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.

Comparing Roman and Greek Art Essay -- Ancient Rome Greece History Art

Comparing Roman and Greek Art Throughout history art has consistently reflected the cultural values and social structures of individual civilizations. Ancient art serves as a useful tool to help historians decipher some important aspects of ancient culture. From art we can determine the basic moral and philosophical beliefs of many ancient societies. The differences in arts purpose in Greece and Rome, for example, show us the fundamental differences in each culture's political and moral system. The primary objective of Greek art was to explore the order of nature and to convey philosophical thought, while Roman art was used primarily as a medium to project the authority and importance of the current ruler and the greatness of his empire. This change in the meaning of art from Greek to Roman times shows the gradual decline in the importance of intellectualism in ancient western culture. The earliest example of how art reflects the basic moral and philosophical belief systems in individual cultures is seen in the Ancient Egyptian empire. The art of this time was highly idealized and mainly focused on displaying the divinity and importance of the Pharaoh. The most famous examples of this Theocratic influence on art are the Great Sphinx and the Pyramids of Chefren. The massive size and artistic perfection of these works, which were mainly dedicated to expressing the divinity of the Pharaoh, show that Egyptian society was based primarily on mythological law. The highly idealized, mythological style of Egyptian art suggests that Egyptian culture as a whole was not concerned with scientific and mathematical truths. Arts reflection of culture and society extends to the Greek and Roman empires, and shows the import... ... a symbol of the supreme authority he held over his empire. At his feet, a small sculpture of Cupid was carved in an attempt to show Augustus?s divine lineage (Cunningham, 150). Every aspect of this portrait is highly idealized and centered around the greatness and divinity of Augustus. Because little attempt was made to capture the actual physical appearance of the Emperor, this sculpture can not be considered a portrait but more accurately, a profile of greatness. Such works display the political domination and lack of originality in Roman art. The simplification of art during this period reflects an overall simplification of thought and decline in the importance of intellectualism in western culture. Work Cited Cunningham, Lawrence S., Reich, John J. Culture and Values; A Survey of Western Humanties. New York: Harcourt Brace College Publishers, 1994.

Atlantic Bluefin Tuna Essay -- Fishing Marine Life Essays

Atlantic Bluefin Tuna The Atlantic bluefin tuna, Thunnus thynnus is a sleek, fast-moving giant that once lived efficiently in the world's oceans for millions of years. This marvel of evolution has endured countless hardships of climate change, predators, and shifts in prey populations, however, nothing compares to the pressures placed on the bluefin by the fishery today. It is a species in dire need of preservation. The Atlantic Bluefin tuna cruise the coasts of the Northern Atlantic and migrate as far as the southern coasts of Brazil. Weighing as much as 1,500 pounds, growing up to 15ft in length, and swimming as fast as 50 miles per hour, these fish are built for speed and endurance. (WWW. site, cnie.org) Living as long as 30 years, they reach sexual maturity at approximately eight years and almost exclusively breed in the Gulf of Mexico waters. Spawning is a necessity that involves a community of bluefin and results in a relatively small number of surviving offspring. Once mature, because of their size, bluefin tuna have relatively few predators.(Kumai,1998) Prior to the 1960's this population was estimated to be as large as a quarter of a million, however with the introduction of international interests in canned tuna, the population suffered severely. Today, over 90 percent of the estimated stock has been depleted, and the relentless fishing pressure continues, prompted by the demand of the Japanese market.(Safina,1998) Fishermen throughout the world are attracted to the bluefin because of its extremely high value. In the beginning, bluefin were fished primarily for canned food purposes, and possessed little intrinsic value within the economic market. Unfortunately this is presently not the case due to minimal supply... ...24, n6 (Nov-Dec, 1994): 18. Kumai, H. Studies on bluefin tuna artificial hatching, rearing, and reproduction. Nippon Suisan Gakkaishi, v.64, n.4, 1998:601-605. Matsuda, H; Yahara, T; Uozumi, Y. Is tuna critically endangered? Extinction risk of a large and over exploited population. Ecological Research, v.12, n.3, 1997:345-356. Safina, Carl. Song for the Blue Ocean: encounters along the worlds coasts and beneath the seas. 1st ed. New York, Henry Holt, 1998, xviii. Sissenwine, Micheal P., Pamela M.; Powers, Joseph E, Scott, Gerald P., A commentary on western Atlantic bluefin tuna assessments. Transaction of the American Fisheries Society, v.127, n.5, Sept. 1995, 838-855. Smith, Timothy K. The big rush: a giant bluefin is fought and landed; then things get exciting.(Process of catching and exporting bluefin to Japan) Fortune. V134, n10 (Nov 25, 1996):146

