Public Health Report: Mental Health in Hackney, London

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PUBLIC HEALTH REPORT

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Contents
PUBLIC HEALTH REPORT..........................................................................................................1
INTRODUCTION............................................................................................................................3
LO1..................................................................................................................................................4
LO2..................................................................................................................................................8
LO 3................................................................................................................................................11
LO 4................................................................................................................................................13
REFERENCES..........................................................................................................................16

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INTRODUCTION
Public health is the science, which advances safety and improvement in term of health
of the people of the community by research of diseases, policy making and
implementation educating and spreading awareness and measures for injury
prevention. The government works a lot on improving the health of public by introducing
various social and health care organization and firms. These firms work are under
certain criteria and guidelines as set by the legislation. They work in providing social
and health care services to the individual in needs and try providing standard quality of
services in order to meet their level of satisfaction.is assignment focuses on making a
public health report on the mental health of people in hackney London. It describes the
cultural practices in England with respective to people suffering from mental disorders.
Cognitive behaviour therapy can help people deal with their stress. there are various
methods with in the cultural activities which help in cognitive behaviour therapy while
few rituals also act as a hindrance of the same. The assignment also discuss about
whether the CBT is qualitative or quantitative method for evolution in public health. Also
the ethics to be followed in consideration with CBT is discussed along with its effectives
and efficiency.

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LO1
Culture refers to a set of values and believes which are been followed by a group of
people that forms a society of people having same cultural norms and values.
(Aronowitz., 2014)The effect of culture and believes on mental health, disorders and
health services related to mental health in the society is very diverse. The study and
understanding of cultural norms of society is important because this what people as
patients bring to the clinical setting and health care organization. The individual and his
family members take various actions in reference to cognitive behaviour therapy for the
one who is suffering from mental illness (Dixon-woods et al., 2014). In earlier 16th
century people never understood the concept of disability or disorder. They had no idea
about the primary and secondary standards of disability nor they know the importance
of physical, mental and economical health. In Christians exorcism was a very common
practice, as the society believed that mentally disordered people were possessed by
evil spirit due to their bad deeds and actions. The German people kept such mentally ill
patients away and isolated from the society of healthy group of people. Darwinism is the
biological evolution theory, which was in trend in late 19th century and the unhealthy,
and mentally retard people were considered as the threat to the society and the healthy
group of people thought that preserving them was of no use as they are a barrier
towards growth and evolution (napier et al., 2014). Asians considered the mentally ill
patients trapped in some kind of black magic and spirit while Greek mythology
considered such ill people inferior then the normal and healthy bunch of people an
where asked to stay separately from their family and friends consisting of a healthy
society. Later in 1990 the government of UK introduced an act called “community care
act” which helped in changing the scenario, it helped in giving recognition to the ill and
mental patients and their rights to demand their needs and requirements for living.
Introduction of The Act of Equality and several other steps and policies made by the
government in favour of the mentally and physically ill patient, later reduced the concept
of treating mentally ill patients inferiors and not giving the their respect and rights in the
society (Jacobs et al., 2013).

