Free Essay

Mental Health Practice

In: Philosophy and Psychology

Submitted By jackson
Words 5169
Pages 21
Introduction:
The first Part of this paper will review the literature to define Classification. Briefly Discuss DSM IV and ICD 10 and list the main categories of clinical disorders. The paper will discuss the main dangers of classification identified as labelling and Stigma which have lifelong implications for those diagnosed with a mental illness. The main advantages of classification such as most appropriate treatment and community education
Definition of the Classification system used to Diagnosis Mental illness. As Social workers it important to try and grasp the concepts of how classification of mental illness is arrived at and to have a basic knowledge of the types of mental disorders people can be classified as having so we can understand the basis of a diagnosis. According Mendelson (2001) “Classification refers to ordering of objects into groups on the basis of their relationship. The result is a classificatory system. Nomenclature related to agreed names that have been assigned to disease or syndromes. Taxonomy covers principles and methods underlying the practice of classification. Finally, nosology denotes the conceptual system that supports the strategy of classifying.” ( Mendelson 2001 p. 63) Golightley (2004) text states that classification is an important step towards the diagnosis of a mental disorder. Mental disorder is broken down into various classifications that represent groups or syndromes of symptoms. Thus if a series of symptoms fits into a recognised pattern of behaviour they can be classified as for example, schizophrenia and a diagnosis made. A diagnosis is a short- hand version of what a psychiatrist believes to be wrong with a client. (Gollightley 2004 P 25) According to both Mendelson (2001) and Golightley (2004) classification is important because it provides a common language, provides terms that enable study of manifestation and natural history of these disorders. Such classification enables treatment and outcomes to be better predicted. Classification system is based on using the DSM- IV and the ICD 10 Currently psychiatrists use one of two texts, either the DSM-IV (American Psychiatric Association’s Diagnostic and Statistical Manual of Mental disorders) or the ICD-10 (International Classification of Diseases Volume 10. (World Health Organisation, 1992). The nature of the diagnosis process is rigorous and great efforts have been made to try to ensure their validity and reliability. For example the ICD , took nine years to prepare and was tested and included extensive field trials of the draft text in many countries it still was subject to many disputes and criticism over the years. It is important to remember that a diagnosis is only as good as the information on which it is based. You might want to think about how many these diagnoses are affected by social factors, social values and historical context. (Golightley 2004 p.25) The main categories of clinical disorders according to DSM-IV are: Psychotic Disorders Schizophrenia Delusional Disorder Mood Disorder Bipolar Disorder (Mania and Depression phases) Major Depressive Disorder Cyclothymia Dysthymia Non – Psychotic Disorders Anxiety Disorders Generalised Anxiety Disorder Phobic Disorders Obsessive Compulsive Disorders Post – traumatic Stress Disorder Eating Disorders Somatoform Disorders Personality Disorders Odd and eccentric Anxious and fearful Dramatic and emotional

Organic Mental Disorder Dementia.

Substance Use Disorders Intoxication and psychosis Dependence Withdrawal Cited from: Pridmore S. Download of Psychiatry, Chapter 3. Last modified: April, 2011. Hopefully this Summary provides a simplified classification system. The prescribed text Mental Health in Australia Covers these disorders in more detail. All Professionals working in the Mental Health sector will need to be familiar with the disorders their clients may be diagnosed with. The main thing to always remember is that everyone is an individual despite the diagnosis that psychiatrists have given them.

