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Prevalence of Mental Health Issues

Mental and behavioural issues are perhaps the leading causes of disability globally. Impairment in individuals aged 20-29 causing mental health issues accounts for over 40 million individuals yearly. In England(Mental Health Foundation, 2021; NHS, 2016), one in every six persons mentions having a frequent psychiatric condition at some point throughout the week. Mixed anxiety in association with depression seems to be the most common mental ailment throughout the United Kingdom (UK), having 7.8% of individuals matching diagnostic standards. In England, 4-10% of individuals would suffer from depression at some point in their lives (Mental Health Foundation, 2021; NHS, 2016). Anxiety in association with depression is a frequent mental health problem, which is dispersed throughout society, as per a spectrum of financial hardship. A combination of anxiety along depression is thought to be prevalent for 1/5thof all days missed at a job throughout the UK (Mental Health Foundation, 2021).

Service user engagement is an individual having lived experience with psychological anguish actively participating in the development of their healthcare plan, depending on the level of understanding of what works for individuals. Incorporating service consumers might cause more affordable and appropriate health services, along with higher-quality, as well as medically significant health research, including improved acceptance of results (Fawcett et al., 2017). User participation has also been linked to beneficial clinical outcomes, including greater self-esteem, confidence, and also therapeutic advantages from enhanced social engagement.

According to Millar, Chambers, and Giles (2016, p. 210), this is design's method allowed it to be "referred to, conveyed, identified, and recognised to others." The service user participation seems to be "a collective name for different ways intended at including service users inside the development of psychological systems in particular" as well as "a collective word for various approaches intended at engaging service users throughout the management of psychological treatments in the first place" (Millar, Chambers, and Giles 2016, p. 216). Moreover, according to the current psychological health concept, service user involvement could be defined as in the formulation, implementation, as well as assessment of the mental health legislation, programs, training, education, along with investigation, active cooperation between service users with mental health experts. Collaboration takes a person-centred approach, including the bidirectional flow of information, delegation of authority, as well as the capacity for advocating at the individual, provider, and/or society levels (Beresford and Carr 2012).

Boardman and Dave (2020) stated person-centred approaches within healthcare have a long history throughout the healthcare practice, also have traditionally been a feature of both the Eastern as well as Western medical systems. Psychiatry is essentially person-centred and takes a biopsychosocial approach. As per the Health Foundation, (2016) utilising person-centred service into "business as usual" necessitates significant modifications as far as how therapies are given, as well as responsibilities played by patients and healthcare experts, along with interactions among patient populations, medical professionals, and organizations. There seems to be no one agreed-upon meaning of the phrase "person-centred care" that seems to be described describe a wide range of ideas along with activities. This is mainly because person-centred care is indeed a new and developing field. It may be since, if treatment has to be person-centred, what that appears like would be measured by the person’s needs, situations, and choices. What is important to one individual regarding health care could be unnecessary or even dangerous to the other (Health Foundation, 2016). This might also modify with time as needs of the person’s development. Instead of offering a succinct yet unavoidably restricted description, the Health Foundation has developed a framework based on four tenets of person-centred treatment: 1. assisting an individual in identifying and creating their talents as well as capabilities to have a self-sufficient with a meaningful life, 2. providing individualised attention, assistance, or treatment, 3. offering a uniform and coordinated method to serve, assists, or care, and 4. Enabling a person to have cared with compassion, decency with respect (Day 2013). This person-centred care is closely associated with service user involvement. Since the core concept of person-centred care is the ability and taking part in their own healthcare setting, it becomes an extremely crucial concept of the service user involvement. The main concepts of service user involvement are also to incorporate the user or the patient into the service or care management (Day 2013). This implies that in a service user involvement, a patient needs to have cared with a person-centred approach, where their decision will be valued and they will take part in their treatment plan. This involvement requires increased cooperation and collaboration with the healthcare professional, patient and family members. Hence, such an approach will lead to better patient satisfaction, and the feeling is being cared for, which will bring positive outcomes (Day 2013).

Benefits of Service User Involvement

The White Paper is a crucial way to accomplish the goal of assisting everyone in living healthier and more satisfying life for longer. In January, the Department of Health and Social Care as well as the Ministry of Justice released Reforming the Mental Health Act, a White Paper that reacts to Professor Sir Simon Wessely's 2018 Independent Assessment of the Act. It is the foundation of our strategy to reform mental health laws. This White Paper lays out the recommendations for comprehensive legislative reform integration along with innovation: collaborating to enhance health as well as social care for every agenda; building on the government's dedication to passing legislation that gives people more regulation over the situation and ensures they care with dignity along with respect. It also advances the aim to enhance the legal treatment of persons with learning disabilities and autistic individuals, reducing the demand for specialised inpatient programmes for such groups (Department of Health and Social Care 2021).

