'Biomedical and Biopsychosocial models of care Essay\r'

'Competing views of the human clay as either a biologic phenomena or a complex microcosm borne of its environment, fill extinct provided the foundation for the development of deuce divers(prenominal) salutary ex adenylic acidles of fretting: the bio health check examination pose, and the retrieval-based psycho cordial baffle. The molding of trouble adopted by bearing providers to a great extent influences the nature of the intercession given, and the trajectory of a forbearing’s journey by means of distemper, to intimatelyness. Historically, the bio medical checkup mold of apprehension has been the first appearance of Western c be for, and has remained largely unchallenged as the dominant type of c ar utilize in the voice communication of psychiatric treatment. It is unspoilt with a focus on disorder, pathology, and ‘ regain’.\r\nThe emergence of the biopsycho genial puzzle (Engel, 1977) and psychosocial reclamation has provided th e affable wellness arna with an effective option to the biomedical get. With an progression that is person-centred and rec everyplacey foc procedured, it aligns with coeval attitudes about affable disorders having their rail lines and impacts in a social context. This paper will critically analyse and compare the benefits and limitations of both seats of care, finished an exploration of three key areas: (i) potency/dis presentment of the tolerant, (ii) implications for treat design, and (iii) outcomes.\r\nIn abnormal psychology, the biomedical model emphasises a pharmacological approach to treatment, and supposes that genial disorders are brain ailments caused solely, or by a combination of chemical imbalances, genetic anomalies, defects in brain structure, or neurotransmitter dysregulation (Deacon, 2013). This supposition makes up maven post of a Descartian divide that exists between biologic psychiatry and a biopsychosocial approach to psychic wellness c are. Engel (1977) viewed the biomedical model as ‘reductionist’, and posited that it neglected the social, psychic and behavioural dimensions of illness.\r\nHe proposed a biopsychosocial model that takes into account ‘the patient, the social context in which he lives, and the antonymous system devised by society to deal with the disruptive set up of illness’ (p. 131). It is in spite of appearance this biopsychosocial textile, that recovery-focused psychosocial replenishment takes place (Cnaan, Blankertz, Messinger & adenylic acid; Gardner, 1988; King, Lloyd & adenosine monophosphate; Meehan, 2007). Less purpose than the biomedical model, psychosocial renewal focuses on the subjective experience of recovery and wellness, that is, the presence of signs and symptoms may non unavoidably align with the individual’s reason of self and wellness.\r\n(i) Empowerment/disempowerment of the patient\r\nA continual criticism of the biomedical model is the assertion that the patient is disempowered. Firstly, the nature of the doctor-patient blood suggests that the patient is a passive recipient grapheme of treatment; the patient is reduced to a diagnosing, and offered diagnosis-specific treatment options. The role of personal picking exists, however in a limit capacity. Secondly, the political theory underpinning the biomedical model assumes complaint to be a deviation from the biological norm, with illness understood in harm of causation and remediation (Deacon, 2013; Shah &type A; Mountain, 2007; Engel, 1977). This lieu assumes the existence of some underlying diseased cause for symptoms and behaviour, and focuses on intention indicators of recovery (King et al., 2007). The implications of this perspective are that the patient can non, from his pay off got resources, do whatsoeverthing to ameliorate his illness, and to affect every change in his behaviour, he essential(prenominal) adhere to diagnosis-specific tre atment set out by the psychiatrist. It is argued that the ways in which a patient can be disempowered by a psychiatric diagnosis ( injury, obligate hospitalisation, farseeing-term pharmacotherapy etc.) distant outweigh any benefits they might receive (Callard, Bracken, David & deoxyadenosine monophosphate; Sartorius, 2013).\r\nComparatively, recovery within the textile of psychosocial replenishment is wide considered to be empowering for consumers of intellectual health service (Shah & vitamin A; Mountain, 2007; Callard et al., 2013). Two key principles of psychosocial replacement are an emphasis on a social quite than medical model of care, and on the patient’s specialtys rather than pathologies (King et al., 2007). Similar to the doctor-patient relationship of the biomedical model, in that location exists a relationship between patients, caregivers and clinicians in the psychosocial material.\r\nThe emphasis however is on the makeup of a curative alliance (Kin g et al., 2007) in which recovery is owned by the patient, with professionals and work facilitating this ownership (Mountain & adenylic acid; Shah, 2008). The aim of psychosocial replenishment is for the patient to lead self-determination over their illness and health, and a fulfilled reason of self despite the possible lengthiness of symptoms ( groom, 2012). This is in stark contrast to the biomedical model in which illness is managed by the practiti acer, and health is hallmarked by the absence of symptoms and disease (Wade &type A; Halligan, 2004).