Critique of Research Article Essay Essay Example for Free

Critique of Research Article Essay Essay The purpose of this essay is to recognize specific aspects of the clinical nursing research paper done by Carlee Lehna and Jack McNeil. I will define and discuss these aspects. In clinical research articles there are literature reviews that give background information as to the problem and research that was performed in the study, and why this problem needed to be studied (Burnes Grove, 2011). The literature review in this particular study explains to the reader about the contrast in health literacy of English speaking only parents and Spanish speaking only parents and what tools the researchers used to measure the parents’ health literacy of their child’s health care. The review was very thorough and understandable. The authors named a couple of different tools and how those tools measured literacy. They also explain why they chose the Test of Functional Health Literacy in Adults tool (TOFHLA), it was the only test that was available in English and Spanish. After reading another article there is another test called Newest Vital Sign. This test is also in English and Spanish takes less time and has only six questions. (Cornett, 2009). Using one test to measure their healt literacy is a limitation. The problem statement helps the reader identify the dilemma for the target population in the research and why it needs further exploration. Burns McNeil discuss that the lower health literacy of the parents the poorer outcomes of their children (Lehna McNeil, 2008). The purpose of this study is to measure the difference in health literacy in two groups of different language speaking parents, i. e. English and Spanish (Lehna McNeil, 2008). The relationship between the problem statement and purpose statement is that the purpose statement is the how the authors are going to find the fix for the problem. The problem statement in this article very clear that the low health literacy is directly related to poor outcomes. The purpose statement is concise and easy to comprehend. In the Lehna McNeil article, the word purpose is mentioned several times and it may make it harder for the reader to decipher the purpose statement, this is a limitation. Target population is a larger total sample group that meets a criteria (Burnes Grove, 2011). Sample is the particular group that participated in the study (Burnes Grove, 2011). The target group in this particular study meet the criteria of parents/caregivers that either only speak English or Spanish and that their children were treated at Shriners Hospital for Children in Galveston, Texas. The sample group is much smaller, they meet the criteria and participated in the tests, interviews and focus groups. These different ways that the researchers used to gather information is a strength. Two of the limitations with the sample is that they only studied parents from one hospital and the authors just specified the language as Spanish, there are many different dialects in those Spanish speaking countries that some information could be lost in translation. The five parts of the study were very easy to recognize. By dissecting this study it helped me identify and learn those 5 parts. I feel a bit more comfortable in reading research papers. This research study was very interesting because I can relate to the difficulty with trying to explain health issues with Spanish speaking families. References Burnes, N. , Grove, S. K. (2011). Understanding Nursing Research: Building an Evidence-Based Practice (5th Ed. ). Maryland Heights, MO: Elsevier. Cornett, S. (2009, Sept 30). Assessing and Addressing Health Literacy. The Online Journal of Issues in Nursing, 14. http://dx. doi. org/10. 3912/OJIN. Vol14No03Man02 Lehna, C. , McNeil, J. (2008, April 2). Mixed-Method Exploration of Parents’ Health Understanding. Clinical Nursing Research, http://cnr. sagepub. com/

The Inequalities In UK Mental Health

The Inequalities In UK Mental Health Introduction and definitions: The World Health Organization (WHO) has defined the mental health as: à ¯Ã‚ ¿Ã‚ ½A 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 communityà ¯Ã‚ ¿Ã‚ ½ (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 (2). 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 medical 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 the present of a true mental illness but it is possible to expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be a 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 (3) The table below gives examples of those factors that promote or reduce opportunities for sound mental health (4): PROTECTIVE FACTORS INTERNAL EXTERNAL à ¯Ã‚ ¿Ã‚ ½ Good physical health à ¯Ã‚ ¿Ã‚ ½ High self esteem à ¯Ã‚ ¿Ã‚ ½ Learning ability à ¯Ã‚ ¿Ã‚ ½ Good conflict management à ¯Ã‚ ¿Ã‚ ½ early and positive bonding and attachment experience à ¯Ã‚ ¿Ã‚ ½ make relationships and ability to maintain or break them à ¯Ã‚ ¿Ã‚ ½ acceptance feeling à ¯Ã‚ ¿Ã‚ ½ good communication skills à ¯Ã‚ ¿Ã‚ ½ Availability of the basic needs such as shelter and food, à ¯Ã‚ ¿Ã‚ ½ validation by the community à ¯Ã‚ ¿Ã‚ ½ support from surrounding social network à ¯Ã‚ ¿Ã‚ ½ present of role models à ¯Ã‚ ¿Ã‚ ½ job security à ¯Ã‚ ¿Ã‚ ½ good education level à ¯Ã‚ ¿Ã‚ ½ feeling secure à ¯Ã‚ ¿Ã‚ ½ political stability VULNERABILITY FACTORS INTERNAL EXTERNAL à ¯Ã‚ ¿Ã‚ ½ congenital diseases or disability à ¯Ã‚ ¿Ã‚ ½ low self-esteem or social status à ¯Ã‚ ¿Ã‚ ½ sexuality problems à ¯Ã‚ ¿Ã‚ ½ relationships problems à ¯Ã‚ ¿Ã‚ ½ feeling of