MentalHealthEssay clean

Mental Health Essay
Total Word Count: 2970/3000
Submission Date: 08/12/2016
Essay 1: Write an essay that examines the mental health needs of a
specific group of your choice. Critically analyze the psychological
interventions of this group.
Abstract
The goal of this essay is to critically analyze the mental health needs of a
specific group (Asian Muslim women, abbreviated to AMW), their utilization of
mental health services and the psychological interventions available and
accessed by this group. Research, books, articles, studies and journals that
look at both the views of AMW and the available psychological interventions
(with a focus on the treatment and statistics around depression and its DSM
derivative – Major Depressive Disorder - MDD) have been examined, along
with statistics on the efficacy of these interventions and the results that can be
obtained with the right form of therapeutic care and psychological intervention
(referring to one of the IAPT services form of psychotherapy, CBT).
The findings indicate that for various reasons, AMW underutilize mental health
systems and possess different barriers that can prevent or hinder them from
accessing available resources. This can still be the case even when
appropriate provisions of psychological interventions are provided to Asian
Muslim women that bridge the stigma attached to seeking psychological care
and treatment and seek to address the different needs of AMW. When this
occurs, then perhaps effective forms of treatment can be created that can
assist in the treatment of Asian Muslim women and their specific health care
needs, despite the cultural, societal, familial, and historical perspectives that
they hold.
Essay
According to the United Kingdom’s Office of National Statistics (2015), the
United Kingdom has roughly 64 million inhabitants (mid-2014 estimate). With
this large population, adequate provision of health services via the National
Mental Health Module: Essay 1
Year 3
1

Health Service (NHS) is vital, including the provision of a Mental Health
Service (Office Of National Statistics, 2015) that can be used to serve the
needs of the multi-cultural population of the UK, as well as the needs of
specific groups within this population.
Despite the provision of such Mental Health Services, evidence shows that for
one group, namely AMW, there is an underutilization of such mental health
services, especially in terms of psychotherapy/CBT. AMW, who are
stereotypically shown to be a “model minority…actually face numerous
culturally based challenges, and have higher rates of mental illnesses than
previously suspected” (Miller, Yang, Hui, Choi, & Lim, 2011, p. 346). These
challenges impact AMW’s choices to seek help due to a wide range of social,
cultural, religious and historical influences.
Atkinson and Gim (1989) found that some of this underutilization seemed to
exist due to a conflict between Asian values and the psychotherapy process
as a whole. Problems also exist due to the preference of the patient: a meta-
analytic review conducted by Calbral and Smith (2011) indicates that clients
demonstrate a strong preference for therapists of their own race or ethnicity.
This is not always possible due to the area in which the patient lives, their own
culture and values and the family’s view on mental health and psychotherapy
services, and the stigma attached to these services by Islamic culture,
historical perspectives and social views.
Lannin, Guyll, Vogel and Madon (2013) went on to state that psychotherapy
Year 3
2

might also be underutilized because certain people (such as AMW)
experience a kind of self-stigma where there is an internalization of the public
stigma (cultural, historical, societal and familial) associated with seeking
psychotherapy. This study looked at whether the self-stigma that people
experienced could be reduced by a self-affirmation intervention wherein
participants reflected on an important personal characteristic. The results of
the study found that a self-affirmation writing task had a positive impact on
willingness to seek psychotherapy; however, they failed to support an indirect
effect on people’s intentions to seek psychotherapy. Findings from this study
show that self-affirmation theory may provide a useful framework for
designing different interventions that seek to address the underutilization of
psychological services. If AMW were in turn allowed to go through these
studies and assessed on their willingness to seek psychotherapy, different
strategies could be employed that could increase their willingness to attend
such services.
Major Depressive Disorder is “characterized by one or more major depressive
episodes” (DSM-IV-TR, 2013, 369), typically where the patient suffers from
low mood, sadness, low self-esteem and a loss of pleasure in everyday
activities. This becomes increasingly problematic over time, and if left
untreated, can lead to suicidal thoughts and feelings. According to Stewart
(2005, p. 135), one of the main treatments for depression is psychotherapy.
This creates a paradox for AMW due to their reservations surrounding
psychotherapy and mental health/illness. Despite the fact that AMW avoid
seeking psychotherapy and psychological treatments, according to
Year 3
3