\r\nThe psychosocial perspective must excessively be considered in terms of its intensity limitations. By placing an emphasis on self-determination and self-management of psychological illness and well universe, there runs a parallel risk of in soundlessing a sense of responsibility or rap music within the patient when less than wanted health outcomes occur. This is of bad-tempered relevance in psychological health setti ngs, where suffering health outcomes are unfortunately, likely (Deacon, 2013). In the biomedical model, the psychiatrist would offer some vitiated consolation to the patient in the urinate of shouldering the bulk of the responsibility.\r\nWith regard to empowerment of the patient, this smack of ‘care’ versus ‘ reanimate’ suggests that the biomedical model of care and psychosocial rehabilitation are two competing models of care that are divorced from one another. They are not, however, mutually exclusive, and it is worth noting that newfangled-day definitions of the biomedical model at least(prenominal) attempt to consider the incorporation of recovery-based treatment approaches (Barber, 2012; Mountain & angstrom; Shah, 2008; Wade & group A; Halligan, 2004). It has been suggested that modern day doctor-patient relationships are far much aligned with the nature of the psychosocial healing(predicate) alliance, founded on engagement and the acquaint ance of skills and noesis of each partner (Mountain & adenylic acid; Shah, 2008). specifically in a cordial health setting, it might be argued that the biomedical model parts ways with psychosocial rehabilitation by use of compulsion (Mountain & angstrom unit; Shah, 2008).\r\nThe role behind much of today’s cordial health legislation is manoeuvre by the ideologies of the biomedical model. This results in patients with a psychiatric diagnosis being a great deal disempowered, by having their right to self-determination overridden by legal powers of compulsion (Thomas, Bracken & Timimi, 2012). patronage a shift towards self-determination by the biomedical model, mental health patients may be forced to repeat treatment against their wishes. In opposition to this, the psychosocial framework favours a community-based, ‘case-managed’ style of care (King et al., 2007), which seeks to empower the patient and maintain independence.\r\n(i) Implications for trea t practice\r\nThe medical model is a reusable framework to assist the psychiatrist in the identification of disorders and diseases. However, scientists have identified uncomplete a biological cause nor a reliable biomarker for any mental disorder (Deacon, 2013), and arguably, most mental disorders have their origin and impact in a social context (McAllister & Moyle, 2008). Therefore, the validity of the biomedical model as a breast feeding model of care in mental health settings must be questioned.\r\nThe all-inclusive nature of the care delivery postulate by a psychosocial framework may, at times, appear to be at odds with more ‘traditional’ concepts of nurse. It is understood that the biomedical model is the model on which many nurses base their practice. It is also the model that has keen-sighted dominated the field of psychiatry (Stickley & Timmons, 2007), despite a plethora of in the public eye(predicate)ations espousing the importance of the inter personal domain and psychosocial factors. Findings from a study by Carlyle, Crowe & Deering (2012) showed that mental health nurses working in an inpatient setting described the role of mental health services, the role of the nurse and nursing interventions in terms of have goting a medical model of care. This was despite recognition amongst the nurses that they used a psychodynamic framework for consciousness the aetiology of mental distress, as being a result of interpersonal factors.\r\nThe problems with the use of the biomedical model in mental health nursing are varied. The predominant goal of the biomedical model is remediation, and and so nurses that base their practice on it must also aim for this outcome. This is obviously troublesome for a speciality that treats disorders that may not have a definable cause, and typically have poor outcomes (Deacon, 2013). Regarding ‘care’ versus ‘cure’, the challenge for nurses working in mental health settings where their practice is underpinned by the medical model, is the inability to achieve the outcome of care that they believe to be appropriate, that is, a cure (Pearson, Vaughan & FitzGerald, 2005).\r\nIn terms of the furnish of nursing care, the biomedical model’s focus on disease and the objective categorisation of people by disease can serve to depersonalise patients and so too, the nursing care provided to them (Pearson et al., 2005). It may well be argued that the biomedical model devalues the role of the nurse, because the humanistic side to care is skeletal in favour of a medical diagnosis and cure. Overall, the ideals of mental health nursing practice are constrained by the biomedical model (McAllister & Moyle, 2008), however, nurses feel comfortable using this model to apologize their practice, in the absence of a outlined alternative.