isolation à ¯Ã‚ ¿Ã‚ ½ institutionalisation à ¯Ã‚ ¿Ã‚ ½ lack of essential needs food , heat , housing .. à ¯Ã‚ ¿Ã‚ ½ loss and separation experience à ¯Ã‚ ¿Ã‚ ½ violence or abuse experience à ¯Ã‚ ¿Ã‚ ½ substance abuse à ¯Ã‚ ¿Ã‚ ½ psychiatric disorder runs in family à ¯Ã‚ ¿Ã‚ ½ discrimination à ¯Ã‚ ¿Ã‚ ½ unemployment peer pressure à ¯Ã‚ ¿Ã‚ ½ pressure from value systems à ¯Ã‚ ¿Ã‚ ½ poverty Table 1: factors that affect good mental health What is the evidence on mental health inequalities? Socio-economic status: Many Community-based epidemiological studies showed an inverse relationship between Socio-economic status and rates of schizophrenia. Saraceno found that the current prevalence (calculated up to one-year prevalence) of the schizophrenia among low-SES is higher than people of high-SES with a ratio of 3.4, and when calculated to lifetime prevalence it is 2.4à ¯Ã‚ ¿Ã‚ ½ (5), and in Britain, suicides rates among people from lower SES nearly double that of high-SES (6). There are five hypotheses to explain this relation (7)(8): 1: Economic stress. The mental illness is a speci?c outcome of the stress related to economic problems, such as unemployment, poverty, and housing unaffordability. 2: Family fragmentation. The inverse SESà ¯Ã‚ ¿Ã‚ ½mental illness correlation is a function of the fragmentation of family structure and lack of family supports. 3: Geographic drift. Individuals movement from communities of subsequent to their initial hospitalization leads to inverse SESà ¯Ã‚ ¿Ã‚ ½mental illness correlation (8). 4: Socioeconomic drift. Low employment rate related to initial hospitalization of lower SES communities. 5: Intergenerational drift. Can be explained as following à ¯Ã‚ ¿Ã‚ ½The inverse SESà ¯Ã‚ ¿Ã‚ ½mental 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 18à ¯Ã‚ ¿Ã‚ ½ (8) Age: à ¯Ã‚ ¿Ã‚ ½ In elderly: In a report for NIMHE (National Institute for Mental Health in England) (9 cited by 21) .the following point regarding mental health problems in elderly has been noticed: à ¯Ã‚ ¿Ã‚ ½ The number of older people with symptoms of mental problems in the UK is about 3 millions. à ¯Ã‚ ¿Ã‚ ½ 10-15% of older people could be diagnosed by depression when applying the approved clinical criteria. à ¯Ã‚ ¿Ã‚ ½ About 5% of people aged over 65 and 20% over 80 are affected by dementia à ¯Ã‚ ¿Ã‚ ½ The economic cost of dementia in elderly is about à ¯Ã‚ ¿Ã‚ ½4.3 billion per year , this is more than the cost for heart disease ,stroke, cancer combined à ¯Ã‚ ¿Ã‚ ½ the above numbers are expected to rise by a third in the next 15 years Mental health problems in elderly are more likely to go undiagnosed. Even where they are recognized, they are often poorly managed (10). The UK inquiry into mental health in later life (11) listed five factors that affect the mental health of elderly: relationships; contribution in meaningful activity; physical health (capacity to do everyday tasks); discrimination (by age or culture); and poverty. à ¯Ã‚ ¿Ã‚ ½ in children : WHO states that the building an effective mental health policy for child and adolescent requires first deep understanding of mental health problems among children and adolescentsà ¯Ã‚ ¿Ã‚ ½(12) 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 3à ¯Ã‚ ¿Ã‚ ½6 per cent of people under 16 years of age (13,14). Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (15). Gender: à ¯Ã‚ ¿Ã‚ ½ Women and Mental Health It is proved that mental health problems are more common among women than men with a higher incidence rates of depressive disorder than men (16). There are many factors to explain this, first: Socio-economic problems such as poor housing conditions and poverty 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 neighborhoods cause stress and anxiety amongst women , another common problem is addiction on prescription medications (for depressive and sleeping disorders) leads to more stress and anxiety. (16). à ¯Ã‚ ¿Ã‚ ½ Men and Mental Health In today world Men tend to be more susceptible to mental health problems than ever before especially suicide, some possible reasons for this are (17): à ¯Ã‚ ¿Ã‚ ½ Men in general are less likely to discuss their feelings or problems or even to admit that they may have depression. à ¯Ã‚ ¿Ã‚ ½ Comparing to women, fewer men look for help when having mental problems. à ¯Ã‚ ¿Ã‚ ½ The impact of unemployment on men is deeper in general. Some mental disorders are more serious in men. For example suicide is considered to be a leading cause of mortality among young men age group(18). Suicide rate is especially high in poor communities for men from age group 10-24 comparing to the same age group in wealthy communities. It is known also that the onset of schizophrenia is earlier in men and the clinical outcomes are poorer (18). Risk groups for mental illness in men include (19): à ¯Ã‚ ¿Ã‚ ½ Older men: many of them are less willing to benefit of provided health services because of the perception that these services are for older women. à ¯Ã‚ ¿Ã‚ ½ Divorced men à ¯Ã‚ ¿Ã‚ ½ because of the lack of support available from their families, and services directed to meet the needs of this group. à ¯Ã‚ ¿Ã‚ ½ Male victims of domestic abuse à ¯Ã‚ ¿Ã‚ ½ especially boys in rural areas. à ¯Ã‚ ¿Ã‚ ½ Gay and bisexual men à ¯Ã‚ ¿Ã‚ ½ few services are available to assist this group to deal with problems such as homophobic bullying and harassment. à ¯Ã‚ ¿Ã‚ ½ Sexual abuse victims, again insufficient support is provided for males of this group. à ¯Ã‚ ¿Ã‚ ½ Fathers à ¯Ã‚ ¿Ã‚ ½ this is mainly due to stresses of parenthood combined with less