The Main Dangers of Classification (Labelling) The current method of diagnosing and classifying mental disorders is difficult because the process largely depends on clinical impressions. For example many disorders mimic each other take Bipolar Disorder and PMDD. Yet both conditions mimic each other so well that if a clinician is not willing to perform two different observations the client might end up misdiagnosed and what worse receive the wrong prescription and aggravate the problem. In addition that many mental disorders may overlap people may have more than one mental disorder that requires skilled clinicians with lots of experience to be able to give correct Dual diagnosis. People labelled tend to fall into patterns of behaviour that are usually associated with the categories even if they have never shown these symptoms before the diagnosis. People use the label as an excuse rather than achieving in spite of the label they have been given. Cited from: http://www.livestrong. Com /article 190.76 benefits- dsm-iv .diagnosis Danger of Stigma: The biggest Danger of Classification According to Meadows (2002), Bland (2009), Healey (2003) and Thornicroft (2008) is stigma * . Meadows describes stigma as a shameful mark of difference, which works as a particular effective social sanction. * Bland (2009) suggests that stigma in mental illness denotes an unjust and involuntary labelling process where the identity of the individual is spoiled, lost in the power of the label and dehumanises them. * Healey (2003) writes the word stigma means a sign of shame or disgrace. Stigma is depicted as a mark placed upon you that can affect people view of you, and even your view of yourself, for the rest of your life. According to Healey stigma can result in a person being denied full and equal social standing with another person. It takes many forms –lumping all people who have had a mental illness into one stereotype. Treating the person with an illness as the illness. Example thinking of a person as schizophrenic not as a person who has schizophrenia * Thornicroft (2009) outlines what causes social exclusion , stigma consists of three related problems for people labelled with mental illness: * The problem of knowledge: ignorance * The problem of attitudes: prejudice * The problem of behaviour: discrimination. Effects of Stigma: Mental illness still generates misunderstandings, prejudice, confusion and fear. Some people with mental illness report that the stigma is at times worse than the illness itself. People are less willing to offer support and empathy if someone is suffering from a mental illness rather than a physical health problem. Those with a history of mental illness may find that others become uncomfortable or distrustful around them and they lose contact with family and friends. Stigma promotes and reinforces social isolation, limits equitable opportunities for employment and recreation, discourages treatment- seeking by those who need it, creates, reinforces and sustains pseudo-psychiatric mythology, and is frequently internalised by people with mental illness resulting in much suffering. Because stigma is so widespread in the community, the mainstream population is often reluctant to engage with people who have severe mental illness. Thereby further perpetuating misconceptions about mental illness. In this sense, stigma leads to a range of relational exclusions from family and neighbourhood/ community networks to places of study and employment. When myths about people with mental illness are circulated in the workplace (e.g. they are unfit for work then this can mean employers are reluctant to employ them. In this sense , stigma has a direct bearing on economic exclusion.( in fact, many people experience only one episode of mental illness- such as depression or a psychotic disorder- and then recover. Some people have an illness which recurs during their life, but many are well much of the time and the illness can often be managed successfully and sustain employment. Mental illness should not be equated with reduced intellectual capacity or ability. Discrimination against a person on the basis of a disability- physical or psychiatric- is not acceptable and against work place discrimination laws. When fears about people with mental illness exists in the housing sector. (E.g. that they are inherently violent, dangerous or untrustworthy) then this leads to consumers finding it hard to obtain housing in their area of choice. This is how stigma relates to geographic exclusion. (Cited p62-3 VICSERV’s pathways to Social Inclusion Proposition Papers – August 2008)

What are the Advantages of Classification Mendlson (2001 p.80-1) best summarises that classification is important for clinicians and researches alike. The process of diagnosis forces the practioner to focus on symptoms, to decide which the dominant are, and to target therapy accordingly. Some diagnosis continues to be problematic. But biological advances, as well as studies of syndrome patterns using statistical techniques, will no doubt lead to greater precision, which will be reflected in future editions of ICD and DSM. The primary benefit would be to properly assess treatment options, since some types of mental illness are treated with medication and others therapy and some with both. Advances have been made in diagnostic methods .Several brain imaging techniques are available. They include computed tomography (CT), magnetic resonance imaging (MRI), and position emission tomography (PET), a type of scan that measures blood flow to specific areas in the brain. These imaging techniques are being used to map brain structure and function in people with normal and abnormal behaviour, and they give scientists greater understanding of how the brain functions with and without mental illness. Research that has differentiated one mental health disorder from another has led to greater precision in diagnosis. Cited at http://www.merkmannuals.com/home/sec07/ch098/ch098c.html last review/revision May 2007 by Caroline Carney Doebbeling,MD,MSc There is currently new trend in clinical psychology , about the usefulness or otherwise of diagnosis- instead of trying to fit people into distinct diagnostic categories , there is another way of seeing things- as seeing our states of psychological distress and disturbance as existing on a continuum, on a spectrum and an approach called ‘formulation’ is used by some professionals which concentrates on the difficulties the person is experiencing and their particular circumstances and aims to help with these. The subject prescribed reading The Psychiatric Interview, Mental State Examination and Formulation by Bruce Singh and Kenneth Kirby (2001) provides a good understanding of how to conduct a psychiatric interview, assessing the mental state, and assembling the information to reach a diagnosis. The paper also outlines the formulation approach. Formulation involves putting together the who and what facts and evidence from literature on evidence – based links association, plus patients theoretical concepts (e.g. Bowl by’s attachment theory, Erickson’s life cycle stages) to generate a considered hypothesis of how these factors have coalesced to lead to present condition. A diagnosis helps the professionals educate people about their illness and recommend self help groups. Australia has developed a number of self help models and approaches which includes the following: * Wellness Recovery Action Plan, * Consumer support networks and carer support networks found in local welfare directories. * SANE Australia education and research special relevance is the Sane Stigma Watch program * The Headroom website has mental health resources developed by young people. * Grow is a community mental health movement helping fellow suffers friendly mutual support. * Beyond Blue: the national depression initiative. * CRS Australia has a number of initiatives related to employment. * The AIMhi project addresses mental health care issues for Aboriginal and Toress Strait peoples in the Top End and far north Queensland. All the above and more can be looked up on their web pages. It is also important from a public health and safety stand point, as some kinds of disorders may require involuntary commitment to an institution in order to protect the patient, their family and others. Classification allows society to apply a legal framework to mental illness to make treatment more possible and appropriate. Thus acts as a pathway to more specialised care and treatment. Classification gives clients that are aware they have something wrong a name to what they have been diagnosed with and most patients have faith in the diagnoses sometimes in spite of the evidence. Some people say they feel reassured by being given a diagnosis as it means that other people go through these experiences as well- so people don’t feel so alone. Classification can mobilise support from other welfare agencies, psychiatric services and programs that can assist clients in their recovery process. Classification can enable people to become eligible for government housing. For example Hasi in the home program for people at risk of homelessness require a diagnosed mental illness. Classification provides income benefits for those in need and allows cheaper prescriptions for medication that otherwise could be costly.

