies who are born prematurely can suffer from learning difficulties and to investigate the two year olds behaviour was the goal.

Orem’s model didn’t seem to fit well with this families care.

The major problem with nursing models concerns the relationship with the clients of the service. These are of two kinds. The employer for most nurses in the UK, the employer is the Government. The Government has aims and objectives for its health care system which is to use evidence based practice which may conflict with a particular nursing model or philosophy (Mckenna et al, 2008). Orem’s model is over fifty years old and is not evidence based.

The problems mainly being centered on the daughter’s behavior the following framework was more appropriate for this family.

An evidence based framework The Family Health Needs Assessment was introduced into the health visiting service in 2003 and is based on the Framework for the Assessment of children in need and their families (Department of Health et al, 2000). The Assessment Framework was intended to help practitioners to become child-centered (Horwath, 2010). The aim being to do an assessment of the family’s health and parenting needs. A triangle is used as an illustration of the Framework the child being in the centre (Rose, 2009).

The three sides of the triangle represent the key factors that influence the Childs health; child developmental needs, parenting capacity and family health and environmental factors. Each one has sub headings specific to the main heading.

Child’s Development Needs

Health

Education

Emotional & Behavioral Development

Identity

Family & Social Relationships

Social Presentation

Self Care Skills

Parenting Capacity

Basic Care

Ensuring Safety

Emotional Warmth

Stimulation

Guidance & Boundaries

Stability

Family health

Family history & functioning

Wider family

Housing

Employment

Income

Family’s Social Integration

Community Resources

The aim of the initial Family Health Needs Assessment (FHNA) is to undertake a full

assessment of the family’s health and parenting needs. The impact of parenting

capacity, family health and environmental factors on the child’s health and well-being

is assessed to identify children and families who may require additional support to

achieve the 5 outcomes identified in Every Child Matters (2004).

Being healthy

Staying Safe

Enjoying and achieving

Making a positive Contribution

Achieving Economic well-being

There is research evidence to suggest that low birth weight and prematurity indicates a greater risk of not achieving the 5 outcomes identified in Every Child Matters (2004).

Then a family health plan can be developed to include the family’s needs as agreed in partnership with the parent/carer. How the family wishes to address these needs

An action plan which identifies specific interventions/support and who this will

be provided by as well as the date for review and a review of progress made against the action plan.

The assessment took some time I had to reword some of the questions for fear of giving offence. The assessment forms were lengthy and there was some duplication. Emotional warmth under parenting Capacity and Emotional and behavioral development under the heading Childs developmental Needs. I found it difficult to know what to include under some of the headings. In Calders study (2003) the practitioners found the heading for ‘the child’s developmental needs’ the most challenging of the three headings. A number got confused between ‘social presentation’ and ‘self-care skills’ and the majority struggled with assessing ‘identity’.

The task for practitioners is to specify what, in relation to health and development, the child is at risk of and how significant they consider this risk to be (Horwath, 2010).

The original Framework for the assessment of children in need and their Families has guidance and support materials which explain the risk of harm, reducing the Framework to ‘the Triangle’ and a set of descriptions separates the needs from the risk of harm. Which could lead to a loss of focus on the child and their needs (Platt, 2006).

Both parents in this case were happy to carry out the assessment some parents can be unco-operative or even hostile Brandon et al, (2009). This could also cause a lack of focus on the needs of children. Brandon et al, (2009) found that good parental engagement can also disguise risk of harm to a child.

It is important hear what children have to say (Archard and Skivenes, 2009). I did engage the two year old with my identity badge which she recognized the picture but in this case I wasn’t able to interview the child because of her understanding and limited speech. I was able to observe her though and record my observations. Brandon et al. (2009) describe the various ways in which professionals don’t include children in the assessment. These include young people and siblings and a failure to address the needs of children who chose not to or are unable to speak because of disability, trauma and fear (Brandon et al 2009).

Groups of children in need that are hard to assess included: disabled children; adolescents; children of different cultures and faiths; and children in asylum-seeking

and refugee families (Brandon et al, 2009). Another group of children that also

has been found to be difficult to assess are children in need from higher socioeconomic groups. These cases were found challenging by social workers because:

the parents were more aware of their rights (Brandon et al, 2009). Care must be given to recording accurately what the child says and managing that information,

especially if it is negative about the parents so not to expose the child to any more risk

Practitioners are responsible for gathering information and they also have to share the findings of the assessment with family members.

From the assessment I identified a problem under the heading Child Developmental Needs Health the two year old daughter was growing physically but was not developing speech and had limited eye contact. The family had just moved from another area. Their daughter had been born premature at 31 weeks and she had had follow up appointments at hospital now that they had moved the hospital was too far away.

The follow up at hospital was important for her developmental reviews. So the first identified need was to register at the Doctors and explain that she needs a referral to the hospital for a full pediatric review.

Speech was a problem in that she was making the occasional sound and not forming her words properly. I made the speech therapy referral and gained assurances that her parents would take her. We discussed taking her to a nursery to mix with other children. After talking it was decided so that mum could go too to join a mother and toddler group. So things moved swiftly we put a time scale on these three major things of three weeks. I arranged to visit again in two weeks.

The aim of this assignment is to show the relationship between social inequality, health and poverty. Throughout this assignment you will see how social inequality and health has a big impact and influence on poverty. Poverty is linked with many groups which interact with each other. I will go into depth about these groups and their links with poverty throughout my assignment (ie race, gender, class, sexual orientation, disability, age). I am going to show you how these insights apply to professional practice in terms of: Challenging social attitudes, working with individuals, working with groups and service provision.

Social inequality relates to how long and how well one lives their life. This is mainly shaped through a persons place in society and their stance built around occupation, education and income. (Graham h: 3) ‘Health is a healthy state of well being which is free from disease’ (wordnetweb.princeton.edu/perl/webwn).

‘Poverty is the state or condition of having little or no money, goods or means of support, condition of being poor, indigence’ (Dictionary.reference.com/browse/poverty).

There are two types of poverty relative poverty and absolute poverty. Absolute poverty is the minimum needed to sustain life. Relative poverty is lack of resources ie money, which people in poverty need to provide them with enough food, clothes, fuel and social inclusion with their friends and local communities. (Blackburn C,)

Social inequality has a big impact on health and contributes to people living in poverty. There are allot of factors which influence a persons life ie: Life expectancy ‘ how long people live and the nature of their jobs ie Professional, managerial/technical, skilled, unskilled and unemployed. Social class ‘ mortality vary by cause of death, infant mortality rate, living on a low income ‘ debt – poor nutritional health ‘ having enough to eat. Poor health ‘ unemployed and people who have never worked are one of the highest groups – also poverty in employment – disability – old age. Other forms of social inequalities are ethnicity and gender especially women through disadvantage and discrimination which are important influences on health. (http://www.Office for national statistics)

I’m going to look at the main causes of poverty:Unemployment ‘ on social security- living on a low income ‘ debt-homelessness ‘ social class ‘ having enough to eat, Poverty in employment ‘ different groups working for low pay – women ‘ poor health ‘ debt – ethnic minorities ‘ gender inequality. Cost of a Child ‘ nutritional food ‘ clothes ‘ trips ‘ toys, disability and sickness ‘ nutritional food – poor health – on social security, old age ‘ fuel poverty – low income ‘ poor health and nutritional needs. (Oppenheim C: Contents)

Unemployment, Poverty in employment, ethnic minorities and gender inequalities:

In Britain today there are around 3.9 million people seeking work, and around 13.5million people are living below the income thrush hold which is unthinkable. It is estimated that 1 in 5 people in the UK are living in poverty. In Britain around 4.5 million people are getting paid less than ‘7 per hour. (Lecture on poverty, slide 13 power point 1, poverty statistics)

Long term unemployment is divided into 3 main categories:

– Older workers who are nearly ready to reach retirement

– People who are prone to illnesses and are not up to working

– People without skills and qualifications

People who are unemployed live in poverty, they experience hardship and trauma, often some social groups who are unemployed talk about being depressed and ashamed that they are in receipt of benefits. (Oppenheim, C: 56,57)

‘The process of claiming and receiving benefits for unemployed has become increasingly stigmatizing’ (Oppenheim, C:59).

The ethnic group that is most effected by poverty is the Bangladeshis they had the highest poverty levels which appeared to be more severe and long lasting than any other groups. Also rates of sickness and disability are much higher within the Bangladeshis group. (JRF findings 2007)

New patterns are coming to light that there has been a rise in self employment and in part time and low paid work. Many of the jobs on offer however are low pay with few long term employment and statutory rights ie sick pay, holiday pay and entitlement. This creates poverty and stores it for the future. (Oppenheim, C: 59)

Within the Joseph Rowntree Foundations one of his aims is to reduce gender inequalities to create a sustainable care system. Most people at home are cared for by women however as a woman’s financial opportunities increase they will tend not to bear the costs of providing care unaided. ‘To create a sustainable care system, care and carers must be better supported and more highly valued to involve more men in caring and reduce gender inequalities.’ (Joseph Rowntree Foundations 2009)

As you can see from the statistics there is still quite a number of years of difference

between the type of work you do, your life expectancy and also gender.