support services when comparing to those available to mothers. à ¯Ã‚ ¿Ã‚ ½ Mourning men à ¯Ã‚ ¿Ã‚ ½ With no or very few appropriate services specifically designed to men who have undergone bereavement. à ¯Ã‚ ¿Ã‚ ½ Men living in rural areas à ¯Ã‚ ¿Ã‚ ½ obviously due to difficulty in getting access to proper support services. à ¯Ã‚ ¿Ã‚ ½ Offenders of young age group à ¯Ã‚ ¿Ã‚ ½ less psychological services are available in juvenile justice centres in spite of the fact that there are high numbers of young Offenders who actually have mental health problems needed to be taken care of. Ethnic group: The à ¯Ã‚ ¿Ã‚ ½Count me inà ¯Ã‚ ¿Ã‚ ½ report by Commission for Healthcare Audit and Inspection ( 20) noted differences in admission rates among different ethnic groups for example that rates were lower in white British ,Chinese and Indian comparing to the national average , while in Bangladeshi and Pakistani group the rates were around the national average , the highest rates (more than three times higher than average) were found in minority black groups (African and Caribbean) and in Mixed groups (White/Black African or White/Black Caribbean). Employment Status and Mental Health It is well-known that getting a job is a protective factor regarding mental illness (21). But this is not always true. As Wilkinson (22) noted that jobs which are insecure or do not achieve the required level of satisfaction could have negative effects equal to that of unemployment. The main factors that cause this are (21): stress associated with fear of job loss, feeling of imbalance between effort and reward and inability to control job circumstances, stressful relationship with colleagues and bosses, cases of harassment or bullying. All this factors can lead ultimately to serious mental health illness. On the other hand, According to OSC Health Inequalities Review (23) people with a mental illness have five times lesser chance to get a job, and if they are already working they become more likely to be fired, financially this group has in general lesser income (twice times chance than the general population) and more likely to depend on invalidity benefits. It is noticed that among mental disorders psychotic illness has the worse impact on employment rates which decline in this group to only one in four. Geographic variation: Studies result on geographic variation of mental illness are inconsistent , for example Hollie (24) has concluded that regarding mental problems it is possible to see notable variation at the household level but this variations do not exist in postcode units , and there is no proven connection with geographical accessibility or quality of residential environment Hollie noticed also that in common mental illnesses the psychosocial environment has greater importance than the physical environmentà ¯Ã‚ ¿Ã‚ ½ Another example comes from a recent Swedish study of 4.4 million adults found that with increasing levels of urbanisation; there was a notable rise in the incidence rates of psychosis and depression (25). 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 (26,27). Disability and Mental Health: Definition: According to Disability Discrimination Act (1995) (DDA) (28) à ¯Ã‚ ¿Ã‚ ½A 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 activitiesà ¯Ã‚ ¿Ã‚ ½ In the light of this definition we can focus on mental health inequality of three groups of people (21): à ¯Ã‚ ¿Ã‚ ½ People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems. à ¯Ã‚ ¿Ã‚ ½ People with both physical disabilities and mental health problems. à ¯Ã‚ ¿Ã‚ ½ 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 (29) had found that when surveyed 52% of disabled people had experienced high levels of stress in the last 12 months comparing to 34% of people who are not disabled , and when it comes to depression disabled women have a higher rate of depression than disabled men with 44% comparing to 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: Many researchers agree that mental illness could be considered one of the fundamental social and health determinants, and it is difficult to separate these both sides because in most cases social exclusion and social inequalities are both cause and consequence of mental disorders (30) Some studies refer particularly to two characteristics that distinguish mental illnesses when it comes to public health problems (30): first they are the recent high rates of incident and second is the early onset which affect much younger age group comparing to other health problems 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 aspects of peopleà ¯Ã‚ ¿Ã‚ ½s lives : personal relationships, employment, income and educational performance. (31,32) 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 (33): à ¯Ã‚ ¿Ã‚ ½ People living in institutional settings: such as care homes or those in secure care or subject to detention. à ¯Ã‚ ¿Ã‚ ½ People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless. à ¯Ã‚ ¿Ã‚ ½ People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse. à ¯Ã‚ ¿Ã‚ ½children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children, à ¯Ã‚ ¿Ã‚ ½ People from groups who experience discrimination. Key policies: These policies can be long term policies focusing on deep change over a 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 the 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) (30, 34) This report mentioned four points that should be consider as priorities: 1- Factors that support the life of the families mainly the Social, cultural and economic conditions: This can be done by reduce child poverty , parenting skills training and high quality preschool education , providing secure places for the children to play in particularly outdoors, and cooperation between the different governmental agencies to compact violence and sexual abuse. 