Part 2 The second part of this essay will discuss how the Social Work and allied health models and the medical model can work together for the best outcomes of the client. The first part of this section of the essay will give brief descriptive definitions to outline each models key principle. Then the paper briefly discusses why measure outcomes. This paper will attempt to discuss the challenges that face Social Workers Practice in mental health. The paper makes suggestions to achieve Effective Partnerships and Collaboration for mental health services. The last section of this Paper will outline key solutions to achieving positive client outcomes recommendations.
Social Work Model mental Health Practice:
The key concepts are: * Evidence- based practice * Recovery * Participation * Partnership * Strength approach * Social inclusion * Best practice * Reduction of stigma * Case management
The above concepts will be expanded on further in the prescribed Text Bland Chapter 3.

Allied Health
Defining the composition of the allied health workforce is problematic the most identified workers come from the following professions: Audiology, Clinical psychology, Dietetics, Occupational therapy, Optometry, Orthotics, Physiotherapy, Speech Pathology etc.
The 1990’s brought about a period of sweeping change in the internal organisation of Australian hospital around clinical directorates and patient-focused care models began. (Boyce 2006 p.89)

The Medical Model:
The medical model that is adopted by doctors and psychiatrists also called the “disease model. The acceptance of this model gives credence to the claim that organic or biomedical causes will be eventually be found. (Prichard 2006 p48)
Prichard (2006) states that the medical model being science based and evidence based practice. That examines a clinical problem and looks at the best research evidence to treat the person.
Gould (2010) describes the medical model as an approach to problem solving that is based on assessment, diagnosis, classification and expert intervention. The medical model is a process whereby, informed by the best available evidence, doctors advise on coordinated or deliver intervention for health improvement. (Gould 2010 p.14)
All three models use Evidence based practice as with all professions, judgements have to be made on the best course of action. This applies to social work when we seek to know how any evidence applies to the specific case of those complex mental health and child protection situations. The evidence –based practice approach teaches that we can usually improve on current best practice, which also reminds us of the limits of our knowledge and the need for further research. (Pritchard 2006 p. 49) Why measure Outcomes?
For consumers:
To facilitate recovery
Provide a point of feedback and dialogue to evaluate the service they receive.
For Mental Health Support Workers;
Informs treatment decisions and service delivery mode. Changes in specific needs
Helps to evaluate the effectiveness of interventions and monitor consumer progress.
Uncover unmet needs and changes in specific needs
For the mental health system:
Guide policy and service development through the establishment of outcomes benchmarks.
Inform staff development and training needs.
Build stronger relationships between service providers, consumers, carers and the community.
Helps organisations to plan and achieve initiatives for individual and community benefit.
Achieves a higher level of accountability
The process of evaluation allows us to do more what is working and less of what is not working. Evaluations need to be approached as a learning tool and part of what is considered good practice for everybody. It is a continuous process of asking questions, reflecting and reviewing, such that it becomes part of day-to-day service development practices.
. (Adams &Bateman 2008 p.93)
The challenges that face Social Workers Practice in Mental Health: Bentley (2002) text outlines a number of challenges that face Social work practice in mental health it covers topics such as:
Social Workers as crisis counsellors Challenges: requires clinical skills of assessment and counselling, combined with the ability to work under time pressure there has been recent progress in training social workers in brief treatment e.g. Suicide prevention training and educating them to respond to symptoms of serious mental illness. There is a need to continue to offer social workers and allied health workers opportunities to get be offered further training such organisations such as VICSERV could have training packages available.
Probably the biggest challenge in the crisis field shared by Social Workers and Allied Health professionals is the inability to prescribe medications that at times is required to help calm clients when unwell. This highlights the need to have access to a psychiatrist when working with certain crisis clients and many rural organisations are unable to provide this service as not enough psychiatrists practice in remote rural areas. (Bentley 2002 P.37)