Class and Food ‘ Although intakes of fat are similar across social groups, minerals and vitamins like fruit and veg are lower amongst manual classes and those receiving benefits and lone parents. (Slide 10 of power point 1 poverty lecture)

Also those groups are experiencing fuel poverty as it has doubled between 2005 and 2007. However an interesting fact has come to light that many of those moving into fuel poverty were not on low income which is a very worrying concern for all members of society, the way to try and tackle fuel poverty is to cut fuel costs or provide help with the cost. (Publications ‘ The NPI Site:2)

Children ‘ According to the JRF Report between 2006-2007 ‘in-work child poverty’ was at an all time high. This is children that live with parents where at least one of them are working and are living below poverty line incomes. (Publications ‘ The NPI site) When parents are living below the poverty line this has a knock on effect on children through cheaper and less nutritional food being provided due to lack of money. Also children miss out on trips, are bought less clothes and toys due to reduced income which their parents earn.

‘Lack of money and other material resources shape both the routines and choices that parents make for their own health and their children’s health.’ (Blackburn, C: Poverty and health: working with families : 136) Disability ‘ People who have a disability are at least two and a half times more likely to be unemployed than someone who isn’t disabled. People who have a disability are more at risk of being in poverty as they experience higher living costs due to extra medication needs, equipment, clothing and bedding depending on their disability. (Oppenheim, C: Poverty the facts: 65)

Old Age ‘ Elderly People are at particular high risk as the government has weakened financial control for some of the poorest pensioners. People who are in well paid jobs normally have private pensions and they also receive a state pension once they reach retirement age. However people in low paid jobs, unemployed and people who have gaps in employment ie mothers are set to experience poverty as they hit retirement age due to inequalities with the labour market. (Oppenheim, C: Poverty the facts: 69)

Outline how you might apply poverty to professional practice in terms of:

Challenging social attitudes

Joseph Rowntree Foundation aims to promote public interest in poverty issues by encouraging public support for abolishing poverty in the UK. (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-UK.pdf)

Currently the public are a long way from supporting an anti-UK poverty agenda. Allot of people are not aware of the problem and don’t believe it is a key issue within our society. Poverty is sometimes related to and more so associated with international groups, absolute rather than relative poverty. ‘The public feel very wary of offering more help to anyone, in case they are ‘taken for a ride’ by freeloaders.’ (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-UK.pdf)

Within professional practice challenging social attitudes could be improved through:

Awareness ‘ built on:

Targeted messages and channels of the issue

Appropriate hooks to get attention and gain sympathy

Passionate and authoritative leadership

Trust ‘ built on:

Statistical evidence for the public to see

Real examples of people in poverty, through media channels

Transaction ‘ To tackle the issue, give the public information on:

What is going to be done about the issue?

Who will carry it out?

How can the public help with the issue?

Working with individuals and groups:

Youth Homelessness

Within the UK between 2006-2007 there were 750,000 young people that experienced homelessness. Causes of homelessness amongst young people are mainly that they come from disadvantaged and poverty stricken backgrounds. Many of them have experienced some kind of trauma or have come from troubled backgrounds while growing up, many also experience a breakdown in communication between parents and step-parents.

Once young people are homeless this impacts on almost every aspect of their lives ie education, jobs, welfare, social contact and may result in them taking drugs and getting into trouble with the law. Many young homeless people experience poor health compared to their peers who are not homeless.

Many also experience mental health problems and depression. Throughout the last decade there have been a number of policies set up to address the problem. The policies have paid particular attention to prevention, focusing more so on the 16 to 17yr old groups and care leavers aged 18-20.

Working with Service Users

Over the years there has been a great increase in the cultural shift in the way that authorities and support providers have been responding to youth homelessness.

A consensus discovered that being statutorily homeless was not always the best outcome for young people. A housing options approach developed, while there were still some concerns about gate keeping, the majority felt that new practices had increased service provision.

Over time people still found the homelessness experience stressful, intimidating and often felt like they had no control over the situation. So both young people and agencies requested a widespread provision of dedicated housing officers for young people. Particularly preventative services ie family mediation and ‘earlier per-crisis interventions’ including working with parents. In tackling the problem the JRF report suggests that there is a need for more evidence based on ‘what works’ in addressing homelessness and an ‘evaluation of supported lodgings schemes in particular’. (www.jrf.org.uk/sites/files/jrf/2000-poverty-attitudes-uk.pdf)

Conclusion

Poverty is far from being abolished if anything it is increasing rapidly and the recession has pushed many families and individuals into poverty even further according to the jrf report. (publications ‘ The NPI Site) Poverty is mainly determined by three factors ‘ access to work, and the failure of government policies to deal with them. Access to work is determined by class, gender and race. If unemployed, people getting a job is not necessarily the answer to their problems if they are going to be receiving a low wage ie lone parents and low income families with children. Social security have failed to pull people out of poverty, often leaving them to cope on minimum incomes. (Oppenheim, C: Poverty the facts: 70) According to the jrf findings on monitoring poverty and social exclusion 2008, from 2002 to now out of 56 indicators 14 improved while 15 worsened and 27 remained steady. (Publications ‘ The NPI Site) This proves that the government have allot to answer for and allot of existing policies need to be reviewed and updated in order to see a major improvement and the abolishment of poverty altogether.

In 1918, half the world’s population was infected by the Spanish flu of the 1 billion infected 50 million past away from the disease. In 2003 humanity was faced once again by a terrible pandemic, Severe acute respiratory syndrome (SARS). SARS was merely a wakeup call, calling to attention the unpreparedness of Canada. In 2005 the World Health Organization (WHO) addressed this concern by implementing an influenza pandemic preparedness plan checklist. Canada responded to this fear of unpreparedness with the “Ontario health plan for an influenza pandemic”. One of the ethical key issues that were addressed was health care workers duty to provide care during a communicable disease outbreak. That is to say do health care workers from practitioners to nurses to volunteers have an obligation to come to work during a pandemic. With a estimated absenteeism rate of 39% amongst all health care workers in Canada during the first two weeks of a pandemic and 34% of nurses who would seek other employment during a pandemic due to fear. Stricter guidelines must be set for Canada health care workers standard of care during a pandemic crisis. Engaging the public to set these guidelines is one of the best ways to reach a consensus on what the duty of health care workers should be. Although there are punishments should a health care worker breach their duty to provide care it is insufficient. Health care workers will be faced with an ethical dilemma when a pandemic arises because of the conflict between performing their duty to provide care, self preservation, and the health of their families. Health care workers need to have an array of facts towards a pandemic situation then contemplate their position on what to do when a pandemic takes place using deontological, teleological, bioethical principles and Kohlberg’s theory of moral development.

When the public was engaged 90% said that health care workers should face all risks if safety precautions are taken, 47% of the public agreed that the government has the right to conscript health care workers during a pandemic. 50% of the public agreed that health care workers should face lose of employment and licensing should they not show up to work. However, as of now health care workers are subjected to a 184050 dollar fine according to the occupational health and safety act. Due to 30% of all SARS cases being health care workers, there is an understandable level of fear. Nurses in particular seem to have a reserved fear during a pandemic with 34% of nurses primarily young nurses would quit during a pandemic. Nurses also exhibit the highest level of fear with 61% of nurses who were scared to care for SARS patients to the point where they would avoid them. This fear felt is brought on primarily from having less than two hours of infectious disease control training. The first step to preparedness, to make an ethically sound decision is to educate and raise awareness. Increased fear was due to perception of greater risk of death, lifestyle change and being treated differently because they are health care workers. Therefore, Health care workers need to understand that although they are in a high risk area there have been several steps taken in regards for their safety. Knowledge of preventive measures should not be assumed by the staff but rather educated by the employers. The knowledge of preventive measures can be learned and preserved by facts, protocol, procedures and practise. When the health care workers are informed of the precautions that they are given it lessens the fear from the pandemic. Once the proper factual presumptions are made the health care worker can then apply ethical knowledge to make their decision.

Deontology ethics stresses that a morally right action is directly brought upon by ones performing their duty. Since a deontological ethical approach emphasizes that our actions be governed by our duties, then a definition of duty must be given concisely. In the Canadian Medical Association’s Code of ethics the expected procedure for physicians during an epidemic is vague and silent to say at best. However, physicians like all health care workers have a duty to provide care. The duty to provide care is one that is given to all health care workers this assumed duty to provide care is initiated and taught in the health care system. Duty of care is the legal term for the obligation that a health care worker has to his or her patients. There is both a duty of care and a duty to provide care for both nurses and physicians. When you first accept the meeting the standard of care you recognize duty to care then the continuity of that care is the health care workers duty to provide care. When a health care worker, nurse or practitioner refuses to go to work during a pandemic they breach both their duty to care and duty to provide care. They are wrong when they violate the duty to care for any new patient and they are wrong when they have going against their duty to provide care to their current patients. Furthermore, when a health care worker does not go to work they impose on the rights of others. Residents of Ontario and citizens of Canada have a right to health care; this right is ill-treated when health care workers do not go to work. Therefore, although there are no specific duties during a pandemic crisis the regular duty to care and to provide care are still valid and should be obeyed from a deontological point of view.

