Stuttering Paper

According to Singular's Pocket Dictionary of Speech-Language Pathology â€Å"stuttering is an articulatory or phonatory problem that typically presents in childhood and is characterized by anxiety about the efficacy of spoken communication, along with forced, involuntary hesitation, duplication, and protraction of sounds and syllables. † Stuttering can be witnessed in the rate, pitch, inflection, and even facial expressions of a speaker. The cause of this problem is not set in stone, which leads to countless theories as to why people stutter. Along with numerous theories as to why people have this disorder, there are also limitless treatment methods that can be used to help a speaker with a stuttering problem. Stuttering has been a controversial topic among professionals for hundreds of years, and we are still learning what works and what does not work for this curious disorder. The etiology of stuttering is not certain to this day. Many professionals are torn between the psychological and neurological theories as to why people stutter. There are many theories which explain stuttering as a psychosomatic problem that can be dealt with by using psychotherapy. The â€Å"Repressed Need† hypothesis explains that stuttering is a neurotic symptom which is fixed in the unconscious. The repressed need is said to come from a longing for either oral or anal gratification. The stutterer is able to satisfy their anal erotic needs by the â€Å"holding back of words that may represent a hostile expulsion and retention of feces. † This theory is closely related to Freud’s Oral and Anal stages. Some theorists believe that stuttering is caused by the â€Å"Anticipatory struggle†. The anticipatory struggle hypothesis explains that p63 â€Å"stutterers interfere in some manner with the way they are talking because of their belief in the difficulty of speech. † The stutterer is so frightened of making a mistake during speech they in turn avoid, brake, or interject their words and sentences. Stuttering is thought to be a variant disorder, meaning it can affect a person in certain situations that bring them great anxiety or fear. Using a phone and speaking in front of a group of people are examples of this . Although many signs point to a psychological explanation for stuttering, genetic and neurological problems have also been tied to stuttering. Early theorists, like the Roman physicians believed stuttering was related to an imbalance of the â€Å"four humors†, and humoral balance treatments were used to treat stuttering until the late eighteenth century. A more modern explanation of a neurological problem that causes stuttering would be the â€Å"cerebral dominance theory†, that explains conflict between the two hemispheres of the brain is the cause of stuttering. Stuttering has many different types of specified dysfluencies. Although there are hesitations and interruptions found in all speakers, the disfluency found in stutterers seems to be more severe. There are several forms of dysfluencies when dealing with stuttering including interjections, repetitions, and revisions. A stutterer can encompass one or many dysfluencies ranging from minor incidents to very extreme episodes of stuttering. Interjections occur frequently in both fluent speakers and dysfluent speakers. An interjection occurs with the speaker uses â€Å"uh† or â€Å"er† while speaking. Repetitions also are common for stutterers. Repetitions can occur in part of the word ,† wh wh what† in the entire word, â€Å"what what what† and in phrases, â€Å" what do what do what do you want? † Revisions during sentences such as,†I was, I am going† also happen often, along with broken words; I was t—alking, and prolonged sounds like the â€Å"wa† sound in what are also usual in stuttering. Like other speech disorders, stuttering mainly occurs in children who show no evidence of having any other type of disorder. Stuttering comes in many shapes and forms and can be slight to extremely severe, making the all characteristics of this disorder always subject to change. Stutterers encompass hesitation, interruption, revisions, broken words, and prolonged sounds in their speech making it hard for people to follow. While most of the characteristics of a stutterer are only apparent when listening to them speak, there are also many secondary characteristics a stutterer may have. The secondary characteristics vary from person to person, however most of them occur in the face or hand motions. Visible characteristics include tension in the face, which can be seen when the speaker is talking and their face seems to turn sour and flushed. Stutterers also may frown, jerk their head, move their eyes erratically, or wrinkle their foreheads during a speech interruption. Stutterers show secondary characteristics in their hand movements and gestures as well. When stutterers feel tension which is usually caused by frustration of speech, they sometimes react by waving their arms and hands. This can sometimes help the stutterer to get out a word, phrase or sound they are trying to express. Vocal abnormalities are also present in some stutterers, including abnormal inflections in tone, and sharp pitch level shifts. A person can begin to stutter at any time, however most cases are recorded at a young age; most frequently between the ages of two through six. An estimated fifteen million individuals world wide, including three million Americans stutter. A child can be diagnosed from eighteen months, when words starts to progress into more fluent speech. The median age of onset according to a study done by Daley (1955); which included fifty young stutterers recorded that the median age of onset was 3. 87. Occurrence becomes less frequent with age, and seems to be tied to the development of language. Although there are millions of stutterers in the United States most of them will â€Å"recover† by adulthood. According to Andrews and Harris’s (1964) research that included 1,000 stutterers; 79% of children will stop stuttering by the age of sixteen. Boys are three times more likely to develop a stutter then a girl would according to the 3-1 ratio concluded by â€Å"US Nationwide, 1-12† Hull el at (1976). Assessing a stuttering disorder can be done in many ways including, recognizing the frequency of the specified disfluency type, calculating the mean duration of stuttering, speech rate, and articulation of the person’s speech. When measuring the frequency of the stutter, the speech pathologist can try to account the percentage of moments of stuttered words or syllables. This is a popular way of diagnosing a stutter, since it is easily reportable. Speech pathologists can use electronic counters to measure the number of syllables stuttered during a speech session. A speech pathologist can also evaluate a patient by checking their speech rate. Checking a speech rate is done by the examination of abnormalities in the respiration, like disordered breathing, and phonation, such as breath holding. A professional can also make assumptions on a patient by listening to how long a stuttering block lasts for. An average duration of a stuttering block is one second, and in some severe cases of stuttering a block can last for an entire minute. When dealing with the treatment of a speech disorder like stuttering, the patient has many options, which may or may not work for them. Since stuttering usually begins at a young age, behavior therapy has been a popular method of treatment that may halt the progression of stuttering in children. In behavior therapy for early stutterers, the clinician can recommend the child to speak slower and smoother by teaching them a relaxed pattern of speech. Modeling and mimicking are excellent ways to help a child with a stutter to over come their impediment. Psychotherapy is another modern way of treatment among professionals. Psychoanalytical therapy can help the stutterer to over come their anxieties of speech, and give them the confidence that they lack. Speech therapists play a role in the treatment of stuttering by helping the patient modify their speech patterns. It seems that most stutters are able to talk in song, so the speech pathologist can teach the patient to speak rhythmically. Helping a person speak rhythmically can be taught by using hand and finger movements to assist the stutterer â€Å"move along† their fluency. While this is an effective treatment for stuttering, some patients might relapse and their learned hand movements become useless and the learned tendency can then become an abnormal secondary characteristic. Although the effectiveness of therapy is unclear, the patient has the option of many treatments, and eventually a stutterer may find something that will work for them or as in many cases, the person might recover spontaneously. Stuttering is classified as a speech disorder, however there is much more to this disorder that meets the eye. Researchers are still trying to pinpoint the exact cause of stuttering but one thing they can all agree on is that the emotional pain a person with a stutter lives with can affect them for the rest of their lives, even after the disorder subsides. Aside from the anxiety, shame, and fear that go along with this speech problem, many people go ahead to live seemingly normal lives. Through out history there have been countless successful individuals who stutter, ranging from Winston Churchill to James Earl Jones which goes to show that while stuttering can be difficult to overcome it does not deter a person from reaching their fullest potential.

