Comparing and contrasting HMO and PPO insurance programs Essay

Comparing and contrasting HMO and PPO insurance programs - Essay Example Whenever a policyholder needs the services of a specialist doctor, the PCP needs to be visited to refer the specialist to be visited by the policyholder, HMO or PPO. Difference between HMO and PPO comes in the PCP aspect. For HMO, there is no choice; the member has to identify a PCP but in PPO, it is not mandatory. It depends on the will of the members to choose a PCP or not. In other words, the PPO members can select a specialist by their own (Daltons, 2007). Personally, I would like to opt for HMO, reason being it suits my needs. I do not need to search for any specialist myself. Whosoever the specialist, I will be referred to by the PCP; it would relieve me from the tension of finding a good specialist. It is cost-effective also, as I will be eligible for coverage or benefits, not available in PPO for getting medical care outside of the private network. I need not pay from my own pocket if I select HMO, as my healthcare insurance provider (Dalton, 2007). It needs to be noted that a PPO member will not pay extra if the chosen doctor is from the preferred providers, but the HMO member can consult only the selected PCP. If there is some emergency, the selected PCP would refer the case to the specialist in the HMO network only. In the case of PPO, advanced permission might be required for costly services, such as MRIs. Even in HMO, procedures and prescription services and copayments for doctor visits are charged. In PPO arrangement, out-of-network charges are only partly paid (Behari, 2010). Role of the PCP is very critical in HMO, as it is the PCP who caters to all healthcare needs of the insurer. A PCP functions as a personal doctor to attend to all needs of the patient. A PCP could either be an internal medicine physician, family physician, and in some HMOs, gynecologists to offer essential healthcare for women. A PCP can be a pediatrician too or a family doctor as well, as per one’s choice for getting treatment for

Thai Restaurant in Brighton, UK Literature review

Thai Restaurant in Brighton, UK - Literature review Example This part of the study focuses on the available reading materials pertinent to the information needed. 2.1 Overview Obesity rate in the United Kingdom has been rising along with the number of restaurants especially in the fast food industry. As of 2011, UK’s Department of Health (2011) revealed the results of a survey for England known as the Health Survey for England (HSE), which showed 25% of all adults are obese, while 10% of children are also obese. Since the beginning of the 20th century, people tended to eat out. Fast food restaurants served meals that increased the level of cholesterol, sugar, and salt in consumers. This was observed to have resulted in the high obesity rate, heart disease, and high blood pressure for people living in UK. Crawford, et.al. (2010) said these are the effects of mass production and consumption of unhealthy food. Thus, it would be a good idea to have a Thai restaurant capable of serving the right menu to promote a way to overcome obesity via healthy and delicious recipes. One relevant literature describes diet and nutrition, and then compares healthy diet models. |This can be a source of knowledge about how to start, promote, and develop a healthy food market in the United Kingdom. ... Dietary patterns affect neurotransmitters responsible for the alteration of moods and actions in the human body. In addition, experts pointed out that any shortage or excess in diet will lead to neurotransmitters causing changes in human growth, emotionally, as well as physically, according to Wiseman (2002). From this understanding of the relation of neurotransmitters with diet, majority of nutritionists came up with dietary patterns or models that may enable human body to control neurotransmitters effectively. Medeiros and Wildman (2012) defined the duty of neurotransmitters to be the brain chemicals that flow and communicate information throughout the body and brain. 2.2 Diet and Nutrition Debruyne et al. (2008) and Insel et al (2011) pointed out that the terms ‘nutrition’ and ‘diet’ exist synonymously. In particular, food is most essential in the human diet for survival. To understand nutrition and diet, Smolin and Grosvenos (2005) identified two groups, namely, macronutrients and micronutrients, wherein the first group includes carbohydrates, proteins, and fats, while the later includes all the vitamins and minerals. Mcguire and Beerman (2009) support the fact that both groups play an essential role in the physical and emotional growth of the human body. Macronutrients enable the body to acquire energy for the production of tissues and cells. Although excess fats in the body can be harmful, the body cannot live without fats. Dr. Meyers, Jeffrey P.(2005) described the many important roles of fats in the body. They protect cell membranes by keeping them flexible, enriched with white blood cells that fight foreign substance and prevent the development of diseases. Without fats, nerves and blood vessels cannot grow normally.

