New approaches

With the developments in recent years, there is a growing potential for new ways to investigate, intervene in and understand the psychological consequences of mental health problems. Health psychology can be described as: the aggregate of the specific educational, scientific, and professional contributions of the discipline of psychology to the promotion and maintenance of health, the prevention and treatment of illness, and related dysfunctions, and to the analysis and improvement of the health care system and health policy formation (Sheppard 89).

All treatments are different and it is of great significance that interventions are matched to the individual’s symptoms. Treatments also need to take into account all factors that might be contributing to the problem. A combination of methods is commonly the most effective and brief outpatient treatment (Maheu et al. , 96). From their review of treatments for phobia, Moore and Carr concluded, for instance, that a six-session family-based behaviour therapy programme was the treatment of choice for phobia.

On the other hand, for severe anxiety problems a programme of twenty-four sessions of combined individual and family-based cognitive behaviour therapy is the treatment of choice (Kent and Hersen 18). Treatment producing favourable outcomes must be guided by a thorough assessment. It is generally recognised that a single method is not efficient. Treatment plans need consider individual needs. Assessment should comprise observations of patients in a variety of settings, including school, work and interviews with co-workers, relatives, parents, teachers and children.

Early intervention is necessary to prevent secondary problems (Kent and Hersen 120). Kent and Hersen (2000) concluded that a variety of psychological interventions have positive outcomes. These include self-centred approaches, such as social skills and self-instruction training, behavioural training and family therapy, as well as combinations of these approaches (Kent and Hersen 124). Cure-based approaches 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).

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