Teaching Gifted and Talented Students

Many educators have become well-versed in modifying the regular classroom curriculum to meet the needs of students with disabilities. Educators are not as experienced, however, in meeting the instructional needs of high-ability students. In a growing number of states, revisions in regulations pertaining to gifted and talented students are requiring that high-ability students, previously served in part-time pull-out programs, must also receive appropriate instruction within the context of their regular classrooms. For example, in Kentucky, high-ability students can no longer be viewed as sufficiently served by a once-monthly or once-weekly program. These students have educational needs that must be met daily, just as students with disabilities have. Many regular education teachers report that meeting the needs of high-ability students equals and often exceeds the challenges of integrating disabled students in their classrooms. High-ability students can be delightful, but they can also be demanding, impatient, perfectionistic, sarcastic, and disruptive. In addition, few regular education teachers have received sufficient training in issues related to gifted and talented education. Before teachers can develop appropriate instructional strategies to meet the needs of high-ability students, they must recognize the value of such efforts. For many educators, services to gifted and talented students may seem to be elitist. However, public education is founded on the belief that all students (including those with high abilities) have the right to instruction appropriate to their needs. Gifted and talented students, like all students, should learn something new every day. General Strategies for Modifying the Curriculum The objectives for modifying standard curricula for high-ability students include: meeting the learning capacity of the students, meeting the students’ rapid rates of learning in all or some areas of study, and providing time and resources so that students can pursue areas of special interest. In order to modify standard curricula for high-ability students, Lois Roets (1993) proposed three options: lesson modifications, ssignment modifications, and scheduling modifications. Lessons can be modified through acceleration or enrichment of content. Assignments can be modified through reducing regular classroom work or providing alternate assignments. Scheduling options include providing opportunities for high-ability students to work individually through independent study, shared learning in homogeneous groupings with peers of similar ability and in terests, and participation in heterogeneous groupings of mixed-ability students. Lesson Modifications. One way teachers can extend or enrich the content they present is by asking open-ended questions. Such questions stimulate higher order thinking skills and give students opportunities to consider and express personal opinions. Open-ended questions require thinking skills such as comparison, synthesis, insight, judgment, hypothesis, conjecture, and assimilation. Such questions can also increase student awareness of current events. Open-ended questions should be included in both class discussions and assignments. They can also be used as stimulation for the opening or conclusion of a lesson. Another strategy for lesson modification developed by Susan Winebrenner (1992) is to use Bloom’s taxonomy of six levels of thinking to develop lesson content. Bloom’s model implies that the â€Å"lower† levels (knowledge, comprehension, and application) require more literal and less complex thinking than the â€Å"higher† levels (analysis, evaluation, and synthesis). Teachers are encouraged to develop thematic units with activities for students at all ability levels. This strategy involves four steps. Teachers first choose a theme that can incorporate learning objectives from several different subject areas. Secondly, teachers identify 6 to 10 key concepts or instructional objectives. Third, they determine which learner outcomes or grade-level competencies will be targeted for the unit. Finally, they design instructional activities to cover each of the six levels of thinking. Assignment Modifications High-ability students are often expected to complete assignments that they find boring or irrelevant because they represent no new learning for them. Allowing them to reduce or skip standard assignments in order to acquire time to pursue alternate assignments or independent projects is called urriculum compacting. The curriculum for a gifted student should be compacted in those areas that represent his or her strengths. When students â€Å"buy time† for enrichment or alternate activities, they should use that time to capitalize on their strengths, rather than to improve skills in weaker subjects. For example, a student advanced in math should have a compacted curriculum in that area w ith opportunities given for enriched study in mathematics. The first step in compacting the curriculum is determining the need to do so. A student is a candidate for compacting if he or she regularly finishes assignments quickly and correctly, consistently scores high on tests related to the modified area, or demonstrates high ability through individualized assessment, but not daily classwork (i. e. , he or she is gifted, but unmotivated for the standard curriculum). The second step in compacting the curriculum is to create a written plan outlining which, if any, regular assignments will be completed and what alternate activities will be accomplished. A time frame for the plan should also be determined. Modification plans can be limited to a few days (i. e. , length of lesson or chapter) or extend over the course of an entire school year. Alternate assignments for high-ability students can either be projects related to the modified area of study that extend the curriculum, or they can be independent projects that are chosen based on students’ individual interests. Winebrenner (1992) described a strategy in which students use written independent study contracts to research topics of interest to become â€Å"resident experts. † The students and teacher decide upon a description and the criteria for evaluating each project. A deadline is determined, and by that date, each student must share his or her project with the entire class. Before choosing their projects, students are also given time to browse various areas of interest. After completing compacted work, students are allowed to look through research materials to explore various topics. A deadline for choosing a topic for independent projects is also given to the students to limit their browsing time. Scheduling Modifications Cooperative learning through traditional heterogeneous groups is often counterproductive for high-ability students. When the learning task involves a great deal of drill and practice, these students often end up doing more teaching than learning. When placed in homogeneous cooperative learning groups, however, gifted students can derive significant learning benefits. This does not mean that high-ability students should never participate in heterogeneous cooperative learning groups. Rather, groupings should be chosen based on the task that is being assigned. When the task includes drill and practice, such as math computation or answering comprehension questions about a novel, gifted students should be grouped together and given a more complex task. When the task includes critical thinking, gifted students should be part of heterogeneous groups to stimulate discussions. Open-ended activities are excellent choices for heterogeneous groupings. Cluster grouping of high-ability students in the same classroom is another option for meeting the needs of gifted students in the regular classroom. The traditional method of assigning students to classes has often been to divide the high-ability students equally among the available classes so each teacher would have his or her â€Å"fair share. Under this system, however, each teacher must develop strategies for modifying the curriculum to meet the needs of the advanced students. With cluster grouping, four to six high-ability students are placed in the same classroom. This system