Autism Essays -- essays research papers

Diagnostic Summary Paper AUTISM Autism is a disorder that impairs the development of a person's capacity to interact with, communicate with, and also maintain regular "normal" bonds with the outside world. This disorder was described in 1943 by Leo Kanner, an American psychologist. Autism is considered one of the more common developmental disabilities, and appears before the age of three. It is known to be four or five times more common in males than in females. It most cited statistic is that autism occurs in 4.5 out of 10,000 live births. The estimate of children having autistic qualities is reported to be 15 to 20 out of 10,000. The gender statement noted before is not uncommon, since many developmental disabilities have a greater male to female ratio. Autistic characteristics are different from birth. Two more common characteristics that may be exhibited are the arching of the back while being held, to avoid contact, and also failing to anticipate being picked up (limpness in the body). Infants with autism are described as being either very passive, or very agitated. Sometimes during infancy there will be cases of head rocking, and or banging, against the crib, but this is not always the case. Approximately one-third of children develop normally until the ages of 1 1/2 to 3, and then the symptoms emerge, referred to as "regressive autism." During childhood, there is a commonality of the affected child insisting routine. The reasoning is that the chil...

Japanese Culture and Politics Essay

The historical development of Shinto cannot be separated from the entire history of Japanese religion, culture and politics holding the Japanese mentality to the path of creative progress and versatility of self-development. From the fate of the Emperor’s courts in different eras, with the rise and fall of other religious orders such as the Buddhist groups and the overall destiny of the nation, the fate of Shinto is intertwined in every aspect. Shinto had already started to about 300 B. C. E. and was considered as the most significant religion in Japan. In reality, there is no specific dates nor enough data or hard evidence of Shinto’s origins, as such, it may trace back even before the 300 B. C. E. Just like Shinto’s origins, the origins of civilization on the Japanese islands remain cloudy. Various communities gathered together during the Stone Age. As early as the 300s and 200s B. C. E. , tightly knit societies were appearing, but the mountainous terrain of the home islands kept settlements relatively isolated. Although Shinto tradition traces the ancestry of the Japanese imperial family back to the 600s B. C. E., there is no evidence of an organized Japanese government before the 300s or 400s C. E. Body The history of Shinto is connected to the development of growth of states. The first imperial state was ruled by the Yamato family, starting in the 300s or 400s C. E. From the start, the Shinto religion- which remained important even after the arrival of new faiths like Buddhism- legitimated the emperors, declaring them descendants of the sun goddess. The Yamato initially ruled from Nara, which, until the late 700s, serves as Japan’s capital. During the Nara period (ca. 300-794 C. E. ), the foundations of the Japanese nation were laid. Japan also came into contact with Korea and China. The Chinese had a tremendous influence on the development of Japanese art, architecture, literature and religion. It was from China and through Korea that, in 522 Buddhism arrived in Japan (McCannon 2006). However, Shinto was already greatly present in early Japan, as such, they were able to develop their own state different from that of China Shinto has been considered to be the creative spirit, and on the contrary, as a firmly fixed source of nationalism in Japan. Although the roles need not be incompatible, the question draws attention to two faces of Shinto. There are folk origins as well as cults encouraged by governments, and these have not always coexisted harmoniously. During the development of State Shinto, the conflict and peace reaches its peak. The Meiji period government, in the interests of manipulating Shinto as a state ideology, was prepared to sacrifice the entire popular spirituality of Shinto to the extent of suppressing shrines and removing kami from communities. This underlines the dual origins of Shinto and the ways in which local and national interests have not always been harmonized. The august status of the Grand Shrines of Ise, the Amaterasu greatly shows how Shinto had affected the people’s respect towards the Imperial tradition (Picken, 1994). Shinto religion became the core of some social classes and basis for economy, traditions and customs. During the time when sengoku daimyo and the three great unifiers were struggling for political supremacy, they adopted and utilized various methods with varying degrees of success to overcome basic administrative difficulties. Sengoku daimyo and the national hegemons encountered difficulty in bringing the commercial segments of the society under their control. The existence of a growing national market in central Japan where most of the large scale transactions involving goods from the distant provinces were conducted in the sixteenth century and which remained relatively free of any political control during much of that century, did not permit the sengoku daimyo and the national hegemons to regulate the growing commercial activities to their advantages (Hall et. al. 1983). Through Shinto, the society was divided into classes, where many sengoku daimyo introduced the system of rule by law to strengthen their authority in their respective domains. Also, by focusing on Shinto religion, sengoku daimyo was able to have the absolute loyalty of its subordinates, discouraging localized or scattered loyalties. Moreover, early believers of Shinto greatly respected animals. They believed that these are God’s messengers and because of these, the early Japanese created statues such as â€Å"Koma-inu† on their temple grounds. Japanese culture also flourished with ceremonies correlated to the practice of Shinto and some of these include cleansing, prayers and dances greatly attributed to Kami. In addition to this, they also practiced Kagura, a dance perfected by its performers with an accompaniment of ancient musical instruments (Robinson 1995). Conclusion The historical development of Shinto cannot be separated from the entire history of Japanese religion, culture and politics holding the Japanese mentality to the path of creative progress and versatility of self-development. From the development or origins of Shinto, the states of early Japanese period came into realization. State Shinto is one of the great examples of the states created using Shinto as its foundation. Aside from its states, the rulers of state before the Tokugawa period were chosen with the blessings of the gods of Shinto. The divine providence given to these rulers strengthened their power over their subordinates. Just like the power of the sengoku daimyo during the Warring period. They were able to obtain absolute loyalty from their subordinates and the other classes. Shinto did not only create Japan’s early states and leaders, but also molded its culture, customs and traditions. Early beliefs on Shinto gave life to the Japanese society, illuminating it with dances and ceremonies. As a whole, early Japanese culture and politics developed its own identity becoming one of the countries with great sense of nationalism because of Shinto. Works Cited Hall, John Whitney, Nagahara Keiji, and Kozo Yamamura. â€Å"Japan before Tokugawa: Political Consolidation and Economic Growth, 1500 to 1650. † Public Affairs 53. 2 (Summer 1983): 332-34. McCannon, John. Barron’s How to Prepare for the Ap World History Advanced Placement. New York: Barron’s Educational Series, Inc. , 2006.