Antonuccio (1995), the results speak for themselves as to the advantages of
seeking psychological treatment to combat depression and it has been shown
that psychological interventions, particularly cognitive-behaviour therapies and
the like, are generally as effective or more effective than medications in the
treatment of depression.
Fogel and Ford (2005) carried out research to address the stigma associated
with mental illness and depression, in an attempt to help individuals to seek
relief from their symptoms rather than suffer in silence. They found, however,
that according to Asian Muslim women’s beliefs, help is seen as a sign of
“personal immaturity, weakness, and a lack of self discipline” (Fogel and Ford,
2005, p. 471). They also state that mental illness can be seen from the
religious “belief that it is a punishment from God or the spirits owing to the
family’s bad behaviour; further seeking treatment will reveal hereditary
problems that will shame the family” (Fogel and Ford, 2005, p. 471).
Psychotherapy could also divulge sensitive information, which could shame
the family. AMW seeking psychological help can also experience a “number of
psychosocial stressors, including language difficulties, experience of
discrimination, homesickness, isolation, and cultural stress due to differences
between their heritage culture and the dominant European culture” (Wong,
Wang, & Maffini, 2014, p. 279).
Weatherhead and Daiches (2010) state that while western people go to their
doctors for advice, Islamic people tend to turn to prayer, religious leaders and
immediate family. Negative views of problems can deter some Asian Muslim
Year 3
4

women from talking to their families, while language barriers, inadequate
services and a community that likes to keep matters in the family can be
damaging and lead to further illness, complications and untreated symptoms,
resulting in a lower quality of life, diminished happiness and high suicide
rates. This supports the fact that AMW as a group choose not to use available
services due to peer pressure and could potentially allow their symptoms to
worsen rather than seek help.
Research by Weatherhead and Daiches (2010) addressed Islamic views on
mental health and psychotherapy, finding that there were seven
operationalizing themes – problem management, relevance of service,
barriers, service delivery, therapist content and therapist characteristics –
which influenced AMW’s views on mental health and psychotherapy services.
This research aimed to explore how a sample of Muslims understood the
concept of mental health and how they tended to address different mental
health issues. For some, “mental health services and Islamic belief could be
potentially complementary but a respect for and understanding of an
individual’s religious beliefs was seen as essential for the therapeutic
relationship to be valuable” (Weatherhead & Daiches, 2010, p. 86).
Certain charities and other services have been set up in the United Kingdom
to help AMW cope with mental illness and health problems, offering
confidential and private help when needed. Services include the provision of
native speaking counselling services, as well as self-help groups, therapy
groups and outreach programs. The Pakistani Resource Centre is one such
Year 3
5

service that was established in 1966 “as a result of concerns expressed by
the community regarding the lack of advice and information available for the
South Asian Communities in Greater Manchester” (Pakistani Resource,
2015). This centre offers mental health support, counselling and therapy
needs as well as other outreach programs and help provisions.
Research conducted by Atkinson and Gim (1989) reveals that even though
there are a multitude of different services available to AMW, they are still seen
as inadequate, resulting in early termination. Illnesses such as depression can
take time to get over and work through, and early termination of treatment
could make the patient worse or leave them feeling abandoned.
Because of this early termination factor, Bartooci (2006), on reviewing a book
on Asian Culture and Psychotherapy, states that psychotherapy needs to be
culturally sensitive, relevant, oriented and responsive. Care must be taken to
make sure that people who are suffering still receive the best standard of care
and compassion in keeping with their cultural values and beliefs. Efforts
should be made to provide therapy in AMW’s native language, with an
understanding of the specifics surrounding their cultural and religious beliefs.
Weatherhead and Daiches (2010, p. 87) state that therapy could be made
more sensitive to Muslim clients by incorporating some patience and prayer
into the therapy setting, thus embracing the spiritual side of the client’s needs
as well as the psychological.
However, despite research, service provision, charities, outreach programs
Year 3
6