allows the students to learn with and from each other and reduces the need for multiple teachers to develop appropriate instructional modifications. Case Studies The following case studies describe how the curric ulum was modified for three academically able students. Mark Mark entered first grade reading at a fourth-grade level. He had mastered math concepts that challenged his first-grade peers. He was placed in a second-grade class for math instruction and in a third-grade class for reading and spelling instruction. Despite these opportunities, Mark was always the first to finish assignments and spent the majority of his school day reading library books or playing computer games. His parents and teacher were concerned that he was not sufficiently challenged, but as a 6-year-old, he was too young to participate in the district’s pull-out gifted program. They were also concerned that he was having difficulty developing friendships in his classroom since he spent much of the day apart from his homeroom peers. A request for consultation was made to the school psychologist. With input from Mark’s parents and teachers, an independent study contract was developed for Mark to channel his high reading abilities toward study in a specific area. After browsing for a week, he chose dinosaurs as his project area. Mark then narrowed his focus to the Jurassic Period and decided to create a classroom reference book complete with pictures he drew. When he completed his daily work, Mark researched his topic area and worked on his project. When completed, Mark’s teacher asked him to share his project with his classmates. Because he had chosen a topic of high interest to his peers, Mark’s status as â€Å"resident expert† on dinosaurs made him attractive to his classmates. Mark’s teacher encouraged these budding friendships by asking the other students to bring dinosaur toys and books from home to share with the class during the following weeks. Katrina Katrina’s parents chose to move her from a private school to public school at the end of her third-grade year. Following the advice of the private school staff, Katrina’s parents enrolled her in a second year of third grade at the public school due to reported weaknesses in reading and written expression. After a few weeks of school, Katrina’s teacher approached the school psychologist with her concern that retention may not have been in Katrina’s best interest. The teacher reported that Katrina was performing on grade level in all areas and demonstrated high-ability math skills. Upon meeting with Katrina’s parents, however, they expressed the desire to keep her in the third grade. They felt that Katrina had suffered no harmful effects from the retention since it involved a move to a new school with different peers. Further, Katrina’s parents reported that she felt very comfortable and successful in her classroom. Although the committee decided to keep Katrina in the third grade, they developed a compacted curriculum for her in the area of math. A contract was written specifying modifications for Katrina in the regular class math curriculum. She was required to complete half of the assignments given to her peers, as long as she did so with 90% or higher accuracy. When finished with her modified assignment, Katrina then used her time earned through compacting for enriched study in mathematics. The committee was careful to avoid presenting material to Katrina that she would study in the future to avoid the possibility of repetition. Instead, an enriched program of study was developed that emphasized critical thinking and problem solving related to the addition and subtraction being taught in her classroom. Katrina’s contract included several choices of activities, any of which she could choose to do on a given day, such as creating story problems for the class to solve, drawing pictures or using manipulatives to demonstrate calculation problems, or activities involving measuring, classifying, estimating, and graphing. Katrina’s teacher would present a specific activity choice in these areas that extended and enriched the basic concepts being taught to the class as a whole. With these modifications, Katrina's advanced skills in math were addressed. Her parents and teacher judged her school year a success, and Katrina made an easy transition to fourth grade, where she was able to work on grade-level material with an average level of accuracy in all areas. Adam Adam demonstrated a very high spoken vocabulary and advanced ideas when participating in class. He completed few of his assignments, though, and showed strong resistance to putting pencil to paper despite obvious high abilities. He was able to read orally at a level 2 years above his fourth-grade status and could perform multidigit calculation problems mentally. However, in the classroom, Adam demonstrated task avoidance and disruptive behaviors. His teacher and parents were frustrated by his lack of work output and behavior problems, and they sought assistance from the school psychologist. In interviewing Adam, the psychologist found that he did not see the need to put on paper answers he already knew. It seemed likely that Adam’s behavior problems were related to boredom and frustration. To test this theory, the psychologist recommended the use of Winebrenner's (1992) â€Å"Most Difficult First† strategy. With this strategy, the teacher identifies the most difficult portion of an assignment and the student is allowed to attempt that portion of the assignment first. If he or she completes it with 100% accuracy, the student is excused from the remainder of the assignment and allowed to use his or her free time to pursue an alternate activity. Adam was resistant to this strategy at first, but he quickly saw its advantages and began completing those assignments that were modified using the strategy. With guidance from the school psychologist, Adam’s teacher then extended modifications to include pretesting and compacting opportunities across the curriculum. Adam used his time earned from compacting to pursue independent projects and recreational reading, and his behavior problems decreased accordingly. Conclusion The focus of educational services for high-ability students is shifting to the regular classroom. While this expansion of services to the regular classroom is a welcome recognition of the need to challenge high-ability students all day, every day, this initiative also brings with it a significant need to train regular education teachers. Support staff such as educators of gifted and talented students and school psychologists must learn to become effective consultants to assist regular classroom teachers in applying instructional strategies appropriate for meeting the needs of high-ability students References Roets, L. (1993). Modifying standard curriculum for high ability students. New Sharon, IA: Leadership Publishers. Winebrenner, S. (1992). Teaching gifted kids in the regular classroom. Minneapolis, MN: Free Spirit. One of the biggest complaints that teachers hear from truly gifted students is that instead of having different or more challenging work, they simply have more of the same work every other student is assigned. For most parents, it is difficult to understand the difference. They see their child who can write and read well, and who can do math calculations easily and quickly and think that by having twice as much homework, the student's needs are being served. Unfortunately, they are wrong. While there has been a significant push to improve the lot of students with disabilities, programs for the truly gifted student are often left to their own devices. Without training and supervision, some teachers will be intimidated by their precocious class and rather than opening doors to more advanced insight, will simply load students down with what amounts to busy work. A child who already knows how to read and write well, probably should not be burdened with basic grammar exercises. Instead, this student should be reading for research and writing essays. This isn't beyond the scope of truly gifted children as young as nine or ten. But with funding cut at every turn and demands being made on public schools to provide services beyond