The Mental Health Act seems to be the principal, which controls the evaluation, treatment, and protection of those affected from psychological illnesses. Individuals detained as per the Mental Health Law require quick assistance for a psychological illness, also, are still at risk of hurting themselves or/and others. A Mental Health Act has been intended to enable healthcare workers the authority to hold, evaluate, and treat persons having mental problems for the sake of their safety and health, as well as community security, under specific circumstances (Gray 2021).

Social and healthcare professionals coordinate with a person who uses services within a person-centred caring. Service user involvement assists individuals to acquire the ability, skills, as well as courage individuals require to better understand how to make knowledgeable decisions regarding their well-being as well as well-being (Thomas, Pollard, and Sellman 2014).  This is well-coordinated as well as modified to the individual's needs, as well as, moreover, it guarantees that persons are cared for with decency, empathy, along dignity at all times. It might seem to be a basic logical way to healthcare; however, it is not in the conventional practice. Healthcare commonly does things "to" or/and "for" individuals instead of "with" individuals, found it so hard to incorporate individual in decision-making as well as primarily sees individual’s objectives in respect of particular treatment outcomes (Health Foundation, 2016). Boardman and Dave, (2020) mention mental health care have a long tradition of being chastised for focusing on disorder classifications and divisions, which are perceived as dehumanising individuals and designating them as deviants while disregarding essential components of subjective cultural, ethnic, social, and trauma situations. Throughout the UK, independent care quality evaluations show that the power gap among patients and professionals persists, with just 60% of individuals stating that they are certainly engaged in decisions affecting their care. Therefore, the government needs to be more open to involving the patient in their decision makings.

Mental health can be defined as a condition of well-being wherein an individual understands their potential, could cope with normal life challenges, job creatively along with meaningfully, as well as contribute to their society (Glasby and Dickinson 2014).

Person-Centered Care and Service User Involvement

The Mental Capacity Act (MCA) seems to be focused to safeguard as well as empowering individuals who might just lack the capability to make choices regarding their healthcare. It pertains to those individuals who are aged 16 or older. It has daily choices like what to wear or what to purchase for the food groceries, along with important life-altering choices including if to go into the treatment centre or have a certain operation. Moreover, just because an individual has one of these medical problems does not mean they are not capable to make a specific choice. One could be not able to make certain decisions while yet being capable of making others (Marshall and Sprung 2017). MCA states 1. Unless otherwise shown, assuming an individual can make their own decisions, 2. As much as possible, one needs to assist individuals in making their choices, 3. Not dismissing an individual’s decision-making capabilities due to them making a bad judgement, 4. If workers choose on behalf of somebody who does not have abilities, workers should do it in their best interests, and 5. Caring and treating someone who does not have abilities must be as unrestrictive as feasible regarding their basic freedoms (Marshall and Sprung 2017). The MCA is important for the proper implementation of the service user involvement. The MCA's main goal is to encourage and protect decision-making inside a legislative structure; with the help of enabling people to make choices independently for themselves when feasible. As a result, it can be stated that this MCA act provides the user legal authority to make their decision in their treatment plan. Hence, the MCA act provides supports to the concept of service user involvement. Moreover, according to this MCA act, it is important to safeguard those who lack the ability to make correct choices. MCA offers a necessary flexible framework, which puts individuals at the centre of a decision-making system. The MCA renders it a particular criminal crime to ill-treat and deliberately ignore persons in the care who does not have the ability to make a proper judgment (Marshall and Sprung 2017). Hence, it can be stated that one of the main purposes of the MCA is to benefit the patient from the service user involvement.

Andermann (2016) mention certain sections of the community, especially those with less influence and economically disadvantaged position, work and live in more deteriorated settings and are much more exposed to disease potential risks including the physiological effects of extreme stress. Individuals who are impoverished and less skilled have had more health issues and die younger than someone affluent and more knowledgeable, according to studies from throughout the world, and these discrepancies occur even in richer nations (Keeling et al. 2013). According to the NHS England, (2017) nearly 40% of people’s desire to be more engaged in choices about their healthcare, according to national polls, and this trend hasn't altered in a year. Likewise, 40% of persons suffering from long-term illnesses desire greater help managing their healthcare in a day-to-day manner. Therefore, discrimination against the poorer community is common. They do not get enough opportunities to take part in their own decision making regarding their healthcare. As a result, such social inequality against poorer communities can create a barrier to accessible and affordable mental health care.