Social workers as Diagnosticians challenges
In 1994, Turner did a useful summary of reasons social workers avoid the term diagnosis. While recognizing that the term assessment, as an alternative to diagnosis, represents a broader approach to understanding the complex biopsychosocial realities of clients and there environment. The first challenge Turner identified was in the intellectual and practical potential for the diagnostic terminology to be misused and abused to the determent of clients and society. Labelling, pathologizing, stigmatization, and reification are terms used to define what many consider to be these unavoidable and negative effects of DSM diagnoses.
Turner addressed a second challenge for diagnosis, in the term applies level of expertise this distances social workers from clients in a judgemental way as it does not acknowledge the client input. (Bentley 2002 p.64-65)
Social Workers as Therapists challenges
Social Workers practitioners engaging in therapist role must be alert to several critical issues that have emerged in the field of mental health during the past 35 years. They need to increase their capacity to serve clients with multiple needs, to integrate early intervention and natural support system intervention, and increase the amount of quality of research for understanding the kinds of therapies and programs that serve clients most effectively. (Bentley 2002 p88)
Social workers as Mediators:
There is a lot of potential to use mediation n mental health settings. According to Clements and Schwebel (1997) there are four appropriate types of disputes where mediation may be useful, conflict over treatment issues, issues of daily living, interpersonal conflict, and personal responsibility. These are broadband categories that seem to encompass almost every aspect of life whether one is a mental health consumer or not. Mediation facilitates peace between all parties as well as peace of mind. (Bentley 2002 p.117)

Social Workers as Educators Challenges
Social workers play a big role in community education is an important aspect of public health and plays important part in health and mental health prevention at both local and national level.
To build on this, it is important to emphasize evaluation- and efficacy-based practice so that and disseminated effectively, both locally and nationally. As such, the potential for this important role within the profession will be more fully realized at both the practice and policy level. (Bentley 2002 p .137-8)
Social workers as case managers challenges.
Strengths – model case management requires a professional who is multiskilled and versatile. All aspects of the organization must be structured to support case managers if an effective program is desired. Failure to provide case managers with the authority and power to make and implement decisions , or saddling them with caseloads that make proactive helping impossible, simply affirms the prejudice and predilections of other professionals about the role.( Bentley 2002 p . 204-5)
Social Workers as Collaborators challenges:
Collaborating across disciplines and agencies is potentially gratifying activity that poses unique opportunities and challenges for social work. Working at critical junction between clients and professionals, social work is positioned to use psychosocial perspective and commitment to social justice to promote better practice for mental health clients. A couple of the challenges facing social work concern potential role restriction and new configuration of teams. Social workers need to carve out a large enough roles for themselves that does not limit them to intake and discharge planning and making referrals that uses all the competencies.
Another challenge social workers face is the new configuration of team. With the advances of technology that have been made, interdisciplinary and interagency teams may be convening electronically and audio visually. How this will affect the quality of care is still to be determined. (Bentley 2002 p.275-6) this text outlines numerous challenges facing the Social work profession this is just a brief summary of the main points made by the author Bentley.
Effective Partnership and collaboration:
Bateman (2008) adds further insight about effective partnership and collaboration for mental health practice.
Recovery oriented service system. Collaborative recovery involves building relationships and partnerships between organisations, consumers, carers, families, workers and other stakeholders that take responsibility for the mental health of the community and provide services in a coordinated and collaborative way.