A Teleological stand point evokes that in order to make a morally good decision the decision maker must weigh out rationally and objectively the outcomes of their actions. The decision maker has to consider ethical hedonism which preserves self interest, versus ethical altruism which emphasizes the benefits of others even at the price of self sacrifice. Fear and concern for self was the second largest barrier for health care workers willingness to work. If the health care workers do go to work the good consequence is that they are helping several people and the bad consequence for this action is that only one person in addition is at risk; themselves. Versus, if the health care worker does not go to work he alone is safe while many others are suffering. However, the largest barrier for health care workers willingness to work is fear and concern for their families. Now the bad consequence of going to work does not only affect only the health care worker but their entire family is at risk. Teleological Utilitarianism states that the morally good action provides the greatest good for the greatest number. In the instance where the health care worker decides to go to work they are most likely serving and helping more people then they puts at risk, even though those they puts at risk are their own family. Therefore, what is teleologicaly good is that health care workers go to work during a pandemic. Moreover, the decision not to go to work can be seen as ethically hedonistic, but at the same time could be selflessly made if it is to protect their families that may rely on them. The public seems to support the latter 64% of which agree that health care workers with young children and or elderly should not be expected to work during a pandemic.

There are four classical principles that guide health care workers on how to ethically function at work. The first is the principle of nonmaleficence as seen in the Hippocratic Oath, fundamentally states that no action taken should result in any harm unless it is necessary to prevent greater harm. The health care workers are creating harm indirectly by not going to work and helping, this negligence that is creating the harm is just as bad as directly doing the harm themselves. The second principle is that of beneficence which states that the professional has a duty to do good. In order for the health care worker to do well and be in compliance with the guiding principle of beneficence they must go to work during a pandemic and perform good; This good is performed by helping others. The third principle of Autonomy is in respect for the patient to have the liberty to choose their own course of action. Most likely a patient with SARS or similar disease will want some sort of treatment. In order to even have the option of treatment, to allow autonomy a health care worker needs to report to work especially during a pandemic when they are needed the most. The final guiding principle of justice interjects that patients need to be treated fairly without discrimination. In order for care to be non-discriminatory then health care workers need to provide care to everyone equally including people who are suffering from the pandemic disease. Also care should be consistent from before the pandemic to after the pandemic. If the health care worker should decide not to go to work during a pandemic both people suffering from the pandemic and non pandemic diseases suffer and do not receive just treatment.

Kohlberg’s theory of moral development can be applied to this ethical maxim to decide which decision would be preconventional, conventional or post conventional. A preconventional action focuses primarily on an egocentric basis. The choice for a health care worker to not go to work during a pandemic due to fear of their own lives is a hedonistic decision. Therefore, according to Kohlberg the decision for health care workers to not go to work due to selfish concerns is preconventional. A conventional decision would encompass that a decision be made that will be good for a group rather than purely yourself. The decision to not go to work for the sake of taking care of your family and children is a self less decision for a certain group. Although the decision is still to not go to work it is considered conventional because it is for the sake of the health care worker’s family. A post conventional decision holds true to the law of justice. The law of justice and individual human rights can be applied to this scenario because every citizen of Canada has a right to health care and health care is to be distributed justly. The decision for the health care worker to go to work for the sake of universal society is considered post conventional. In order to make a truly moral decision Kohlberg’s theory of moral development could be used as a guideline for health care workers to make ethically appropriate decisions.

In conclusion, the choice whether or not health care workers should go to work during a pandemic is an ethical dilemma. In order for health care workers to make an informed decision they need to be made aware of the facts. Although there is a fine set in the occupational health and safety act of 184050 dollars the penalty is not enough as the public agrees health care workers who do not go to work should face loss of employment and licensing. The decision for health care workers to not go to work during a pandemic due to selfishness and fear even thought precautions have been set is a hedonistic decision. This hedonistic decision falls under Kohlberg’s stage of preconventional or immature level of moral reasoning. Although health care workers have a duty to care and to provide care to their patients they also have a duty to take care of their families. The decision for health care workers to not go to work during a pandemic due to fear of infecting their family which needs them, falls under a conventional and mature decision. The decision for health care workers to go to work during a pandemic in compliance with the duty to care and to provide care is a post conventional decision and is most applauded. Since this decision provides the greatest good for the greatest number of people it falls under utilitarianism. Furthermore, this decision also conforms to the principles of professional ethics. A health care worker going to work prevents harm from being done i.e. nonmaleficence; this treatment being provided is beneficial and is in accordance with the principle of beneficence. Autonomy and Justice is fulfilled by the health care worker going to work because it provides patients the option of treatment and all patients receive treatment justly without discrimination. The guidelines currently set for health care workers role during a pandemic are to incoherently put and need to be clearly stated in terms of their responsibility to go to work. The guidelines should integrate a full array of ethical theories in order for health care workers to reach a sound and informed decision.

In health and social care services, quality is an essential component and a concept with many different interpretations and perspectives. It is important to both users of health and social care services and external stakeholders. While completing this unit I have gained knowledge of these differing perspectives and considered ways in which health and care service quality may he improved. I have tried to explore the requirements of external regulators and compare them with the expectations of those who use services. I have also learnt about few methods that can be used to assess different quality perspectives, and develop the ability to evaluate these methods against service objectives. I have also focussed on concepts of managing service quality with an aim of achieving continuous improvement and exceeding minimum standards. I have made a sincere attempt to understand strategies for achieving quality in health and social care services. By completing this unit, I sincerely hope that I have learnt basics of as to how to evaluate systems, policies and procedures in health and social care services. I have learnt about methodologies for evaluating health and social care service quality.

TASK 1
Stakeholders are essential in health and social care regarding quality; discuss analysing the role of external agencies in setting standards. (1.1; 1.2)

Stakeholder as one who is involved in or affected by a course of action. Patients are part of the stakeholder group that both pays for our health care system and are the end-user of it. The interests of health care organizations, medical professionals and other health care providers are represented through various government bodies, professional organizations and labour unions.

We must try and understand quality considering the perspectives of staff and also perspectives of those who use services. Quality might have the same outcome but opinions of the health and social care staff and the patients might be quite different.

In simple terms, quality is fitness for purpose. Quality is about meeting the service users’ requirements. If quality is about meeting service users’ requirements, it is important to discover what these requirements are. If we provide services with extras that service users don’t want, we will not be adding quality.

Stakeholders can be the external agencies eg Care Quality Commission; Supporting People; National Institute for Clinical Excellence; Health Service Commissioners; local authorities; users of services eg direct users of services, families, carers; professionals; managers; support workers.

There are many organisations in the UK known as health and social care regulators. Each organisation oversees one or more of the health and social care professions by regulating individual professionals across the UK. These organisations, also known as regulators, were set up to protect the public so that whenever you see a health or social care professional, whether private or in the NHS, you can be sure they meet the standards set by the relevant regulator.

To practise profession in health and social care, people must be registered with the relevant regulator. If they are not registered and still practise, then they are breaking the law and they may be prosecuted. These registers are made up of only those professionals who have demonstrated that they have met the standards set.

These registers are open to the public. So if you want to check your professional is registered, you can do this either online or by calling the relevant organisation.

In health and social care, professionals, clinicians and others, whose work is informed by traditional bodies of knowledge, are increasingly aware of the need for continuous personal development. High- quality services cannot be sustained unless health and care staff are consistently engaged in learning, individually and together.

All care services need to work to standards and have a system for measuring that they are meeting standards. The health care system has audits which check that services meet quality standards, while social services have inspection units which register and inspect services. Standards are influenced by laws, subsequent regulations, codes of conduct and values.

All organisations such as homes, day centres or community services, need a system to monitor how effectively services are being delivered and whether service users’ are having their needs met. Organisations may have their own quality monitoring systems. At a local level, quality assurance groups may seek to clarify, prioritise or set standards.

Different parts of the system and external agencies need to work together, as part of a culture of open and honest cooperation, to identify potential or actual serious quality failures and take corrective action in the interests of protecting patients.