\r\nPsychosocial rehabilitation as an alternative to the biomedical model not only has collateral implications for consumers of mental health services only if also to the nurses who provide their care (Stickley & Timmons, 2007). Indeed, a wealth of publications supports a shift from the medical model to a recovery-based, psychosocial approach (Engel, 1977; Barber, 2012; Caldwell, Sclafani, Swarbrick & Piren, 2010; Mountain & Shah, 2008). In contrast to the biomedical model, the nurse-patient therapeutic alliance is at the core of the psychosocial framework (King et al., 2007). In this way, the role of the nurse moves away from being task-focused, to actively developing, coordinating and implementing strategies to avail the recovery process (Caldwell et al., 2010). Additionally, this model of care strongly aligns with nursing perceptions of their role as care providers, their beliefs regarding the aetiology of mental disorders, and their attitudes towards top hat practice (McAllister & Moyle, 2008; Carlyle et al., 2012).\r\n(i) Outcomes\r\nGenerally, the biomedical model has been associated with vast improvements in medical care throughout the 20th century. despite its persistent dominance of both policy and practice, the biomedical model in regards to the delivery of mental health care is characterised by a lack of clinical innovation and poor outcomes (Deacon, 2013). It does, however, have its redeeming qualities. The primary strength of the biomedical model is its core familiarity base derived from objective scientific experiment, its transcendental appeal, and relevance to many disease-based illnesses (Pearson et al., 2005; Wade & Halligan, 2004). Evidence-based medicament allows the psychiatrist to access objective evidence about the safety and effectiveness of their interventions (Thomas et al., 2012). Shah & Mountain (2007) argue that the model’s compressed methods used to cooperate evidence that have resulted in numerous effective psychopharmacological treatments, cannot be translated in helping to identify which specific el ements of psychosocial treatments are effective.\r\nThis assertion is evidenced by a study documenting the efficacy of a psychosocial rehabilitation programme (Chowdur, Dhariti, Kalyanasundaram, & Suryanarayana, 2011) in patients with fearsome and persisting mental illness. The study showed portentous improvement for all participants across a range of parameters used to measure levels of functioning. However, the results did not reveal the specific effects of sundry(a) components of the rehabilitation programme, making it difficult to insulate each component and to study its effect. Regardless, the boilersuit benefits of psychosocial rehabilitation should not be cut simply due to study limitations.\r\nDespite the biomedical model’s rigorous study methods and evidence-based core, tangible signs of progress are few and far between. Indeed, the biomedical approach has failed to elucidate the very biological basis of mental disorder, and also failed to reduce bell ringe r (Deacon, 2013; Schomerus et al., 2012). Kvaale, Haslam & Gottdiener (2013) intractable that biogenetic explanations for psychological illnesses increase ‘prognostic pessimism’ and perceptions of dangerousness, and do teensy to reduce stigma. This conclusion has obvious implications in a society where the layperson’s, and in fact, nursing student’s misgiving of mental illness is a biogenetic, ‘medicalised’ one (Kvaale et al., 2013; Stickley & Timmons, 2007).\r\nIn contrast, psychosocial rehabilitation programmes may have the effect of reducing stigma. As previously discussed, psychosocial rehabilitation is underpinned by an ideology that seeks to empower the patient. Research has shown that empowerment and self-stigma are opposite poles on a continuum (Rüsch, Angermeyer & Corrigan, 2005). By enhancing the patient’s sense of self, insight, societal roles, and basic self-care functions (King et al., 2007), psychosocial rehabilitation programmes have the ability to reduce the negative effects of stigma. In a study particular to patients with schizophrenia (Koukia & Madianos, 2005), caregivers and relatives reported begin levels of objective and subjective pack when the patient was engaged in a psychosocial rehabilitation programme.\r\nIn their exploration into the validity of evidence-based medicine in psychiatry, Thomas et al. (2012) differentiate between specific factors (e.g. pharmacological interventions targeting specific neurotransmitter imbalances), and non-specific factors (e.g. contexts, values, meanings and relationships). They determined that non-specific factors are far more of the essence(p) in relation to affirmatory outcomes, which would support a psychosocial approach.\r\nIn recent years, public opinion and policy has become more aligned with the recovery model, evidenced by the wealth of literature echoing Engel’s (1977) proposition of a ‘new medical model†™ founded on a biopsychosocial approach. Recently, the Australian Government Department of health adjudge the positive outcomes associated with a recovery-based model, and released the matter framework for recovery-oriented mental health services (2013). Despite their ideological differences, psychosocial rehabilitation need not be viewed as the antithesis to the biomedical model, with literature suggesting a degree of compatibility between the two that is becoming more apparent in the modern delivery of mental health care (Barber, 2012; Mountain & Shah, 2008; Shah & Mountain, 2007).