Women in combat and the risk of post-traumatic stress disorder and Essay

Women in combat and the risk of post-traumatic stress disorder and depression - Essay Example Women hold important positions in the armed forces including military police, intelligence, as pilots, as physicians, as physiotherapist, for transportation, as mechanics, civil affairs etc. It is really pitiful that their efforts are undermined and are always treated as less victimized when compared with their male counterparts. They perform small but imperative jobs and their contribution cannot be diluted. Even though women are expelled from allocating in straight combat specialties encompassing infantry or armor, but they do endow with varied support as travelling outside military base, working with the combat soldiers, exposure to fire or victimized under any casualty (Hoge, 2007). Research findings reveal that there exist a gender difference if veterans are screened for depression, PTSD (Post Traumatic Stress Disorder), pain, obesity etc (Haskell, 2010). Screening of veterans have been performed and it was instituted the prevalence of MST and depression amongst the female veter ans. Results disclose that almost 14% of the female veterans were positive for MST while half of the females (48%) were found to be the sufferers of severe depression, indicating that females are at double risk of depression irrespective of cultural or racial milieu or financial standing.

Primitivism and Exoticism Essay Example | Topics and Well Written Essays - 1500 words

Primitivism and Exoticism - Essay Example If an entity is being adopted or being infiltrated in the other culture then the entity becomes foreign for that specific culture. Exoticism deals with the exotic adoptions in arts from diverse and previous cultures and incorporates it in the modern era of art. It demonstrates that â€Å"Exoticism is to space what Primitivism is to time†. However, Primitivism and Exoticism in the modern music congealed the preceded understanding of these two schools of thought in the modern art. Exoticism and primitivism in music do not only deal with foreign or previous contents and contexts but also utilized the developed outcomes of those contexts in the modern manner. This paper is aimed to discuss the association of Exoticism and Primitivism to the music in the era of modernism and it will be discussed in the light of chapter seven of the book Modernism and Music: Anthology of Sources by Daniel Albright. Primitivism The side of modern music which is embarked in the ideology of Primitivism is contained with some distinct traits which are not usually found in the conventional ideals of primitivism in other modern art forms like paintings. It can be understood by contrasting the two art forms in the domain of Primitivism. Primitivism in the art is accepted to be consisting on three major factors. These major factors are intensely separate in their realistic sense and concepts. However the modern primitivism does incorporate all three of these distinct factors which are fascination, the factor of disgust and a significant proportion of terror. Modern primitive art is formulated by the compilation of these three factors in which the pessimistic account is more illuminated than the optimistic shade of the demonstration. (Albright, 2004). Primitivism in modern music is significantly different from the other art forms regarding Primitivism. It can be said that Primitivism in music contains a less amount of pessimism as compared to the Primitivism in painting and literature. Musical primitivism is immensely based on research and this research involves the analyses of folksongs. The researchers of these folksongs realize the non modernity of those folksongs which were produced in the preceding times. The essence of Primitivism is steeped under the principle that the art of previous times must be adopted and demonstrated on the canvas of modern art in the modern times. Similarly, the Primitivism in modern music manifests the correspondence of preceding folksongs with a lesser of the dark side (Albright, 2004). Primitivism and Modernism Modernism is often described as the post feudal and post colonial era in which the preceding ideologies were replaced with the modern ideologies including the equality of mankind. The most fundamental change which is marked to be identified as the major change was the rise of capitalism and industrialization in the prominent parts of the world. This major change initiated the congealment of society by every possible aspect and perspective including the system of politics in the society, educational system and most importantly the art. The period of modernism is also known as the era of enlightenment in which many thinker and artists played there significant roles in their scope of excellence. Many of the artistic movements were formed and appreciated in

History (Fifteen Year War in Asia) Essay Example | Topics and Well Written Essays - 1000 words

History (Fifteen Year War in Asia) - Essay Example This essay will address the responses of African Americans and Japanese Americans before and during the World War II. Many influential African descendants began admiring Japan after Japan’s defeat of Russia. W.E.B. Du Bois, Booker T. Washington, Marcus Garvey and Harry Dean all wrote and spoke about their high regard for the Japanese. These men considered Japanese to be a people of color. For a people of color to vanquish a country ruled by a white monarchy gave African Americans hope. If Japan could triumph over Russia, why could Japan not defeat America? Marcus Garvey believed the wind of change had started blowing. His organization the Universal Negro Improvement Association began supporting pro-Japanese causes in American and Britain. The African descendents and African Americans did not only admire the Japanese for their victory in the