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Influence of Social circle on accessibility of mental health intervention: cultural values
influence the mental health care a lot, may it be from seeking initial help at professional
level or may it be the diagnosis and treatments procedures till the after treatment care
and other social reintegration. In the case of mental health care the first thing that an
individual can relay on is the informal communication that is between family and friends
(tew et al., 2012). As the individual who is suffering with abnormal behaviour will first
seek help and suggestion for this mishap from their closest relatives and family.
According to the analysis and studies that show the relation between a social interaction
and a mental health state , it is seen that face to face interaction with family and close
friends while sharing problems and issues reduces stress and getting mental peace.
Influence of a healer before biomedical in accessibility of mental health intervention:
once the social interaction is not giving any results of improvement for the person
suffering for mental issues the next help which is achieved is from a priest or father. As
seen the ethnic group in hackney London includes a 16.3% of white people, 11.4%
black African .the catholic believes insist people to seek help from religious followers
and spiritual guides at times this can be helpful. As seen the maximum population in
hackney London turns out to be of whites, they prefer going to the church and seek help
from father (tew et al., 2012). This can be helpful as people have many cultural believes
regarding their path of treatment and cure hence talking to the father in church can
conveying all the problems to him with the blessing of god will give them peace and
internal satisfaction and enthusiasm and encouragement from father and his religious
knowledge will help them win over their current condition. By the reports of WHO it is
said that mental disorders are enhancing in both developed and developing countries.
Also with this studies also show that alternative practitioners also play a very important
in fulfilling mental disorder patients requirements (sorketti, Zainal and Habil., 2012)
In order to achieve the cognitive behavioural therapy for assessing people with mental
illness or disorders, it was seen to have social interaction as a beneficial action for
releasing stress as getting isolated builds up more frustration when this doesn’t work
seeking help from the priest or father who acts as the religious follower and can guide
the individual suffering from mental health by his religious knowledge and strong

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believe. There are various hindrances in achieving the cognitive behaviour therapy,
which pull people from not taking professional help or take any action under the shadow
of culture and believes (Dobson and Dozois., 2019), and religious norms.
Demonic value with reference to mental illness: many cultures today also have believed
that the abnormal behaviour of an individual can be a result of spiritual possession. In
less developed areas like hackney London where people where these believes are still
apart of the local culture. With time mental health, which is been explained in terms of
possession, has taken various forms. As a result of which any individual who suffering
badly with distress and debilitating mental or psychological problems are persecuted
and abused physical out of the believe that the ghost has captured and trapped their
soul (Szasz., 2013), and all this is because of bad and evil deeds. The cultural followers
like priest and father at times other then giving a moral support to the patient and his
family distract them from going for professional help and support and they suggest the
family and relatives to go various rituals which might help the soul to set free from the
evil spirit. Such patient needs urgent care and treatment y professional where
government has already come up with various health and social service centre, which
provide special services for mental disorder patients. With well trained health care
professional and all the required equipment’s for dealing with such patients
(Greenberg., 2013). It is high time that society realise that such patient need more care
concern and calm behaviour other then physical abuse and isolation. Also professional
at time face difficulty in treatment planning and diagnosis for patient, which come from a
very orthodox and suspicious culture (Cook., 2013). The patient with strong cultural
background usually face problem in getting post treatment care.
Social stigma with reference to mental illness: The individual with mental illness are
challenged doubly. Where on one side they deal with their difficulties of understanding
their symptoms and disabilities including their sudden change in behaviour and on the
other side is the challenges and difficulties they face by the misconception of mental
illness being judged and discriminated by the society. (Katz., 2014)As a result of these
issues people who are suffering with mental illness are unable to life a quality life that,
includes health care satisfaction, better job, safe housing and being in connect and

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communicate with diverse groups of people with in the society. The studies and
research are going on to understand the result and impact of the mental disorder on an
individual’s life and his surrounding. Still several researches are to be done to know the
scope of prejudice and stereotype against the individual suffering from mental disorder
(Hendersonet al., 2012).
Stigma is a feeling which usually not good or is unfair regarding any illness, it is the way
of behaviour. Stigma can be of two types pubic stigma and self-stigma. Public stigma
refers to the reaction or expression the people of the society have against the people
suffering with mental illness while self-stigma is the prejudice that an individual with
mental illness face against himself. Stereotype, prejudice and discrimination are three
factors on the basis of which stigma can be well described (Krajewski, Burazeri, and
Brand., 2013).
Stereotype can be said as social because these are the reaction and expression of
group of people, they seem to be effective on the mental health of the patient because
of the expressions of the people who are apart of this stereotype group (Henderson et
al., 2014).
Prejudice leads to discrimination; it is a fundamentally effective act. It can also lead to
changes in the behaviour. Anger leading prejudice can result in a hostile kind of
behaviour by the patient (Weiss., 2018).

