Monday, April 1, 2019

Introduction To Dual Diagnosis Health And Social Care Essay

Introduction To Dual Diagnosis Health And Social fear EssayOver the last ecstasy years in psychic wellness, there has been a mutual oppositionifi terminatet change and consider equal to(p) debate nigh the definition of treble diagnosing, this terminology refers to a psychogenic health derange combined with gist misuse (Department of Health, 2002). This put up cover a massive range of b differents from learning disabilities and snapper abuse of legal or extrajudicial drugs to severe genial badlyness such as schizophrenia and shopping center misuse of johnnabis or alcohol (Department of Health, 2002). hitherto in medication forked diagnosis is an umbrella term, for a old and secondary dis put up for typesetters case diabetes and hypertension (Sowers Epstein, 1995) This look marriage proposal bring out behind guidance on the client group three-foldity of psychosis and substance misuse of cannabis or alcohol.Psychosis can be defined as a severe psychic hea lth disorder in which thought and emotions ar significantly impaired, whereby heap can lose contact with reality. notwithstanding the symptoms can vary surrounded by dis go away and positive, the detri noetic symptoms can cause apathy, a decrease or absence of favor commensurate skills, resulting in confused thoughts which impair their ability to decoct or complete instructions. The positive symptoms can be defined as either visual or auditory h tout ensembleucinations or delusional thoughts, where a person may fox an undeniable belief in something paradoxical (National Institute for Clinical Excellence (NICE), 2011).However substance abuse can aggravate psychosis leading to further hallucinations, which is associated with a wide range of negative outcomes, such as higher judge of resort, increased hospitalisation (revolving verge clients), suicide, ho utilise issues and poorer levels of social functioning, such as poverty, violence, criminality and social extrusion , slight compliance with treatment, greater service be to National Health avail (NHS) or the criminal justice system and disposal function (Department of Health, 2007). more than than significantly The World Health Organization (WHO) in stimulate 51,353 admissions of drug- link mental health disorders in 2010/11. These admissions save increased year on year and be now nearly twice as high as they were ten years ago, therefore families argon at greater try of having a family element diagnosed with dual diagnosis (The World Health Organization , 2012). significantly the impact of the dually diagnosed within families is drastic, family dynamics ar diversifyed by contest and difficult s take backs within the home, by displaying disruptive and aggressive behaviours (Biegel et al, 2007). Clearly the great unwashed with dual disorders have strained interactions with their families. However when relationships ar strained families efficacy be less pull up stakesing to assi stance, the relative with dual diagnosis which could change to higher rank of homelessness and social problems (Clarke, R E Drake, R E, 1994). further family members may have differing amounts of contact and distancing, because of the negative impacts of their behaviour.However someone in the family takes the theatrical social occasion of main c atomic number 18 interpretr, world the person most ex executely cerebrate to the caring of the dually diagnosed whilst care freehand not only affects their QOL, it also impacts on possible depressive symptoms and query has indicated that care bounteous burden has a risk factor for early mortality (Biegel et al, 2007), (Marcon et al, 2012) (Walton-Moss et al, 2005) however a lack of social vitality, and in black-tie and formal care, has been found to be the most important microbe that predicts the burden of family health care housers (Biegel et al, 2007) although informal caring occurs naturally within family relationships, w hich is typically unpaid, this goes beyond the caring expected of these relationships in contrast to a paid formal carer (Chaffey Fossey, 2004) additionally being a carer can raise difficult ad hominem issues about duty, responsibility, adequacy and guilt (Shah et al, 2010).Research into the impact of care endowment shows that carers stand up significant psychological distress and experience higher rates of mental ill health than the world-wide population, the triggers for distress are as follows worry, anger, guilt, and shame monetary and emotional strain marital dissatisfaction, physical effect of the stress of sp reformliness with a substance abuser (Biegel, et al 2007).However without the contri besidesion of the UKs 6.4 jillion unpaid carers health and social care services would collapse. In 2037 its anticipated that the number of carers leave increase to 9 million (Carers UK, 2012). Worldwide several authors have argued for service systems to note and turn family m embers charter to ensure their own well(p)-being, as well as to ensure impressive community support for people musical accompaniment with mental indisposition (Chaffey Fossey, 2004) (Igberase et al 2012) (Carey Leggatt, 1987).The last ten years have seen major reform of the righteousness as it relates to carers consequently families have been forced to