Russo-Japan war. The Japanese were admired for their acceptance of people of color. Many Japanese speakers in America at that time brought an African American wife or mistress to address the African Americans. In a time of Jim Crow laws to have a Japanese man affiliate himself with African Americans proved that Japan could provide a more racially equal environment than America. The thought of a society with little or no racial tension appealed to African Americans. To boost the pro-Japanese stance, Elijah Muhammad, a Nation of Islam leader, Marcus Garvey and Harry Dean, Paul Cuffe’s grandson, put forth the theory that Africans and Japanese were related by blood. A theory was put forth that Africans and Japanese were related by blood. Harry Dean, a sailor by profession, brought a tale back from Africa. This tale, the Teo Saga, claimed a chief, more Japanese than Africa, told how South Africa, Madagascar, Sumatra, Java, Korea and Japan once were connected by land. After the great flood these places were separated by water. Elijah Muhammad pointed out the

African-American women Essay Example for Free

African-American women Essay Firstly however we must address the problems that occur when separating the effects of time and interference. Baddeley and Hitch (1977) conducted a survey whereby they asked rugby players to recall the names of teams they had played against during the previous season. Due to illness and injury some of the players had been unable to play in all the fixtures. This meant for some of the players two games back meant two weeks ago whereas with others two games back meant four or five weeks ago. The findings showed that passage of time was not the main factor that determined how well the teams could be recalled, but it was the number of games that effected recall. In other words forgetting occurred more often where team members had other games interfere with previous fixtures rather than trace decay. If interference is the major cause of forgetting within L. T. M it should be true that people will remember material over a time period providing no interfering material intervenes. It is clearly difficult to set up a condition whereby no participant is immobilized after learning with any opportunity for the occurrence of any new learning. This has led researchers to look at the effect of different types of interfering material on recall. McGeoch and McDonald (1931) asked participants to learn and relearn lists of adjectives and then compared their performance on recall tests after interpolated tasks. Forgetting these adjectives was at its least when participants simply had to rest during the learning and recall and increased when participants were required to learn nonsense syllables in the interval. Rates were even higher when it was adjectives that were learned in the interval and were at there highest when the adjectives learned were similar in meaning to the original list. This shows that forgetting increases as a function of the similarity of the interfering material. Retroactive Interference Proactive Interference Retrieval Failure This is also known as the tip-of-the-tongue phenomenon and comes about when we think we know something but cannot recall it at that precise moment in time. This is due to the fact that the correct retrieval cues are not available. Sometimes different words related to the original memory can prompt us to remember the memory and these are called interlopers. Brown (1991) has reviewed this phenomenon for the last 25 years and has concluded that people can correctly name the first letter of the target word between 50 and 70 per cent of the time along with being correctly accurate with the number of syllables in the word. The interloper theory (retrieval cue) was investigated by Perfect and Hanley (1992) who found that distinctiveness of the target word and its similarity in meaning play a factor in recall. Tulving was another researcher to investigate retrieval cues and it was his work with Osler (1968) that led to some interesting findings. They presented participants with lists of words, each paired off with a weakly associated cue word e. g. city-dirty. Participants where then tested for free recall (without the cue word) or were cued with the word e. g. dirty. They found that cued recall consistently produced higher levels of recall. To counteract the argument that any semantic association might aid the recall, they gave participants weak semantic associates which were different to that of the original cue words. These cues did not aid in recall and so led them to conclude that specific retrieval cues aid recall if and only if the information is stored at the same time as the information about the membership of the word in a given list. While Tulving stressed the importance of cues at the encoding stage he later admitted that cues not present at this stage could also be helpful under certain circumstances. Context Dependant and State Dependant Learning Research has shown that we remember more if we recall things in the same state as what we learned them in. In other words how we encode material at the time of learning is clearly important. Godden and Baddeley (1975) presented deep-sea divers with lists of words to learn. They learned these on the beach and under 15 feet of water. Recall was then tested in either the same or the opposite environment. Findings showed that recall was significantly better if tested in the same environment. These differences however are only small but it has been suggested that by even simply imagining the original environment can be helpful. Smith (1979) gave participants a list of 80 words to learn while sitting in a distinctive basement room. The following day he tested some of the participants on recall in the basement room and others in a fifth floor room with quite different surroundings. Average recall for the basement