Wednesday, May 29, 2013


Mental illness The story of Josh, a former solder in the US army elucidates a widely debated issue on the impact of military service on mental health. Several studies have tried to analyze the effects of military service on the mental health of the soldiers, particularly those under deployment during operations. Many of these studies have documented that; military service may contribute to the occurrence of mental health problems among the military men and women (Rickwood, 2006 and Charles et al 2004). Based on practical and theoretical explanations, this paper will critically analyze the story of Josh in relation to the issue of mental health problems. The paper will identify some of the major risk factors for relapse as well as the risk factors for developing a mental illness. The paper will also discuss how Josh could have received help from an organization or agency that employs a recovery approach. Basing on the findings, the paper will analyze the provision of primary care and access to services as some of the national standards for mental health services could be used to facilitate Josh recovery. Studies have shown that, an estimate of about 400 million people suffer from a mental health problem, with one in four people worldwide experiencing some form of mental health problem in the course of a year. This figure is more worrisome among individuals exposed to a number of risk factors ranging from risk and protective factors that increase the vulnerability of the individual when faced with stressful situations. According to Appleby (2007), both the risk and protective factors may include a number of areas such as person’s biology, personal attributes and environmental factors that may increase stress-vulnerability of the individual. Based on the Josh case, there are a number of risk factors that may contribute for a relapse and even the subsequent occurrence of a mental illness. It can be mentioned that, a combination of risk factors contributed to the occurrence of chronic depression and post-traumatic stress disorder that Josh had to endure while still in the army (You Tube videos, 2010). From the start, it is important to mention that, there are a number of environmental factors that contributed his ambition to join the army despite it not being the career of his choice. As outlined in the video, Josh was forced to join the army at a tender age of 20years in order to be able to provide for his family. It is mentioned that, having been raised by a single mother and growing up in a poor neighborhood, Josh had no option but to join the army in order to address the issue of poverty and low social support in their lives (You Tube videos, 2010). Another environmental issue that is of high priority to josh was the major life events he had to endure while still serving in the army. According to Anthony (1993), the life-threatening events that occur during military combats may result into the occurrence of mental illness among those serving in the military. In this case, josh had to suffer depression for a long time because the depressive experiences he endured when serving in the army. However, his reluctance to acknowledge and seek help made the condition to become worse to the extent he had to endure clinical depression. His condition became worse when he developed posttraumatic stress disorder, which to a large extent affected both his physical and psychological stability thus making him to become unfit to continue serving in the army (Charles et al 2004). There are a number of risk factors for relapse after suffering from depression. Before looking at some of the major risk factors, it is important to mention that, individuals serving in the military service usually have a big challenge during their transition back to civilian life after military service. It is mentioned that, Josh served in the army for eight years and hence the transition to civilian life was not only challenging but also one that is defined by difficult in adjusting and avoiding the occurrence of depression or other mental illness (Charles et al 2004). According to Anthony (1993), the military culture exposes one to a number of risk factors for relapse and even ones that could contribute to the development of mental illness, like the case of Josh. Having suffered from depression and post-traumatic stress disorder, some of the major risk factors for relapse include the feeling of worthlessness, feeling low or miserable, lack of energy, lack of enthusiasm, lost of interest or pleasure in normal activities, lack of appetite and weight loss, loss of sexual interest, insomnia, poor memory, concentration and decision making and thoughts of suicide (Coleman, 2005). The prolonged occurrence of these factors may contribute to the occurrence of depression and other medical conditions. Some of the risk factors for developing a mental illness include situations whereby the affect individual re-lives the traumatic event through keeping a memory of the events thus experiencing nightmares, intense emotional or physical reactions which may be highly distressful (Charles et al 2004). The second risk factor for developing mental illness is when the affected individual is overtly alert or wound up. In this case, the individual appears to be a constant state of instability whereby he or she may be seeing danger everywhere and everything seems a potential threat. This may affect the ability to concentrate, sleep and even the interactions which other people around him or her. There are other risk factors such as, lose of spouse, substance abuse, alcohol use, anxiety disorder, prior exposure to other traumatic events may contribute to the occurrence of mental illness among individuals who may have served in the military under demanding circumstances (Appleby, 2007 and Ashcraft & Anthony, 2005). Sainsbury Centre for Mental Health is one of the most established centers that employ a recovery approach in helping individuals suffering from mental health problems. This center seeks to make recovery a reality that offers a viable way of helping patients suffering from mental health problems. There are a number of ways in which the recovery approach at this centre promotes mental wellbeing rather than treating mental illness (Shepherd, Boardman & Slade, 2007). There are a number of principles applied at the organization which