the scope of mere education, too often G/T programs are left to their own devices. The solution lies in the intervention of parents and the interest of the community at large. This is the point where mentors from various professions can spark a bored but talented student to the next level. Imagine how much more interesting a talk about cancer cells would be from a visiting oncologist. People in the community are often more than willing to help, but it takes more than just teachers making the request. Parents have to get involved. Quite often parents are the first to notice their child's abilities. Some schools will try to put off testing or divert attention, but the parent needs to be their child's advocate. Students are legally entitled to and schools are federally mandated to offer programs for students according to their abilities. This means that gifted children deserve and should receive educational work commensurate with their abilities. Don't take no for an answer. Parental involvement can be a double-edged sword. Gifted programs need parents to push school districts to offer and support programs for gifted students that go past minimum standards. Without parental pressure, districts will ignore programs and allow them to atrophy. But it is also important that the need for parents to view their children as gifted isn't allowed to drive the enrollment of the program. In some district, testing for admission has become a tug of war for parents to get their children into programs viewed as having better teachers or lower enrollment. While any gifted student should be encouraged to take more challenging courses, it is a mistake to simply place a student into a program. It is also a mistake to water down curriculum in order to raise enrollment in advanced classes. Students need to be in programs that fit. Some students are good across the board learners and will be in language arts, science and math programs; other students have abilities in just math or just language arts. Make sure your student is in classes that fit his or her needs. Many parents make the mistake of thinking that having a child in a G/T program of classes is a ticket to academic success. That isn't really the case. Students in advanced classes suffer from some of the same problems that students in regular classes endure. And students in gifted classes have been known to fail. Failure is seen as anathema for most parents, but especially those of gifted students. Their first reaction is to blame the teacher or the school. Sometimes that action is justified, but just as often students make the choice to fail. Sometimes the decision to fail is an attempt to fit into the prevailing social structure of the school. Gifted students sometimes have difficulty dealing with their peers and will â€Å"dumb down† in order to fit in. Other times, learning disabilities such as ADD or anxiety will create situations in which the gifted student has problems processing or completing work. This doesn't mean the student doesn't deserve to be in an advanced program; it means that the student's educational disabilities need assistance in much the same way that a nearsighted student needs glasses to see the board. It's a balancing act. One of the biggest hurdles gifted students face is the social acceptance within the school. In some schools being in the gifted program is a mark of excellence. In others, it labels you as a nerd and causes problems that can be difficult for a shy or immature student to overcome. Teachers and parents should always monitor their student for situations where they are settling for lower recognition in order to avoid confrontation or bullying. This is especially a problem for some minority students and needs parental intervention and outside activities in church or the community in order to give the student a social support structure. Students such as this thrive in activities such as Boy Scouts, Girl Scouts, church service, community volunteer programs and other activities that require a level of independence. By having a group of friends outside of school, the gifted student won't feel the need to mitigate their own achievements in the classroom in order to keep friends. Finally, and this is a very hard situation, parents have to learn to separate their personal needs from the accomplishments of their child. It's very easy to look at the kid who does math and science well and try to push them into a program for Med school. Don't do it. Gifted kids learn quickly, but they also suffer from the same false starts and lagging development that other kids experience. The failure or success of your gifted child belongs to them. And if that is the case, parents have to develop a hands off policy towards homework and projects. Teachers can spot the project where Mom or Dad tweaked something here or added something there. By intervening on such projects, parents dilute the learning experience and undermine their child's self-confidence. Gifted children often have self-doubt because they are doing things that are months or sometimes years beyond their peers. Don't exacerbate that by taking over the learning experience. Gifted children can offer a great deal of joy, but they are also a huge challenge. Quite often hey will offer opinions far beyond their years and understand provocative situations while still appearing innocent. It is important to support your child without smothering them. No matter what their abilities, they will still suffer the same teen angst and doubt held by others of their age. Roll with the punches, expect to be challenged and encourage them to explore areas beyond their comfort zone academically. BACKROUND http://www. azagt. org/teaching-gifted. html Common wisdom of the day once said bright children take care of themselves. Leta Hollingworth didn't believe a word of it. Instead, she thought teaching gifted students required specialized environments designed to bring out the full range of talents of the student. Hollingworth stumbled onto the concept of teaching gifted and talented students in a different way than the ordinary when her own teaching career hit a dead end. Hollingworth had been born and raised in Nebraska. She even graduated from the University of Nebraska at the age of 20, in 1906. Two years later, Leta Anna Stetter (Hollingsworth) moved to New York City and married Harry Levi Hollingworth, a Columbia University graduate student. Expecting to resume her teaching career in New York, her plan failed when she learned no one in New York City hired married women as teachers. Bored with the prospect of being a housewife for the rest of her life, Hollingworth took the next step in developing the methods for teaching gifted students still in use today. She enrolled at graduate school, too. Perhaps it was here that her interest in teaching gifted children sparked to life. She studied educational psychology and became a Columbia University professor. She focused her research and studies on finding the origins of human intelligence. She measured thousands of babies and monitored others for decades. It seems to have been important to Hollingworth to uncover any gender issues before tailoring methods for teaching gifted children of either gender. Her meticulous studies debunked the idea female inferiority. Over the years, her research and her methods for teaching gifted children led to more research and more books. She considered it vital to identify gifted children at as early an age as possible. She also advocated grouping gifted children with other gifted children instead of placing them in classes designed for the average student. Because Hollingworth considered daily contact a key component to her methods of teaching gifted and talented students, she eventually established a school in New York that was devoted to exceptionally bright students. Instead of a teacher-led program of study, the flow of the education was student driven instead. Hollingworth felt her special students would benefit from knowing about some of the challenges life might send their way. To prepare them, her curriculum for teaching gifted students included learning experiences based on issues they were likely to encounter at some point in their adult lives.