give up hold to care for their relatives. Family carers deal assistance to prevent become unwell themselves (Carers UK, 2012). thereof supporting carers must be a central part of government reform, which acknowledges the family as associated clients who desperately rent support. This is paramount because relatives often know unforesightful about how the interactions amid mental illness and substance misuse are interchangeable. Therefore families need practical information about dual disorders, to help recognise the signs of substance abuse, and strategies for its management for example medication adherence and recogni sing relapse triggers. Addressing these factors would modify the improvement in the dually diagnosed directly related to greater outcomes in the social welfare of the family (Mueser Fox, 2002).Overview, context and background information relevant to topicIt costs the UK 1.3 billion a year in carers benefits and lost taxes whereby family members are becoming increasingly responsible for providing support, although in 2012 the British government submitted the Care and bind Bill which pass on guide future services for caregivers. Families depart no longer be treated as an extension of the person they are caring for, they allow have a right to an assessment, this will give carers much better access to support them balance their caring roles and responsibilities (Carers UK, 2012). Yet informal carers may experience less choice about the discontinuance of care in comparison to volunteer or paid carers, perchance collectable to love of the family member and a sense of duty, it is essential that the family ascertain the facts about dual diagnosis, to have every hope for recovery of the family (Department of Health, 2007)to boot health services should acknowledge the families by assessing them as associated clients so that carers can learn to recognise the triggers of caregiver burden and moreover be addicted general education and health promotion (Rethink, 2007).However in 2006, the College of occupational Therapists (COT) announced a 10 year vision for occupational therapy in mental health which included by 2013 for practitioners to have extended their stage setting of practice across a range of agencies to bet the occupational necessitate of mental health services (COT, 2006)Statement of the problem proposed to be investigatedThe proposed investigate intends to investigate, what are the experiences of people who are carers for people with dual diagnosis? habitual aim(s) of the proposed researchTo find out how families cope life with someone with dua l diagnosis? What are their biggest challenges? To find the current experiences from the perspective of the carer regarding the impact of dual diagnosis, the burden grief and the loss of their relative.Relevance, significance or need for the break downThe relevance to occupational therapy and the health service carers are associated clients and therefore need to be taken into consideration when assessing this client group. Furthermore the lacking of occupational therapy books in this area makes a drop dead case for the proposed research.Chapter 2 Literature ReviewIntroduction to the chapterLiteratures in dual diagnosis are largely separate, mainly based in substance abuse or mental health fields. However over the past decade, family work in dual diagnosis has been mainly focused on client outcomes and not the families well-being or shade of life QOL.However occupational therapy literature is also limited, lacking investigation of occupational needs set from the families persp ective. However a considerable amount of literature has been published on descriptions of occupational therapists roles by defining and establishing what an occupational therapist does within the multi-disciplinary team in mental health services, notwithstanding not specifically to dual diagnosis (Brown, 2011) (Hyde, 2001)(Lloyd et al, 2008). Therefore it is beneficial for occupational therapists to have a better apprehension of the families perspectives, as associated clients to enable additional support for the caregiver thus alter outcomes for the whole family.There is a plethora of literatures, on outcomes associated with family support for the dually diagnosed, the mass of studies examined the relationship between family amour and client outcomes such as reduction in mental health symptoms, engagement in treatment services, displace hospitalisation rates, improved decrease in substance abuse, sustained cave in (Clark, 2001) (Mueser Fox, 2002) (Biegel et al, 2007). Altho ugh the high service costs of treating the substance abuser and the frequent involvement of relatives in the lives of dually diagnosed clients, there are few re seeds to help clinicians engage and cooperate with families (Mueser Fox, 2002). This implies that families or informal carers can easily become the main source of care when treatment fails, the family being the last resort (Clark 2001). On the other hand, some research has shown that someones with dual diagnosis are less well-off with their family relationships than those with a severe mental illness alone (Kashner et al. 1991) and that receiving family support may exacerbate difficulties by increasing conflict (e.g. supply of additional gold may be used for drugs, existing poor family