\r\nConclusion\r\nRecent years have seen significant changes in the perceptions of mental illness, and the planning of mental health services that are available. The move towards community-based care, psychosocial rehabilitation programmes, and empowerment of the patient through self-determination has been accompanied by a growth in research, and positive outcomes for mental health consumer s. Despite this progress, modern mental health care is still largely dominated by the biomedical model. Whilst contemporary interpretations of the psychiatric biomedical model recognise the value of social and psychological factors, they appear to do so in a way that relegates those factors to an order downstairs that of biological factors. This occurs in the absence of any definable biological causes for mental disorders (Deacon, 2013).\r\nA contemporary model is required in modern mental health services. Indeed, Barber (2012) suggests that recovery should be thought of as the ‘new medical model for psychiatry. Psychosocial rehabilitation is associated with improved objective and subjective patient outcomes, and emphasises the role of the nurse. As observed by Engel (1977), the dogmatism of biomedicine inadvertently results in the thwarting of patients who believe their genuine health necessitate are being inadequately met. certain incorporation of a biopsychosocial appro ach into modern mental health care, would create a framework for consistent positive outcomes, and straight-out innovation.\r\nREFERENCES\r\nBarber, M. (2012). Recovery as the new medical model for psychiatry. psychiatric Services, 63(3), 277-279.\r\nCaldwell, B., Sclafani, M., Swarbrick, M., & Piren, K. (2010). psychiatrical nursing practice and the recovery model of care. daybook of Psychosocial Nursing, 48(7), 42-48.\r\nCallard, F., Bracken, P., David, A., & Sartorius, N. (2013). Has psychiatric diagnosis labelled rather than enabled patients? The British checkup journal, 347, doi: 10.1136/bmj.f4312\r\nCarlyle, D., Crowe, M., & Deering, D. (2012). Models of care delivery in mental health nursing: a mixed method study. Journal of Psychiatric and psychical Health Nursing, 19, 221-230.\r\nChowdur, R., Dharitri, R., Kalyanasundaram, S., & Suryanarayana, R. (2011). Efficacy of psychosocial rehabilitation program: the RFS experience. The Indian Journal of Psychiatr y, 53(1), 45-48.\r\nCnaan, R., Blankertz, L., Messinger, K., & Gardner, J. (1988). Psychosocial rehabilitation: toward a definition. Psychosocial Rehabilitation Journal, 11(4), 61-77.\r\nDeacon, B. (2013). The biomedical model of mental disorder: a critical depth psychology of its validity, utility, and effects on psychotherapy research. clinical Psychology Review 33, 846-861.\r\nDepartment of Health. (2013). National framework for recovery-oriented mental health services. Canberra, Australia: Australian Health Minister’s consultative Council.\r\nEngel, G. (1977). The need for a new medical model: a challenge for biomedicine. Science, 196, 129-136.\r\nHarding, C. (2005). Changes in schizophrenia across time: paradoxes, patterns, and predictors. In L. Davidson, C. Harding, & L. Spaniol (Eds.), Recovery From Severe noetic Illnesses: Research Evidence and Implications for Practice (pp. 19-41). capital of Massachusetts: Centre for Psychiatric Rehabilitation.\r\nKing, R. , Lloyd, C., & Meehan, T. (2007). handbook of psychosocial rehabilitation. Carlton, VIC: Blackwell Publishing.\r\nKoukia, E., & Madianos, M.G. (2005). Is psychosocial rehabilitation of schizophrenic patients preventing family burden? A comparative study. Journal of Psychiatric and Mental Health Nursing, 12, 415-422.\r\nKvaale, E., Haslam, N., & Gottdiener, W. The ‘side effects’ of medicalisation: a meta-analytic review of how biogenetic explanations affect stigma. Clinical Psychology Review, 33, 782-794.\r\nMcAllister, M., & Moyle, W. (2008). An exploration of mental health nursing models of care in a Queensland psychiatric hospital. International Journal of Mental Health Nursing, 17, 18-26.\r\nMountain, D., & Shah, P. (2008). Recovery and the medical model. Advances in Psychiatric Treatment, 14, 241-244.\r\nPearson, A., Vaughan, B., & FitzGerald, M. (2005). Nursing models for practice. Sydney, NSW: Elsevier.\r\nRüsch, N., Angermeyer, M., &am p; Corrigan, P. (2005). Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20, 529-539.\r\nSchomerus, G., Schwahn, C., Holzinger, A., Corrigan, P., Grabe, H., & Carta, M. (2012). ontogeny about public attitudes of mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavica, 125, 440-452.\r\nShah, P., & Mountain, D. (2007). The medical model is dead †long live the medical model. The British Journal of Psychiatry, 191, 375-377.\r\nStickley, T., & Timmons, S. (2007). Considering alternatives: student nurses slipping at one time from lay beliefs to the medical model of mental illness. Nurse Education Today, 27, 155-161.\r\nThomas, P., Bracken, P., & Timimi, S. (2012). The anomalies of evidence-based medicine in psychiatry: time to afterthought the basis of mental health practice. Mental Health Review Journal.\r\nWade, D., & Halligan, P. (2004). Do biomedical models of illness make fo r good healthcare systems? The British Medical Journal, 329, 1398-1401.\r\n'