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LO2
Over the passing years, researchers have come up with methods and tools that help to
gather and assess data. Evaluation of data can be done by two methods that are
qualitative and quantitative. When considered both they are highly beneficial on
understanding certain information or outcome of any test or survey conducted. There
are benefits of both qualitative and quantitative methods of evaluation, though it is
expected that any one can be completely accurate in the desired situation on collection
of data (Mertens., 2014). Qualitative evaluation can not have human biased responses
says the statistics as it is more trust worthy while in quantitative evaluation the truth is
harder to achieve and the evaluators usually do not agree on various responses.
Quantitative: observations, which are made on the basics of scientific tools and
measurements, are called quantitative observations. In this the results are counted or
calculated and any one else coming up with assessing the same condition quantitatively
will be able the find the similar result. Quantitative method is usually used for goal
setting and calculating the performance (Ritchie et al., 2013).
Advantages of quantitative evaluation:
The data information collected is usually in form of surveys, experiments etc. therefore
the collection of data is rapid. In order to prevent biasness the quantitative data
collected is randomized. It often provides reliable and repeatable data information,
which is helpful in planning future processes. The quantitative evaluation generalises
the findings and its not specific this helps in identifying troubles prior (McCusker and
Gunaydin., 2015)
Disadvantages of quantitative evaluation:
In quantitative research every answer cannot be followed .As all the data collected is
through surveys and experiments the answers can be or cannot be true. Due to
involving of experiments and researches in collection of data it hampers the cost.
Specific details of feedbacks are not achieved as it depends on the collective data.

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Qualitative: observation, which is made using any five senses, as defined scientifically is
called qualitative evaluation or observation. It is harder to find accuracy in qualitative
evaluation. If two people are trying to evaluate a similar condition they can end with wit
conflicting results. It includes emotional and judgemental responses. It is usually used in
research and business (McCusker and Gunaydin., 2015).
Advantages of qualitative evaluation:
The data collected has a enhanced level of detail as in qualitative evaluation they focus
more on the subtleties that is found in the information and lesser focus on the metrics of
the data. While gathering data for qualitative evaluation if at any point it is realised that
the information is not giving any result, the focus can immediate shift to anew direction.
Qualitative data can be gathered on the basis of gut instinct and this data collected is
considered precise, as it is not in numbers. The data collected here is based on
observations and experiences therefore the evaluators can come up with other
interesting questions for detail views.
Disadvantages of qualitative evaluation:
The data gathered in qualitative evaluation is highly subjective and this can be the
negative component of the process. The qualitative data collected is rigid enough
(Mertens., 2014). hence it becomes difficult to assess and demonstrate it. The detailed
information often collected is overwhelming but it takes a lot of time. In qualitative data
evaluation often the information collected is valuable but then it’s difficult to present it.
Psychometric test is a standard method of testing any individuals mental and
behavioural activities and capabilities. This scientific test is specially designed and
introduced to measure and monitor candidates suitability based on characteristics of
personality and aptitude (Kline., 2015). The psychometric instruments help in identifying
styles of thinking, behavioural patterns, and emotional processes these help in
processing cognitive behavioural therapy for individuals suffering from mental disorder.
While we evaluate this approach through qualitative evaluation technique we use
different modes of perception gathering tools like questionnaire, interviews feedback
surveys etc. it is important to take feedback and a round of questionnaire from people

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so that we can monitor the changes and improvement achieved after the intervention
that is cognitive behavioural therapy so that we can make a report on the improvements
and the individual himself can make self report of his mental illness before the
intervention of cognitive therapy and after the intervention. Usually in order to evaluate
any intervention qualitatively we use comparative analysis (Pawlikowski, Altstötter-
Gleich, and Brand., 2013). Comparative analysis is defined as comparison done item by
item of two or more components, alternatives, processes, data, system or qualification.
When we evaluate the similar approach by quantitative evaluation technique, we
measure human behaviour and other attributes and it involves the mathematical and
statistical analysis of psychological processes and hence the report of final analysis is
formed in the form of numerical data. And to evaluate the intervention quantitatively
correlational analysis is used. Correlational analysis is defined a statistical evaluation
method of studying the relationship and comparison between two numerical values or
variables (Kline., 2015). And this is done when the researcher wants to establish
connection between the data of variables.