Fortune 500 Essay Example | Topics and Well Written Essays - 1000 words

Fortune 500 - Essay Example Studying the different locations in which Marriott operates, as well as the marketing strategies it employs, can give one a good idea about how it is able to achieve such tremendous success. Marriot Hotels has been operating since 1927, originally springing from the business idea of a place for drinks. Slowly it expanded to a chain of hotels and restaurants, which a few decades later, expanded into Marriott International. This company is famous throughout the world for providing excellent hospitality services throughout the world. It operates today in 68 different countries including the United States of America. It has locations in developed countries like the Unites States and England, as well as developing countries like Egypt and Pakistan (Marriott International, 2011). One remarkable characteristic of all these franchises is one common to most successful multinationals: the quality of the service they provide remains constant and impressive from country to country. To study the success of a company as successful as Marriott, we need to assess their marketing strategies. One way to do this is to consider the four P’s marketing mix. ... The first of these factors is the product of the company. This factor encompasses the type of product, the diversification in the company’s product range as well as the quality and standardization of the product. In the case of Marriott, the company’s product is hospitality service. They provide a five star hotel service to their customers, and they are ranked as not only a fortune 500 company, but also one of the top hotel chains operating on an international scale. The product of this company is unlike that of a mere bed and breakfast inn. The international standards of hotel management, hygiene, courteous service, and food are amongst the several characteristics, which set its product apart from the rest. There prevails a high rate of customer satisfaction that correlates with the services that Marriott provides. A very important aspect of a company’s product is the brand name that it offers to the people who are choosing between different companies providing their desired service. The brand name of Marriott hotels is an internationally recognized one, which is a great contributing factor to the creation of value of this company in the hospitality market. The next factor in the marketing mix is the price, which the company charges for its product or service. This is a very important factor in any market, as it not only determines the number of customers a company has, but also the target market, which the company aims to serve. Marriott Hotels, for example, charge a heavy price for each night lodgings from their customer. Their hotel rates are similar to the rates of most five star hotels, which is therefore also an indicator of the status of the company in the hotel industry. The price that

Casey Anthony Investigation Term Paper Example | Topics and Well Written Essays - 1750 words

Casey Anthony Investigation - Term Paper Example Her grandmother also explained that her mother had only reported not seeing Caylee for almost a month, after giving different explanations regarding where she was. Casey Anthony was also untruthful to the case’s detectives, for instance, claiming that she thought her nanny had kidnapped Caylee on the 9th of June, adding that, too afraid to contact the police, she had been trying to find her. In October of 2008, Casey Anthony was charged with 1st degree murder (Lundy et al, 2008). To this charge, she pled not guilty. Caylee’s remains were discovered in a wooded area adjacent to the family home five months later. Initial reports from the investigation and testimony in the trial pointed to duct tape being discovered on the skull’s mouth and front (Walensky, 2011). The trial lasted for approximately six weeks in 2011, during which time the prosecution asked the Court for Casey to receive the death penalty. They claimed that her mother who wanted out of parental dutie s, used chloroform to knock her out and suffocated her with duct tape had murdered Caylee. Jose Baez, countering on behalf of the defense team, claimed that, on June 16, Caylee had drowned in the Anthony’s pool and that her grandfather had sought to hide the body. Evidence in the Casey Anthony Case Roy Kronk first alerted the police to the presence of a suspicious object in August after coming across it on his job as a meter reader. The area where he discovered this object was in a wooded area that lay adjacent to the Anthony’s house. After failing to get through the first time, he managed to get police officers to look at the scene. However, they did not find anything despite Roy telling them to look for something that looked kike a skull in a bag. Roy called a second time in December to report the same thing and, this time, the police found Caylee’s remains in a gray bag together with duct tape (Walensky, 2011). The tape was attached to the little skullâ€℠¢s hair, and the police uncovered more bones after a more thorough search of the area around the discovery. Dr. Jan Garavaglia, the medical examiner in the Casey Case found that the child remains discovered were actually those of baby Caylee and that she had been murdered, although she could not determine what caused her death. Investigation of evidence discovered at the crime scene was also carried out through computer technology. Software from the computer investigations department, under the control of Dennis Bradley, also investigated the computer utilized by Casey Anthony, treating it as a crime scene (Walensky, 2011). Investigations showed that the user had conducted a whooping eighty-four searches on chloroform. However, Dennis admitted that the software had a flaw that had caused it to process erroneously forensic information. Apparently, Casey Anthony had only searched for chloroform once. In addition, the search result that the user had opened was concerned with how 19th c entury man had used the chemical (Walensky, 2011). The Casey Anthony prosecuting team presented close to 400 items of evidence, some of it put together from the crime scene investigation. During the investigation, investigators discovered a single strand of hair in Casey Anthony’s car that was genetically similar to another strand recovered from a hairbrush that belonged to Caylee (Walensky, 2011). The investigators could also determine that the former strand had come from a dead body because the hair root showed dark banding,

Analysis of Group Processes Essay Example | Topics and Well Written Essays - 1000 words

