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1.Evaluate the needs of people with specific mental health problems and disabilities

2.Promote mental health care that is culturally and ethnically sensitive

3.Demonstrate knowledge and understanding of effective care provision for disabled people with mental health problems

4.Review provision for disabled people with mental health problems. 

Types of Community Mental Health Services

This essay explores community mental health services and the needs of learning disability and inpatient hospital services. Community mental health service is an organized community care system where patients are provided with mental illness services not necessarily in a specific facility or hospital. Community mental health services are as follows; psychiatric wards in general hospitals, Day centers/clubhouses, Local primary care medical services, Supported housing with partial or full supervision, community mental health centers, and Self-help groups for mental health. On the other hand, inpatient hospital service refers to the services provided by the hospital to the inpatients through the instruction of the professional health provider(s) with an objective of providing care and treatment. These services may include bed and boarding services/use of hospital facilities, medical social services, therapeutic services, and service of private duty nurse/attendance. These services are given to the patients depending on the extent of their health condition. Inpatients services, for instance, are given when a patient has been admitted for a period significant to their full or partial care. The essay focuses on these services to enlighten on whether they are helpful when administering care to the patients of mental health problem and learning disabilities. 


However, in service provision, mishandling of patients may be experienced as a result of therapist high demand denying them time to rest. The high cost of educating a therapist also may lead to therapists being few to attend the patients hence demand for the therapist poses big chances of mishandling the patients. In other circumstances, the therapist may find it difficult to deal with a client who may be difficult to handle as a result of the severe injury they might have experienced.

Psychiatric ward services with locked doors help nurses to control patients, provide secure and efficient care for patients, as well as protect nurses and patients against the outside. On the other hand, the limitation of these psychiatric is making nurses have extra work, patients feel confined in one place, feeling of dependence and forced to adjust to the needs of other patients. Nurses, in particular, get high control over the patients (Walsh and Boyle, 2009).Community mental health services are not limited to it and can also offer day centers, local primary care medical services, supported housing, community mental health centers, and self-help groups for mental health.

It is a mandatory requirement under the Equality Act (2010) that all nurses have an understanding of the needs of the people with learning disabilities for assurance of reasonable adjustments (Troiano, Liefeld and Trachtenberg, 2010, 40(2), pp.35-44).  The Nursing and Midwifery Council (NMC) 2014, developed standards that require that all pre-registering nursing students regardless of the specialization they are to choose to be able to understand the needs of this vulnerable group.  

Challenges in Service Provision

There are needs associated with the people with mental health problems and /or learning disability and these are communication need, health needs, capacity and self-consent, reasonable adjustments, need for independence and inclusion, need to express distress, need for health promotion, need for medication, working with families and lifespan.

Communication in terms of how people with learning disability express themselves and digest information is a need the nurses to should engage in. learning disabilities individuals have difficulties communicating as a result of how they understand the information and communicate it. Communication in terms of gestures, signs, symbols, objects, should be taken into considerations as learning disabilities have problems with language, speech, communication and sensory impairments. Families are the important bridges between health professionals in advising on how the patients communicate. Community learning disabilities are also very useful as they have speech and language therapist and professionals who understand how they communicate with learning disabilities (Creek and Lougher, 2011). 


Disability living allowances (DLA) is a service that should be provided if the person has needed daily help from other people for a period of three months and should be maintained for the next six months (Beatty, Fothergill, and Platts-Fowler, 2009). This service is available for working adults and children needing help with personal care because of physically or mentally disabled (Corden et al. (2010).  Attendance allowance is also another service for the disabled age over 65 years people and should be provided when a person has been needing help for six months. The two services are to be effected without affecting those salaried and those not. Healthcare professionals providing the service must be able to accompany a written document explaining the extent of disability and the need for assistance. For a customer to access this service they need to do the following; creating awareness of the reason for the service, access the service, apply for the benefit, allow an assessment of eligibility then an award of the benefit is given or rejected (Corden et al. 2010). If rejected the customer may have a chance to appeal the process. Mental health condition individuals require these services because they are prone to self-harm, panic attacks, hearing voices, anxiety, paranoia and they need someone around them.   

Creation of Good web-based information with individual services for younger audience and development of child-friendly sites to help them increase their knowledge which they are unlikely to hear from the adult such as their parents and cares is advisable (Schieve et al. 2012 pp.467-476). So the communication in these websites should be reflective of their needs and services of the transition from childhood to adulthood (Burns et al. 2010, p.S22).