and NHS efforts to make access to mental health care universally and
culturally inclusive, research by Sue, Saad and Chue (2012) shows that
alarmingly AMW have a higher prevalence of Major Depressive Disorder
(MDD) than do white women in primary care settings, and a similarly elevated
rate of suicide compared to White women. For AMW, “Islam forbids the taking
of one’s life. Suicide is considered a sin and subsequently a crime” (Khan and
Reza, 2000, p). It is a criminal offence in the UK to attempt suicide, therefore
taking of one’s life is a taboo subject, legally and culturally, which could
impact an AMW’s choices surrounding suicide and their feelings around
suicidal thoughts, scaring them into silence and fear of talking about such
feelings with anyone else. This could impact on AMW’s choice to seek
psychological or medical interventions surrounding treatment.
A comparative outcome study in psychotherapy for depression by Van
Cuijpers, Straten, Andersson and Van Oppen (2008, p909) states that, “one
possible explanation for this finding is that most effects of psychological
treatments are caused by common non-specific factors and not by particular
techniques (Cuijpers, 1998)”. These common factors include the therapeutic
alliance between therapist and client, belief in the treatment, and a clear
rationale explaining why the client has developed the problem.” When the
patient (such as an AMW) has problems creating a therapeutic alliance due to
the barriers discussed above, the lack of results/cure in the treatment of
depression via psychotherapy due to cultural values and the conflict that
occurs between the two, and also with no clear explanation of why the client
has developed the problems, the likelihood of a successful outcome in
Year 3
7

therapy is diminished.
Alonzo, Harkavy-Friedman, Stanley, Burke, Mann & Oquendo (2011) state
that even with treatment, suicide attempters with MDD or other forms of major
depression are at risk of repeat attempts at suicide and often these are the
people who do not utilize treatment, such as AMW. “[A] major depressive
episode typically requires ongoing treatment for at least 6 months to attempt
to secure and maintain remission” (Alonzo, Harkavy-Friedman, Stanley,
Burke, Mann & Oquendo, 2011, p160). For AMW, who show a lack of uptake
of available resources and treatments, the severity of the depression may
increase, repeated attempts at suicide may occur, and this could all potentially
unfold within a culture that keeps psychiatric problems hidden and behind
closed doors.
On reviewing the issues highlighted so far, a successful outcome in
psychological interventions for AMW as a group comes down to the different
forms of therapy that are available and the abilities of the therapist to create a
working therapy relationship with the client via working through the
operational themes outlined by Weatherhead and Daiches (2010) of problem
management, relevance of service, barriers, service delivery, therapist
content and therapist characteristics. Laungani (2004) regards Freudian
Theory, the Behaviourist theory and Humanist theory as the main schools of
psychotherapy that are currently used in the United Kingdom. They all look at
“fundamentally different ways of viewing, construing and understanding
human behaviour and the emotional, cognitive, behavioural and existential
Year 3
8

problems which form an integral part of humanity” (Laungani, 2004, p. 108).
All of these schools were created by western culture, for all cultures,
dismissing the fact that it is not always the case that a single form of
psychological intervention will suit everybody, and neglecting the view that
some groups, such as AMW, have different psychological needs and
reservations regarding treatment.
Despite this, in a study by Honyashiki et al (2014) on CBT as a form of
psychotherapy treatment for depression, it was found that clients in receipt of
CBT forms of treatment to combat depression were significantly more likely to
yield a response than clients who did not receive any treatment. In light of
these results, it seems ironic that for the majority of AMW, there still seems to
be reluctance to receive treatment, or they could be denied treatment due to
cultural, historical, familial or societal stigma attached to receiving treatment.
Further to this, Wuthrich & Rapee (2013), in a review of psychological
treatments for depression in adults, went on to demonstrate that CBT is
superior to other forms of therapies, such that treatment with CBT can
maintain remission of depression and reduce relapse after treatment has
finished.
Psychotherapy is not the only form of treatment that is available to Asian
Muslim women in the UK for the treatment of mental disease and mental
health. Treatment could also be pursued via medical means. Here “the
concept of mental disease derives from the so-called medical model of
abnormal behaviour, which operates on analogy from diseases of the somatic
Year 3
9

