Abuse
The problem: Homelessness
Homelessness is a social problem with an extremely negative consequences to mental health care which is currently inadequate in America. When the outpatient and the inpatient mental health service were reduced, the impact was an increasingly high rate of homelessness and increased number of inmates in prisons. Approximately 1.25 million people who are mentally ill are in prison. This high umber cost taxpayers a lot of money for their daily upkeep which is more costly than providing treatment. When determining the health of those suffering from mental problems and illness, it is almost impossible to examine them in isolation from their living context. Health is the combination of social, biological and psychological aspects which is more than the biological attributes of an individual.
Deinstitutionalization of mental health patients happened in the 1960’s and 1970’s; when many thousands of them were never hospitalized or got any proper diagnosis for their mental illness. For the last three decades, mental health conditions have not been treated following the closure of outpatient and inpatient services and also due to laws that restricted the enactment of mental health treatment services. In the United States, therefore, there is limited access to mental health care. If health situation of a person worsens, it directly influences the overall living condition of an individual and there is lack of well being of those who are homeless. Homelessness leads to poor health and then again poor health contributes to homeless. Those suffering from psychiatric dossier such as Bipolar disorders suffer from depressive feelings with moods referred to as hypomania and mania. If such conditions are not treated with mood stabilizer medication, the patient becomes worse. A serious case of Bipolar disorder poses high risk to harm others or one involuntarily. Such people suffer widespread stereotypes, prejudice and social stigma against them.
Bipolar disorder
Bipolar disorder is also known as maniac-depressive disorder or bipolar effective disorder. A person suffering from bipolar disorder operates between menial state when they become hyper energetic, highly agitated and restless and lacks sleep. More than two million Americans are diagnosed with bipolar disorder each year and one percent of adult population suffers from the condition. The condition develops in later adolescence or in adulthood or it may some times occur in children. Bipolar disorder is a long term illness and it is not easily recognized therefore one may not be early diagnosed. The condition must be carefully managed to sustain the life of the patient. The symptoms of the disorder include mania and depressive conditions., mania conditions are increased energy, restlessness, and highly distracted speech due to racing thoughts.
Depressive symptoms include racing thoughts where by a patient jumps from one decision to the next, has poor judgment of their ability and reality such as deciding to knock down a tree with his forehead thinking that it will fall down. The patient has low self esteem which may lead one to abusing drugs, goes for unnecessary shopping spree, and become hypersexual. The person becomes rush and impulsive. One also suffers hypomania leading to pervasive and persisted irritable or elevated mood. The mood may be euphoric and aggressive. Sometimes the person becomes highly provocative and irritable. The patient suffers from poor insight. Hypomania conditions that symptoms that a bipolar sufferer has do not involve delusions and hallucinations.
An African American male who is homeless suffers from diagnosed bipolar disorder that has not been treated. With time this condition has affected his social life in terms of not being able to own and maintain a residential home or either hold a steady job. He suffers from emotional problems which is associated with his past childhood experience of abuse and neglect. The little support he has had in his adult life is when he gained access to housing benefits for the mentally ill in the few existing systems. The program provided him with the necessary medication and therapy as well a relatively stable living environment which supported his social and health success. However, the client has severally been expelled from the program due to violation of rules. This expulsion is attributed to is a sign of the mania symptoms of the bipolar disorder he suffers from. Which he may sometimes become aggressive, agitated and do weird things like breaking windows and walls due to poor judgment of reality and his ability.