Meeting the Needs of People with Learning Disabilities

Health needs. People with disability prematurely die before their counterparts’ population. People dying from multiple disabilities die of deaths that could have been avoided with quality healthcare. Certain cancers, CHD, and respiratory diseases are the main cause of these deaths (Heslop et al. 2014, 383(9920), pp.889-895).  Nurses will be accountable for the provision of compassion, and effective care and treatment to people with these special needs (Thomas et al. 2010, 67(6), pp.614-623).

There is a need for adjustments to enable people with disability to access healthcare. These would include even physical adjustments, and adaptation adjustments to help persons with learning disabilities to understand and engage in their health care (Edwards and Elwyn, 2009).  Nurses should be aware of the laws covering this area, reflect on their own attitude beliefs and practices of working with the people with learning disabilities as well as identify areas where such user-friendly and resources can be found. Nurses also need to collaborate with the community learning disability teams to work as a unit in improving health in hospitals.

Need for medication. Learning disabilities are likely to be diagnosed with several medications due to the likelihood of developing other complications. They need additional medication to deal with this other complication they develop compared to non-learning disabilities. However, precaution must be taken to avoid overmedication to people with learning disabilities. 


In promoting mental and healthcare that is culturally and ethnically sensitive it should be noted that cultural competency is unavoidable for professionals dealing people of diverse cultures and the following need to be done; adherence to good practices when providing the service. It is a personalized service which includes giving individuals more choices and control on what service they access and how they access it (Walker, and Sonn, 2010, pp.157-180).  It also includes the provision of flexibility in the coordination of support tailored to the needs of the individual. In the health context, this can be done through the introduction of persona budget to some individuals with mental health conditions (Rathod et al. 2010).

The other practice is user involvement and consultation in design which is critical as it ensures that the communication channels are able to meet people with mental and /or learning disabilities needs. A good example of a design that has been done through consultation includes Mencap and young active people (YAP) currently (young.Mencap) and it is meeting communication needs of the users.  Allen, 2007, states that this consultation must share the design of communication and not result to be a tokenistic (Bernal, Jiménez-Chafey, and Domenech Rodríguez, 2009, p.361).

Ensuring Culturally and Ethnically Sensitive Healthcare

Community health care providers and hospital professionals should use a range of other communication channels because individuals’ health conditions are not the same, they have a different preference, learning disabilities are different, and differences in their ages also prevail. Continuous of handling case where the need arises to enable staff build closeness with the users. Capturing and passing of information is encouraged where the case needs to be referred to another colleague with communication needs which have been disclosed (Gaddes, 2013).

Several measures are to be chosen in the provision of effective care to mentally disabled individuals in the following ways: Use of videos and pictures and DVDs interactive will help in the facilitation of communication between and ability to remember for customers with the inability for comprehends text-based communication. Community health service providers and hospital professionals should use Interactive DVDs to help the customer to use them in their own time, with their own pace of preference (Bernal, Jiménez-Chafey, and Domenech Rodríguez, 2009, p.361). 


Community healthcare service helps people more than inpatient hospital service to maintain family relationships, friendship, jobs as they undergo treatment rather than when they remain in an institution. Mentally disabled people are likely to live more fulfilling lives in their communities than when they are in the hospital facilities all through.

The provision for the disabled people with mental health problems is as important as treating them. In order to do it first a diagnosis is needed. This means a psychiatrist will have to carry a mental health diagnosis assisted by other professional healthcare providers. It is however difficult to meet definite diagnosis of mental health disorder due to lack of physical test. Instead medical history and a collection of lists of symptoms are done to make diagnosis for mentally disabled. In this case a doctor is required to be contacted where unlikely behavior has been noticed to help create a mental health care plan for the person thought to be infected (Büttner  and Hasselhorn, 2011).

There is also a need of confidentiality in order to protect patients care needs by consulting with the person you care about to share the care needs as early as possible after the diagnosis has been done so that as documentation or care plan is done they will be contented with it (Heslop et al., 2014). However they should not deter you from finding better ways to help them improve their condition.  

Effective Care for Mentally Disabled Individuals

The establishment of the need will also be required to be done by talking to the person you care about to let them know what you want to do to them and what you don’t want to do as a healthcare provider (Shakespeare, Iezzoni and Groce  2009.

Close scrutiny of behavior by paying close attention to what they say, feel, plan or about to do by how they express themselves is important rather than dismissing what they say. This will help to learn suicidal feeling, hatred to life, feeling of isolation or loneliness, and pointlessness of life from them. If you notice this behavior, take an immediate action to finding assistance from known community mental health team or call emergency numbers to get assistance.