Explain what the potential impacts of not appropriately managing quality in health and social care settings might be? (1.3)

If quality in health and social care settings is not appropriately managed, this could lead to serious consequences. It could lead to inability to improve the health and social well-being of people in the area for which they are responsible; Planning and commissioning health and social care will be unable to meet the needs of people in that area. It will cause inability to secure the delivery to people in an area of health and social care that is safe, efficient, co-ordinated and cost-effective. Also the availability and quality of health and social care in that area will deteriorate. The development of standards, guidance and strategic targets will be stagnant. This would mean that local targets will not be achieved. It would mean that patient satisfaction will diminish and targets and expectations will not be met.

Obviously, if the quality is inappropriately managed, it would have a significant impact on all three basic criteria. It would lead to poor clinical effectiveness. Safety of the patient ill not be guaranteed and this would lead to poor outcome in terms of patient experiences.

Where the regulatory bodies find that providers are not meeting the standards, they require them to improve and has a range of enforcement powers they can use. These powers include warning notices, penalties, suspension or restriction of a provider’s activities, or in extreme cases, cancellation of a provider’s registration which effectively means closure of a service.

Providers who train healthcare professionals also have a responsibility to deliver training in a safe and effective way in line with the standards set by the professional regulators. The professional regulators have an interest where the quality of training may put patients at risk.

I. What are the major quality issues that were identified in the last State of Social Care (CSCI, 2009) standards report? What might be the implications for service users? (2.1)

CSCI’s report, The State of Social Care in England 2009, concludes that services do not meet the expectations. The report is believed to highlight that social care services are struggling to meet people’s needs. Fewer people are receiving the care they need to enable them to live independent lives in their own homes. It is all so understood that the report will say there are continuing and chronic difficulties in recruitment and retention of staff throughout the whole care sector.

People, whether they pay for their care or are publicly funded, are not always getting the individualised help that they need to make decisions about their support which in the long term can be costly to individuals, family carers, councils and the NHS.

People are not always getting quality personalised support, particularly those with multiple and complex needs, some of whom may have little, if any, choice about their care. There are concerns about people who are ‘lost to the system’ because they are ineligible for publicly funded support or are ‘self-funders’.

There is an increased demand and resources are limited which is putting a lot of pressure. The report states that people who have complex needs are not getting personalised care. It notes excellent examples of people receiving the support they need but adds that too many people are not getting the right amount of personalised care.

Many people do not get the information, advice or support they need to help them make informed choices about their care.

Implications for service users:

Poor quality service can disrupt funding, damage the reputation of organisations and individuals and lead to inappropriate planning decisions.

Improving quality improves patient care and value for money.

It is important to improve quality because it will lead to preventing ill health and provide patient-centred care. It will also help to manage increasing demand across all programmes of care and to tackle health inequalities. Improved quality will lead to deliver a high-quality.

People who would be affected the most because of poor quality will be mainly the older population, people with long-term conditions, people with a physical disability, maternity and child health, family and child care people using mental health services, people with a learning disability acute care and palliative and end of life care.

There are many different approaches to understanding quality. Describe any three approaches of your choice highlight a particular strength of each approach.

Different understandings of quality:

A common quote is: “Some things are better than others; that is, they have more quality. It is a grade of goodness or excellence. Quality therefore means free from defects. In my opinion, quality means patient’s satisfaction.

After reading and learning more about quality, I have realised that quality can be understood with variour approaches. It can be measure in terms of the exceptional (highest standards) or in terms of conformity to standards. It can also be described as fitness for purpose, as effectiveness in achieving institutional goals; and as meeting patient’s needs.

Quality as exceptionality

This is the more traditional concept of quality. It is associated with the idea of providing a service that is distinctive and special, and which confers status on the owner or user.

Many institutions emphasise that health and social care must have exceptional standards. However, it is not possible for the agency to condemn all other institutions. This approach is not always possible.

Quality as conformance to standards

The word ‘standard’ is used to indicate pre-determined specifications or expectations. As long as an institution meets the pre-determined standards, it can be considered a quality institution fit for a particular status. This is the approach followed by most regulatory bodies for ensuring that institutions or programmes meet certain threshold levels.

Quality as fitness for purpose

This approach has the following questions ‘Who will determine the purpose?’ and ‘What are appropriate purposes?’. The answers to these questions depend on the context in which quality is viewed. The purposes may be determined by the institution itself, by the government, or by a group of stakeholders.

Quality as effectiveness in achieving institutional goals

In this approach, a high quality institution is one that clearly states its mission (purpose) and is efficient in achieving it. This approach may raise issues such as the way in which the institution might set its goals (high, moderate or low), and how appropriate those goals could be.

Quality as meeting customers’ stated or implied needs

This is also a variation of the fitness-for-purpose approach. This is where the purpose is customer needs and satisfaction. Quality therefore corresponds to the satisfaction of the patients.

Which approach to quality (you may choose one that isn’t above) do you feel is more often used by providers of health and social care services users and why do you think that this is the case? (2.2)
Standards-based understanding of quality

In my view, I think health and social care providers use an approach which is conformance to the standards. Many regulatory bodies set goals and aims for a particular healthcare setting and the organisation works hard to achieve these goals.

Implementing quality needs planning. There should be policies and procedures. Government should set some targets. An audit can be an excellent tool to check if appropriate quality of care is being delivered. There should be constant monitoring and review should take place at regular intervals. Good communication is the key to implement good quality. Proper information should be shared especially when shifts finish, hand over should be done adequately. We all should be open and ready for adapting to change.

Standards: minimum standards or best practice should be the goal or certain benchmarks should be set. We must have measurable performance indicators. All health and social care settings should have codes of practice. There should be legislation in place which could either be local, national or European legislation.

In the ‘standards-based’ understanding of quality, health and social care institutions must demonstrate their quality against a set of pre-determined standards. These standards will set a threshold level of quality.

However, quality assurance today has changed. While in the past quantitative criteria was enough to demonstrate that a standard had been met, more qualitative criteria is now incorporated and institutions may thus be able to more easily maintain their individuality.

IV Suggest the potential barriers to delivering quality at this scheme and other health and social care services (2.3)

There are a number of barriers to improving quality. It could be due to lack of proper implementation of documented procedures. There is a lack of incentives to change traditional ways of providing care. Also a lack of a patient-centered culture and values. One of the biggest problem is lack of relevant training and support. Also we don’t have enough expertise in interpreting survey data. Sometimes it is just the resistance to change which can be quite difficult to overcome.

We shall discuss relative impact of a range of potential barriers. The biggest constraint is the time available to focus on improving the quality of services, followed by a lack of leadership.

People need to be identified, trained and supported to provide leadership and commitment.

Lack of leadership in delivering quality is an important barrier.

Training if not received properly could lead to poor quality in health and social care. We know there could be few health and social care workers who received no training, few who were trained in all the identified areas of quality, some who had been trained in only one area (predominantly clinical governance and audit) and the remainder received an inconsistent mix of training in different areas. A consistent package of core training in all facets of quality is needed for all NHS staff.

Staff must be rewarded through the appraisal process, this could lead to a morale boost and lead to better quality of work.

How does legislation (relating to quality) impact on the delivery of quality in health and social care service(s) offered in England and Wales? (3.1)

Rules and regulations must be followed because safety depends on them. They usually come from one of two sources as they may be local and designed by the employer or they may have been designed by the government. Hospitals have their own policies and they also follow rules set by the NHS and the government. Wherever they come from, it is important that they are followed as they are put in place for the good of everyone.

One of the main sets of rules and regulations is The Health and Safety at Work Act 1974. This act provides the basis of health and safety law. It places general duties on all people at work, including employers and employees.

All places of employment are subject to health and safety law. Employers must have relevant policies in place. These must be designed for health and social care so that all of the staff can follow them and comply with the safety laws. Most care establishments have the following policies like fire policy, lifting policy and hazardous waste policy. When running or managing a care service and carrying on a regulated activity there are certain things you have to do by law. Though the legislation should be used as guidance only, and is not legal advice.

Another important act is Health and Social Care Act 2008. The Health and Social Care Act 2008 established the Care Quality Commission as the regulator of all health and adult social care services. It is important to be aware of all the up to date provisions.

We should try to describe quality and safety from the perspective of people who use services and place them at the centre of the registration system. It is important that anyone registered to provide or manage a regulated activity is aware of the guidance that has been produced. It is very important to be aware of the legal side of things so that we can ensure the safety of patients and also ourselves.

Identify other factors that might influence the achievement of quality in health and social care services (3.2)

How to deliver high-quality healthcare in the most efficient manner possible is the question that is very important. In my opinion, healthcare delivery should be clinically effective, focusing on treatment outcomes, including survival rates, symptoms, complications and patient-reported outcomes. In my view, health and social care must be safe: avoiding harm, looking after people in clean, safe environments, and reporting any medical errors or adverse events.

One main goal should be ensuring that healthcare is available to all according to need and avoiding financial barriers that prevent access to necessary care.

It is important that health and social care is efficient: paying attention to value for money, avoidance of unnecessary interventions, and careful use of limited resources. Health and social care should be responsive: providing personalized, patient-centred care, delivered with compassion, dignity and respect; measuring, analysing and improving patients’ experience and satisfaction.