2- Establishing an educational system that can effectively support children on both emotional and economical scale by: à ¯Ã‚ ¿Ã‚ ½ Schools health promoting programs, involving teachers, pupils, parents and working with families to enhance the home learning environment (HLE). à ¯Ã‚ ¿Ã‚ ½ Taking steps to encourage sport activities and social events beside academic performance. 3- Reduce unemployment and poverty levels to reduce their negative effect on mental health, and while this is not an easy goal but the steps that could be taken my include: à ¯Ã‚ ¿Ã‚ ½ Supporting efforts to improve pay, work conditions and job security. à ¯Ã‚ ¿Ã‚ ½ Taking advantages of workplace based support by early detecting and caring of personal problems or psychiatric symptoms before developing into serious stages. . 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 a 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 (30,35). à ¯Ã‚ ¿Ã‚ ½ Comprehensive: promotion of mental Health is not only the responsibility of health services alone; other sectors of society should join that effort. à ¯Ã‚ ¿Ã‚ ½ Based on evidence à ¯Ã‚ ¿Ã‚ ½ Responding to the needs of the local communities, and with the agreement of these communities. à ¯Ã‚ ¿Ã‚ ½ Under continuous assessment: The strategy should undergo critical evaluation and can be changes should be made 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 (36). The idea of these standards is to deal with mental health discrimination and compact social exclusion in patients with mental illness. And that can be achieved by promotion: à ¯Ã‚ ¿Ã‚ ½ Increase the awareness about the importance of mental health in the society à ¯Ã‚ ¿Ã‚ ½ Take strong position against discrimination affecting individuals with mental illness, and promote the steps that make the social inclusion possible for them. Tackling inequalities for special risk groups: The Suicide prevention strategy: One of the best example is the strategy based on work by 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 (38): 1. To identify and work on people with the highest suicidal risk. 2. To raise the awareness about mental well-being in the society . 3. To target common suicide methods and limits the possibility to get access to such methods if possible. 4. Work with the media for better coverage of suicidal behaviour and its dangers. 5. Support the research for better understanding of suicide and the possible way to reduce it. 6. To evaluate the steps taken to achieve lower rates of suicide. Women and Mental Health: Preventing: The results of UK-based survey (38 cited by 21) shows that mental health services for women: à ¯Ã‚ ¿Ã‚ ½ Do not respond to special need of mental health in women. à ¯Ã‚ ¿Ã‚ ½ Can be unequal. à ¯Ã‚ ¿Ã‚ ½ Sometimes prove to be unsafe for women. à ¯Ã‚ ¿Ã‚ ½ May not reflect to the gender effects on social inequalities, which present in deferent levels such as class and race. However, in their response to a survey conducted in England and Wales (38), women said that they services should: à ¯Ã‚ ¿Ã‚ ½ Provide Sense of Security for them. à ¯Ã‚ ¿Ã‚ ½ Encourage the feelings of independence and ability to make choices and control their life again. à ¯Ã‚ ¿Ã‚ ½ Try to identify and deal with the real causes beyond the stress and the problems they face not only the symptoms of these problems. à ¯Ã‚ ¿Ã‚ ½ support motherhood by directly address this group problems, such as suitable accommodation, jobs opportunities, education. à ¯Ã‚ ¿Ã‚ ½ Embrace their inner strength and potentials of recovery. These points are crucial 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 some changes to the support services that make these services more related and directed to solve men mental health issues: (21): à ¯Ã‚ ¿Ã‚ ½ the services should be designed especially for men and with easy access in mind , this include both the place and timing of the selected service , for example choosing places that men usually meet in , or including sport activities or introducing programs that run only by men à ¯Ã‚ ¿Ã‚ ½ Holistic approach, works on the person as a whole, not just on mental health. à ¯Ã‚ ¿Ã‚ ½ Early intervention to prevent anxieties and concerns build up, especially in stress and anger management. à ¯Ã‚ ¿Ã‚ ½ Trust and confidence are vital to solve problems of identity and role which can cause a lot of stress and self-image problems in men. Ethnicity and Mental Health: Preventing: One of the main problems in this group is the accessibility to the mental health services due to many factors such as: à ¯Ã‚ ¿Ã‚ ½ Linguistic communication. à ¯Ã‚ ¿Ã‚ ½ Stereotypic approach to their problems. à ¯Ã‚ ¿Ã‚ ½ Ignorance about the importance of mental health. Sashidharan in his report titled: à ¯Ã‚ ¿Ã‚ ½Inside Outsideà ¯Ã‚ ¿Ã‚ ½ (39 cited by 21) discussed the mental health services provided for black and minority ethnic groups in England and Wales. And he noticed that these services are different when comparing to services provided to the majority white population in some aspects: à ¯Ã‚ ¿Ã‚ ½ Patients are less likely to receive specialist mental care. à ¯Ã‚ ¿Ã‚ ½ Patients are more likely to undergo obligatory admission (there are differences exist between different ethnic groups and different age groups). à ¯Ã‚ ¿Ã‚ ½ Patients are more likely to