The Four Tenets of Person-Centered Care

Lawn (2015) mention more efficient collaborations of care among service users, caregivers, as well as workers; deeper grasp of the feeling of psychological illness for patients along with families by the service providers; highly specified assistance depending on the focused necessities; increased awareness of the efficacy of individual practices; and higher service user empowerment, self-belief, and sensation of being valued, all of which ultimately led to higher living standards, are the benefits of service user engagement.  Participation of service users is encouraged in health care through collective decision-making as well as self-management. Moreover, the importance of knowledge and skill is emphasised differently in these approaches.

Abayneh et al. (2017) mention involvement of service users along with caregivers has the power to enhance the psychological health system by increasing acceptance, significance, appropriateness, as well as efficiency of treatment, as well as better service quality, with more favourable feelings among service providers. According to this study, Abayneh et al. (2017) mention increased appropriateness along with the quality of care, as well as increased protection against maltreatment and encouragement of compassion for patients was recognised as potential advantages. Hence, it can be stated that service user involvement has the potential to lower the rate of discrimination, improve health literacy, and establish a better therapeutic relationship with the patient. Moreover, proper respect and dignity will help to improve the autonomy of the patient and higher rates of social inclusion.

Additionally, mentally ill individuals are often stigmatized. Therefore, their decision making capability and self-esteem can be hindered. Therefore, according to the service user involvement model, if they are allowed to take part in their own healthcare decision, they might develop a lower level of stigma and a greater level of self-esteem. According to a clinical trial study, Kohrt et al., (2021) mention patient engagement in the care process can significantly reduce the level of stigma in an individual. Moreover, according to Lawn, (2015) personally focused cooperative, respectful engagement of psychological healthcare service users within care choices in their interpersonal contacts with service providers as well as systems may be defined as involvement in psychological health. However, it may also refer to an individual’s acceptance of the fact that they have a mental disorder and their willingness to seek or/and accept help. This could also include serving as social workers as well as advocates for law and policy reform at the sector and system levels.

According to Semrau et al. (2016) despite indicators of the service user as well as caretaker participation in psychiatric healthcare system development in several countries including the UK, there used to be a shortage of high-quality studies along with insufficient evidence foundation for the activity, which was being done. The majority of the studies focused on service user as well as caregiver participation in a service level instead of in the system level, as well as frequently included service users as study participants in service evaluations instead of in the specific creation of policies or/and services, healthcare expert training within mental health service, as well as mental health investigations. There were relatively few studies, which analysed the engagement of service users. Moreover, several of the findings measured had no direct and clear relationship to the performance of service user participation on mental healthcare system bolstering, especially concerning the impacts of user or care provider participation on service users or carers themselves, or the effects of their involvement upon service users or carers.

The White Paper on Reforming the Mental Health Act

Lawn (2015) mention a variety of impediments towards service user involvement was found. There is a dearth of information available to them, while improved health literacy will allow them to make more educated decisions. Healthcare professionals and agencies believe that involving service users would be a more costly investment and as such the systems for delivering care are inherently tokenistic. Issues concerning the representation of service users in groups were used as a rationale to prevent user participation. There were also dual standards: individuals who spoke controversial things may be dismissed, dismissed because non-representative or perhaps regarded as a service user as ill. Conflicts in service were also evident, particularly in the case of mandatory therapy; the feeling that as healthcare workers, "we know best," as well as a dearth of recognition by employees of users' "expertise."

A review of the publications turned up multiple examples from throughout the world of promoting initiatives with groups that included service users, including families, or carers, especially in advocacy as well as empowering activities (Semrau et al. 2016). Therefore, the healthcare provider needs to arrange for a workshop, where these people can openly interact with each other. This will help them to develop a better understanding of their condition and will help to boost their confidence. Moreover, such a workshop will help to improve the health literacy of the patients.

Mental health advocates have emphasised the necessity of having a holistic strategy that includes not just service consumers, but also carers, the greater community, including decision-makers, as well as consideration of the socio-cultural environment. While planning interventions, it also is crucial to consider the overall perspective of the service user engagement. For instance, interventions must assess whether existing service access rights with relevant skills and experience could be used for future engagement, or whether enablement or the formation of novel service user cohorts is required (Semrau et al. 2016).