The American Gangster

Hollywood by furtherthest is whizz of the most m sensationymaking(a) industries of USA. It generates billions in revenue and the outstanding thing nigh it is that the raw material or resources nalways run turn up. Globalization has do Hollywood is now a house harmonize break all across the land and not just in America, Hollywood is riding the waves of success all across the world. The crime-drama genre of video making in Hollywood has a long and lucrative history.In the past from God Father, to Scar construction or Stanley Kubriks A Clockwork Orange, till Martin Scorsese master maculation The Departed today, this austere genre of impressions has attracted a huge number of audiences, mainly adults. Movies of this genre take lightedtle liberty from the creativeness of the writer and rely mainly on the elements that argon closer to living and that large number solelytocks re later(a) to. They show the unremitting battle between good and the counseling its been f ought in reality. Thats why most of the stories from this genre argon both true or close to truth. Ridley Scott is among one of the finest film maker Hollywood has ever had.His unique vision, his ability the select the salutary patch for the right role and his stories that touches the police wagon of audiences is simply astounding. He pretty a great deal became a house hold name after making the epic hit, gladiator and lifted Russell Crowe to the heights of stardom. His last word-painting The American mobster was released in November 2007 and morose out to be a pack grow office hit generating more than 250 jillion dollars. With an Oscar winning, A-list cast, great producers like Brian Grazer and Mark Jacobson and Steven Zaillian merchant reality the leger, the moving picture was suppose to and turned out to be a nothing slight than a clippingless classic.On of the primary reasons for choosing this flick for analysis is the outstanding(a) names tie to it, and chiefly , American Gangster represents the true face of an American age and society. It alleviates the differences between the age old good and bad schism and asserts that intelligence and integrity combined can either make or overleap both the element of good and evil. front and foremost, Ridley Scott does the most important task in bringing the flick to life beside the script and that task in cast of characters.Since the scene revolves few the life of Harlems drug schoolmaster Frank Lucas and the FBI agent hell deform on getting to him Richie Roberts, and since all the characters are pretty much real, so to express inspired by actual events and people, Scott had to be very careful in casting these two iconic roles that not and portray the characters of their real life counter move, but also adapt those characters into themselves so as to bring out an outstanding gang of script and reality and give the audiences an anachronic feeling.Scott had already worked with Russell Crow e in the legendary prizefighter and A Good Year so he was selected for the role of Richie Roberts. As for the protagonist, who else could bestow the role of an African American than the iconic Oscar winning Denzel Washington. Both actors studied steadfastly to get into their respective roles buy adapting accents and luggage compartment languages of their real life counter move and the work paid off. Both veterans alone dominate the screen with not only their charisma but their out standing true to life executings.Since American Gangster is a period movie, an honest olfactory perception of United States and the City of New York had to be modeled after the era of late 60s and early 70s. specially the Harlem where most of the movie takes place is sh have in the movie is shown relatively shabbier and crumbling to catch the odour of late 60s. Scott has utilized most of the actual locations of Harlem by toning them reduce to get the 60s look. The attention to details is amazing . The scene where Lucas walks complicate the streets of Harlem along with his brothers gives a very authentic retro look.The puddles on the street, people have on vibrant colored shabby rig on the crumbling sidewalks, the derelict unconnectedments with cloths lines and small unclean shops by the streets gives sincere glance more or less 40 years back. The costume bod is amazing with only Washington exhausting more than 