How can health and social care workers ensure their knowledge base is up to date and that their work is of a quality standard and what role and responsibilities do health and social care service providers have in relation to this. (3.3)

As health care or social care workers, we must endeavour to keep our knowledge base up to date and ensure that our work is of quality standard. Ideal care workers will go out of their way for patients, they try to understand what it’s like for the service user and carer; they are happy and interested in their work and knowledgeable about their jobs and are always ready to help. Good communication is the key.

We must attend seminars, meetings, group discussions and do online studying along with regular text bok reading. Group discussions and team work will help us to realise the gaps in our knowledge.

Care workers should have knowledge of services and legislation relevant to users and carers’ needs. They must know about the benefit system and sources of funding, or who to refer to if they don’t. It is of utmost importance that they know when and whom to ask for extra help. Health and social care workers should know about the people they are caring for. They should be familiar with the roles of other people in relation to meeting service user and carer need.

Health and social care workers must understand their limitations and have up-to-date knowledge. It is recommended that care workers review their learning over the previous 12 months, and set their development objectives for the coming year. Reflecting on the past and planning for the future in this way makes your development more methodical and easier to measure. Care workers may already be doing this as part of their development review with an employer.

CPD is a personal commitment to keeping our professional knowledge up to date and improving our capabilities. It focuses on what we learn and how we develop throughout your career.

As a professional, we have a responsibility to keep our skills and knowledge up to date. CPD helps us turn that accountability into a positive opportunity to identify and achieve our own career objectives. CPD is an opportunity to do ourselves some good; the nature and scale of the benefit depends entirely on us.

I. Identify method used to assess quality, evaluate the method with two more methods of your choice (one external and internal (4.1)

Measuring the quality of health care has become a major concern for funders and providers of health services in recent decades. One of the ways in which quality of care is currently assessed is by taking routinely collected data and analysing that data. The use of routine data has many advantages but there are also some important pitfalls.

The Measurement of Quality:

Methods for assessing quality can be various. We could use questionnaires, focus groups, structured and semi-structured interviews, panels, complaints procedures, feedback forms and road shows.

Nice questionnaires should be prepared which should be given to the patients to fill in their own time. This could give us a fair and honest opinion about our services. Small focus groups and interviews can also be a good technique. To achieve good levels of quality service, we must have complaints procedures in place. Feedback forms could be an excellent measure for quality of any service provided. This could also prove beneficial in improving the quality by acting upon any suggestions made by the patients.

Scientific methods of measurement are increasingly necessary. Evaluation requires good methods in order for the resulting data to be useful. Further, data from evaluations are being used to create significant change within organizations, so faulty data based on inaccurate measurement methods carry a great risk.

Quality will not be improved simply as a result of inspection. It must be built into the people and the processes carrying out the work of the organization. In health and social care setting we must all define quality, measure its achievement, and create innovations to constantly improve. This requires active involvement of all within the organization, from the mailroom to the boardroom. Visible, supportive leadership is essential.

II. “If quality is about meeting customers’ or service users’ requirements, it is important to discover what these requirements are” (Martin and Henderson, 2001 p. 178)

Quality is most easily recognised in its absence and many public perceptions of healthcare are based upon measuring the absence of quality for example, waiting times, waiting list sizes, even illness itself are all measurements of the absence of quality.

The client/patient: the client/patient’s view of the quality of their experience will depend upon two factors: a successful outcome and a positive experience before, during and after treatment. However, some procedures which may be deemed clinically desirable to maximise the probability of a successful outcome may be highly uncomfortable and inconvenient for the patient.

Increasingly, the separation between these aspects is being questioned as it is recognised that clinical outcomes are influenced by a patient’s general state of well-being. This increases the need to take account of what has been traditionally considered as non-clinical aspects of care.

Service quality is more difficult for patients to evaluate than goods quality. A patient’s assessment of the quality of health care services is more complex and difficult for them as well.

Patients do not evaluate service quality solely on the outcome of a service; they also consider the process of service delivery. The antibiotics may have resolved the throat infection, but if discourtesy and an uncaring attitude marked the patient’s interaction with the provider, the perception may well be “poor service quality.”

The patient defines the only criteria that count in evaluating service quality. Only patients can judge service quality; all other judgments are irrelevant. Patient’s requirements, in my opinion, are:

Access: approachability and ease of contact.

Communication: keeping patient’s informed in language they can understand. Listening to them is equally important. Less use of of medical jargon.

Competence: possession of the required skills and knowledge to perform the service.

Courtesy: politeness, respect, consideration, and friendliness of health and social care worker. Credibility: trustworthiness, believability, and honesty of the service provider.

Reliability: the ability to perform the promised service dependably and accurately.

Responsiveness: the willingness to help patients and to provide prompt service.

Security: freedom from danger, risk, or doubt.

Understanding of the needs of a patient: making the effort to know patients and their needs.

III. Service user involvement has become a ‘buzzword’ in policy aimed at achieving quality. Discuss strategies used to involve service users and their effectiveness. (4.2)

“Service user involvement is a two way process that involves both service users and their service provider in the sharing of ideas, where service users are able to influence decisions and take part in what is happening”

Patients, carers, parents and advocates of the sick and vulnerable should have input into the kind of health service we have. They should be consulted about changes to services, and they should be involved in the design of those services. They should help to set the standards by which services are judged, and help to assess whether a particular aspect of the service meets those standards. At every stage, the users of the health service should be offered the opportunity to play an active part in developing, delivering and evaluating their service. Involvement can be achieved by using the following methods.

Information sharing
This may include letters, posters, newsletters, videos, tapes, text messages and forums.
Listening
This may include: one to one interviews, group interviews, focus groups, and service user meetings, one off events, questionnaires and workshops
Consultation
This may include: one to one interviews, group interviews, focus groups, questionnaires, one off specific focused events, workshops, and video or drama events.
Participation
This may include: user panels focused on specific topics, resident groups, inclusion in organising events, videos and other media to give information to other service users.

Patients should be involved in making decisions about their own health care. They should be actively involved in co-designing services, redesigning services, developing services or change management. The government should be undertaking peer education and support. More patients should be taking part in research. These strategies could be used to involve service users.

Due to previous experiences of working with a range of people in the care sector I believe that throughout my time on various work placements with people who have disabilities and difficulties in communicating, along with the experiences gained throughout my studies, my wish to pursue a career in the care profession has grown.

To further my interest in working with and around people I completed a course in childcare.

Throughout this course I was able to gain valuable experience of working with special needs children. While this was very challenging I also found it an extremely rewarding and enjoyable experience. To further my knowledge and passion for working with people I took a health and social care advanced course and took a week’s experience in a day center that involves working with people who suffer from difficulties in communicating and having disabilities. This again helped to broaden my understanding of working with people and also how to deal with children and adults with disabilities.

Within my spare time I have researched the job role and requirements for health promotion to find out what is involved. To build upon these interests further, I am taking up a one week work experience within the health field. I will be spending the first week in a care home focusing on helping elderly people that suffer from dementia and my second week assisting a health promoter to experience a more professional job role in health care. I am looking forward to this valuable experience as it will further consolidate my desire to study health and social care.

I currently work as a sales assistant which has given me a valuable experience of working with people and how to assist their needs in any way possible. During this time I am developing effective communication skills and good working relationships. In addition to this it is also helping me to show how committed I am to my responsibilities as well as demonstrating good organisation skills. Having to juggle work and school as well as social activities this also shows that I am developing my time keeping skills to make myself more committed and more punctual.

During my first year of sixth form I helped to raise money for the McMillan Cancer trust charity. I also found this very rewarding as I was helping others that were in need, just like during my work placements. I often play sports after sixth form with my friends; this has helped me to develop extra skills in working well in a team. In addition I have completed voluntary work with a year six class to increase my knowledge of working with young people, another activity that I very much enjoyed and found extremely rewarding. To further my interest in working with people I have recently volunteered to do a level 3 v-volunteering in my spare time, the certificate itself is an accreditation form Newcastle University. During my spare time I mainly like to dance and sing. I find this is a good way to express myself in addition to help me keep fit. I also attend the gym often to also help keep me fit. I also like to attend various different events and take advantage of any activities that I am offered whether it is through school or outside of school. This helps to increase my confidence and also helps me to meet new people.

I feel that university is definitely the right path for me. I am always working extremely hard to achieve the best I can, a feat which I intend to carry on throughout my university years. I feel I have the necessary skills needed to enjoy university to the full and also be successful in future years. In addition I would also like to go to university to help develop my skills even further so I can gain a good job in the health and social care sector which is always my main interest.

