Research 1: Exploring Mental Health Service User Perspectives on Targeted Violence and Abuse in the Context of Adult Safeguarding
The research conducted by Carr et al. (2019) found that the victims of abuse and violence suffered from mental health problems. Due to the vulnerability of these victims, the abusers targeted such individuals. According to the author, the main reason is that the victims were fearful and showing signs of abuse. The vulnerability and risks of such individuals were exacerbated by different factors such as the victims’ environment, relationships, situations, and diagnosis. Factors that increase the risk include inadequate support packages, lack of preventative support, lack of access to mental health services, and exposure to violence.
The users of mental health services did not report the abuse and violence due to the issues that compromised the recognition of such cases. The problems that hamper reporting of abuse include the lack of credibility of the believing services, many feeling that they were not worth it, and stigma because of their mental health. “Many participants reported a history of targeted abuse and violence” (p.4). These incidents had been normalised due to their frequent occurrence in their lives. Most victims had suffered discrimination through racism, homophobia, sexism, abuse based on gender identity, and disability, and a quarter of the victims had experienced sexual abuse in their childhood, especially women.
The victims of abuse used different strategies to cope with the abuse. Most survival strategies, such as isolation and deteriorating mental health, were negative. Some people managed positively, such as being more resourceful, persevering, and creative. Due to the inadequate help from the mental health services, the victims had to cope by using positive and negative strategies. In addition, the safeguarding was not satisfactory according to the abuse victims. Adult safeguarding was not adequately explained or available to the participants, so they thought they did not need it. The victims who sought adult safeguarding services did not get the support or experienced delays that reduced their likelihood of reporting. The help offered by the social workers to the participants was inconsistent, inappropriate responses, focused on eligibility, and inflexible. However, the independent mental health practitioners, therapists, and advocates were helpful.
The authors used qualitative methods to carry out the research. The qualitative methods were controlled interviews with the health service users that experienced violence and abuse. Also, focus groups involved mental health practitioners and stakeholders in adult safeguarding in care homes. The interviews focused on the mental health service user or survivor. The interviewees were 23, with 92% being women. Some of them were done through conversations on Twitter with 585 people in 2017 (Carr et al., 2019, p.6). The qualitative method is applied to social media platforms.
The approach resulted in findings related to women due to the predominance of women in the interview. In addition, it promoted the development of a culture of sharing information between the agencies and practitioners to safeguard the victims with mental health problems (Baumgärtel, 2020, p.16). The mental health service users’ issues, such as neglect, violence, and risks, are brought to the centre to increase awareness of the mental distress that the people in care homes go through.
The Use of the Research in Health and Social Care Practice
The research has had significant implications on health and social care practice. It raises awareness of the need to safeguard mental health users’ wellbeing. The service users may be affected by trauma and abuse, making them vulnerable and, therefore, needier protection. Health and social care should recognise victims who have experienced isolation, neglect, loneliness, and homelessness (Baumgärtel, 2020, p.23). Once identified, the mental health services victims should be supported to avoid victimising them further. It is a challenge for health and social care workers to pay attention to victims of abuse and violence in care homes. Consequently, policies on appropriate care and mental health services should be implemented.
Research 2: Impact of Stigma in Healthcare on People Living with Chronic Illnesses
According to Earnshaw and Quinn (2012), in their article Impact of Stigma in Healthcare on People Living with Chronic Illnesses, research data indicated a correlation between internalised stigma and experienced stigma, with the participants that experienced stigma having more internalised stigma. All forms of stigma experienced, internalised, and anticipated indirectly affected the participants’ quality of life and access to care. The participants with chronic illnesses who experienced discrimination, prejudice, and stereotyping were less likely to access quality healthcare. Past encounters with healthcare workers that stigmatised the patient were likely to be repeated. These instances of people living with chronic illnesses reduced their likelihood of access to healthcare.
Also, the people who experienced and internalised stigmas had a more anticipated stigma. The past experiences of stigma influenced the participants’ internalisation. The internalised stigma correlated to access to care such that participants who internalised the stigma had less access to care (p.160). In addition, the more they internalise the stigma, they experience a lower quality of life. Although the trauma experienced affected the quality of life, the relationship was not direct. Also, the internalised affected the access to healthcare services indirectly. The research reported that anticipated stigma did not directly affect the quality of life but indirectly affected the participants’ quality of life. Conclusively, internalised stigma had the bulk direct effect on the quality of life and access to care that was strong.
The research used quantitative research methods for in-depth data analysis. Path analysis was used to determine the impact of the stigma on the participants’ quality of life and healthcare access. The analysis finds a correlation and the research between the stigma and the regression of the internalised and externalised stigma. The study used interviews to collect data from “447 students and 184 participants reported living with chronic illnesses such as pain disorders, irritable bowel syndrome, diabetes, and asthma” (p.163). The variables were categorised as experienced stigma, anticipated stigma, internalised stigma, and care access and quality of life.
Out of the 184 participants examined in this research, many have gone through stigma from healthcare workers who had lesser access to healthcare services affecting their health. “The experienced, internalised and anticipated stigma causes patients not no access to care hence reducing their quality of life” (p.154). This result was because the stigma is a barrier to regular healthcare access because of the shame and guilt associated with these illnesses (Ziersch et al., 2021, p.9). They, therefore, experienced psychological distress due to the discrimination and stereotype they experienced.
Use of the Research in Health and Social Care Practice
With the increasing number of people suffering from chronic illnesses and hence undergoing stigma today, this research will enable healthcare practitioners to reduce discrimination, stereotype and prejudice among patients (Ziersch et al., 2021, p.12). When caregivers help reduce stigma, the quality of life will increase among those with chronic illnesses, improving the quality of life and increasing the population.