be wrongly diagnosed. à ¯Ã‚ ¿Ã‚ ½ Patients are more likely to be treated with psychiatric drugs and Electroconvulsive therapy (ECT), more than receiving talking therapies. à ¯Ã‚ ¿Ã‚ ½ To have higher readmission rates and stay for longer in hospitals. à ¯Ã‚ ¿Ã‚ ½ To be admitted to secure care/forensic environments. à ¯Ã‚ ¿Ã‚ ½ Their social care and psychological needs are less likely to be addressee within the care planning process. à ¯Ã‚ ¿Ã‚ ½ To have worse outcomes. A strategic approach in Ethnicity and Mental Health: In England and Wales a framework has been developed for action for à ¯Ã‚ ¿Ã‚ ½delivering race equalityà ¯Ã‚ ¿Ã‚ ½ in mental health (40 cited by 21) The framework introduces three points which are essential to reach the targets of better services and results in mental health problems in minority ethnic groups, these points are: à ¯Ã‚ ¿Ã‚ ½ Providing high quality Information services. à ¯Ã‚ ¿Ã‚ ½ To insure that the provided services are easy to access and can respond quickly to minority groupsà ¯Ã‚ ¿Ã‚ ½ needs. à ¯Ã‚ ¿Ã‚ ½ Involve the community in the efforts toward better mental health. In other words any approach should take in consider both quality of health services and the already existing socio-economic inequalities that ethnic groups may face. Some suggested steps for this approach may include (21): à ¯Ã‚ ¿Ã‚ ½ Providing interpretation and translation services beside mental health service to insure highest possible quality. à ¯Ã‚ ¿Ã‚ ½ Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in the ways people express of mental stress. à ¯Ã‚ ¿Ã‚ ½ Researching better tools and assessment measures that can better assess patients from different backgrounds and ethnicities. à ¯Ã‚ ¿Ã‚ ½ Ensuring that services understand and respect spiritual requirements for different cultures. à ¯Ã‚ ¿Ã‚ ½ Ensuring access equality to services that more culturally accepted including, counseling, psychotherapy and advocacy. à ¯Ã‚ ¿Ã‚ ½ Addressing common problems of 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 (41) described :à ¯Ã‚ ¿Ã‚ ½inequalities created by service provisionà ¯Ã‚ ¿Ã‚ ½. Mental health services for disable people should be customized to their needs, some recommendations for such services may include: à ¯Ã‚ ¿Ã‚ ½ Promotion for well-being, mental health, and living with disability. à ¯Ã‚ ¿Ã‚ ½ Early intervention: for people who show symptoms for possible mental illness. à ¯Ã‚ ¿Ã‚ ½ Personalised care based on individuals wishes and needs. à ¯Ã‚ ¿Ã‚ ½ Stigma: work for better social inclusion and try to deal with problems associated with 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 in the first place. In the year 2005 the Department of Health introduced a report titled à ¯Ã‚ ¿Ã‚ ½Securing Better Mental Health for Older Adultsà ¯Ã‚ ¿Ã‚ ½ (42) to launch a new program to enhance the levels of services provided for elderly suffering mental illnesses or problems, this report promoted for a new policy that depends on two important steps: à ¯Ã‚ ¿Ã‚ ½ Ensuring equality in the provided mental services; that means that the availability of these services should depend on the actual need for it not on selective age groups. à ¯Ã‚ ¿Ã‚ ½ The approach of these services should be Holistic and personalized to meet both mental and physical needs for older age group. 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 prominent role to address the mental problems associated with sexual orientation. PACE organization has published practice guidelines for mental health services working with lesbian, gay and bisexual people (43 cited by 21). The guidelines suggest that these services should especially designed to meet the needs of LGB people, examples of such services include particularly counseling and advocacy. In response to these guidelines and other studies about LGB such as (44 cited by 21). Mental health services for LGB people should: à ¯Ã‚ ¿Ã‚ ½ Deal with the problems of heterosexism and homophobia that this group frequently faces. à ¯Ã‚ ¿Ã‚ ½ Raise the community awareness about the problems that this group suffer especially social exclusion and discrimination. à ¯Ã‚ ¿Ã‚ ½ The services directed to LGBT people should be able to interact effectively with this group à ¯Ã‚ ¿Ã‚ ½culturally competentà ¯Ã‚ ¿Ã‚ ½. Preventing in Mental Health Problems: People with mental health problem are in need for à ¯Ã‚ ¿Ã‚ ½resilience factorsà ¯Ã‚ ¿Ã‚ ½ which may be the only way to heal from mental distress and to fight the stigma and discrimination they frequently face (21), 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 à ¯Ã‚ ¿Ã‚ ½accepting communitiesà ¯Ã‚ ¿Ã‚ ½ (45). Examples for these services can be found in à ¯Ã‚ ¿Ã‚ ½report on Mental Health and Social Exclusionà ¯Ã‚ ¿Ã‚ ½ which has been introduced by Social Exclusion Unit. The report included a 27-point Action Plan especially designed to deal with discrimination and stigma (21). In this action plan the health and social care services play an decisive role to fight the problem of social exclusion and provide the proper support for community and families, this support may include help to find better accommodation, and provide financial (46). Beyond this report, it is essential 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 at 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 effective reduction in inequalities levels in mental health within primary care, and the primary care organization studied is not Contributive to tackle inequalities in mental health. (47). 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.