Analysis of Group Processes - Essay Example Group Overview This group has been formed for the purposes of attaining a particular objective. The primary directive of the group is to provide Death Star Hospital (DSH) with clear directions on how to achieve a better healthcare service delivery in Death Star Hospital. The group is made up of seven people, all from different hospital departments. Each member has their own responsibilities, and in working together the group is able to meet its targets and obligations (Hogg and Tindale, 2001). The group is tasked with formulating a way through which DSH will increase efficiency in all its departments to ensure a better quality service is delivered to patients. Members of the Group 1. Yoda: Team Manager Yoda is the most learnt member of the group; he is a hospital administrator. His creativity, positive thinking, passion and dedication make him the right man to be at the helm of the group. He easily interacts with people and has a witty sense of humour. We nicknamed him Yoda because o f how he is able to perceive what one wants to say when having difficulty in explaining oneself. Despite being a highly ranked member of the hospital management, he prefers working in the ‘trenches’ with the rest of staff, as he loves his work. 2. Leila: HR Manager When she arrived in Death Star Hospital three years ago, the human resource department was on the verge of being scrapped from the company due to its unproductiveness. Leila single-handedly brought the department back to life, and it is one of the most efficient and productive departments within the hospital. No challenge is too big for this young lady; she is extremely proactive when it comes to finding solutions in case any problem arises. However, her strict attitudes make her come across as aggressive in situations that involve confrontation, and she can be extremely intimidating. 3. C-3PO: Health Science Librarian C-3PO is the Health Science Librarian at DSH and she is held in high regard among her peers in the industry. C-3PO believes in self-drive and is not patient with people who delay her progress. She has excellent people skills. 4. Luke: Chief Resident His high level of expertise makes him a highly experienced doctor within DSH. He is a conservative person and does not talk much during work hours. He does not take personal or professional attacks lightly, and he tends to be very defensive if his department comes under fire. He has gotten himself into trouble with the hospital administrator for putting the needs of his department in front of the hospital’s needs. 5. Darth Vader: Financial Manager His impeccable cost cutting mechanisms are unmatched within the hospital. Darth Vader had climbed the corporate ladder to the manager position within the first four years of joining Death Star Hospital. Sometimes he gets too personal when hospital departments abuse their budget allocations. He is a good team player and a good listener when people give him suggestions and ideas . 6. Landor: System Analyst Landor has been with DSH for around six years now; he is currently the head of the hospital’s IT department. He was instrumental when DSH was switching from a manual system to a computerised one three years ago. He is a good communicator and is able to determine user requirements without fail, and he delivers each and every time even when given short deadlines. 7. R2-D2: Chief Nurse R2-D2 is the head of the nursing department of DSH. Even though she is young, she maintains a high

Kodak and Fujifilm Term Paper Example | Topics and Well Written Essays - 1750 words

Kodak and Fujifilm - Term Paper Example Throughout this period, the company has undergone through various transformational phases which has seen it even be declared bankrupt in January 2012 (Eastman Kodak Company, 2004). Eastman Kodak Co. is known for its best photographic film products which has for ages, been the central part of its business. Mostly, these products included cameras, printers and other machines for use in the production of film products. This company became very dominant for a longer period of time and history has it that most of the 20th Century, it was the only company that held a high prestigious and dominant position in the industry (Eastman Kodak Company, 2004). The first argument one can give forth is that probably there was no greater competitor back then which left Kodak as the only sole producer of the said photographic materials thus; it thrived as a worldwide monopolist. For instance, the company had nearly 90% of the United States of America film share of the market. The remaining percentage w as left to the struggling small companies which were no match to its growth success (Devereaux et al, 2006). In the late 1990s, Eastman Kodak Company started facing financial struggles, which after in-depth analysis, were found to be due to under-performance in its sales prospects leading it to incurring greater transactional and production costs. The resultant effect was the decline in the sales of its photographic materials. Consequently, Kodak’s dismal performance during this period was attributed to the uptake of information technology by firms in their operations. This sudden shift caught the company unawares since it continued producing these film products when the market for the same was diminishing gradually with each passing moment. Sooner or later, the company had no positive sales records. Its slow response to transit to digital photography despite it having invented the current technology in use, in modern digital cameras, led to its fall. However, as a turnaround at around the year 2007, Kodak started using digital photography in its operations, a move which led to it registering profits in its operations. It also focused on digital printing of the films and even started using generating revenues through an aggressive litigation of patents. In the month of January 2012, the company filed for a bankruptcy protection and followed this move in the succeeding month with an announcement that it had ceased production of pocket video cameras, digital cameras, and the digital picture frames. Instead, it stated that its focus would be on the corporate market of digital imaging. August the same year, the company announced for the sale of its commercial scanners, photographic film but not the motion picture film, and the kiosk operations all of which served as measures to emerge from the bankruptcy state. Kodak also sold most of its patents Intellectual Ventures and RPX Corporation, which was an umbrella corporation for companies like Apple, Amazon, F acebook, Samsung, Microsoft, Google and HTC. Fujifilm Company Ltd. This is a Japanese multinational imaging and photography company that was established in the year 1934 and has its headquarters at Tokyo, Japan. The aim of its establishment was to regard it as the first Japanese photographic company producing photographic films. At its inception, this company had only one goal of being a cinematic-film producer but, overtime, it has grown into being a fully fledged multi-dimensional

Smallpox Vaccination Essay Example | Topics and Well Written Essays - 1250 words

Smallpox Vaccination - Essay Example Since smallpox vaccine comes with side effects, it is argued that it should not be administered. It is true that the smallpox vaccine is associated with certain side effects: it is estimated that approximately one in 1 million primary vaccinees and one in 4 million revaccinees will die from adverse vaccine reactions (Maurer et al. 889). There are more severe health related complications that may follow either primary vaccination or revaccination. For instance, it may have and impact on the nervous system that may result in postvaccinial encephalitis, encephalomyelitis, and encephalopathy, and more serious skin infections. Progressive vaccinia (vaccinia necrosum) generally occurs in individuals with weakened immune systems and eczema vaccinatum generally occurs in people with eczema and related skin diseases. Such complications may progressively result in severe disability, permanent neurological damage, and sometimes even death. History of vaccination has seen approximately 1 death per million primary vaccinations and 1 death per 4 million revaccinations. In most of the cases death is often the result of postvaccinial encephalitis or progressive vaccinia. ... Hence, smallpox vaccines should be produced further and should be used in case of any sudden outbreak. It is estimated that 300-500 million deaths in the 20th century was due to smallpox. The World Health Organization estimated that in 1967, 15 million people were the victims of the disease and that two million died in that year due to smallpox (WHO Factsheet n. pag, 2007). World Health Organization certified the eradication of smallpox in 1979 after successful vaccination campaigns throughout the 19th and 20th centuries (WHO A52/5, 1999). While the last case of smallpox in the United States was in 1949, the last naturally occurring case in the world was in Somalia in 1977. After the disease was eliminated or eridicated from the world, routine vaccination against smallpox among the general public was stopped because it was no longer necessary for prevention. United States discontinude the smallpox immunisation in 1972 and also halted the production of vaccine in 1983. Today, stockpiled vaccine has been used only for laboratory researchers working on orthopoxviruses. Since most of the population today is considered to be nonimmune, there is concern raised as to whether smallpox immunization should be resumed or not. This is in view of the current threat from the bioterrorists (Baltimore and McMillan 110-4). There are four factors that have contributed to skepticism of smallpox vaccine's effectiveness. The dubious notion that lesions from cowpox, a disease of cattle, could prevent smallpox, a related but different human disease is the first point. Secondly during the 19th century, which preceded modern bacteriology and the age of refrigeration, it was impossible to know exactly what was in any given dose of vaccine. Thirdly the reported amplification