Social Work Personal Statement

I have decided to take up the course in social work because firstly the subjects which I am doing sociology looks at people and society’s problems, I have in this subject done work on family and at the moment doing religion, this has fascinated me to help people who are facing problems such as abuse in families. Secondly I have done personal study on this subject which I have enjoyed reading around in periodicals and journals which had fuelled my interest in gaining a more depth knowledge of working with different type of people and their problems. Thirdly I would like to take up a course which fascinates me and in which I will determined me too succeed and the challenge of working to deadlines

Whilst in the sixth form I have been involved in a scheme which aimed to provide children entering school with a low reading age, with the help their required to improve their reading levels. I also at in my private time tend to go to old people house who are disabled because one of my close relative is there also this house is opposite my house so I go in and talk to different people and talk or play games with them. This is another reason why I want to do this course because I have some experience of what I will be facing in this course, it won’t be shock to me at first time round because I know in social work you get people who are hard to handle especially youngsters

My part time job which is shop assistant helped develop my understanding of responsibility and has given me increased confidence also enabled me to act initiatively with dealing with unexpected problems and has helped to develop my communication skills . Working with the children in school has improved my interpersonal skills so that I can now work with children who can be awkward sometimes without any problems

As an individual I like keeping fit which I have a gym in my house, I also like listening to music and going out with mates which provides me a different environment from college and work, this gives me an opportunity to make new friend and meet new people. I also in my part time help my younger brother and sister with their homework or I sometimes learn from my mum how to sew clothes

As an applicant, I will bring with me an enthusiasm and motivation for this subject. My ethics background and cultural awareness should allow me to become and integrated yet individual of a university member in an increasingly cosmopolitan society.

Personal Statements: the Good, the Bad and the Ugly

Personal statements with positive impact

“After I was made redundant, I decided to become a support worker. This was because I had been volunteering for several years in the Youth Service, working with young people at risk of offending. I got a job in a special needs school where I supported pupils on an individual basis. I needed to develop a good relationship with each pupil and to adapt my communication to their special needs. An example is how I worked with a boy who was afraid of the doctor ( describes her intervention and outcome). Working in this field for three years has encouraged me to tackle an Access course; I have learnt the theory of communication and can see why I was successful in my work with school students. I would like to develop my skills and knowledge further by studying for a social work degree.”

“Skills I had gained as a support worker were needed when my father was diagnosed with dementia. I had always relied on his support and found that I had to be reliable and useful for him without letting my emotions overwhelm me.”

“I am currently working as a support worker in a multi-disciplinary community mental health team. Although I work mostly with the OTs I have a good opportunity to get an overview of the other professions including social work. I have worked together with social workers in the team to support vulnerable people in the community and particularly like the wider perspective they bring to their work such as involving carers.”

“I have worked in the substance misuse field for 5 years and have undertaken NVQ3.I have been offered the post of manager in the service I work in but thinking about my own development needs , I now want to train as a social worker to gain a wider experience of working with vulnerable adults and children.”

“I am a nursery nurse and wanted to take my interest in child protection further by studying OU courses on health and social care.”

Statements with Limited Impact

“I have always been passionate about care , becoming a social worker would allow me to fulfil my ambitions”

“I have been employed as a carer for 6 years. I enjoy my job and the experience. This has been excellent for my personal skills as I have to talk to people like the elderly.”

“I believe my personal drive is a key factor in my success as manager in a care home and I would be an asset to your degree”.

“Working as a support worker means that I have learnt skills in communication and team work.” (No further discussion of these points)

Lengthy exposition of previous employment in various retail and marketing companies, paragraph ending with “The work experience linked to social work was a six week placement in day centre where I helped escort the old people home.” No further discussion of what person learnt from this, what impact it had on decision to apply to train as a social worker.

“Having gained an NVQ 3 in health and social care and with vast experience in paid and voluntary work, I want to further my career by studying for a professional social work qualification ….. (then follows list of all the service user groups applicant has worked with) … in all these my skills in prioritising my workload, meeting deadlines , time management and team working has improved enormously.” No evidence given to demonstrate this statement.

Other statements contain very general comments on social work – such as ” A social worker’s vocation is very complex and more than interpreting the problem and assisting people find a solution. It involves methods, theories and ethics.” There is a danger that these types of generalised comment are either from websites or books and articles which are not referenced – plagiarism can rear its head even before some applicants have started their academic career!

This essay will be constructed into four parts, harm reduction, abstinence based reatments, substance misuse and recovery. There will be a discussion on the history of harm reduction and what harm reduction is in the substance misuse field, for example problematic or harmful behaviour that is caused to the individual or others either socially, psychologically, physically or legally brought on by substance misuse. Secondly an explanation on abstinence based treatments, what they are and what the relationship is between them and harm reduction. Thirdly referring to recovery and what it means in the substance misuse field and what the implications are for the service users. Last but not means least a discussion about the two different approaches and how it impacts on the service user. To conclude a summary of the main points will be made. (136

Harm reduction pilot schemes started back in the 1980’s and were a response to reduce the risk associated with harm caused by alcohol problems and injecting drug use, in response to the HIV and AIDS prevention strategy. Harm reduction is a process and not a treatment and should be integrated with other forms of intervention, it reduces the negative consequences of drug use. It is about educating the individuals, carers, partners and family members about the risks involved with their drug use and helping them take responsibility and learn to accept it rather than to ignore it. Most harm reduction interventions are aimed at preventing diseases due to blood- borne viruses (BBV) as well as overdose and other drug related deaths (Tatarsky & Marlatt 2010). Harm reduction services include needle exchange services methadone and buprenorphine programmes. Needle exchange provides services where the users have the opportunity to dispose of their old needles, syringes and spoons for example. Moreover they will also receive advice and support on safer injecting, reducing injecting and prevention of overdose, they will receive a pack which contains clean injecting equipment to take away, reducing the risk of them sharing equipment with others (NTA 2006). Substitute prescribing such as methadone and buprenorphine programmes, buprenorphine and methadone are licensed for use in opioid dependence where methadone is dispensed in liquid form and buprenorphine is administered by tablet form sublingually (Connock, Juarez-Garcia & Jowett, et al 2007). (236)

Abstinence based treatment

Abstinence means refraining from an activity which is known to be harmful and addictive or reducing this activity with the ultimate goal of being abstinent (McKeganey et al 2006). Doing this involves not taking a particular substance, avoiding areas where this is likely to be on offer or adopting a healthier lifestyle. Abstaining can be difficult to do especially when the substance has been part of their life for so long, this is where the individual has to look at healthier ways to deal with their substance use. This can include a range of abstinence based treatments to help the individuals with alcohol or drug such as Non-drug interventions the twelve step programme (self help) and Psychosocial interventions such as motivational interviewing or CBT. The twelve step programme is a set of guiding principles outlining a course of action for recovery from addiction, compulsion, or other behavioural problems, it was originally proposed by Alcoholics Anonymous (AA) as a method of recovery from alcoholism. Motivational Interviewing is usually offered to achieve and maintain abstinence, it was originally used with problem drinkers but has also been applied to the treatment of illicit drug misuse (Raistrick et al 2006). There are several Pharmacological interventions available to treat alcohol dependence which are disulfiram, acamprosate and naltrexone. These all work in different ways Disulfiram is used for individuals who wish to abstain altogether, if taken with alcohol it can cause some very unpleasant effects; vomiting, headache, palpitations and breathlessness. Acamprosate and naltrexone are an anti-craving drugs used in the maintenance of abstinence (SIGN 2003). However there is an increased risk of overdose or death due to a relapse after a period of abstinence as tolerance levels will have changed to that particular substance (REF). (288)

Substance misuse

Substance misuse is defined as the use of a substance for a purpose not consistent with legal or medical guidelines (WHO, 2006).

It is a misuse of all psycho-active substances including illicit drugs, non-prescribed pharmaceutical preparations and alcohol misuse.