makes it different from the traditional ways of dealing with mental health problems. One of the primary principles is based on the purpose of the recovery approach. In the organization recovery is deemed as an approach that seeks to help the affected individual to build a meaningful and satisfying life based on their own selves, while identifying and solving the presence of ongoing or recurring symptoms contributing to the problem. Therefore, away from the traditional approach, this perspective encourages and facilitates self-management as a panacea to a successful recovery program based on the unique needs of each patient (Coleman, 2005). Another important principle relates to the journey of recovery. As opposed to the traditional approach, this new approach offers a collaborative strategy where the clinicians and the parents become partners in the entire journey of discovery. Therefore, recovery approach reinforces the point that, recovery cannot occur in isolation and hence there is need for social inclusion and support for the affected individuals(Ashcraft & Anthony, 2005). In the case of Josh, he was able to become a “living library” because of the help and acceptance he received from those around him. In an instance where he had to handle the mental health problem, he could not been able to recover and to further his musical ambitions to the level he has reached in the present. Another vital element about the recovery approach is based on how it encourages hope, love and support. These elements are deemed to be central based on how they help the individual to find new meanings in life and to gather positive outlook about their future. They are also important based on how they help the individual to discover their personal identity, one that is separate from illness to a more lively, supportive and one that full of new opportunities for the revering individual (Shepherd, Boardman & Slade, 2007). The case of Josh offers an illuminating picture of how hope remains to be an integral aspect in the entire recovery process. Another vital issue to note about the recovery-based services can be found on how it emphasizes the personal qualities and formal qualifications of the staff. Based on this approach, the staffs are required to remain creative, compassionate, realistic, resilient and always willing to cultivate their capacity for care and hope. This is because; this approach encompasses a change of paradigm from illness, pathology and symptoms to one that represents health, wellness and strength (Ashcraft & Anthony, 2005). Basing on Josh case, it is important to mention that, his case is among a myriad of such cases that remain unidentified thus unresolved. It can be mentioned that, service members co-exist in a culture that impedes their ability to freely access the appropriate mental health care. According to Charles et al (2004), the current military culture defined by certain practice, procedures and attributes may affect how a service member seeks care, before, during and after deployment. Primary care and access to services are some of the two national standards that may have been used to facilitate josh recovery. It is important to mention that, josh case become worse based on how he was unable to receive timely and appropriate primary care despite thus making him to spend a lot of time visiting a number of hospitals and rehabilitation centers (Shepherd, Boardman & Slade, 2007). According to this standard, primary health care teams are required to identify and assess mental health needs of the service user in order to instigate a recovery approach that would prove effective. Another important element about this national standard is based on how it advocates for effective treatments that encompasses referral to specialist service in the case; the patient requires further assessment, treatment and/or care (You Tube videos, 2010 and Ashcraft & Anthony, 2005). The second national standard that may be applied to facilitate Josh’s recovery is enhanced access to services. As aforementioned, service men may be impeded by the military culture to access help when faced with mental health problems thus affecting them to a level where recovery becomes problematic. Therefore, this national standard provides people such as Josh to seek help at any time whenever the need arises (Ashcraft & Anthony, 2005). In this case, recovery is facilitated based on the point that, improved access to services may help in meeting the unique needs of the patients as well as providing adequate care to the affected individuals. As aforementioned, the role of local health and social care community organizations is essentially to ensure that the advice and help given to the affected individuals remains consistent in order to avoid cases of relapse (Shepherd, Boardman & Slade, 2007). In conclusion, mental health problems are a serious problem facing the contemporary society. The story of Josh in the video offers a succinct picture of what many people have to go through when faced with depression and other mental problems. Nevertheless, as a new idea, the recovery-oriented approach offers new rationale for mental health services in the modern society. As mentioned in the discussion, the recovery approach is essentially designed to promote self management as well as active support from professionals, family members, peers and other people who may prove helpful to helping thousands of people who may be suffering from mental health problems around the world. References Anthony, W.A. (1993). Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11 –23. Appleby, L. (2007).Breaking down barriers: the clinical case for change. London:Department of Health Ashcraft, L. & Anthony, W.A. (2005).A Story of Transformation: An Agency Fully Embraces Recovery. Behavioral Healthcare Tomorrow, 14, 12–22. Charles al (2004), “Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care,” New England Journal of Medicine, 351(1):234-345. Coleman, R. (2005). Recovery: An Alien Concept.New York:Hansell Publishing. Rickwood D. (2006). Pathways of recovery: preventing further episodes of mental illness (monograph) .Canberra: Commonwealth of Australia. Shepherd,G., Boardman,J., & Slade, M., (2007).Sainsbury Centre for Mental Health: Making Recovery a Reality.policy paper. You Tube videos, (2010). Living Libraries - Jeremy & Josh. accessed on 14th, August 2012 from