group was 18 but for those in the fifth floor room it was only 12. A third group was tested in the fifth floor room but were instructed to imagine themselves in the basement. The average recall for this was 17 words. There is also some evidence to suggest that not only external environment plays a role in recall but also our internal environment i. e. physiological state or mood may play a part. Godwin et al (1969) found that heavy drinkers who learn things in a drunken state are more likely to recall them in a similar state. Eich (1980) has found similar findings with a range of drugs including marijuana. Research into the Role of Emotional Factors in Forgetting Flashbulb Memories Psychologists have often ignored the role of emotion in human cognitive processes but it seems likely that the way we feel has an impact upon the way we remember things and one particular type of memory that seems to be influenced by emotion have been called flashbulb memories. This is a particularly vivid, detailed and long lasting memory of an event that is usually highly significant and emotional and is usually unexpected. It can be a personal event or something that provokes worldwide interest e. g. death of Princess Diana. Research carried out by Brown and Kulik has led them to conclude that the event must be surprising and have real consequences for the persons life. They believe that such an emotional event triggers a neural mechanism that causes details of the scene to be imprinted on the memory. They believe it is a special type of memory because the detail and accuracy with which the event is remembered and the fact that the structural form of the memory is always so similar. They believe six different types of information about the event are stored being i. Where they were ii. What they were doing iii. The person who gave them the news iv. What they felt about it v. What others felt about it vi. What happened in the immediate aftermath However not all psychologists believe that flashbulb memories are special. Neisser (1982) believes that the longitivity of such memories result from frequent rehearsal and reworking of the event rather from neural activity at that precise moment in time. He believed that we recall it clearly due to the fact that we resort to storytelling techniques when telling someone about the event. It is still unclear whether flashbulb memories represent a particular type of memory or whether they are substantially similar to most memories for big events. Repression Another view about the way in which we forget things was put forward by Freud (1915-18) who believed that some memories become inaccessible as a result of repression. He believed that we use an unconscious process that ensures that threatening or anxiety-provoking memories are kept from our conscious awareness. These memories may stay repressed for years and never come to mind or can do in the form of hysterical neurosis. Although it has proved difficult to recreate repression in laboratory circumstances a number of attempts have been made. Levinger and Clark (1961) asked participants to generate associated words with words presented by them. Some of these words were emotionally neutral e. g. tree, window and others were emotionally arousing e. g. angry, quarrel. When asked to recall these associated words results showed that people tended to recall the emotionally neutral ones as opposed to the emotionally provoking ones, which helps to support the idea of repression. However such tests are considered suspect and Holmes (1990) concluded that there is no experimental support for the concept of repression. Recently research has focused upon repressed memories associated with child sexual abuse and whether or not recovered memories are genuine. The main problem with assessing whether or not they are true is that they have no independent, objective corroborative evidence. Williams (1992) found that 38 percent of a group of African-American women who were known to have suffered abuse reported repressed memories about it although it was clear that some of these memories were false. Loftus (1997) conducted an extensive review of studies that led him to believe that even psychologically healthy individuals altered their memory of events based on false suggestions about them. Baddelley concluded that it is important to exercise great caution in interpreting such reports.

Health Policy And The Social Determinants

Health Policy And The Social Determinants INEQUALITIES IN MENTAL HEALTH Introduction and definitions: Mental health is described by the World Health Organization (WHO) as: a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (WHO 2001a, p.1). According to NHS website every year in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide (http://www.nhs.uk/conditions/mental-health/Pages/Introduction.aspx , accessed 20-4-2010) Mental health inequality is a long standing problem that has been tackled for decades by epidemiologists, sociologists and health professionals. And because this problem has both strong social and health aspect there is no unified approach to identification and resolution. From Sociologists viewpoint inequality with mental health is a problem that has two main explanations: people are poor because they have mentally illness that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to involve in the etiology such as genetic factors, diet, and hormonal disturbance which interact with personality disorders or emotional state to produce mental illness. The problem of inequality is not only about serious mental illness but we can expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be public health indicator: How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity (Mental Well-being Impact Assessment ,2009) The table below gives examples of those factors that promote or reduce opportunities for good mental