Research 3: The Sound of Silence; The Continued Under-reporting of Abuse in Care Homes
The data in this research was gained by Moore (2019) after evaluating two studies in 2015 and 2019 in England. It aims to provide evidence of consistent underreporting of the mistreatment of older people and hidden abuse in different care homes in the private health sector. Quantitative research shows that abuse happens with a notable frequency following an analysis taken from calls received from elder abuse helplines, which estimated to be “30% of members, 16% of staff in care homes admitted to having engaged in psychological abuse, 10% committed physical abuse, and 80 % of these workers reported that they had witnessed abuse from their fellow workers in care homes” (p.38). Many participants said that they were aware of the maltreatment. However, it was a concealed matter, not being spoken about or reported to the regulatory authorities, which was a remarkable finding in the survey. In most instances, the number of reported abuses came from care homes. In cases where abuse is present, there is very little or no legal action taken because external entities are not quick to respond to abuse incidents. That shows that abuse is present, but very few people are ready to discuss it. This is because older people are among the minority group in society due to their advanced age and dependence on help. In other instances, evidence has shown that efforts to report abuse are met by deliberate strategies to suppress these reports. Surprisingly, mistreatment is done in care homes and domestic circumstances.
The results indicate that abuse has become an open behaviour that people engage in because of the misrepresentation of older people. The concealment is not only in “England but is widespread and entrenched in many nations” (p.39). There are, however, other notable barriers that result in reporting failures in these homes. The result of the research shows that those employed in care homes fear facing the repercussions that come along with reporting abuse. One is at risk of harm by care homeowners or supervisors, or they lose their jobs or are excluded from training opportunities. This study shows that 16 people were afraid to lose their jobs on this basis, an issue similar to findings that have been done before (p.39). If there is no job loss, there is also fear of receiving ill-treatment in the workplace, such as being excluded as other people get privileges.
Findings show that the culture and norms of organisations play a significant role in causing abuse reporting failures. Employees in care homes also need more empowerment because the safeguarding policies, The Care Act of 2014, do not warrant their protection (p.39). When their fears are not adequately addressed, they are afraid that they may end up jobless, suffer stigmatisation from their leaders and colleagues for standing up against what is wrong, or lose favours in the workplace for filing their complaints. There is also notable ignorance of policymakers because they put policies thinking that people will practice these measures. However, many people aim to make financial progress more than they value their obligation to care for the vulnerable and protect them from maltreatment.
The research method used by Moore (2019) for this study was the quantitative approach. It was first conducted for new employees in just-established elderly care homes. It was later repeated to eleven members in new care homes who answered an anonymous questionnaire. The method was used to gather descriptive and quantifiable data on the mistreatment and abuse of older people where they had previously worked. They gave information about the maltreatment they had seen and their failed attempts to report abuse. Names of these members and their care homes were not taken. Attached to each questionnaire was an explanatory information document with a detailed explanation of the research purpose, types of abuse, and protection procedures. This research says that “285 of the 391 surveys were returned” (p.41). This qualitative figure, therefore, shows that the survey was a success.
The 285 people completing the questionnaire showed that abuse still happens in most care centres, yet there is a high level of ignorance in reporting this critical matter. “There is a track record where employees are unwilling to cooperate with the regulatory authorities and report these vices” (p.43). In any case, it has become a matter that has been taken lightly and normalised in these institutions. As per the findings, and to reduce elderly abuse, these homes must appreciate their workers ready to stand out against this vice. The rights of these employees should also be safeguarded (Rahman et al., 2021). There is also an urgent need to strengthen policy responses to prevent abuse among older people at risk.
Use of the Research in Health and Social Care Practice
After the research, it was clear that underreporting of most home care practitioners resulted from fear of the consequences, which lowered the quality of care. Policymakers and regulators can solve the issue by enacting policies that preserve patients’ rights and protect employee rights with the help of the research’s findings (Rahman et al., 2021). This way, every barrier will be eradicated, and quality will be ensured.
List of References
Baumgärtel, M., 2020. Facing the challenge of migratory vulnerability in the European Court of Human Rights. Netherlands Quarterly of Human Rights, 38(1), pp.12-29.
Carr, S., Faulkner, A., Hafford-Letchfield, T., Megele, C., Gould, D., Khisa, C., Cohen, R. and Holley, J., 2019. Keeping Control: Exploring Mental Health Service User Perspectives on Targeted Violence and Hostility in the Context of Adult Safeguarding.
Earnshaw, V.A. and Quinn, D.M., 2012. The impact of stigma in healthcare on people living with chronic illnesses. Journal of health psychology, 17(2), pp.157-168.
Moore, S., 2019. The sound of silence: evidence of the continuing underreporting of abuse in care homes. The Journal of Adult Protection, 22(1), pp.35–48.
Rahman, M., Ahmed, R., Moitra, M., Damschroder, L., Brownson, R., Chorpita, B., Idele, P., Gohar, F., Huang, K.Y., Saxena, S. and Lai, J., 2021. Mental distress and human rights violations during COVID-19: a rapid review of the evidence informing rights, mental health needs, and public policy around vulnerable populations. Frontiers in psychiatry, 11, p.603875.
Ziersch, A., Walsh, M., Baak, M., Rowley, G., Oudih, E. and Mwanri, L., 2021. “It is not an acceptable disease”: A qualitative study of HIV-related stigma and discrimination and impacts on health and wellbeing for people from ethnically diverse backgrounds in Australia. BMC Public Health, 21(1), pp.1-15.