Putting a Stop to Smoking Essay -- Tobacco Education Prevention

It is shocking to know that there are about ten people who die from smoking every single minute, and nobody seems to have any idea about it. Indeed, there is â€Å"a growing gap between the real world and the academy† since people are more intellectual about things that are irrelevant to the real life and are ignorant of things that are imperative to live in the real world (Orr 310). Did you know that there are over four hundred thousand deaths caused by cigarettes and tobacco each year in the U.S. alone? That makes it about five million deaths worldwide each year, according to â€Å"Statistics about Smoking.† Smoking is notorious for causing avoidable diseases and deaths, and yet not many institutions have develop an appropriate system to prevent cigarette and tobacco from killing millions each year. For instance, all universities promote health and wellness and many claim to be substance-free, yet they do not restrict the selling of cigarettes and tobacco in camp us stores or smoking on campus. People are dying, thousands are getting hooked, and a whole population is being affected, hence it‘s urgent that a university aims to educate students to combat smoking. The ideal student will learn the immediate and long-term affects of what cigarette can do to himself and others around him, to resist peer pressure, and be capable of recognizing and resisting advertisement and media ploys. In order to achieve this, the university must provide a curriculum that includes classes such as Anatomy, Smoking Biology with seminars, Media Effects, History of Smoking, Tobacco Industry 101, and DARE with community service. Many people are not aware of the many ways cigarette or tobacco use can harm them and others around them because they have never... ...its students to spread their knowledge. The classes that a university provide should enable the ideal students to learn the immediate and long-term effects of tobacco use, and to recognize and resist both peer pressure and media ploys. More importantly, they must also enable students to share their knowledge with society and help others, so that the entire population can effectively combat smoking together by preventing people from puffing their lives away. Works Cited Martin, Terry. "Global Smoking Statistics." Quit Smoking | Quit Smoking Support | Smoking Cessation. The New York Times Company, 28 Jan. 2007. Web. 26 Oct. 2010. http://quitsmoking.about.com/cs/antismoking/a/statistics.htm. "Statistics about Smoking - WrongDiagnosis.com." Wrong Diagnosis. Health Grades Inc., 2010. Web. 31 Oct. 2010. http://www.wrongdiagnosis.com/s/smoking/stats.htm.