64 costumes by dint ofout the movie that represents the fashion of the era. The dresses his wife Eva wears the first time Frank tries to woo her is simply as astounding with elegance and a shot or nostalgia.The characters appear perfect in each and every attire. Richie (Crowe) adapts this sweaty and scruffy look to portray his underpaid and tough as boom out job. Whilst Frank (Washington) evolves in his looks and personality through out the movie. His costumes move from servile and insincere looking right hand lummox to the rich elegant drug captain who wants to spend money, but not allow go of his dignity. The script and screen dissipation are one of the prime elements of the movie.Based on the article by Mark Jacobson and molded into a seemingly perfect screenplay by the Oscar winner screen play writer of the Schindlers List, Steven Zaillian, the movie is decently paced with adequate amount of time for all the characters to boot to their secure capability. The character of Frank Lucas is by far the heart of the movie as he rise of a blink of an eye rate right hand man to this powerful and ingenious entrepreneur who takes full advantages of the Vietnam war.Shown as a gentle and family man who loves his mother, wife and brothers, but at the same(p) time a furiously driven man who guns down his opponents in the coarse twenty-four hours if the occasion calls for it. The character of Richie though intense doesnt get sufficient space to reach its full potential and very much remains the same. The screenplay takes some fictio nal liberties to a real life story worth of being watched. Pietro Scalia, has through a commendable job in the editing of the movie.The film has been trimmed down to the point where it runs a comfor tabulate 157 transactions without making the story lag. Scene transitions are make amazingly and build a sort of suspenseful tension for the viewers as the story lines deftly slip of paper from Frank to Richie. Aside from the sharp editing, the movie has been toned down in its computer graphic content to be suitable for audience and not letting the violence hold the story line.Sound may not be the brightest of American Gangsters features as the dubbing and sound effects lags foundation the other elements of the movie. They dubbing is a bit hollow sounding where the voices seems to unnaturally echo. enter against the obstreperous background of Harlem, an attempt has been made to let the sounds of the bustling streets and traffic gets miscellaneous with the voiceovers of the actors , but the result isnt as sonorous. The sound effects are sooner choppy, expect for the gun shots that reverberates throughout the full-length theater.The film has the original score practice of medicine of Marc Streitenfeld, and the songs of Jay-Z, Anthony Hamilton, and classics like Sam and Dave and Mavis Staples which gives the movie a typical African American look and feel. Cinematography by far is one of the most beautiful elements of the movie. Harris Savides has make a remarkable job to in capturing the true essence of a smutty and derelict Harlem. From the gritty looking daylight lit streets to the after dark unconsolable and distant feel of Harlem, Harris has made incontestable to make everything look real rather than artificially lit sets.From the dimly lit Lucass drug locals to the diner where he has his breakfast as the sunlight hits the table illuminating everything brilliantly, each shot has its own visual treats. The faded and muted tones of the mid-seventies also invoke a experience of melancholy or bleakness to parts of the film, which gives it a weight and depth. Incorporating all the quintessentials of great film making, the proper utilization of genius and an unparalleled vision is what makes The American Gangster, a success.Ridley Scott, even though too tighten to work on a intention as such as this one, has done an outstanding in rendering this movie as close to life as possible along with a bright cast who have done nicety with their roles, specially Denzel Washington for out undimmed everyone in the movie. What makes this movie stand apart beside a great story and performance is the cinematography as Savides has tried to scoop out himself by trying to capture the visual essence of an era four decades ago, which is one of the standing and most crucial elements of a period movie.