What is important in establishing partnerships and collaborative relationships:
Commitment to be involved in joint venture, shared values and philosophies, mutual respect and trust between agencies, consumers and carers, compatibility of core service/ client/issues, good leadership , clear goals, agreed action plans and responsibilities with honest and open communication.

Challenges to successful collaboration: * Competition with other organisations for funding, resources and staff * Fragmentation of the sector and many organisations working in isolation. * NGO funding stream is often not conductive to networking, i.e. funding is allocated for service provision only. * Time constraints * Divergence of practice perspectives and organisational objectives. * Distrust between organisations and lack of goodwill to work together * Lack of understanding of perspectives and practice. * Different levels of experience in collaborative efforts and professional training in staff. * Power differentials between consumers, carers and service providers. * Role strain.

Successful partnerships are constructed at two levels- the organisational level and the individual representing that organisation. At the organisational level, it is important that there are structures and support in place to allow for collaboration to occur. However it is often the individuals who become the champions for partnership and the change agents for the organisation. Individuals selected to be involved in the collaborative process need to be self- reflective, flexible in their thinking and able to see other ways of operating.
Some benefits of successful partnership and collaborative relationship:
Shared resources, shared expertise, recovery becomes everyone’s ‘business, working together common goals, providing bench marking for service delivery, research practice, more streamlined services, better advocacy and less duplication of programs and services. (Bateman 2008 p. 27-30)
Integrated service
Integrated services are services that are joined together to provide one access route for service users. Such services imply common training to at least some extent and shared values. Multi – disciplinary approaches retain the professional and often the organisational identity of the professional involved. The slowness of establishing joint planning teams has hindered the development of wide spread effective integrated services (Golighetly 2004 p 139-40)
Key solutions to achieving positive client outcomes recommendations: 1. Promotion recovery focused programs/ services. Working in partnership to provide care and treatment that enables service uses and carers to tackle mental health problems with hope and optimism and to work toward a valued lifestyle within and beyond the limits of any mental health problem (Gould 2010 p.173) According Green states that even though recovery is an individualized and nonlinear process, several common factors integral to facilitating recovery for a person with a severe mental disability has been identified from the literature: hope, coping skills, empowerment, and supportive social networks. (Green 2006 p.341) Thornicroft (2008) reducing Stigma and Discrimination : Candidate interventions highlights suggestions that will result in better outcomes Action to support people with mental illness might include: promotion in formulating care plans and crisis plans for people with mental illness, providing cognitive- behavioural therapy for people with mental illness to reverse negative self- stigma, creating user led and user run services, developing peer support worker roles in mainstream mental health care. Etc. The article also covers action to support people with mental illness at work and actions needed at national and international level to reduce stigma to improve outcomes for people with mental health conditions to be included in society in general. 2. Consumer participation is vital for client outcomes. Bland (2009 p48) the rationale for consumer participation is summarised in two basic propositions. * Participation is a right. By this argument, the recipients of a service have a right to be fully involved in planning, delivering and evaluating mental health services. * Participation ensures better services. By this argument, consumer’s participation in services is a way of improving services. Participation will strengthen accountability mechanisms, and ensure increased responsiveness of mental health services to the needs of consumers. 3. Care coordination plan can assist clients to get better outcomes. Care coordination plans are typically developed for consumers with complex needs and multi- service involvement. The plan documents issues and problems for a client, goals and actions will be taken to achieve these goals, and identify a key worker responsibility for liaising between services.(p.24 Good Practice Guide) 4. The Strengths case management model is effective for achieving client outcomes. The strengths model is based on the idea that support and services should be focused on the individual’s positive internal qualities and abilities the strengths that assist the patient to function in the community. The principles of the strengths model in summary include: a) the focus is on individual strengths rather than on the pathology.
b) The case manager- client relationship is primary and essential .c) interventions are based on patient self determination. d) The community is viewed as an oasis of resources, not as an obstacle. e) Patient contact takes place in the community, not in the office. f) People with mental illness can continue to learn, grow, and change. (Lawton 2003 p269-70)