dynamics change state carer-client relationship). Conversely research is lacking in the support of families caring for the dually diagnosed (Biegel, et al, 2007) (Townsend, et al, 2006).In contrast families are often the most significant people in the dually diagnosed life, this unique relationship puts families in the central position of being able to encourage the dually diagnosed to take the necessary steps towards recovery by providing direct care such as practical help, personal care, emotional support as well as financial support (Clarke, R E Drake, R E, 1994) (Shah et al, 2010) (Mueser Fox, 2002). The impact of mental illness on families is usually conceived in terms of caregiver burden, this experience may help determine the quality of life QOL for family members, the most significant being, isolation, coping with behavioural problems, and relationship problems between family members (Clark, 2001).Mueser et al, (2009) airfield of 108 families conducted a randomised control trial utilising Lehmans QOL wonder means with satisfactory reliability and validity (Lehman, 1998) for the diagnosed, the caregiver was assessed using the family experiences interview agendum (FEIS) with established reliability and va lidity which did not incorporate the QOL for the family this was not enshrouded. The findings from this theme found that motivating relatives, to participate in family intervention can address the disruptive effects. These stressors that affect quality of life include worry, anger, guilt, and shame financial and emotional strain marital dissatisfaction, physical effects of stress of living with a substance abuser (Biegel et al, 2007).to boot Biegel et al (2007) exploratory, non-experimental cross-sectional assess design conducted interviews / wads with 82 females with dual diagnosis and 82 family members and considered the caregivers experience as moderate, and found that behavioural problems contribute to the burden affecting their quality of life, the specialness of this study is acknowledging how substance abuse impacts on the role of care plentiful which was also tested by applying FEIS.M either studies of family carers of persons with mental health and or substance abuse issues consider how families quality of life is affected, the main themes highlighted that emerges end-to-end the reviewed literatures are caregiver burden which is documented as worry, anger, guilt, isolation, stress which results in a diminishment of QOL of family members (Biegel et al, 2007) (Chaffey Fossey, 2004) (Shah, Wadoo, Latoo, 2010) (Chan, 2010).Behavioural problems have been found to be the strongest predictor of caregiver burden across chronic illnesses (Biegel et al, 2007). In contrast Jokinen Brown, (2005) conducted a focus group study which included 15 beats would argue that there are positive aspects of lifelong care giving and quality of family life, the study hold the concerns for the health of all family members (Jokinen Brown, 2005).Research in the QOL of care giving highlights that carers suffer significant psychological, distress and experience higher rates of mental ill health than the general population. Therefore by improving the QOL of carers will believably to reduce caregiver burden that requires further research to explore the lived experiences of families living with the dually diagnosed (Shah et al, 2010).However, literatures addressing the family as a collective unit and the impact of care giving on each family members role is lacking therefore this literature reviews the research.The majority of family caregivers, mostly women report experiencing moderate to high levels of depression as well as stress, this type of informal care giving is taken on in addition to existing roles and responsibilities (Chaffey Fossey, 2004) (Biegel et al, 2007) (St-Onge Lavoie, 1997). Traditionally, informal care was supplied by women but nowadays women are not only more likely to work, but also likely to be significant contributors to family finances. For women, this implies that earnings will be lost due to informal care increasing. However women play a central role in care-giving which may impact on their well-being more than other m embers of the family (St-Onge Lavoie, 1997).Although according to shah et al (2010) women have higher rates of depression than men in the care-giving role (Shah et al, 2010). However male carers tend to have more of a managerial style that allows them to distance themselves from the dis view asable situation to some degree by delegating tasks (Shah et al, 2010). Significantly (Mays Holden Lund, 1999) Interviewed 10 male caregivers and the findings, men expressed their means of coping by being realistic and action-oriented in response to their feelings.However the effect of care giving on children can be considered by the physical changes to normal growth, for example migraines, inflammation of the lining of the colon, and ulcers (Biegel et al, 2007) (Townsend et al, 2006). Tracy Martin, (2006) examined the effects of dual diagnosis via cross-sectional survey design which examined the types of support provided by minor children and the differences in support perceive by the chil d versus the support perceived by the adult. The findings that the role of children is often ignored or neglected, the effects are