Innovative Organisations Essay Example | Topics and Well Written Essays - 2000 words - 10

Innovative Organisations - Essay Example The focus of the writer’s study is on the Apple’s innovative product - iPod which is a current bestseller and in high demand. This product is having the features of downloading favourite music, books and other literatures which can be read and listened too. This iPod can be used in cars and other mobile settings. This report will be able to explain the innovation process and strategies used for the success of iPod product. Through this work the writer would like to put across the factors that help an organisation become innovative and iconic. To withstand in the platform of performance, companies need to be innovative in their activities. So, innovation is getting importance in this highly competitive scenario. In 1960s and 1970s innovation meant a new idea, concept, product or process-invention and in the 1980s it changed in terms of creating something new and bringing it into use. Later in 1990s, innovation was defined as creating something new, bringing it into use and getting a profit from it. Innovation is given huge importance in organisation because keeping pace with innovation is equal to a key to prepare for the future. It will lead to future survival and success of the organisation and it can make competitive advantage out of it. That is why it is seen that organisations are spending huge amount of money for R &D activities. Through this research work, the writer would like to do a study on the innovative process in an organisation and analyse how innovative that organisation is, in the area of performance. For the purpose of this study, the selected Company is Apple Inc., an innovative organization and the writer would concentrate her work on the innovative product iPod. The writer has selected this company because it ranked first in FT500 list of most innovative companies in the world. Apple iPod is the most successful product of Apple

How unemployment is individual and social problem Essay Example for Free

How unemployment is individual and social problem Essay In this essay I will discuss how unemployment is an individual and a social problem and how Max Weber distinguished power, authority and coercion and how the functionalist, conflict theorist and symbolic interaction theory view the economy and by the mid century how they have evolved and the role of these theories to explain social and economic phenomenon. How unemployment is individual and social problem Unemployment is caused by many factors in a modern market economy. It can be caused by rapid technological change, business cycle or recessions, seasonal factors in some industries particularly such as changes in tastes and climatic conditions which affects demand for certain products and services, individual perceptions and willingness to work and search for jobs, their values and attitudes towards some jobs and about employers, accessibility for retraining and acquisition of work skills, willingness and perception of unemployed of the benefits of training and the possibility for them to get a job after the training even though they have a chance to get a job, discrimination in the workplace based on race, color. religion, ethnicity, age and class. It can be seen from the above causes unemployment in a particular period can be a combination of caused by social factors and how the economy as a whole works and also due to the subjective individual factors. In a sociological point of view according to functionalist and conflict theorists the unemployment is caused primarily by the social factors than by the individual factors. However according to Max Weber and symbolic interaction theories individuals construct their own social constructs and perception and they can be subjective in their behavior and there fore can become unemployed even though the actual condition they can get a job in the job market. In summary applying the sociological and the primary causes of unemployment unemployment is individual as well as a social problem in a market economy. As discussed above it is caused by the society as well as by individuals. Even the economy or societal factors are not present unemployment can be caused by individual perception and their own subjective behavior. . Max Weber’s distinction among power, authority and coercion Power can be defined as one person’s ability to influence others does what ever they want even though they don’t like to do what is demanded and they resist doing what is demanded. For example a professor can influence the students to assign work and demand them to do to satisfy some criteria. As well a dictator like Hitler can control all aspects of life because of this ability to impose his will on majority of people. In other words a person or group on other person or other groups can use power legitimately or illegitimately. That is power need not come from proper authority or legitimate authority. That is power and authority can be different in this respect. According to Max Weber authority can arise from tradition, charisma of certain powerful people or from legal-rational. That is authority need not come from any logical reason but likely to come from respect for the past. For example a monarchy in Western Europe can get authority because they ruled the populace over a long period of time. Even the traditional authority can exist in modern democracies because the people respect the monarchy or authority of monarchy at least in a limited symbolic head of states in Western Europe. Authority also can arise from charisma of some powerful people. They have authority because of their charisma. This arises because they have the ability to lead a vast number of people for a particular cause using their powerful charm and influence over ordinary people. For example Martin Luther King, Gandhi. Nelson Mandela is the modern examples of charismatic authority they had because of their ability to charm and influence a vast majority of people for a particular cause. Authority also can arise from legal-rational. That is in society authority is given to individuals and organization based on rationally enacted laws and regulations. This authority is impersonal and differs from charismatic authority because the legal-rational authority is impersonal and the charismatic authority is personal and admired by the people who accept that authority. In modern societies the authority is derived from the legal-rational compared to charismatic and traditional in varying degrees in industrialized societies in particular. Coercion is the extreme manifestation of power in a way threatens the person to complete obedience because it threatens the person coerced physically, financially and socially. This results in persons following the authority of another because of fear rather than will. Coercion is mostly linked with abuse and conflict. Coercion exists in many dictatorships in the past as well as in the present world in many parts of the world where citizens are forced to follow the regime of dictatorship. The view of the economy in the perspectives of functionalist, conflict theorists and symbolic interaction theory Functionalist perspective of the economy In the perspective of functionalist sociological theorist social systems including economy works like a biological organism where every part of the system work in a united manner so that smooth functioning is maintained and so that society builds consensus between different parts of the system.. In this change is evolutionary and the changes take place to minimize dysfunction and to enhance the stability and its survival in the future. In this respect Capitalism will not collapse and will endure in the future as the functions of the system will adjust and evolve so that it maintains the social order and stability without any radical overhaul of the economic system. In addition the social, legal, political, religious systems will not be in conflict with the economic system and work in unison with the economic system so the whole social organism survive and social order is maintained and their functions and their purpose even though different work as a unified system. As discussed above this is the functionalist view of the economy. Conflict theorist view of the economy In contrast conflict theorist believe society do not work as a unified system. Conflict and struggle take place as different groups work to maximize their benefit in the same time other groups loose. Functionalist view conflict in a negative manner. However the conflict theorist see the conflict to some extent is beneficial as it forces the parties to come to a common ground and make the economic system or the social system to change for the better and minimize the losers and maximizing the benefits for a greater number of groups as well make the power system in check so that abuse of power is minimized. In this context the economic system and social order changes continually and changes take place and shaped by different interest groups in varying degrees in a market economy. However Marxism as a conflict theory predicts radical change to the economic system to move towards a socialist system it has not eventuated. However Max Weber as a conflict theory predicts the viability of the market economy with some reform to minimize the negative aspects of capitalism like alienation and the negative impact of bureaucracy in capitalist economies and more democracy in society and continuous reform of the economic system to make it work efficiently but also effectively by legal, social and political reform appropriate to a countries historical, cultural, political and social context.