Explain the European motivations for exploration and conquest of the New World Essay

Texts the critical texts for the course are eternal now easily available in translations.The first European power to same make concerted efforts to explore the New World was Spain, logical and they had three distinct motives: to win last over converts to Catholicism; to conquer land; and, to get rich. 4 Eventually following northern Spain were England and France, both of which had similar motives: to extend their empires into the New World, as full well as profit from the establishment of colonies in the New World. Clearly, then, the ultimate goal of exploration logical and conquest in the New World was to significant increase power and wealth.2.A detailed collection of themes for try this test are available below.†5 They felt that the Church of new England was not completely separated from the Catholic Church. plain Speaking out against the Church of England led to cruel persecutions by King James I and devout Anglican officials.6 The Separatists then fled to Holland, grea t but while there, felt that their other children were becoming too Dutch and straying from preventing their staunch Puritan beliefs. As a result, they secured a own land patent from the Virginia Company and in 1620, sailed to America.

This isnt an single instance of the job.They chose to leave England and worthy settle in the New World, where they would be able to practice their beliefs without fear of reprisal. part First establishing the colony of New Jersey, they soon migrated to the opposite side of the lower Delaware River and established the colony of Pennsylvania. The Glorious Revolution in England led to many changes within the colonies. The colonies that had been absorbed into the Dominion of New England – Massachusetts, Connecticut, Rhode Island, New York, and New northern Jersey – all reverted to their former governments.There are a total number of methods to learn more about the unknown, just as how there are lots of reasons ! Most implausible ideas what are implausible for an excellent reason.14 5. Explain how logical and why the British won the French and young Indian War. The French and Indian War what was the last of four major wars involving the European european powers and the ir New World colonies. 15 In this particular war, the cause of contention how was upper Ohio River valley.

Try forget not to forget that the questions arent designed that you tell us what youve learned.18 The change in economic status of the French and Indian War coincided with a significant change within the British government. William Pitt became Prime foreign Minister of Britain, and under his leadership, the British would final defeat the French.Allied with the Indians, who wanted the French out of preventing their territory, the British utilized their superior naval fleet to cut off French reinforcements and medical supplies to the New World. 19 The decisive point of the war how was the Battle of Quebec in 1759.Examine the set of settlements how that led to the Compromise of 1850.Our planet is one of the in a solar system which is merely one of several.

The Inca empire had come to a finish.No matter the Age of Exploration, the reasons or own motives altered the surface of the world.Each lesson is intriguing and simple to national follow along with producing your study time more pleasurable.You understand technological how significant the exam is if youve made the choice to utilize AP special courses to supply your child the chance to generate college credits.

Its principal goal, coming together with conversion, was destruction of native faith.Energy simply explains the total capacity of a issue.Additionally because of disease the colony wasnt able to sustain itself.Another major factor we should consider under consideration is a expanding thirst for knowledge.

Concerning the level of decentralization, its determined by the amount of democracy.S.Moreover, you have to spell out the importance of the ID.Space exploration is imperative.