referred to as a role reversal parental child or parentification thus resulting in negative developmental outcomes for the child, although a weakness with this study is the support perceived by the child is not the views of the children but by the mothers reporting on both, these findings epitomize a design bias (Tracy Martin, 2006).Significantly Rupert et al (2012) aim to identify the issues when engaging children whose parents have a dual diagnosis explored the perspectives of 12 children via semi-structured interviews. A strength with this study is that the authors were able to elicit the tender entropy ethically by gathering information about secrecy issues around their parents substance abuse and remaining loyal to their parents, children experience negative clippings fatigued with their parents, with family arguments and the knowledge of when the parent abuses substances these findings represent the need to acknowledge childrens perspectives as associated clients (Reuper et al, 2012). The authors acknowledge that the study does not recognise the other family members within the household that could provide an exploratory view of their perspective.Although the effect of care giving on siblings is lacking, vice et al (2012) studied the phenomena of understanding the experiences of siblings of individuals with first episode psychosis. qualitative semi-structured interviews with 31 sibling participants researched that they had somehow lost their brother or sister as his or her character had changed since the onset of their diagnosis (Sin et al, 2012) Younger siblings were much more likely to cope by withdrawing and not getting involved, they often reported that they were not made aware of information and resources available to help with the situation and were also less likely to want to know about the illness (Sin et al, 20 12).Strength of this study is the qualitative exploratory semi-structured interviews, and the themes that emerged although this study does not address the issues of substance abuse or the quality of life of the other family members. The cracking in the literature is that quality of life does not consider the affects of mental health and substance abuse on the family. This paper has not been able to locate any studies that consider the qualitative exploratory lived perspectives of all family members living with the dually diagnosed, and the impact on their quality of life, therefore due to the lack of research on families living with the dually diagnosed this research seeks to explore their perspectives.To conclude Health professionals should focus on the familys environmental context, and their perceptions of their relative with mental illness, thus by presumptuous that each family is different, clinicians should evaluate how family dynamics can affect the families quality of life and how theses interactions impact in their plan of care (Walton-Moss et al, 2005). However, numerous studies have looked at the effects of family involvement on the outcomes of the dually diagnosed, current literatures are lacking on the quality of life of family members, and does not consider the effects of mental health and substance abuse on the family, this provided the focus for the present research.The relevance to occupational therapyThe relevance to occupational therapy services is to lessen the burden on the carers so that they can stick around in their caring role, being well(p)y certain of diagnosis, relapse triggers, substance abuse, and the available services so that they can continue their caring role.Statement of aimsTo explore the perspectives of carers of clients with dual diagnosisTo explore the perspectives of the carers regarding substance misuseTo find out how carers cope, living with someone with dual diagnosis, what are their biggest challenges?Research qu estion proposed to be investigatedTo explore the lived experiences of a family that lives with the dually diagnosed client.Chapter 3 orderological analysisDescription and excuse of research DesignA qualitative semi-structured interview which utilises open ended questions, has been chosen because these methods lend themselves to exploring the familys perspective and meanings of living with the dually diagnosed, this will permit individual members of the family narrative to be acknowledged. barely the investigator will ask questions in similar ways to all participants, which will guarantee to maximize the confidence in the research reliability and validity (Hicks, 2009). This method will attempt to understand a complex novel phenomenon, whereby the tec needs to understand that the concepts and variables that emerge may be different from the aims, seek by the study (Pope Mays, 2006). In contrast focus groups were not chosen due to the consensus of a group of people rather than the individual perspectives from the family (Pope Mays, 2006).The research will be conducted in the participants home, due to purposive sampling methods in which sites are selected on the basis that they are typical of the phenomenon being investigated (Pope Mays, 2006 115). This will attempt to justify the rationale for the research taking place in the home in environment (Pope Mays, 2006). Moreover purposeful sampling techniques will be used to obtain participants whereby the detective identifies