kind. Hence, any disabling psychological maladjustment or behavioural
disorder may be so classified” (Reber, 1995, p. 452). Blease (2012) states
that depression is reported to be the most common mental disorder in the
world and affects approximately 120 million people. Antidepressants are the
treatment of choice among physicians in the US and the UK. “In the UK, in
2006 31 million prescriptions were written for antidepressants by physicians…
in the US, the economic cost of lost working days due to illness is estimated
to be in the region of 40 billion dollars each year” (Blease, 2012, p59).
Spence (2010) states that one in ten people are currently depressed, and that
whilst people claim that depression is under-diagnosed, we seem to have a
prevailing reductionist approach, suggesting that depression is simply a
chemical imbalance and can be treated with the right chemicals. Although
there is a counselling culture in the NHS, depression is still on the rise and
people can become dependent on both counselling and drug treatment.
Simon and Perlis (2010) conducted research into personalising the treatment
of depression as well as mental illness treatments. They created a conceptual
model for identifying and evaluating evidence relevant to personalizing
treatment for depression and reviewed evidence relating to three specific
treatment decisions: between antidepressant medication, psychotherapy and
a selection of specific antidepressants and specific psychotherapy
interventions. The limited evidence indicated that some specific clinical
characteristics might inform the choice between antidepressant medicine and
psychotherapy treatment, leaving individuals varying widely in response to
specific depression treatments. However, the inability to match patients with
Year 3
10

treatments implies that systematic follow-up assessment and adjustment of
treatment are more important than initial treatment selection. This is made
difficult when there are numerous (social, cultural, religious, historical) barriers
and perceptions that can stop an Asian Muslim woman seeking psychological
interventions. Issues of access to such help and services can complicate the
range of interventions and treatment available.
Other issues may be encountered when working with Asian Muslim women in
a counselling setting: these issues might arise from the views of the therapist,
their training and the work that they carry out. Questions arise, such as “does
the clinician recognise the power distribution and position of the client in
respect of their own group and how this might affect status, labelling, safety
and risk?” (Grant, Townsend, Mulhern and Short, 2010, p. 182). Also, has the
therapist assessed different disadvantages that the group members may hold,
such as finances, or oppressive elements that may occur in the mental health
sectors, such as racial prejudices and perceptions? Grant et al. (2010, p. 191)
summarise with the following: “in relation to CBT practice, it is important to
understand the role of racism and disadvantage in diversity, the tensions
between culturally supported and empirically supported therapies, feminist
critiques of mental health, the positive role of small voluntary organisations,
the specific relationship of CBT and diversity, [and] the role of an ethic of
social justice.”
Further to the above, Nagayama (2001) states that even though there is an
increasing demand for psychotherapy among ethnic minority populations
Year 3
11

(including Asian Muslim women), there is not enough adequate evidence that
empirically supported therapies are effective with ethnic minorities. Ethical
guidelines suggest that psychotherapies should be modified to become
culturally appropriate for ethnic minority groups, including AMW, because
people “from one cultural group may require a form of psychotherapy that
differs from psychotherapy for another cultural group. Moreover, there may be
cultural variations among persons within a cultural group that require
additional modifications of psychotherapy interventions” (Nagayama, 2010, p.
502). Thus, there is a need for sensitivity to culture, diversity and race in
therapy that embraces the key social, cultural or historical perspectives that
are relevant and appropriate for consideration when working with AMW as a
specific group, addressing their differing mental health needs, and the
appropriate psychological interventions of this group. The appropriate health
care professionals working in the diverse multicultural society of the UK
(especially should they come into contact with Asian Muslim women) should
have “an introduction to equality and diversity, discrimination and social
identity in relation to medical and health care” (McKimm & Webb, 2010, p.
465), thus enhancing the psychological work done with this group in the face
of mental health and mental illness.
References
Alonzo, D., Harkavy-Friedman, J., Stanley, B., Burke, A., Mann, J., &
Oquendo, M. (2011). Predictors of treatment utilization in major depression.
Archives of Suicide Research, 15(2), 160-71.
American Psychiatric Association. (2013). Diagnostic and statistical manual of
mental disorders. Text Revisited (4th
ed.). Washington DC: American
Psychiatric Association.
Year 3
12

