Promoting health and preventing ill health Essay Sample

Promoting Health: Schizophrenia

This essay is based on the prevention and promotion of schizophrenia. The paper will begin by describing the background of schizophrenia. It will also explain the rationale for selecting schizophrenia as a health condition for this essay. Next, the paper will provide a critical discussion on the epidemiology of schizophrenia, including the risk factors, vulnerable population, its presentation, and prevalence in the UK. Additionally, the essay will explain the assessment of schizophrenia and the applicable assessment tool. The next section of the paper will describe three health promotion goals that the paper intends to realise by completing this work. Furthermore, it will provide a critical discussion on the interventions for health promotion goals, including roles of individual and his/her social network, multi and interdisciplinary teams, organisations, and departments, among others. Lastly, the essay will provide a critical discussion on evaluating health promotion care planning, including its effectiveness, alternatives, justification, and recommendations. The conclusion will contain a summary of key elements discussed throughout the essay.

Background of Schizophrenia

Swiss Psychiatrist Paul Eugen Blueuler first coined the term schizophrenia in 1910. In Greek, the words schizo mean 'spilt' and phren means 'mind.' schizophrenia was initially intended to mean 'loosing of mind and feelings' since it was characterised by fragmented thinking and mental confusion. It was also referred to as 'split personality (Perkovic et al., 2017). However, National Collaborating Centre for Mental Health (Great Britain) (2013) indicates that schizophrenia is not a split or multiple personality but involves psychosis where one cannot differentiate what is imagined and what is real. The world may appear to them as a jumble of confusing sounds, thoughts, and images. The individual with schizophrenia struggle in the society and hardly do well in school at work, and in relationships. Often, they feel withdrawn and frightened.

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Emil Kraepelin first defined schizophrenia as dementia praecox, a progressive mental health disorder of unknown aetiology. He observed the early onset of the condition to begin in adolescence, leading to a less or more irreversible deterioration in cognitive and functional capacity (Kendler 2020). According to National Collaborating Centre for Mental Health (Great Britain) (2013), schizophrenia is a chronic, severe mental disorder characterised by distorted thinking, emotions, perceptions, language, behaviour, and sense of self. According to Perkovic et al. (2017), the symptoms of schizophrenia include hallucination, delusion, lack of motivation, disorganised speech, and trouble with thinking. Early interventions diminished reoccurrences and contribute to improved quality of life. However, Perkovic et al. (2017) assert that schizophrenia does not any known cure, but there are antipsychotic medications that help elevate the symptoms and improve long-term outcomes.

Rationale

Knowledge and early intervention of schizophrenia are crucial to individual quality of life, health, and wellbeing. Catalano et al. (2021) noted that schizophrenia could be disabling and change the course of one's life. The early onset-of schizophrenia begins in young adults and threatens an individual's independence and quality of life at a crucial time (Kimotho 2018).  Timely access to necessary support and treatment enabled people with schizophrenia to lead a healthy life, work, have families, and pursue their life goals, thus, positively contributing to society. Moreover, for decades, societies have stigmatised and stereotyped people with mental health conditions such as schizophrenia as violent and split or multiple personalities. Moreover, there are also myths that individuals with schizophrenia belong to the mental hospital and cannot recover.  Katschnig (2018) also argued that society treats individuals with schizophrenia as lesser humans, making them feel isolated and deprived of social life. According to Kimotho (2018), this contributes to further stress and depression, which affect even those who are already on medication. Therefore, it is essential to promote health to enhance early interventions and adherence to treatment and change the societal perspective regarding schizophrenia.

Epidemiology of Schizophrenia

Schizophrenia is a major psychiatric disorder that changes one's perception, thoughts, and behaviour. The positive symptoms include delusion, hallucination, and negative thoughts comprise emotional apathy, poverty of speech, social withdrawal, self-neglect, and lack of drive (Halvorsrud et al., 2019). Schizophrenia is unequally distributed in society. According to Cadge, Connor, and Greenfield (2019), schizophrenia tends to more prevalent in lower- socio-economic groups. Halvorsrud et al. (2019) also state that men are 1.4 times likely to develop schizophrenia compared to women. Wang et al. (2020) indicated that the incidence of schizophrenia is about 16 per 1000 people. The condition affects 0.7% of the UK population (Cadge, Connor, and Greenfield 2019).  According to the Office for Statistics, Schizophrenia affects about 9.65 of children between 5 and 16 years and accounts for about 25% of the mental health disorders among adolescents between ages 10 to 18 years (Halvorsrud et al., 2019).