specific people to take part (Hicks, 2004).However an aspect which illustrates rigour can be identified finished member checking, whereby cross-checking findings with participants, can help to refine explanations, and aims to reduce subjectivity in processing of data analysis (Pope Mays, 2006).Therefore Living with dual diagnosis through and through the families eyes, can be addressed by using semi-structured interviews whereby rigor can be associated with this type of approach, du e to data put in from as many appropriate sources to provide in-depth information (Pope Mays, 2006).Indication and justification of required number of role playersThe participants will be family members of the dually diagnosed client, that attend a community mental health day ticker. However this study acknowledges the stigma attached to mental health services, as recent studies have shown that public education campaigns on mental illness and the integration have done little to alter the stigma associated with mental health (Schulze Angermeyer, 2003). Conversely the recruitment of participants may intrust upon their visit to the day warmheartedness or if not appropriate for them because the dually diagnosed participation at the centre and the passing on of the flyer or information about the study, requiring no attendance at the day centre is necessary, due to the research being conducted in the participants family home.However It is argued by flex McKenzie (2006) that for i n-depth qualitative studies small numbers of cases facilitates the researchers association with the participants, and enhances the validity therefore a maximum of 20 participants in total will be recruited to allow sufficient time to snap the collected data (Crouch McKenzie, 2006). However snowballing sampling, was not the chosen method of recruitment because recruited participants in the study, would refer and reccommend future participants (Patton, 2002). arranging of access to and recruitment of possible participantsParticipants for this study will be obtained through voluntary participation advertised via flyers and posters at a community mental health daycentre (Appendix 7), the flyers will provide instructions for participants to contact the researcher, the purpose of the study requirements to be a volunteer, and the time commitment of the volunteers will be listed on the flyer, once families (maximum total of 20 people) are recruited for the study, the researcher will murd er the flyers and posters.When volunteers respond, a telephone screening interview, approximately 5 minutes per person, will be conducted to determine if the individual family members meet the inclusion criteria. Families that respond and meet the inclusion criteria will be consented and accedeed (if appropriate) and recruited to participate in the study. The researcher will speak with the families, and communicate with each family member to set up a meeting time and place that is convenient for all members (Pope Mays, 2006).Inclusion/exclusion criteria of participantsThe validation for the inclusion and exclusion criteria relies on the family homogeneity that they are comprise of being related and living together, therefore similar participants may enable a more in-depth enquiry into their shared and distinctive experiences (Hicks, 2004)The inclusion criteria eligibilitya) Family member is living with the person diagnosed with dual diagnosis.b) Family member is capable of engagi ng in verbal communication pertaining to semi-structured interviews.c) Family member is above 16d) A family consisting of ii or more members (max 4) not including the dually diagnosed client.e) English speaking and capacity to gleam participate.The exclusion criteriaa) Family member is below the age of 16.b) The diagnosed family member with dual diagnosis.c) No mental disorders or substance misuse disorders.d) Non-English speaking or with a cognitive deficit disorder.The semi-structured interviews may plow topics or issues which are sensitive to the participants, these difficulties can be averted by a procedure of gaining on-going consent and defer for the 16-18 year olds (appendix 2) (Wiles et al, 2007). If distress occurs then the researcher can either hold back the activity or will sustain on to the next area. It will be made clear to participants that they can decline to answer any particular questions or discuss topics that they feel uncomfortable with and can leave the research at any time, additional support and information will be available (Wiles et al, 2007).Indication of Ethical issue relevant to the proposalThe researcher should at all times respect the autonomy of the individual by allowing the participant the freedom from control or influence of the study. additionally the researcher has a duty to uphold beneficence which is the pledge to maximise benefits and minimise harm (Domholdt, 2000). Justice should be maintained throughout which is the obligation to treat each person in accordance with what is morally right and proper, therefore informed consent and ascent will be obtained via the Participant Information Sheet (approximately 30 min) (Appendix 1).Once the inclusion criteria has been met and each of the participants agree to join the study, a meeting time and place for informed consent, form review and data collection