health (DOH 2001): MENTAL HEALTH PROTECTIVE FACTORS INTERNAL PROTECTIVE FACTORS EXTERNAL PROTECTIVE FACTORS EMOTIONAL RESILIENCE physical health self esteem/positive sense of self ability to manage conflict ability to learn CITIZENSHIP a positive experience of early bonding positive experience of attachment ability to make, maintain and break relationships communication skills feeling of acceptance EMOTIONAL RESILIENCE basic needs met food, warmth, shelter CITIZENSHIP societal or community validation supportive social network positive role models employment HEALTHY STRUCTURES positive educational experiences safe and secure environment in which to live supportive political infrastructure live within time of peace (absence of conflict) MENTAL HEALTH DEMOTING/VULNERABILITY FACTORS INTERNAL VULNERABLE FACTORS EXTERNAL VULNERABLE FACTORS EMOTIONAL RESILIENCE congenital illness, infirmity or disability lack of self esteem and social status feeling of helplessness problems with sexuality or sexual orientation CITIZENSHIP poor quality of relationships feeling of isolation feeling of institutionalisation experience of dissonance, conflict, or alienation EMOTIONAL RESILIENCE needs not being met hunger, cold, homelessness/poor housing conditions etc. experience separation and loss experience of abuse or violence substance misuse family history of psychiatric disorder CITIZENSHIP cultural conflict experience of alienation discrimination the negative experience of being stigmatised lack of autonomy the negative experience of peer pressure unemployment HEALTHY STRUCTURES value systems effects of poverty negative physical environment Table 1: factors that promote or reduce opportunities for good mental health What is the evidence on mental health inequalities? Socio-economic status: Community-based epidemiological studies across countries and over time have consistently identified an inverse relationship between Socio-economic status and prevalence rates of schizophrenia .The ratio between the current prevalence (defined as period prevalence up to one-year prevalence) of the disorder among low-SES and high-SES people was 3.4, whereas the ratio for lifetime prevalence was 2.4 (Saraceno et al,2005), and in Britain, twice as many suicides occur among people from the most lower SES (Blamey A et al ,2002). There are five hypotheses to explain this relation (Hudson 2005): Hypothesis 1: Economic stress. The inverse SES-mental illness correlation is a speci ¬Ã‚ c outcome of stressful economic conditions, such as poverty, unemployment, and housing unaffordability. Hypothesis 2: Family fragmentation. The inverse SES-mental illness correlation is a function of the fragmentation of family structure and lack of family supports. Hypothesis 3: Geographic drift. The inverse SES-mental illness correlation results from the movement of individuals from higher to lower SES communities subsequent to their initial hospitalization. Hypothesis 4: Socioeconomic drift. The inverse SES-mental illness correlation results from declining employment subsequent to initial hospitalization. Hypothesis 5: Intergenerational drift. The inverse SES-mental illness correlation is a function of declines in community SES levels of hospitalized adolescents between their  ¬Ã‚ rst hospitalization and their most recent hospitalization after turning 18 Age: In elderly: National Institute for Mental Health in England (NIMHE) has reported the following point regarding mental health problems in elderly : 3million older people in the UK experience symptoms of mental health problems the annual economic burden of late onset dementia is  £4.3 billion which is greater than that for stroke, cancer and heart disease combined dementia affects 5% of those aged over 65 and 20% over 80 10-15% of all older people meet the clinical criteria for a diagnosis of depression these numbers are set to increase by a third over the next 15 years (NIMHE, 2009). Mental health problems in elderly often go unrecognised. Even where they are acknowledged, they are often inadequately or inappropriately managed (DH 2005c). The UK inquiry into mental health and well-being in later life (2006) identified five factors that influence the mental health of older people: discrimination (for example, by age or culture); participation in meaningful activity; relationships; physical health (including physical capability to undertake everyday tasks); and poverty. in children : WHO states, that the à ¢Ã¢â€š ¬Ã… ¾development of a child and adolescent mental health policy requires an understanding of well-being and the prevalence of mental health problems among children and adolescents(child and adolescent mental health policy, 2006) However, there is an evidence that levels of distress and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3-6 per cent of people under 16 years of age (Bird et al.1988; Costello et al. 1988). Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (Zeigler-Dendy,1989). Gender: Women and Mental Health Mental health problems are more common among women than men with higher incidence rates of depressive disorder than men (Palmer, 2003). There are many factors to explain this, first: Socio-economic factors such as poverty and poor housing conditions cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighbourhoods cause stress and anxiety amongst women , dependency on prescription drugs (for depressive and sleeping disorders) often leads to anxiety. Men and Mental Health Men tend to be more vulnerable to mental health problems and suicide than ever before due for a number of reasons including: Men in general are less likely to talk about their problems or feelings or to admit that they have depression. Men are less likely to seek help for mental and emotional health problems. Unemployment has a greater impact on men in general. Some mental disorders are more serious in men for