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Janoutová et al. (2016) indicated that one quarter has wholly recovered in long-term follow-up on people who have schizophrenia. Most conditions have improved while deteriorations are only 10% throughout their lifetime. Halvorsrud et al. (2019) argued that schizophrenia has a worse prognosis with early onset in childhood or adolescence than onset in adult life. Wang et al. (2020) also indicate that about one-fifth of individuals with schizophrenia experienced positive outcomes with only mild impairment. Halvorsrud et al. (2019) indicate that one-third of individuals with Schizophrenia present severe impairment that requires psychiatric and intensive social support. According to Cadge, Connor, and Greenfield (2019), individuals with schizophrenia have a 5 to 10% chance of dying by their own hands within 10 years after being diagnosed with schizophrenia which is around 3times higher compared to the general population.

The risk factors for schizophrenia include genetics; there is a greater likelihood of schizophrenia being passed to children from parents. Secondly, environmental factors such as exposure to toxins like marijuana, viral infections, or highly stressful situation can trigger Schizophrenia (Wang et al. 2020). Schizophrenia can also result from brain abnormality and changes in brain chemistry and circuits.

Assessment

Early diagnosis of schizophrenia is essential in reducing the challenges such as social, physical, and economic impacts and its debilitating effects. Holistic and systematic assessment is crucial to both the service user and physician (Macfadden et al., 2011). The presence and severity of schizophrenia can be screened using Clinical Global Impression-Severity (CGI-SCH) scale. CGI-SCH is effective in assessing positive, negative, depressive, and cognitive symptoms of schizophrenia. Grover et al. (2017) also indicates that CGI-SCH is a reliable and valid questionnaire used to evaluate the severity and treatment response in schizophrenia. Additionally, the service user's functionality can be assessed using the Personal and Social Performance (PSP) scale, Strauss-Carpenter Levels of Functioning (LOF), and Global Assessment of Functioning (GAF) (Psychosis, NICE 2014). These assessment tools are used to rate the service users functioning over the past months in four areas, including personal and social relationships, aggressive and disturbing behaviour, self-care, and engagement in socially useful activities.

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The physicians assign scores from 1 (lack of autonomy in basic functioning) to 7 (excellent functioning) in all four areas. The service user's health status is also assessed using Medical Outcomes Survey Short Form -36 (SF-36). The survey has 36 items and screens the service user's health status over the past four weeks in eight different areas, including physical health. The survey evaluates body pain, general health, physical functioning, and role-physical (Grover et al., 2017). The mental health assessment comprises role emotional, mental health, social functioning, and vitality. The assessment evaluates for adverse events and serious adverse events associated with schizophrenia. According to Psychosis, NICE (2014), the Diagnostic and Statistical Manual (DSMIV-TR) is used to evaluate the presence of schizophrenia based on the symptoms presented and to rule out the presence of schizoaffective and mood disorder.

Health Promotion Goal

The increased medical morbidity and mortality are associated with schizophrenia and related mental health disorders. The additional deaths are historically attributed to suicide and accidents (Stilo and Murray 2019). However, these only accounts for a small fraction of deaths as most deaths related to schizophrenia emerge from physical illness. The World Health Organisation definition of healthy life comprises mental, physical, and emotional health. The goals of health promotion for schizophrenia will thus reflect the physical, social, and emotional health of service users.

Goal 1: To create public awareness on factors influencing an individual's wellbeing to minimise mental health by 30% by 1st December 2022. While there are many misconceptions about mental health, specifically schizophrenia, society has no adequate information regarding factors, such as environmental factors, such as drug and substance abuse and depression, contributing to Schizophrenia (Stilo and Murray 2019). Moreover, the goal aims to create a supportive society that tolerates, accommodates, and supports individuals with mental health issues to support their recovery.

Goal 2: To conduct education and training programs to educate people with schizophrenia about their conditions to stimulate self-acceptance and positive coping mechanisms to promote medication adherence and minimise relapse by 40% by 1st December 2022.  Leonhardt, Hamm, and Lysaker (2020) indicate that most people with schizophrenia hardly accept their condition and are forced to take their medication under supervision. Lack of self-acceptance and limited information regarding one's mental health status reduces their compliance to medication and commitment to the recovery process leading to relapse and further deterioration.  