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LO 3
Ethics are defined as the correct rules and conduct that are to be followed when
searching out information or practicing health and social care (Dryden and Branch.,
2011). Ethical considerations in health and social care are mostly subject of fostering
the respect and dignity of the patient and managing to safeguard patient’s rights. The
ethical considerations are to be followed by every legally registered health and social
care practitioner in this world that provides treatment, intervention and service delivery
to the disabled and sick. Psychology and mental health are the aspects of health and
social care that requires the ethics to be followed very precisely as the group of
individual seeking support and help in this sector are vulnerable and highly at risk of
getting harmed and abused. Different set of standards of care and ethical codes are
followed by the practitioners while performing different procedures and interventions on
the individual. Similarly the cognitive behaviour management therapy is the trending and
leading intervention provided in mental health and wellbeing care. Following and
maintaining the ethics in providing this intervention is crucial and is to be well managed
and monitored. The main idea to follow the ethics in mental health and social care is to
safeguard patient’s rights and as CBT has been proved to be one of the most effective
psychotherapeutic management therapy and treatment for choice for variety of mental
issues these procedures require utter care and ethical considerations while delivery.
Sookman (2015), introduced a set of issues that were identified as ethical breach or
ethical issues while delivery of cognitive behaviour therapy. Some aspects that the
therapy comprises of and can include any sense of ethical issues are initial assessment,
exposure based therapy, informed consent, out of office appointment, therapeutic
relationship, professional boundaries, and risk management (Morrison et al., 2002). The
article discussed how the major ethical issue arise during this intervention is the patient
therapist relationship, as the therapist in this intervention gets well acquainted and
involved in the personal life of the patient the chances of getting attachment and breach
of professional boundaries is high. It is usually seen that the specialists in this sector are
trained effectively to provide care with in depth knowledge of the boundaries and
relationship guidelines they have to follow under the standards of care. The authors
described how the interventions and approaches included in CBT have to strictly adhere

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to the ethical guidelines that the practices should be evidence based, and cannot be
practiced if the intervention do not undergo the withstanding current requirements of the
treatment and has any implication of harm to the human subject with complexity of the
clinical presentation.
The ethical considerations during different phases of CBT are being identified and are
important to be followed this includes during the assessment phase the home visit and
the measurement of the mental status involves running various tests and questionnaire.
The practitioner should follow the ethics of respect, communication and boundaries
while this phase is carried out (Dryden and Branch., 2011). Next phase includes psycho
education and this involves through knowledge and information regarding evidence
based programmes and approaches that are used for the patient. Informed consent is
another crucial element in the CBT intervention process. Informed consent helps
safeguard the rights of the individual who engage in the health and social care. Ethics
dictate that the participants are voluntarily involved in the process and there is no
coercion. It also involves discussion of potential risks from the intervention or the
process. Also participants have to be mentioned beforehand with the experiences and
expectations from the therapy. As for example the coping strategies when indicated will
help cope but are not viable to reduce the distress caused by other events (Morrison eet
al., 2002). Also the tolerability and exposure to the therapy is being identified and is
discussed beforehand as example some authors suggested that the prolonged
exposure to PTSD may show exacerbation through therapy. The risk assessment and
reduction process should be included as per the ethical guidelines for the CBT (DiMauro
et al., 2013). It involves risk reduction through the assessment and providing therapies
that do not exceed the normal real life experience rate. For some disorders like anxiety
disorder out of office sessions and homework are required to inbuilt and cope with the
fears of the individual. Many patient respond only to the set settings and not in office.
When these out office sessions are considered attention to the boundaries management
is paid. Professional boundary crossing includes informed consent, information of
procedure, evidence based practice, and accompany by family member is considered.
Ethics in CBT also includes the involvement of family interventions that provide positive
outcomes and better skill development and reduced shame and blame.