example suicide is the leading cause of death among young men. The rate for young men aged 10-24 years is higher among those from deprived communities compared with those from affluent communities. Men also experience earlier onset of schizophrenia with poorer clinical outcomes (Piccinelli, 1997) Risk groups for mental illness in men include (DHSSPS,2004): Older men: they are less willing to use health services because of the perception that these services are for older women. Divorced men because they have less support available from family , and services designed to meet the needs of this group is particularly. Male victims of domestic abuse -especially boys in rural areas. Gay and bisexual men few services are available to help men deal with problems such as homophobic bullying and harassment. Male survivors of sexual abuse lack of co-ordinated support for adult survivors of abuse Fathers despite examples of good practice, men have comparatively less access to support services than women, to enable them to cope with the stresses of parenthood. Bereaved men lack of appropriate services specifically targeted at men who have experienced bereavement. Men in rural areas particularly isolated in terms of service access. Young offenders inadequate psychological services in juvenile justice centres despite the high proportion of young people entering the juvenile system with a range of mental health problems. Ethnic group: A review by Commission for Healthcare Audit and Inspection,( Count me in, 2009) noted that Rates of admission were lower than the national average among the White British, Indian and Chinese groups, and were average for the Pakistani and Bangladeshi groups. They were higher than average among other minority ethnic groups particularly in the Black Caribbean, Black African, Other Black, White/Black Caribbean Mixed and White/Black African Mixed groups with rates over three times higher than average, and nine times higher in the Other Black group. Employment Status and Mental Health Having a job helps to maintain better mental health than not having one, but this is not always true as many factors involve For example, jobs which are unsatisfactory or insecure can be as harmful to health as unemployment (Wilkinson et al , 2003). Anxiety about job security, lack of job control, perceived effort-reward imbalance, negative relationships in the workplace, including bullying and harassment can have negative mental health consequences. According to OSC Health Inequalities Review (2006) people with a common mental disorder are five times more likely to be unemployed, and if they have work they are more likely to be excluded, people with an identified mental health problem are twice as likely to be on income support and four to five times more likely to be getting invalidity benefits. A person with a diagnosis of a psychotic illness leaves him with only a one in four chance of being in employment. Geographic variation: Studies result on geographic variation of mental illness are inconsistent , for example Hollie has concluded that In mental health problems there is substantial variation at the household level but with no evidence of postcode unit variation and no association with residential environmental quality or geographical accessibility. It is believed that in common mental disorder the psychosocial environment is more important than the physical environment (Hollie et al, 2007) On the other hand, a recent Swedish study of 4.4 million adults found that the incidence rates of psychosis and depression rose with increasing levels of urbanisation (Sundquist K.et al.,2004). Another study by Royal Commission on Environmental Pollution shows that people from densely populated areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters; in London schizophrenia rates are about twice those in Bristol or Nottingham (Royal Commission on Environmental Pollution, 2007a, 2007b). Disability and Mental Health: Definition: According to Disability Discrimination Act (1995) (DDA) A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activities In the light of this definition we can focus on mental health inequality of three groups of people: à ¢Ã¢â€š ¬Ã‚ ¢ People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems. à ¢Ã¢â€š ¬Ã‚ ¢ People with both mental health problems and physical disabilities. à ¢Ã¢â€š ¬Ã‚ ¢ People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience. Disabled people are more likely to experience stress and emotional instability than those who are not disabled. a report by the Equality Commission for Northern Ireland (2003) has found that whilst 34% of those who were not disabled had experienced quite a lot or a great deal of stress in the last 12 months prior to the survey, the percentage rose to 52% for disabled people. Experiences of depression within the last 12 months were higher among women who were disabled (44%) than men (34%). Conclusion: Inequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address different kinds of mental health Inequalities associated with it. Question 2 : word count (2000) Tackling inequalities in mental health Introduction: Mental illness, among other disorders, is widely considered as a significant determinant of both health and social outcomes and many studies have spotted mental health disorders as both consequence and cause of inequalities and social exclusion. Mental health diseases have two distinct characteristics as a public health problem: first very high rates of prevalence; secondly : onset is usually at a much younger age than for other health problem , Mental health diseases effects all areas of peoples lives : personal relationships, employment, income and educational performance. (Friedli and Parsonage , 2007; McDaid , 2007) Who is at risk for mental health problems? Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs. A review of recent evidences on mental health inequalities can help to define the large groups at risk: à ¢Ã¢â€š ¬Ã‚ ¢ People living in institutional settings: such as care homes or those in secure care or subject to detention. à ¢Ã¢â€š ¬Ã‚ ¢ People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless. à ¢Ã¢â€š ¬Ã‚ ¢ People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse. à ¢Ã¢â€š ¬Ã‚ ¢children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children, à ¢Ã¢â€š ¬Ã‚ ¢ People from groups who experience discrimination. Key policies: These policies can be long term policies focusing on deep change over long period or short term seeking fast results such as health promotion. Long term aims: Inequalities in mental health are not only about equality of access, but also about quality of access. In the year 2009 Mental Health Foundation has published a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities ,2009) This report mentioned four priorities for action: 1-Social, cultural and economic conditions that support family life: This can be done by reduce child poverty , parenting skills training and high quality preschool education , increasing access to safe places for children to play, especially outdoors, inter-agency partnerships to reduce violence and sexual abuse. 2- Education that helps children both economically and emotionally by: schools health promoting programs, involving teachers, pupils, parents and supporting parents to improve the home learning environment (HLE) support social, sports and creative achievements, as well as academic performance 3- Reduce unemployment and poverty levels and promote and protect mental health by: Supporting efforts to improve pay, work conditions and job security. Facilitate early referral to workplace based support for employees with psychiatric symptoms or personal crises to prevent employment breakdown. 4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too. However, these strategies take long time to be effective, that means the need for more rapid actions or short term aims. Short term aims: Mental health promotion: To build an effective strategy to promotion for health equality the following points should be achieved: à ¢Ã¢â€š ¬Ã‚ ¢ Comprehensive: Mental Health promotion is not only the responsibility of health services alone; other sectors of society should join that effort. à ¢Ã¢â€š ¬Ã‚ ¢ Based on evidence à ¢Ã¢â€š ¬Ã‚ ¢ Based on the needs of the local communities, and with the agreement of these communities. à ¢Ã¢â€š ¬Ã‚ ¢ Subject to evaluation: The strategy should be subject to critical evaluation and can be changed when necessary. A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service Framework for Mental Health (DOH 1999). The purpose of these standards is to deal with mental health discrimination and social exclusion associated with mental health problems. And that can be achieved by promotion: promote mental health for the whole society, working with individuals and communities Stop discrimination against individuals and groups with mental health problems, and take steps towards better promotion for their social inclusion. Tackling inequalities for special risk groups: The Suicide prevention strategy: One of the best example is the strategy based on work by (DOH 2002) and The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals: 1. To reduce the risk in key high-risk group. 2. To promote mental well-being in the wider population. 3. To reduce the availability and lethality of suicide methods. 4. To improve the reporting of suicide behavior in the media. 5. To promote research on suicide and suicide prevention. 6. To improve monitoring of progress towards the target for reducing suicide. Women and Mental Health: Preventing: The results of UK-based survey (Williams, 2002) shows that mental health services for women: Do not meet womens mental health needs. Can replicate inequalities. Can be unsafe for women. Can be insensitive to the effects of gender and other social inequalities, such as race, class and age However, in their response to a survey conducted in England and Wales, women said that they wanted services that: à ¢Ã¢â€š ¬Ã‚ ¢ Keep them feel safe. à ¢Ã¢â€š ¬Ã‚ ¢ Promote empowerment, choice and self-determination. à ¢Ã¢â€š ¬Ã‚ ¢ Place importance on the underlying causes and context of their distress in addition to their symptoms. à ¢Ã¢â€š ¬Ã‚ ¢ Addressee important issues relating to their roles as mothers, the need for safe accommodation and access to education, training and work opportunities. à ¢Ã¢â€š ¬Ã‚ ¢ Value their strengths, abilities and potential for recovery. (DH, 2002a) These points are important to build a need-based action plan for better equality in health services. Men and Mental Health: Preventing: The Equal Minds conference workshop which had special focus on men and mental health listed five service design features targeted at mens mental health and well-being (equal minds, 2005): à ¢Ã¢â€š ¬Ã‚ ¢ Accessibility and flexibility of services regarding time, location. For example, Select places familiar for men, Men Only sessions run by male staff, make use of some activities, such as sport and physical activity programmes. à ¢Ã¢â€š ¬Ã‚ ¢ Holistic approach, works on the person as a whole, not just on mental health. à ¢Ã¢â€š ¬Ã‚ ¢ Early intervention to prevent anxieties and concerns build up, especially in stress and anger management. à ¢Ã¢â€š ¬Ã‚ ¢ Trust and confidence are important to solve problems of identity and role that can underlay mens anxieties and self-perceptions or lack of self-esteem. Ethnicity and Mental Health: Preventing: The main problem in this field was the barriers to access services. Barriers include: à ¢Ã¢â€š ¬Ã‚ ¢ Language. à ¢Ã¢â€š ¬Ã‚ ¢ Stereotyping. à ¢Ã¢â€š ¬Ã‚ ¢ Lack of awareness or understandings of mental illness. The report Inside Outside (Sashidharan, 2003) which addresses mental