Conclusion

The prevalence of mental health issues is now increasing in the world as well as in the UK. As a result, to improve the mental health service proper implementation of service user involvement is important. Such an approach can improve the decision-making ability, and boost the confidence of the patient. However, there is not so much evidence-based research has been done in this field, which will help to properly implement this method.

References

Abayneh, S., Lempp, H., Alem, A., Alemayehu, D., Eshetu, T., Lund, C., Semrau, M., Thornicroft, G. and Hanlon, C., (2017). Service user involvement in mental health system strengthening in a rural African setting: qualitative study. BMC psychiatry, 17(1), pp.1-14.

Andermann, A., (2016). Taking action on the social determinants of health in clinical practice: a framework for health professionals. Cmaj, 188(17-18), pp.E474-E483.

Beresford, P. and Carr, S., (2012). 2012. Social care, service users and user involvement. Jessica Kingsley Publishers.

Boardman, J. and Dave, S., (2020). Person-centred care and psychiatry: some key perspectives. BJPsych International, 17(3), pp.65-68.

Day, J. (2013). Interprofessional working: an essential guide for health-and social-care professionals. Australia: Cengage Learning.

Department of Health and Social Care, (2021). Integration and innovation: working together to improve health and social care for all.

Fawcett, B., Fillingham, J. and Ward, N., (2017). Service user and carer involvement in health and social care: A retrospective and prospective analysis. Macmillan International Higher Education.

Glasby, J. and Dickinson, H., (2014). Partnership working in health and social care: what is integrated care and how can we deliver it?. Policy Press.

Gray, J., (2021). Reform of the Mental Health Act in the UK. The Lancet Psychiatry, 8(8), pp.652-653.

Health Foundation, (2016). Person-centred care made simple What everyone should know about person-centred care. [online] Health Foundation. Available at: <https://www.health.org.uk/sites/default/files/PersonCentredCareMadeSimple.pdf> [Accessed 26 December 2021].

Keeling, J., Chapman, H.M. and Williams, J., (2013). How To Write Well: A Guide For Health And Social Care Students: A Guide for Health and Social Care Students. McGraw-Hill Education (UK).

Kohrt, B.A., Jordans, M.J., Turner, E.L., Rai, S., Gurung, D., Dhakal, M., Bhardwaj, A., Lamichhane, J., Singla, D.R., Lund, C. and Patel, V., (2021). Collaboration with people with lived experience of mental illness to reduce stigma and improve primary care services: a pilot cluster randomized clinical trial. JAMA network open, 4(11), pp.e2131475-e2131475.

Lawn, S., (2015). Integrating service user participation in mental health care: what will it take?. International journal of integrated care, 15.

Marshall, H. and Sprung, S., (2017). The Mental Capacity Act:‘Best interests’—a review of the literature. British journal of community nursing, 22(8), pp.384-390.

Mental Health Foundation, (2021). Mental health statistics: the most common mental health problems. [online] Mental Health Foundation. Available at: <https://www.mentalhealth.org.uk/statistics/mental-health-statistics-most-common-mental-health-problems> [Accessed 26 December 2021].

Millar, S.L., Chambers, M. and Giles, M., (2016). Service user involvement in mental health care: an evolutionary concept analysis. Health Expectations, 19(2), pp.209-221.

NHS England, (2017). Involving people in their own health and care Statutory guidance for clinical commissioning groups and NHS England. [online] NHS England. Available at: <https://www.england.nhs.uk/wp-content/uploads/2017/04/ppp-involving-people-health-care-guidance.pdf> [Accessed 26 December 2021].

NHS, (2016). Mental Health and Wellbeing in England Adult Psychiatric Morbidity Survey 2014. [online] NHS. Available at: <https://webarchive.nationalarchives.gov.uk/ukgwa/20171010183932tf_/https://content.digital.nhs.uk/catalogue/PUB21748/apms-2014-full-rpt.pdf> [Accessed 26 December 2021].

Semrau, M., Lempp, H., Keynejad, R., Evans-Lacko, S., Mugisha, J., Raja, S., Lamichhane, J., Alem, A., Thornicroft, G. and Hanlon, C., (2016). Service user and caregiver involvement in mental health system strengthening in low-and middle-income countries: systematic review. BMC health services research, 16(1), pp.1-18.

Thomas, J., Pollard, K. and Sellman, D. eds., (2014). Interprofessional working in health and social care: Professional perspectives. Macmillan International Higher Education.

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