People use substances because it makes them feel good, feel different and makes them more sociable. Using substances only becomes misuse when a problem arises such as it having a negative impact on health or functioning and may take the form of drug dependence causing problematic or harmful behaviour to the individual or others either socially, psychologically, physically or legally. (99)

Recovery

The Recovery Model as it applies to mental health is an approach to mental disorder or substance dependence that emphasises and supports each individual’s potential for recovery. Recovery is seen within the model as a personal journey, that may involve developing hope, a secure base and sense of self, supportive relationships, empowerment, social inclusion, coping skills, and meaning. For someone who misuses substances recovery may not be about being totally abstinent it may simply mean still using drugs but in a safe way, for instance having clean works for injecting or substitute prescribing for opioid misuse. Recovery principles bring about the change in the way a service user thinks and aims to produce a change in behaviour, however before these changes can only happen if the person is ready to change, ambivalence may be experienced by the service user and this can affect motivation on a daily basis. Motivational interviewing techniques go hand in hand with the harm reduction model as one of the key factors with motivational interviewing is dealing with ambivalence. Prochaska and DiClemente 1983 provide a framework to understand the change process it was originally created to help understand what individuals go through in changing their behavior. it uses 5 principles, precontemplation, contemplation, preparation, action and maintenance (Hansen et al 2008). Service users with little or no motivation and who are not engaging in any attempts to change are seen as being in the pre-contemplation stage as they do not see their behaviour as a problem and there is no need to change it, this could be due to an attempt to change in the past without success and may feel demoralised so may become resistant to change. It is important to engage service users at this stage and build a trusting rapport so that in the future they will be able to turn to the practitioner for help. The contemplation stage is when a person acknowledges that they may have a problem and work towards developing motivation to change but could become ambivalent, engaging with the service user in discussion about their ambivalence is the goal at this stage getting them to think about what their problem is and how it is affecting them. Individuals in the preparation stage may want to change and have a plan but need help to do so, the reason individuals may seek treatment could be that their problem is having negative effects on life for example, criminality or job loss. The action stage comes next this is where the service user is actively setting goals to change and will be developing skills to do so, supporting the service user in making these goals achievable are key here, goals need to be small and achievable to the service user. In the maintenance stage the service user sustains changes in behaviour and works towards preventing relapse by identifying the supports around them, at this stage the service user may decide to make long term goals and problem solve how to best accomplish them. Prochaska and DiClemente 1983 describe a sixth stage and it is the relapse stage the service user reverts to the behaviour they were trying to change, the practitioner should provide support for the individual in a non-judgemental way as they may be feeling ashamed and guilty for relapsing, re-evaluate the stage of change the individual is at explore the relapse episode trying to discover if the relapse was shorter or longer than previous relapses and were they able to reduce their use, this may be an opportunity for the service user and practitioner to work on other relapse prevention techniques. (Prochaska & Diclemente 1983). However service users may move back and forth between the stages. This does not represent failure, but rather the nonlinear nature of the model. Recovery is about making the best out of their life and having quality of life and as nurses we should provide support and advice to achieve their goals (Network 26 2009). (660)

Both the abstinence model and the harm reduction model have similar goals. The goal in this case is to create a better quality of life for the person receiving the service. Harm reduction approaches are often perceived to be the opposite of abstinence based approaches to drug use and sometimes even as condoning drug use. This is not the case, harm reduction complements abstinence based drug treatment approaches by providing Injecting drug users with the knowledge and tools to stay healthy and alive until they are able or willing to achieve abstinence. Abstinence remains the most effective way of reducing the negative consequences of drug use. For injecting drug users who are unable to remain abstinent, harm reduction measures such as methadone maintenance treatment and needle and syringe programs are ways to reduce negative consequences. For example the abstinence approach to caring for an individual who uses heroin and has HIV service users would find that they would be encouraged to stop using heroin completely and to abstain from sex. While with the harm reduction programme the individual may be taught how to use heroin more safely i.e. clean needles and spoons and other paraphernalia or to substitute methadone for heroin and to practice safer sex. It can be argued that because abstinence based services were not providing HIV education and preventive tools such as condoms and syringes, individuals using these services would remain unaware of the risks of HIV and how to protect themselves from it. (247)

Conclusion

In conclusion, the integration of harm reduction and abstinence based treatment is more powerful than either model separately. The abstinence goal provides more room for the more abstract harm reduction work to occur. The accepting atmosphere of harm reduction with the addition of the clarity of the goal of abstinence promote patient retention better than either separately. The implications of this integration is that harm reduction can be more accepted and powerful in the public sector. It is important to look at the wider context of why people use drugs. Taking away a coping mechanism from a drug user may do more harm than good unless the core issues that led to drug use are dealt with in the first, hence the reason the motivational interviewing approach is more empowering for the service user (134

ABSTRACT

Purpose – Greed triggers fraud and corruption which is one of the biggest problems we are facing in our country as its increasing enormously rather than decreasing. The purpose of this study is to assess the different types of fraud and corruption and because it is such a broad topic we will focus on a life situation which highlights how greed plays a huge role in the creation of fraud and corruption.

Design/ Methodology/ approach – in depth interview are conducted with a senior quantity surveyor who has been working for a contracting company for the past six years and has allowed me to be part of the investigation process that is being conducted. The reason behind the investigation is to find out how come they owe such a great amount of money for tax but money had been deducted from their salaries since they started working and reasons of being unfairly dismissed.

Findings – The employer of the contracting company seems to be deducting money from his employee’s salaries but not paying the tax company without the knowledge of his employees using it for his own private use. Additional information was found that all his workers haven’t been registered under the department of labour and the company has been running for a number of years now and unfair dismissal was practised in this company.

Originality/ Value – The final results of this paper will help us understand and beware that there are all kinds of corruption in the industry. Ms Anonyms will hand over all her payments slips to the investigation officers to prove that she has been working and paying for her tax over the past years while working and to also open a case of unfair dismissal and take it to the Commission for Conciliation Meditation and Arbitration (CCMA).

TERMS OF REFERENCE
PROPBLEM DESCRIPTION

Fraud and corruption play a big role in the construction industry which this results in the hindering of development in our country and the country not moving forward.

AIM

The Aim of the research is to bring the matter of fraud and corruption to attention of the reader. To detect risks in the industry and to provide users with relevant anti- corruption resources.

OBJECTIVES

To find out what triggers fraud and corruption

To what extent is an individual willing to scoop low to get what they want and not be caught

How corruption affects the Construction industry

How it hinders development.

PROPOSAL
Chapter one

1.1 Introduction

Greed is a critical issue affecting the construction industry and country as a whole as it leads to fraud and corruption which plays a huge part on the hindering of development in our country.

Chapter 2

2.1 Greed

The selfishness of an individual of wanting more and not being satisfied of what they already have.

2.2 Fraud

A criminal offence done intentionally because of personal motives which the individual will gain that could affect another individual.

Corruption

Chapter three

3.1 Case study

Ms Anonymous finds herself in the middle of a fraud and corruption situation that she was not aware off.

3.2 Tax invasion

CONTENT PAGE

PGE NO.

Acknwoledgements

Abstract

Terms of reference

CHAPTER 1
INTRODUCTION

Fraud and Corruption are broad and complex issues but their roots are embedded in a countries social or cultural history, Political and economic development and it includes both these committed by the government, employers, employees, management staff, individuals or a group of people who have come together with one agenda only and these committed is motivated by Greed.

Greed steers and individual into fraud and corruption which also triggers the power of the mind, when a person starts procrastinating about the benefits and what one shall gain they begin to start plotting ways in making these thoughts into reality and once these thoughts become reality and the outcome is greater than expected they start abusing the situation into their own advantage.

The construction industry sector is recognised as carrying the highest risk of corruption, the rate of corruption and fraud in the industry is increasing enormously rather than decreasing which is slowing down the economy and surprisingly it has become an ordinary and normal habit that is being practised. It is almost like a swimming pool which everybody now wants to jump in and swim in the deep end not bearing in mind that not everybody can swim.

CHAPTER 2

HISTORY

GREED

Greed is that extreme desire to attain or posses more than what one has such as material wealth which is usually more than what one needs and deserves. It also involves using being wealthy to gain power over others also denying others of wealth and power.

It is basically being selfish, thinking of one’s self while at the same-time affecting other people negative way. For example if a building inspector would accept a bribe from a contractor to approve and state that all work done is of good quality and condition while that is not true than that is an act of being greedy because looking at the situation the only people gaining here are the building inspector and the contractor while in the long it will negatively affect the community as a whole or the people who will be in use of the premises that is being built.

FRAUD

In the country we live in fraud is a criminal act that would disadvantage an individual or a group of people and it is also a civil law violation. Fraud is done intentionally which involves dishonesty for personal gain or damage to other individuals. Fraud can be categorized into many forms for example theft and embezzlement.

In a case of fraud you would have for example a person such an Alien (not belonging in the industry) who knows nothing about the construction and the whole background of it having certificates qualifying him in erecting projects in a case that he doesn’t even how foundation is done.

CORRUPTION

Corruption in any case is the act of being dishonest and abusing power or the person’s position. Corruption can happen anywhere and is usually committed by an individual or a group of people such as officials or private persons. Corruption comes in many forms such as bribery, nepotism, cheating, vote rigging and extortion.

An example of corruption would be paying off kickbacks to get multi million rand contracts for dubious reasons, having to regularly donating huge sums of money to maybe political parties or buy expensive gifts such as cars worth millions rands in-order to get something in return.

“Corruption and fraud come in with greed because they are actions stem from the lack of ethics and undermine human institution and human relations.”

CHAPTER 3

CASE STUDY

Ms Anonymous and Contracting Company.

Ms Anonymous has been working for a contracting company for the past 3 years as a senior quantity surveyor for this company. She did more than just her employed position where she also worked in the civil side of the work and any other work that needed attention she would be gladly to assist in other words she was more of an asset to the company and they had mentioned that to her as well.

