Cure method pervades most mental health services, and actually most health care. In most professional training, future clinicians are taught to identify a patient’s problems or symptoms whether in terms of neurochemical imbalances, faulty cognition, dysfunctional family relationships or disturbed intrapsychic processes (Maheu et al. , 193). They then learn methods to put things right: medication, cognitive therapy, family therapy, psychotherapy, counselling, advice and education.
Although there are many cure-based models, all have the same approach: the purpose is to identify basic problems and interventions to improve or remove them. Evidently, interventions which have to reduce specific problems or make better a patient’s ability to cope with their difficulties may be helpful. However, cure-based method can have the nature of a problem in work with patients who have serious mental health problems. Skills-based approaches The development of skills — skills training — is very popular in services for people who have serious mental health problems (Kent and Hersen 96).
Presenting a clear direction for work, this method starts with the recognition of a patient’s skills and skills deficits. The things that a patient needs to learn are then broken down into their constituent parts. Then the intervention takes the form of building up skills gradually, at most times within a behavioural framework. In many areas ‘rehabilitation’ has become closely associated with skills development. For example, a patient is taught the skills he needs to live independently and then moves out of the hospital.
Much help with day to day activities is seen not as actually in progress support to enable the patient to do things, but as training the patient to do them without assistance. Needs approaches Concepts of need are widely recognised. There is a desire to develop ‘needs led services’: define the needs of service users and develop treatment and support that is responsive to these (Kemp 36). Needs approaches try to move towards identification of the complex requirements of the patients.
They open the possibility of a variety of ways in which a patient’s needs, once defined, can be met: not merely treating symptoms or teaching skills, but also presenting supports, aids and adaptations in the surrounding environment. This gives the opportunity to avoid many of the problems inherent in problem/symptom based approaches. Despite the benefits of needs-based approaches, their usefulness depends on the way in which need is considered. The term ‘need’ usually refers to very different things.
On the one hand, it includes everything from basic physiological necessities (food, water) to different psychological needs (love, esteem, belonging) (Kent and Hersen 39). On the other hand, it refers to ways of providing services to make certain that basic human needs are met, thus people are said to ‘need’ a day centre, hostel or medication. When needs assessment in mental health services involves evaluation of needs for specific services (Kemp 64) the devalued status of people with serious mental health problems is reinforced.
The basic purpose of this method is that help should be directed towards ensuring that patients with developing and serious mental health problems can lead the lives they want to lead. Such method has several important points. First, the patients, their interests, wishes and social circumstances are of great importance. Second, a range of different interventions, supports and approaches can be utilised. Mental health problems do not require a choice between medical, social and psychological approaches. These may all be helpful.
Third, the focus shifts from modifying the characteristics of the patient to changing the community in which the patient functions. In the presence of developing disability it is not always possible to change in the features required. The point is that at least as much attention must be paid to the conditions; changing the demands of different situations so that a patient can be adapted. Therapies A wide range of therapies (for example, speech, occupational, physical, music and psychotherapy and many others) are available.
The appropriateness of these therapies depends on the individual deficits and needs of the patient. For example, most autistic patients benefit from some focused training in communication and some from help with motor and social skills (Sheppard 1991). Psychotherapy with autistic patients is usually ineffective (Kem 36,), although some indicate that it can give the therapist insight into the patient’s disorders and fears and can increase the patient’s awareness and capacity to control feelings (Maheu et al. , 90). Behaviour therapy
Behaviour therapy is the main treatment for addressing mental health problems and over 70 per cent of patients are helped by this method of treatment (Maheu et al. , 100). In coping with anxiety, for example, it comprises gradual exposure to the feared situation while strengthening strategies for coping. Exposure may be accomplished in prolonged and made again and again doses called ‘flooding. ‘ It is usually used in combination with response prevention. However, this can cause distress and should be used carefully with children. Another technique that can be used is systematic desensitisation, which involves teaching the patient to relax.
Then the patient is exposed to increasing levels of anxiety while he or she remains relaxed. Behavioural analysis can also be used to disclose factors that may automatically contribute to the problems. Cognitive behavioural therapy, which is also used, teaches the patient to understand how his or her thinking contributes to their mental problems and how to remove them. Family interventions Whilst family factors may not cause mental disorders, they are often connected with maintaining the condition since family members have often been manipulated into a helpless, weak role.
Family therapy actually is an important part of treatment of mental health problems. Some family members, understandably, feel that helping their loved person is appropriate and useful, but allowing patients to avoid fearful situations can be harmful. Therefore, family members should be encouraged to create clear boundaries and reduce overprotectiveness. Methods that deal with the family context may have more continual and efficient outcomes than those solely focused on the patient (Schulz and Greenley 95).