Goal 3: To train people with psychosis on nutrition, physical activity, and healthy living style to reduce obesity-associated antipsychotic medications by 60% by 1st December 2022. Antipsychotic drugs are known to have a side-effect on weight gain (Townsend 2018). Weight gain can contribute to depression, lack of self-esteem, and social withdrawal, thereby contributing to further deterioration. Thus, the goal is to ensure that people diagnosed with schizophrenia and are under antipsychotic medications adopt healthy living habits.

Interventions

The physical and social health disparity of individuals with schizophrenia and severe mental illness is increasingly concerning. Besides the unwanted side-effects of antipsychotic medications, the increased morbidity is attributed to adverse lifestyle factors such as physical inactivity, poor diet, and drug and substance abuse (Tranter and Robertson 2021). Additionally, the social determinates of mental health, such as families, individuals, community, and the entire population, also increase the risk of mental health condition and substance user disorder, thereby worsening the existing mental illness or substance abuse (Compton and Shim 2020). Therefore, the multidisciplinary approach can be adopted to implement evidence-based interventions that aim to minimise mental health conditions, promote recovery, and improve quality of life and health outcomes.

The community mental health nurses, social workers, and psychologists will work alongside public health organisations to employ a universal approach in educating the community members about schizophrenia. The initiative will promote healthy lifestyles, clarify misconceptions and myths about schizophrenia, prevent the onset, and eliminate or reduce causal risk factors such as substance abuse (Compton and Shim 2020). The intervention will also aim to provide society with adequate information regarding the need for early screening and check-ups to identify the early onset of schizophrenia and make a timely intervention. However, Tanaka et al. (2018) noted that mental health's societal attitudes and stereotypes prevent people from accepting their mental health conditions and challenging them not to seek mental health screening.  Catalano et al. (2021) also reiterate that societal beliefs and attitudes toward mental illness impede the recovery process of individuals with schizophrenia due to social isolation, discrimination, and prejudice. Thus, the educational and information campaign will ensure that community members understand accurate and precise information about mental health conditions and change their attitudes and behaviour towards people with mental health conditions.  

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Additionally, the psychologist, mental health nurses, psychiatrist, GP, and the government will selectively work with individuals diagnosed with schizophrenia to promote their adherence to medication and self-acceptance (Compton and Shim 2020). The team will employ diverse strategies, including restrictions, enablement, environmental restructuring, persuasion, and education, to promote the behaviour change. Education will increase the service users' knowledge and understanding of their condition and encourage self-care.  The government will equally play a role in passing rules, legislations, policies, and guidelines to reduce opportunities for people with schizophrenia to access drugs and substances and promote inclusion. The government can also encourage people with schizophrenia by passing regulations and legislation that eliminate the criminal justice system, employment, educational, and financial inequalities (Carney, Bradshaw, and Yung 2016). Moreover, environmental restructuring will be employed to change people's social and physical context with schizophrenia. These will include providing diet, private gym, and behavioural support classes to help service users participate in interventions together with the trainer. According to Valiente et al. (2021), lack of self-acceptance limits medication adherence and management. These interventions will eliminate barriers to early screening and early interventions to prevent the prevalence of schizophrenia.

Furthermore, obesity, as a side effect of antipsychotic drugs in people with schizophrenia, increases physical disability, mortality, and morbidity. For instance, the health effects of obesity include high blood pressure, diabetes, heart disease and stroke, breathing difficulties, and cancer. Moreover, the individual with increased body weight due to antipsychotic medication is likely to get depressed due to their new appearance (Luo et al. 2020). This can further contribute to depression, stress, and suicidal behaviour. The intervention will thus focus on ways to prevent relapse and adopt healthy lifestyles that prevent obesity. This intervention will require a nutritionist to personalise a healthy diet to service users. The physician will also actively work with the service user to engage in physical activities. Other multidisciplinary teams in this intervention will include service user's family members and carers to provide them with social support. The community mental health nurse also assesses medication adherence, and the social workers will assess service users' living conditions, self-care, and living activities.