Antonuccio, D. (1995). Psychotherapy for depression: no stronger medicine.
American Psychologist, 50(6), 450-452.
Atkinson. D. R and Gim. R. H. (1989). Asian American cultural identity and
attitudes towards mental health services. Journal of Counselling Psychology,
36(2), 209-212.
Blease, C. (2012). Mental health illiteracy? Perceiving depression as a
disorder. Review of General Psychology, 16(1), 59-69.
Calbral. R. R and Smith. T. B. (2011). Racial/ethnic matching of clients and
therapists in mental health services; a meta-analytic review of preferences,
perceptions and outcomes. Journal of Counselling Psychology, 58(4), 537-54.
Cuijpers, Pim, Van Straten, Annemieke, Andersson, Gerhard, & Van Oppen,
Patricia. (2008). Psychotherapy for Depression in Adults: A Meta-Analysis of
Comparative Outcome Studies. Journal of Consulting and Clinical
Psychology, 76(6), 909-922.
Fogel. J. and Ford, D. E. (2005). Stigma beliefs of Asian Americans with
depression in an internet sample. Canadian Journal of Psychiatry, 50(8), 470-
8.
Grant, A. Townsend, M. Mulhern, R. & Short, N. (2010). Cognitive
Behavioural Therapy in Mental Health Care. London: Sage.
Honyashiki, M. A., Furukawa, T. M., Chen, P., Noma, H., Tanaka, S.,
Ichikawa, K., . . . Caldwell, D. (2014). Specificity of CBT for depression: a
contribution from multiple treatments meta-analyses. Cognitive Therapy and
Research, 38(3), 1-12.
Khan, M. M. and Reza, H. (2000). The pattern of suicide in Pakistan. Crisis,
21(1), 31-35.
Lannin, D.G, Guyll, M. Vogel, D. L. & Madon, S. (2013). Reducing the stigma
associated with seeking psychotherapy though self-affirmation. Journal of
Counselling Psychology, 60(4), 508-19.
Laugani. P. (2004). Asian Perspectives in Counselling and Psychotherapy.
Hove: Routledge.
McKimm, J., & Webb, H. (2010). Diversity, equal opportunities and human
rights. British Journal of Hospital Medicine, 71(8), 465-469.
Miller. J. M, Yang. M, Hui. K, Choi. N and Lim. R. (2011). Acculturation,
enculturation, and Asian American college students’ mental health and
attitudes toward seeking professional psychological help. Journal of
Counseling Psychology, 58(3), 346-357
Nagayama, G. (2001). Psychotherapy research with ethnic minorities:
Year 3
13

empirical ethical, and conceptual issues.. Journal of Consulting and Clinical
Psychology, 69(3), 502-10.
Noles, N., Gelman, S., & Eccles, Jacquelynne. (2012). Effects of categorical
labels on similarity judgments: a critical analysis of similarity-based
approaches. Developmental Psychology 48(3), 890-896.
Office Of National Statistics. (2015). Office OF National Statistices. Theme
Population, http://ons.gov.uk/ons/taxonomy/index.html?nscl=Population
(accessed 2nd
December 2015).
Pakistani Resource Organisation. (2015). Serving The Asian Communities In
Greater Manchester. http://www.pakistani-resource.org.uk/index-2.html
(accessed 5/10/2015)
Reber, A. (1995). Penguin dictionary of psychology(2nd
ed.).. London: Penguin
Books.
Simon, G and Perlis, R. (2010). Personalized medicine for depression: can
we match patients with treatments? American Journal Of Psychiatry,
167(12), 14-45.
Spence, D. (2010). Bad medicine: depression. British Medical Journal, 340.
Stewart, W. (2005). An A-Z of counselling theory and practice (4th
ed.).
Cheltenham: Nelson Thornes.
Sue, S., Cheng. J .K. Y, Saad C. S and Chu. J. P. (2012). Asian American
mental health. A call to action. American Psychologist, 67(7), 532-4.
Weatherhead, S. and Daiches. A. (2010). Muslim views on mental health and
psychotherapy. Psychology and Psychotherapy: Theory, Research and
Practice, 83(1), 75–89.
Wong. Y. J, Wang. K. T and Maffini. C. S. (2014). Asian international
students’ mental health-related outcomes: a person x context cultural
framework. The Counseling Psychologist, 42, 278–305.
Wuthrich, Viviana M., & Rapee, Ronald M. (2013). Randomised controlled trial
of group cognitive behavioural therapy for comorbid anxiety and depression in
older adults. Behaviour Research and Therapy, 51(12), 779-786
Year 3
14

MentalHealthEssay clean

Recomendados

Recomendados

Mais conteúdo relacionado

Destaque

Destaque (12)

Semelhante a MentalHealthEssay clean

Semelhante a MentalHealthEssay clean (20)

MentalHealthEssay clean