Rizal – Man of Mystery

Rizal was really Jack the Ripper. Jack the Ripper is polled as Great Britain’s most evil person on BBC History Magazine. His hatred for women and savage killing of at least 5 prostitutes is a tale of horror still talked about today. His case was never solved thus his identity is one of the world’s great mysteries. How is this related to Rizal? Our national hero Jose Rizal was in London during the killings from May 1888 to January 1889. He was copying a book, â€Å"the Sucesos de las islas Filipinas† staying in the library for the whole day.But not much is known of his whereabouts at night. Other than his mere presence in London, the killings link to Rizal because he was a doctor. Skilled with the surgical knife, he even performed on his mother’s eye. Jack the Ripper’s victims were brutalized with strategic cuts on the neck and incisions that took out the uterus from the abdomen. In his many letters sent back home, not once did he mention the killing s – undoubtedly the biggest news of that time.When Rizal departed from London in 1889, the killings stopped. In 1986, the present day owners of the house Rizal stayed in reported finding preserved human innards and a confession letter from Rizal. Most obvious of all, the links is that Jack the Ripper and Jose Rizal shared the same initials. Illustration depicting how Jack the Ripper cut his victim Reflection I was really shock and horrified while reading this article. I never ever thought that Dr. Jose Rizal our national hero would be a murderer.About the story of Jack the Ripper, I already saw a part of it but in anime form from the anime Black Butler because I am really an anime lover, but I really thought that it’s just a story, not real. That’s why I’m really surprise when I had read the article. I was almost convince by the evidences presented though, as well as the letters by Jack the Ripper that was left at the crime scenes and the preserved human innards found at the house where Rizal stayed. But after thorough thinking, I said to myself that this wasn’t the kind of hero we have.Our hero is not a murderer but a passionate one. If he was that violent, then he would have agreed to Andres Bonifacio have a bloody war using swords, and other deadly weapon against the Spanish colonizers. But, he didn’t agree to Andres Bonifacio because what he wants is a silent war and not the bloody war, where lots of life would be wasted. So, with that perspective of mine, I don’t believe that Dr. Jose Rizal is Jack the Ripper. And, there’s also one question that keeps running in my mind, who name Jack the Ripper as Jack the Ripper that it even coincides to Dr.Jose Rizal’s initial letters to his name? And another is that the preserved human innards at the house where Rizal stayed were only found out almost a century after that is Dr. Jose Rizal left the place in year 1889, and yet it had been discovered only al most a century after that is in year 1986. If it had been discovered sooner, it would have been a strong evidence I guess, but it took a long time before it had been discovered. And if ever it would be true, then I guess it’s not that really a big deal since Jose Rizal is a doctor, and he even operated his own mom.Who knows he’s on a study of something at that time, trying to discover something new for his career. Another is, he has a purpose why he went to London at that time and that is to copy a book entitled â€Å"the Sucesos de las islas Filipinas† and certainly not to murder. To sum it all, I really don’t believe about the content of the article. Though, there are evidences presented, still it’s not enough to judge Dr. Jose Rizal. Because for me, he is a passionate man who even wrote â€Å"Mi Primera Inspiraccion† or My First Inspiration that is especially dedicated for his mother.

Is it possible to see Elizabeth Bennet as a feminist heroine?

Elizabeth Bennet is perhaps the least conventional of Austen's characters, and certainly does not conform to what her society expected of her in the way of being submissive. Austen herself admitted that ‘pictures of perfection †¦ make me sick and wicked', and so our lovable protagonist Elizabeth is set apart from the traditional heroine with her independence of mind, and courage to challenge accepted role of women. To the modern day reader her refusal to be the demure, submissive ideal woman of the conduct books written by such a Hannah Moore, insisting ‘girls †¦ hould early acquire a submissive temper and a forbearing spirit' allows her to appear a feminist heroine. By refusing two offers of marriage Elizabeth exercises her only available method of choice, as Henry Tilney of Austen's Northanger Abbey points out ‘Man has the advantage of choice, woman only the power of refusal'. This demonstration of control earns our respect for Elizabeth as a heroine, and it certainly challenges the society's insistence on the significance of class distinction, appealing to the modern reader. Feminist critics Gilbert and Gubar assert that ‘Elizabeth stands out as a young woman who has no intention of following the prescription of restraint and submission for the achievement of happiness'. She demonstrates this with the manner in which she turns down Mr. Collins' proposal, explaining her refusal of his hand in marriage, ‘You could not make me happy, and I am convinced that I am the last woman in the world who would make you so'. Mr. Collins is so shocked by her rationality he believes it can only be due to her modesty; and hopes ‘when I do myself the honour of speaking to you next I shall hope to receive a much more favourable answer'. Her action contradicts entirely the principles set out in the conduct books, and the reaction she receives reinforces the unusualness of our heroine's honesty. Charlotte, however, seems to conform with society's expectations of a young lady, and accepts as though she is presented with no happy alternative, ‘convinced that my chances of happiness with him is as fair, as most people can boast on entering the marriage state'. Austen paints a bleak picture of this marriage for the reader, deeming it ‘impossible' for Charlotte ‘to be tolerably happy', and her position reveals the difficulties facing young women, and the pressure on them to marry. Elizabeth's refusal to submit to this is certainly what sets her apart, with more modern ideas of how women ought to be. When she is around Darcy Elizabeth behaves very differently from the more traditional Bingly sisters, not allowing her herself to be put down. In their discussion over how accomplished young women are, Elizabeth is not afraid to put her own argument forward, and demonstrates her intelligence and rationality by deducing ‘[Darcy] must comprehend a great deal in your idea as an accomplished woman'. Miss Bingly on the other hand simply reiterates