The problem started when Ms Anonymous received a letter that she needed to go sort out her tax returns. When she went to pay a visit at the tax company (SARS). S he was informed that she owes a lot of money and was asked why she hasn’t been paying for her tax? She was shocked and told them that she has been paying for her tax ever since she started working for her recent company the past three years. They told her to request and RIP5 form from her employer and also to keep all her pay slips as proof of payments for tax when needed to check her account and also that her company was one of the companies that were chosen for audits in 2012 so they would be an investigation with regards to her matter of not paying tax and would take things from there.

Audits where later on done of the company and it revealed that they owe a great deal amount of money and that they have not been paying whatsoever. They told Ms Anonymous to bring all evidence as proof that money has been deducted from her account for tax and they had promised that no information regarding with her account would he linked to the owners of the company and had assured her that she did nothing wrong as they had called in her to query her about her tax number. Investigations continued as the tax investigators kept coming into the office to do Company Audits and since they had no financial and bank statements and how much is being charged from the workers it pin pointed that they have been not paying such as VAT and PAYE.

Things started to be little offish at work where they were all panicking and looking for fingers to point as they were not aware how and what had led SARS to come and audit the company with realising that SARS had chosen them themselves than rumour went out the Ms Anonymous had went to SARS. Later on they made false pay slips saying as he was paid more than she was being paid so that it will show as if she was the one who was not paying Tax but then Ms Anonymousness Payslips had proven all of that wrong.

A month later Ms Anonymous was called into the Bosses office and was told that due to financial constraints they will have let her go because they will not be able to afford and they will be giving her 3 months to look for her job and are willing to give her good recommendation.

TAXATION

The importance of paying tax

Nobody wants to pay tax which is highly understandable but that money is the only money raised through tax that the government relies on to produce public revenue to pay for public expenses that provide goods and services to the public. Without tax and people not paying it becomes difficult for the government to try meeting the basic needs of the country. Both the state and the local governments are imposed in collecting tax.

There are different types of taxes that need to be paid which are:

Income taxes

Payroll taxes

Sales taxes

Excise taxes

Wealth taxes

“Article I, Section 8, says: “The Congress shall have Power to lie
And collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the country”

Benefits and uses for tax

As mentioned above that tax pays for goods and services for the public such as:

Education

Public housing

Public welfare such as security

Unemployment benefits

Highways and public transportation

Health

Police

Fire protection

Tax also includes daily operating expenses of the government and also salaries of the government employees and also interest on debt owed by the government. It is highly important as the benefits of tax keep the country in place and running and also reaching out to the people who are unable to afford from themselves. The roads we walk and drive in everyday is because of the tax that is being paid, the public clinics and hospitals that help our people to get treatment and be attended to when they cannot afford when they are sick is because of tax and the list goes on but all in all it is beneficial for the country for tax to being paid.

Responsibilities of income tax payers

The income tax system is a voluntary act and compliance but it does not mean that tax payers can only pay tax when they want to or not pay tax when they also don’t want to. In other words everybody who is working must pay tax and in order foe people to comply with the legal responsibilities the tax law must be fair and firm.

When looking at being fair, the government must be fair enough as to the people paying tax wont resent him as the government and the leader of the country and also resent paying tax at the end of the day and making sure that everybody complies. When looking at being firm, people who don’t comply with this law and try to duck it must be punished and made seen that they are committing a criminal offence and should pay dearly for such action.

Penalties for Tax Fraud

In most cases people who don’t pay tax are due to carelessness or negligence or usually done intentionally and find ways to avoid paying tax which is seen as tax fraud and these people are faced with tax interest or tax penalties. Tax fraud is when people who avoid paying tax and are not honest to the government about their monthly/annually incomes so they can be taxed fairly with regards to how much they earn and they lie in-order to pay little tax which becomes unfair to the government and all other tax payers.

Tax fraud is a crime and people who commit such crime face high consequences close to about 75 percent financial penalties. There is no way of ducking and hiding from paying taxes because eventually everybody is caught just that it might not be now but when it comes to fraud and corruption someone always slacks up and leaves foot prints.

LABOUR RELATIONS ACT (LRA)

The labour relations act is the relationship between people who work and those who they work for. The labour relations act was reshaped and implemented to create a good and working-full environment in the workplace. To give an employer and a employee to work under good and fair principles knowing their rights and limitations and which lines not to cross. To protect the employee against the employer and to also protect the employer against the employee but in most cases employees are opening cases against their employers. it is hoped that democracy in the workplace will bring industrial stability, economic growth, and labour peace.

Dismissals of the Labour relations act

Chapter VIII of the LRA concerns unfair dismissals. Section 185 records that every employee has the right not to be unfairly dismissed. The term “dismissal” is examined in the section 186 and includes:

A termination effected by an employee with or without notice.

An employer’s failure to renew a fixed term contract when an employee has a reasonable expectation

Refusal of an employer to allow an employee to return to work after maternity leave.

Retrenchment

When retrenchment is introduced it is usually when a company is facing some financial difficulties and is done for the followings reasons, economic, structural or technical reasons and before retrenchment takes place a proper procedure needs to be taken in-order to allow for retrenctment which is as follows:

Consultation

Immediately when the employer has no other options but to apply retrenchment, he has to inform his employees buy holding up a mass meeting where everybody is present or he could hold individual meetings with the individuals who will be involved in the retrenchment.

Employees are allowed to interact with the employer and also suggest other alternative ways which could be looked into such as reducing working hours and also workings days, the appropriate method to be used for the people are to be dismissed. Minutes can be taken in this case as it would help for misunderstood situations and to protect both the employer and employees.

When consultation is taking place members of the trade unions can be present to protect their workers and all the commission for conciliation, Mediation and Arbitration (CCMA) can also be present to intervene in this matter.

Disclosing of information in writing

When complementing retrenchment the organisation or the employer should issue letters to the employees that will be affected because of retrenchment. The information should inform the employees of the pending and the dates of retrenchment, reasons why they will be intiating retrenchment, the servenrane pay that is proposed, the assistance of the employer with regards with interviews and assisting them in getting new employment if possible.

Should there be any misunderstanding or any disputes that could take place than the employer shall refer to the written information to clarify any mis-understandingand these disputes could be handled by the labour court or the Conciliation, Mediation and Arbitration (CCMA).

Opportunity for feedback

The employer should give employees the opportunity to give feedback with the proposed retrenchment that will take place, give them a chance to make presentations and whatever is said and presented must be taken inot consideration by the employer and try to negotiate as so all paryies are happy.

The last in 1st out rule should be applied when dealing with retrenchment as you can’t compare a person who has been working for a company for the past 3 years over a person who has been around the company for 2months. If the company is going through financial constraints and they wish to let go a few staff than they should consider the last recently employed staff.

CHAPTER 4
CHAPTER 5

Data collection

With the information gathered with regards to Miss Anonymouses case we can draw up the following checklist:

The company has been deducting tax from her salary

She received a monthly income

She enjoyed annual and sick leave, UIF and PAYE benefits

She has been working for the company for the past 3 years

She signed an employment contract of reinstatement in September 2009

There is no proof of her being registered by her employer under the Labour court

Data analysis

With the gathered information it shows that Miss Anonymouses was a full employee of the company which also makes her fall under the people who should be paying tax to the government every-month. Having a look at her payslip it clearly shows that money has been deducted for tax from her payslip and with her knowledge she has been paying for tax. Additional information has been found that she was has not been registered under the labour court meaning she can’t be taxed as they may not be aware of how much she gets paid which is would make it hard for the tax man to tax her properly. The company is at fault for using moneyof the employees for their own personal use and without their knowledge and this sot of behaviour does fall under fraud and corruption and is a crime.

She has been working for the company for over the past three years so if the company was going through any sort of financial problems and they saw using the retrenchment system as part of covering costs than they did not follow the proper procedures of dismissal, she was not even consulted properly or given a chance to discuss the matter and negotiate or think of other alternative ways to avoid such dismissal.

Re-solutions, suggestions

When referring to the case study, the best possible steps that could be taken here is that Ms Anonymous keeps all proof of her payments that she can represent to SARS, write each and every single thing said to her and if they is anything asked or told to ask for it in writing and signed for because in the country we live in anything is possible and to make life easy is having all proof and evidence just to be on the safe side.

With regards to unfair dismissal, she should take the matter to the CCMA and report the act of unfair dismissal because no proper procedures where taken so it is either they will have to compensate her even more or giver her, her job back if she is willing to take it back. Each and every employee has a right to be treated fairly in the working environment and legal action can be taken in situations like this.

CHAPTER 6
CONCLUSIONS

Fraud and corruption is everywhere and is triggered by greed of an individual and it reduces economic growth, quality of life and undermines government creditability and reduces effectiveness. The fight against them should be presented in a short period of time in order to fight corruption. Every federal department and agency should work together continuously. Audit and investigation s could find any corruption or fraud cases, but the most important thing is to define how to prevent and detect them at the earliest stage possible.