health services for people from black and minority ethnic communities in England and Wales. Suggest that patients from all minority ethnic groups are more likely than white majority patients: à ¢Ã¢â€š ¬Ã‚ ¢ To follow aversive pathways into specialist mental health care. à ¢Ã¢â€š ¬Ã‚ ¢ To be admitted compulsorily (there are differences also between ethnic groups at all ages). à ¢Ã¢â€š ¬Ã‚ ¢ To be misdiagnosed. à ¢Ã¢â€š ¬Ã‚ ¢ To be prescribed drugs and Electroconvulsive therapy (ECT), more than talking therapies. à ¢Ã¢â€š ¬Ã‚ ¢ To have higher readmission rates and stay for longer periods in hospital. à ¢Ã¢â€š ¬Ã‚ ¢ To be admitted to secure care/forensic environments. à ¢Ã¢â€š ¬Ã‚ ¢ Their social care and psychological needs are less likely to be addressee within the care planning process. à ¢Ã¢â€š ¬Ã‚ ¢ To have worse outcomes. A strategic approach in Ethnicity and Mental Health: In England and Wales a framework have been developed for action for delivering race equality in mental health (DH, 2003b) The framework focuses on three building blocks which are essential to improved outcomes and experiences of people from black and minority ethnic communities: à ¢Ã¢â€š ¬Ã‚ ¢ Information of better quality and more intelligently used. à ¢Ã¢â€š ¬Ã‚ ¢ Services which are more appropriate and responsive. à ¢Ã¢â€š ¬Ã‚ ¢ Increased community engagement In other words any approach should take in consider both quality of health services and the socio-economic disadvantages experienced by people from ethnic communities. Some suggested steps for this approach may include: Providing interpretation and translation services beside mental health service to insure highest possible quality. Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in expression of mental distress. Developing assessment and diagnostic tools that can better assess patients from different backgrounds and ethnicities. Ensuring that services understand and respect spiritual requirements for different cultures. Ensuring access equality to culturally appropriate services including, counseling, psychotherapy and advocacy. Addressing common problem for people from black and minority communities, such as housing, employment, welfare benefits, and child-care. Disability and Mental Health: people with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they are liable for what Rogers and Pilgrim (2003) described :inequalities created by service provision. Mental health services for disable people should be customized to their needs, some recommendations for such services may include: Promotion for mental health, well-being and living with disability. Early intervention: for people who show symptoms for possible mental illness. Personalised care based on individuals needs and wishes Stigma: work for better social inclusion and tackling stigma and discrimination associated with some disabilities. Elderly and mental health: In order to achieve better equality for this group, policy makers should insure better access to mental health services on the first place. In the year 2005 the Department of Health published a report titled Securing Better Mental Health for Older Adults to launch a new programme to bring together mental health and older peoples policy in order to improve services for older people with mental health problems. The National Directors for older people and mental health promoted the dual principles of: à ¢Ã¢â€š ¬Ã‚ ¢ Delivering non-discriminatory mental health and care services available on the basis of need, not age and à ¢Ã¢â€š ¬Ã‚ ¢ Holistic, person-centred older peoples health and care services which address mental as well as physical health needs Here, it is essential to emphasis the importance of specialist mental health service for older adults. Sexual Orientation and Mental Health: In this group health promotion plays a great role to address the mental problems associated with sexual orientation. PACE organization has drawn up a set of practice guidelines for working with lesbian, gay and bisexual people in mental health services (PACE guideline.2006). The guidelines suggest promoting services and resources specifically for LGB people, including services such counselling and advocacy provided by LGB organisations. In response to these guidelines and studies about LGB such as (McNair et al, 2001). Mental health services for LGB people should: Reflect upon the homophobia and heterosexism that LGBT people may experience within mental health services. Enhance awareness of LGBT people problems, and the forms of discrimination and social exclusion they may face. Consider the nature of a culturally competent for LGBT people Preventing in Mental Health Problems: people with mental health problem are in need for resilience factors that enable them to recover from mental distress and to fight the effects of discrimination and stigma, we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive accepting communities (Dunn, 1999). Examples for these services can be found in report on Mental Health and Social Exclusion which has been published by Social Exclusion Unit. The report included a 27-point Action Plan aimed at tackling stigma and discrimination, focusing on the role of health and social care in addressing problems of social exclusion, unemployment, and supporting families and community participation through ensuring access to goods and services such as housing, financial advice and transport (SEU,2004). Beyond this report, it is important that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic approach that aim prevention on the long run. Conclusion: It is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for reducing inequalities in mental health within primary care, and the primary care organization studied is not conducive to addressing inequalities in mental health. (Craig, 2009). For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.