The rules within the program may sort of be reminding him of his child hood experience of abuse and being neglected. And his violation of the rules sought of satisfies his ego and to free himself from feeling unworthy due to the low self esteem he may sometime feel. It is important to note that this aggressiveness happens involuntarily rather than voluntary.This is because he wishes to benefit from the therapy , medication and the housings benefits that this program has. Therefore, his actions leading to expulsion should not be interpreted as his unwillingness to improve the condition he is in. Additionally, the patient lacks an outpatient program treatment services which could better serve his needs. The main cause of the client’s condition is childhood precursors. The bipolar disorder may show early traits such as full major depressives episodes, sub threshold mood abnormalities that are cynical an mood fluctuations that depicts as Attention –Deficit Hyperactivity Disorder(ADHD). This may be irritability or hypersensitivity. Child precursor bad experiences as the cause of bipolar disorder has received some un agreed aspects as either being chronic or the experiences should be fluctuating with time (Miklowitz and Kiki, 2008, p 881-897). A number of researches have however shown that many bipolar patients have a history of stimulant use during childhood which causes earlier onset of the condition that is independent of ADHD (DelBello, et. al, 2001, p 53-57)
Outpatient program for patients with bipolar disorder
A high number of mentally ill individuals are at great risk of being at the hands of criminal justice system . This is attributed to health related concerns such as symptoms of the psychological disorders such as aggressiveness and substance abuse. Homelessness is another factor that also causes them to commit minor offences and being jailed. Local policy makers and all concerned officials have to recognize the pattern and work collaboratively with State officials tom establish a program that will consider an outpatient program for the mentality ill. Intensive Outpatient Programs (IOPs) are beneficial because psychotherapy is not enough and hospitalization may cost too much. Such a program will allow those suffering from anxiety disorder and bipolar disorder symptoms to have comprehensive health treatment in some hours of the day depending on ones need. Such a program is beneficial because a can go back home after the therapy, can work during some hours of the day, the program combines both group and individual therapies and it provides intensive treatment at a more freedom setting than in hospitals. Also the treatments through IOPs are much better than the traditional psychotherapy.
IOPs are also advantageous for they provide a structure of maintaining routine. A patient suffering from bipolar disorder can best be treated through psychotherapy. Such a therapy is usually supportive in nature which will, help a client with increased education and coping skills of the condition. This will involve helping a client on how to predict his or her own fluctuations. Such a therapy should b flexible in nature because the needs of the client are diverse. Hospitalization should be considered as viable alternatives as well.IOPs are the solution to the effect of deinstitutionalization that resulted to too many individuals living in the community. This is the process of replacing long stay psychiatric hospitals with the current community health services for developmental disability and diagnosis. This was with the aim of reducing the number of mental health institutions in the country. This means that these institutions were no longer being supervised by health workers.
Many of the patients and clients we left to cater for themselves and maintain their personal devices and medication regimes. The result was that there was the creation of community services which were partially or are fully supervised. The community programs provide special teams for intervention and treatment and also provide housing to qualified patients. These programs have the same costs as inpatient hospitalization(Fakhourya. 2007, p 313-316) The shortcomings of this deinstitutionalization process is that the community program do not offer full social interaction, many patients have limited social contact, jobless and live in sheltered environs. The community services are unable to meet complex needs and are uncoordinated. The patients who are admitted were discharged without sufficient support and preparation. Many of the people went to prison and became homeless. Many mental health sufferers suffer from risks of being imprisoned, homeless overcrowding in institutions, ill-treatment and being discriminated(PBS 2010). Women with mental health problems are more likely to be killed or abused or they become a harm to other. They fall victims of excessive force by police officers during arrest and street hoodlums(Now Public, 2010)
Reference
David J. Miklowitz and Kiki D. Chan Prevention of Bipolar Disorder in At-Risk Children: Theoretical Assumptions and Empirical Foundations Dev Psychopathol. Dev Psychopathol. 2008; 20(3): 881–897. doi: 10.1017/S0954579408000424.
DelBello MP, Soutullo CA, Hendricks W, Niemeier RT, McElroy SL, Strakowski SM (April 2001). Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset”53–7. John Wiley & Sons A/S
Akhourya W, Priebea S (2007). “Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare”. P 313–316.medicine publishers
PBS, (2010) Deinstitutionalization: psychiatric. Retrieved from
http://www.pbs.org/wgbh/pages/frontline/shows/asylums/special/excerpt.html
on June 15, 2010
Now public(2010) one homeless mentally ill man kill. Retrieved from
http://www.nowpublic.com/health/one-homeless-mentally-ill-man-kil
on June 15, 2010
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