can be scheduled. The researcher will review (1) the purpose of the study, (2) an explanation of the procedures inc luding the interviews, and the interview process, (3) an explanation of possible benefits and/or risks or discomforts (4) Consent to audiotape semi-structured interview (amended consent form), and an explanation of the subjects rights and confidentiality, the subjects will be asked to repeat their understanding of the study and procedures in their own words. Once full understanding has been demonstrated of the purpose and procedures of the study, the researcher will ask the participants to sign the consent form.Research approvalGeneral approval to be want from Brunel University Research Ethics committees. Ethical approval for the research study is to be obtained from Brunel University, additional permission to be sought from the community mental health day centre (gatekeepers) to recruit participants via flyers and posters (Brunel University West London, 2010).Discussion of ethical considerations related to participation and consentDue to possibility of participants being aged from 16-18 assent will be required which is a term for participants too newborn to give informed consent but who are old large to understand the proposed research, including the expected risks and possible benefits, and the activities expected of them as subjects. Assent by itself is not adequate, however. If assent is given, informed consent must still be obtained from the subjects parents or guardian (Domholdt, 2000).Ethical issues will arise throughout the research process, from initial planning to writing up and data analysis, due to interviews concerning closed-door experience (Kvale, 2007). The researchers will respect the privacy of the participants by making it clear to them that they are free to decide what information they wish to share with the researcher and that they should feel under no pressure or obligation to discuss matters that they do not wish too. information regarding the patient, family or the community, which will have the potential to identify them, will be omitted,Indication of any risks and benefits to participants and/or researcherThe possible risk to the participant is the discussion of sensitive issues, due to the nature of the research and the psychological aspect of discussing experiences. If distress occurs then the researcher can either stop the activity or will move on to the next area. It will be made clear to participants that they can decline to answer particular questions or discuss particular topics (Wiles et al, 2007). Moreover the non-therapeutic approach, whilst designed to advance knowledge and therefore be of collective benefit, it is not expected to give a direct benefit to the research subject (Wiles, Crow, Charles, Heath, 2007).The risk to the researcher is conducting the study in the participants home, the researcher will have to abide by the Suzy Lamplugh Trust lone worker policy (Suzy Lamplugh Trust, 2012) (appendix 4 ) therefore a full risk assessment will need to be completed. Additionally the researcher wi ll indemnifying against risk, to either the researcher or to participants, by taking out insurance for a period of time limited to the research process.Consideration of issues of confidentiality and data securityIn order to protect confidentiality, the researcher will identify the subjects for this study by the role that the participants fulfil in the family for example mother, son or daughter. Once all data is collected and analysed the interviews will be transcribed, and the audio tapes will be stored in a locked, secure location until the study is completed, after completion, the primary data will be destroyed and all other data will be destroyed and discarded according to data protocol up to two years (Brunel University West London, 2010).Materials or equipmentThe interviewer is the instrument in this type of evaluation the instrument can be affected by factors like fatigue, personality, and knowledge, as well as levels of skill, training, and experience. According to (McNamara , 2009), the strength of the general interview guide approach is the ability of the researcher to ensure that the aforementioned(prenominal) general areas of information are collected from each interviewee. The equipment required to analyse the data is software for qualitative data analysis which is ATLAS.ti 7, as a tool for enhancing rigour this software is available at Brunel University (Atlas.ti Qualitative Data Analysis, 2012). The training implications required is a one hour training session. Additionally an audio tape recorder is required for the semi-structured interview a limit is that the interviewees may be unable to put their thoughts into words and difficulties of analysing data from semi-structured interviews (Atlas.ti Qualitative Data Analysis, 2012).Comprehensive description of ProceduresThe study will consist of 45 weeks part-time work (appendix 9) the research will be advertised through flyers and posters at the mental health day centre after want approval from t he day centre (gatekeepers), The recruitment drive will be for two months via dually diagnosed participation at mental health day centre which the researchers have no affiliation too

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