Evaluation of health promotion care planning

Mental health influenced an individual's quality of life and can be maintained by finding a community for social support. Shereda et al. (2019) asserted that community is about feeling connected to and accepted by others. Cochrane, Moran, and Newton (2021) argue that loneliness and isolation deteriorate people with mental health conditions. As such, an inclusive, accommodating, and supportive community is critical for people with schizophrenia to thrive. Also, Shereda et al. (2019) stipulated the importance of early screening to improve mental health conditions and recovery management. However, the traditional beliefs and misconceptions about mental illness have persistently hindered people from undertaking early mental health screening to escalate recovery-focused interventions. Elraz (2018) further suggested that mental illness misconceptions have promoted isolation and discrimination against people with mental health conditions. El-Nady et al. (2018) also indicated that community-level initiatives effectively reduce discrimination and stigma, promote mental health awareness, prevent mental disorders, and support social inclusion and recovery. Thus, public education is a critical strategy intervention that helps change society's mind towards mental illness and develop a more inclusive and supportive culture towards people with schizophrenia.

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Additionally, the interventions geared towards people with schizophrenia are critical in improving their understanding of their mental condition, accept-self, and adhere to medications (Nguyen et al. 2020). In addition, government interventions through legislative and policy initiatives will improve individual's access to employment and educational opportunities, thus reducing the concern that if one is screened and found to have a mental health condition (Gray, Davies, and Snowden 2020), they are still confident of completing their education, securing jobs, and being accommodated in the society. Cochrane, Moran, and Newton (2021) confirmed that psycho-education and training effectively help the service user deal with the social stigma associated with schizophrenia and cope with emotional distress. Gurusamy et al. (2018) also reiterated that psycho-education coupled with family interventions improves mental health outcomes and reduces relapse rates. Elraz (2018) also noted that antipsychotic drugs are associated with weight gain, leading to serious psychological and physical health effects. Consequently, the Nursing and Midwifery Council (2018) contend that service users with schizophrenia must be informed of the negative and positive outcomes of these medications and other available evidence-based alternative options so that they can make informed treatment options. Shereda et al. (2019) also argued that individuals with schizophrenia under antipsychotic medications must be trained to engage in healthy eating habits, physical activity and adopt healthy lifestyles.

Alternative Health Promotion Initiatives for Schizophrenia: The alternative options in promoting health for schizophrenia include coercion and modelling. The coercion could be used to ensure that people with schizophrenia are prohibited from undertaking unhealthy habits such as substance abuse, physical inactivity, unhealthy eating and are forced to take their prescriptions to prevent relapse. Secondly, modelling can inspire and motivate people with schizophrenia to imitate healthy lifestyles and adhere to their drugs.

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Justification: Some people with schizophrenia hardly accept their mental health conditions, hence reluctant to take their prescriptions without supervision. Moreover, Baldacchino and Sharma (2021) noted that people with schizophrenia are more likely to involve in drug and substance abuse which exacerbates their conditions. Besides, Zhou and Li (2020) indicated that collaborative modelling effectively helps individuals with schizophrenia to shift their negative energy and attitude to productive lifestyles and adhere to their care plan. Collaborative modelling fosters self-management (Mezey et al., 2021). Therefore, coercion and modelling are equally effective approaches in helping persons with schizophrenia to adhere to their medications and adopt necessary lifestyles to prevent adverse effects of antipsychotic drugs.

Recommendation: Brown et al. (2019) indicated that while mental health conditions affect the community regardless of class, people in low-income communities face serious mental health inequities. Hence, the mental health promotional programs and government interventions should focus on low-income communities to increase the community knowledge of mental health conditions and stimulate healthy mental health practices.

Conclusion

Health promotion is critical in empowering individuals to control their health and recovery process and health outcomes. The traditional beliefs, myths, stigma, and stereotypes of psychosis continue to lower the confidence and self-esteem of people diagnosed with mental health conditions. Consequently, people are reluctant to screen for their mental health and access early interventions to fear being stigmatised and discriminated against. The health promotion program for schizophrenia thus targets the community, families, and individuals and encompasses multidisciplinary teams' efforts to change society's attitude and behaviour toward mental health conditions. The initiatives, including public education and campaigns, psycho-education and training, persuasion, and restriction of service users, were adopted to enhance community and individual response to schizophrenia. These programs, alongside government intervention, are critical in helping individuals accept their mental health conditions, adhere to their medications, and adopt healthy eating and healthy lifestyles. 

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