Conclusion

Community mental health service has been an alternative bridge to dealing with the mental health issues by boosting the service where otherwise patient would remain in the hospital for a long time. There has also a connection between mental disabled to their families, maintenance of friendship. Inpatient hospital services have the limitation of separating people with their loved one which would raise stigmatization and loneliness even higher making it difficult for the patients to heal faster even though there are counseling therapy services are offered in the hospital. An agreed and understandable definition of cultural competence has not been found and no evidence exists to help clearly understand culturally and ethically sensitive mental health care.

Culturally and ethnically sensitive care poses challenges and may require nurses learning time to time again to understand a diverse cultural phenomenon which is also determined by race, economic status, social status, religious practices, values, and beliefs. Nurses have greater challenges between sticking to their professional qualification skills and choosing to adhere to the cultural beliefs when offering services to the learning disabilities. However, there is a need of ensuring that all culturally sensitive and ethically acceptable care services are adhered to in order to avoid conflicts that may arise from psychiatric wards in general hospitals individuals with a certain set of beliefs concerning their decision of care they receive. 

References

Beatty, C., Fothergill, S. and Platts-Fowler, D., 2009. DLA Claimants, a New Assessment: The Characteristics and Aspirations of the Incapacity Benefit Claimants who Receive Disability Living Allowance (No. 585). Department for Work and Pensions.

Bernal, G., Jiménez-Chafey, M.I. and Domenech Rodríguez, M.M., 2009. Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice, 40(4), p.361.

Burns, J.M., Davenport, T.A., Durkin, L.A., Luscombe, G.M. and Hickie, I.B., 2010. The internet as a setting for mental health service utilisation by young people.Medical Journal of Australia, 192(11), p.S22.

Büttner, G. and Hasselhorn, M., 2011. Learning disabilities: Debates on definitions, causes, subtypes, and responses. International Journal of Disability, Development and Education, 58(1), pp.75-87.

Corden, A., Sainsbury, R., Irvine, A. and Clarke, S., 2010. The impact of Disability Living Allowance and Attendance Allowance: Findings from exploratory qualitative research.

Creek, J. and Lougher, L., 2011. Occupational therapy and mental health.Elsevier Health Sciences.

Edwards, A. and Elwyn, G. eds., 2009. Shared decision-making in health care: Achieving evidence-based patient choice. Oxford University Press.

Gaddes, W.H., 2013. Learning disabilities and brain function: A neuropsychological approach. Springer Science & Business Media.

Heslop, P., Blair, P.S., Fleming, P., Hoghton, M., Marriott, A. and Russ, L., 2014. The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. The Lancet, 383(9920), pp.889-895.

Rathod, S.,Kingdon, D., Phiri, P. and Gobbi, M., 2010.Developing culturally sensitive cognitive behaviour therapy for psychosis for ethnic minority patients by exploration and incorporation of service users' and health professionals' views and opinions.Behavioural and cognitive psychotherapy, 38(5), pp.511-533.

Shakespeare, T., Iezzoni, L.I. and Groce, N.E., 2009. Disability and the training of health professionals. The Lancet, 374(9704), pp.1815-1816.

Schieve, L.A., Gonzalez, V., Boulet, S.L., Visser, S.N., Rice, C.E., Braun, K.V.N. and Boyle, C.A., 2012. Concurrent medical conditions and health care use and needs among children with learning and behavioral developmental disabilities, National Health Interview Survey, 2006–2010. Research in developmental disabilities, 33(2), pp.467-476.

Thomas, J.L., Wilk, J.E., Riviere, L.A., McGurk, D., Castro, C.A. and Hoge, C.W., 2010.Prevalence of mental health problems and functional impairment among active component and National Guard soldiers 3 and 12 months following combat in Iraq.Archives of general psychiatry, 67(6), pp.614-623.

Troiano, P.F., Liefeld, J.A. and Trachtenberg, J.V., 2010. Academic support and college success for postsecondary students with learning disabilities.Journal of College Reading and Learning, 40(2), pp.35-44.

Walker, R. and Sonn, C., 2010. Working as a culturally competent mental health practitioner.Working together: Aboriginal and Torres Strait Islander health and wellbeing principles and practice, pp.157-180.

Walsh, J. and Boyle, J., 2009. Improving acute psychiatric hospital services according to inpatient experiences.A user-led piece of research as a means to empowerment.Issues in mental health nursing, 30(1), pp.31-38

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