what Darcy says, and for this Austen reduces her to ‘his faithful assistant'. Miss Bingly tries to creep towards Darcy, with her flattering tone, whereas Elizabeth is far more straightforward, and spirited. The Bingly sisters had disapproved of Elizabeth since her early entrance to Pemberly, exaggerating her state after walking of having a mucky petticoat and messy hair to call her ‘wild'. Interestingly it seems she is not only referring to how she looked, but also condemning her out of the ordinary behaviour, determined to look down on the people of Meryton. Having been polite to Elizabeth's face Austen reveals the sisters to be false, and unkind. Although Elizabeth does appeal to the reader as a modern heroine, one might argue that Lydia is the sister with the most modern attitude, eloping to a man she lusts after, declaring in her letter that her and Wickham's marriage shall take pace ‘some time or other †¦ it does not much signify when'. However it is clear Austen disapproves of her attitude, and means for the reader to disapprove of her, through the objective narrator; a voice condemning her as ‘always unguarded and often uncivil'. Perhaps it is as punishment that Lydia's marital life shall be unfulfilled, as when Austen exiles Maria Betram in ‘Mansfield Park', for running away with Henry Crawford despite her marriage to Mr. Rushworth – sent to ‘another country, remote and private'. It seems she is also in search of attention, and Gilbert and Gubar's observation that ‘marriage †¦ is the only accessible form of self-definition for girls in her [Jane Austen's] society' helps us to speculate that this may have been her ulterior motive for this relationship. In her letter to Harriett she confirms that she will find their surprise amusing, ‘oh what a great joke it will be! ‘, and her frivolous attitude towards her situation demonstrates her selfishness and compulsive mind, which Elizabeth view kindly. When rationally attempting to deter her father from permitting Lydia to accompany Mrs. Forster to Brighton, her sensible attitude is prominent as she analyses the danger she poses to the Bennets, explaining ‘our importance, our respectability in the world, must be affected by the wild volatility †¦ which marks Lydia's character'. Her key phrase ‘in the world' reminds the reader of the very different world inhabited by the girls, one in which it would not be possible for Lydia's conduct to be deemed acceptable. Elizabeth's attitudes here puts into perspective that although she challenges the assumed role of women in society, Elizabeth is still sensible to the significance of keeping reputation's up, and remains dignified in Austen's ‘world'. Once more exercising her only ‘power', Elizabeth also refuses Darcy's first proposal, despite his having ‘had no doubt of a favourable answer'. This attitude is much like Mr. Collins' expecting, as most men would at the time, an acceptance from girl with notably few prospects (as picked up on by the Binglys), despite his attitude towards the affair communicating his beliefs that it would be ‘a degradation'. She appears to rebel against society's expectations, and her contradiction to Darcy's assumption that a young woman must accept his hand in marriage is almost humorous, lending emphasis to the significance of Elizabeth's choices. When turning him down she tells him in no uncertain terms for why, with a forceful, truthful and compromising response, which uses very plain words like ‘unwillingly' which take her straight to point, and point out a rather painful truth. This demonstrates both her independence and the way she challenges the accepted conduct of a young woman of the time, to be perhaps more considerate of a man's feelings. Elizabeth demonstrates her strength not only by refusing to submit to men, but also through holding her own with Lady Catherine at both Rosings and Longbourn. She declares herself ‘a gentleman's daughter', and as such Darcy's equal, and refutes Lady Catherine's accusation that she has ‘upstart pretentions', refusing to conform to her society's expectation of her not to challenge her class superior. Her forwardness is picked up on by Lady Catherine, who is perhaps actually delivering a compliment, rather than a criticism, when noting ‘you give your opinion decidedly so for so young a person'. Elizabeth also refuses to be humbled just because Darcy earns ‘ten thousand a year', and is intended to marry Lady Catherine's daughters ‘of the same noble line'. In these scenes, Elizabeth appeals very much to the less class-conscious modern reader, and it is here that Vivien Jones sees Elizabeth as an agent for change, arguing ‘the old and new are synthesised in the union of the mercantile Gardiners and the landed gentry'. This suggests her marriage brings about a healthy change in the novel, as Darcy conquers his pride and welcomes the Gardiners to Pemberly. In this way we might regard Elizabeth as a modern heroine – a woman who makes a difference to her society. However, we can not ignore the fact Darcy is as fluent about her ‘inferiority', admitting to having ‘struggled' to suppress his feelings, as he is about his love for her in his initial proposal. Therefore, it seems their marriage shall be still quite traditional; with the woman subservient to her husband. Of course, in Jane Austin's society women were still swearing in their marital vows to ‘love, honour and obey', and so some critics argue that by the end, in choosing to marry Mr. Darcy, ‘Elizabeth conforms in the end to the feminine ideal of the helpmeet'. She is absorbed into Darcy's world, in which she will have little influence at all. But, we must not ignore the fact that it was, in the end her choice for marriage, and although she could not propose when she wanted it, she made sure it did not take place when it didn't suit her. Uniquely, our heroine stands out as a woman who feels she ‘may take liberties with her husband', and to feel this way in such a time must not be overlooked by the modern reader as what is expected. Although Jane Austen herself would never have used the term ‘feminist heroine', there is certainly debate about how she appears to the modern reader. Elizabeth Bennet is certainly appealing as our twenty first century heroine through the intelligence and courage to be independent, and Vivien Jones argues that she has the power to change the social order. However, as Marian Cox observes, ‘though she mocks patriarchal structures, Austen must inhabit them', pointing out that despite Elizabeth's independace, she still must marry, for due to the laws of primogeniture she had no other option of maintaining wealth. This does mean Elizabeth can not be seen as a heroine however, as she still challenges her society, and marries a man she loves which is better than most women of the time.