5. Carr article Schizophrenia: towards better understanding and better outcomes presents the argument that early detection and treatment of schizophrenia is important in reducing the duration of untreated psychosis and promoting better outcomes 6. Gould (2010) suggests the following actions will improve client outcomes 7. . A key aspect of the implementation of the New Service Framework for Mental Health Services is the creation of specialist functional teams such as crisis resolution teams, early intervention teams and assertive outreach teams. 8. Challenging inequality. Addressing the causes and consequences of stigma, discrimination, social inequality and exclusion on service users, carers and mental health services. Creating developing or maintaining valued social roles of people in the community they come from. 9. Personal development and learning helps clients as can share knowledge. Therefore workers need to keep up to date with changes in practice, take part in professional development training opportunities, and continue developing research skills and evidence – based practice. 10. The identity of social work within integrated mental health services will depend upon the development of sufficient leadership capacity within the profession, and the creation of cadre of advanced practitioners. The promotion of social perspective within a mixed economy of mental health care also requires that social workers have the skills to work between and across organisational boundaries. The development of integrated mental health services places demands on all professions including social workers and allied health to develop new ways of working that are effective to address client outcomes.( Gould 2010 p 173- 182)

Conclusion: This paper was an introduction to trying to understand the Australian Mental Health system taking into account the Medical model, the Allied health sector and Social Workers perspectives. All three models have recognised the importance of Evidence Based Practice as the common denominator that they all need to continue to develop to try find best treatment for clients with mental health issues.
The Paper highlights that Classification of Mental disorders is problematic, however as Mental Health workers it important to have a general knowledge of the disorders so that can understand how diagnosis are made, the treatment options and care plans are implemented.
The paper suggests that all professional models need to work together in a Recovery, collaborative Partnership, coordinated plans and integrated mental health services is the future direction for mental health to achieve best outcomes for clients.

References:

1. Bateman, Jenna (2008) Mental Health Recovery Philosophy into Practice a workforce development guide. Published by Mental Health Coordination Council Australia.

2. Bentley Kia J. (2002) Social Work Practice in Mental Health Contemporary Roles, Tasks, and Techniques. Wadsworth Group. Brooks/ Cole , Australia

3. Bland, R (2009) Social Work Practice in Mental Health an Introduction Allen and Unwin, Crows Nest NSW, Australia.

4. Boyce, R (2004) Using organisation as a strategic resource to build identity and influence: Australian Health Review 2004.

5. Carr, V (2011) Schizophrenia towards better understanding and better outcomes. Journal Medicine Today Volume 12, Number 2. University of New South Wales, Sydney Australia.

6. Green, Gilbert J (2006) A Solution –Focused Approach to Case Management and Recovery with Consumers: journal Families in Society July- Sept, 87, 3, Academic research library.

7. Goligtley, Malcom (2004) Social Work and Mental Health third edition by Learning Matters Ltd, Great Britain.

8. Good Practice Guide 2009 a resource of the Victorian Service Coordination Practice Manual: published by Primary Care Partnerships, Victoria, Australia.

9. Gould, Nick (2010) Mental Health Social Work in Context: by Routledge, London.

10. Healey, Justin (2003) Mental Health Issues in Society: volume 190 The Spinney Press Australia.

11. Ki rkby, K (2001) the psychiatric interview, mental state examination and formulation In S. Black & B.S. Singh (Eds.). Foundations of clinical psychiatry (2nd edn. pp.82-113) Carlton South, Victoria: Melbourne University Press.

12. Lawton, Kristen (2003) Effect of Strength Model Versus Community Treatment Models on Participant Outcomes And Utilization: Psychiatric Rehabilitation Journal; Winter 2003:26; Health Module

13. Meadows, G (2001) Mental Health In Australia Collaborative Community Practice:

Oxford University Press, South Melbourne, Australia.

14. Mendelson, G (2001) what does psychiatry encompass? In S. Black& B.S Singh (Eds.), Foundations of clinical psychiatry (2nd ed., pp.63-81) Carlton South, Victoria: Melbourne University Press.

Reference Continued:

15. Pathways to Social Inclusion Proposition Papers (August 2008) published by Psychiatric Disability Services of Victoria, Australia.

16. Pritchard, Colin (2006) Mental Health Social Work Evidence Based Practice: by Routledge , London.

17. Response Ability Challenging Stigma: (2005) Commonwealth of Australia Publication.

Web site References:

Advantages and disadvantages of a diagnosis: cited at http.//www.mental health forum.net/forum,showthread.php?9852-advantages-and disadvantages 22/04/2011

http://www.livestrong.com/article190,76 benifits-dsm-iv.diagnosis.

Classification and Diagnosis of mental illness: http://www.merckmannuals .com/home/sec07/ch098/ch098c.html.

Thornicroft, G (2008) Reducing Stigma, and Discrimination: International Journal of Mental Health Systems 2:3 http://www.ijmhs.content/2/1/3.

Pridmore. S (2011) Down Load of psychiatry Ch 3.

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