Mental and Behavioral Health Services Essay Example for Free

Mental and Behavioral Health Services Essay While the future of Mental and Behavioral Health Services continue to strive through many striving goals to develop continuous practices, treatments, evaluations, policies, and research, advancements are taking place to better the future of this program and its outreach to the people. Mental disorders are common in the United States and internationally. An estimated 26.2 percent of Americans ages 18 and older — about one in four adults — suffer from a diagnosable mental disorder in a given year.1 When applied to the 2004 U.S. Census residential population estimate for ages 18 and older, this figure translated to 57.7 million people.2 Even though mental disorders are common in the population, the main load of illness is concentrated in a much smaller proportion — about 6 percent, or 1 in 17 — who are suffering from a serious mental illness.1 In addition, mental disorders are the leading cause of disability in the U.S. and Canada.3 Many people suffer from mo re than one mental disorder at a given time. Roughly, 45 percent of those with any mental disorder meet the criteria for being strongly related to having 2 or more disorders.1 Awareness of having a disorder is very uncommon in the U.S. DEFINED FUTURE PROBLEMS Behavioral health is a state of mental/emotional being and/or choices and actions that affect wellness. Substance abuse and misuse are one set of behavioral health problems. Others include, but are not limited to, serious psychological distress, suicide, and mental illness (4. SAMHSA, 2011). Many of these problems are far-reaching and take a toll on individuals, their families and communities, and the broader society. Research allows us to get a better picture of what the future looks like and what people need to be continuing to do and improve on. By looking over research, statistics predict that by 2020, mental and substance use disorders will exceed all physical diseases as a major cause of disability worldwide. The annual total estimated societal cost of substance abuse in the United States is $510.8 billion, with an estimated 23.5 million Americans aged 12 and older needing treatment for substance use. Along with that, every year almost 5,000 people under the age of 21 die as a result of underage drinking and more than 34,000 Americans die every year as a result of suicide, almost one every 15 minutes. Also, Half of all lifetime cases of mental and substance use disorders begin by age 14 and three-fourths by age 24—in 2008, an estimated 9.8 million adults in the U.S. had a serious mental illness. The health and wellness of individuals in America are jeopardized and the unnecessary costs to society flow across Americas communities, schools, businesses, prisons jails, and healthcare delivery systems. Many programs and services are working together to minimize the impact of substance abuse and mental illnesses on America’s communities. Many practitioners have a very deep understanding approach to behavioral health and perceive prevention as part of an overall continuum of care. The Behavioral Health Continuum of Care Model helps us recognize that there are multiple opportunities for addressing behavioral health problems and disorders based on the Mental Health Intervention Spectrum, first introduced in a 1994 Institute of Medicine report, the model includes these components: ( It is important to keep in mind that interventions do not always fit neatly into one category or another) * Promotion: These strategies are designed to create environments and conditions that support behavioral health and the ability of individuals to withstand challenges. Promotion strategies also reinforce the entire continuum of behavioral health services. * Prevention: Delivered prior to the onset of a disorder, these interventions are intended to prevent or reduce the risk of developing a behavioral health problem, such as underage alcohol use, prescription drug misuse and abuse, and illicit drug use. * Treatment: These services are for people diagnosed with a substance use or other behavioral health disorder. * Maintenance: These services support individuals’ compliance with long-term treatment and aftercare. Two strategies for promoting the more important and most effective openings in having access to mental and behavioral health services include providing education to reach the public, and the prevention and early intervention matters intertwining with the Continuum model components of treatment and maintenance. 7 The New Freedom Commission Report and Surgeon General’s Report both emphasized the importance of changing public attitudes to eliminate the stigma associated with mental illness. Advocates for the mentally ill identify stigma and discrimination as major impediments to treatment. Stigma prevents individuals from acknowledging these conditions and erodes public confidence that mental disorders are treatable. A plurality of Americans believe that mental illnesses are just like any other illness; however, 25 percent of survey respondents would not welcome into their neighborhoods facilities that treat or house people with mental illnesses, suggesting that some level of lingering stigma persists.8 Sixty-one percent of Americans think that people with schizophrenia are likely to be dangerous to others9 despite research suggesting that these individuals are rarely violent.10 With that being said, the media plays a large role in shaping how the youth think and behave from many of the messages kids receive from television, music, magazines, billboards, and the Internet use. However, the media can be used to encourage positive behaviors as well. Four evidence based communication and education prevention approaches are through public education, social marketing, media advocacy, and media literacy that can be used to â€Å"influence community norms, increase public awareness, and attract community support for a variety of prevention issues† (SAMHSA). Public education is usually the most common strategy and is an effective way to show support to the development and success of programs and increase awareness about new or existing laws, publicizing a community based program, and reinforce instruction taught in schools or community based organizations. Through social marketing, practitioners use advertising philosophies to change social norms and promote healthy behaviors. Social marketing campaigns do more than just provide information and tries to convince people to adopt a new behavior by showing them a benefit they will receive in return.11 Social marketing campaigns are being used in a variety of social services and public health settings. Media advocacy involves shaping the way social issues are discussed in the media to build support for changes in public policy. By working directly with local newspapers, television, and radio to change both the amount of coverage the media provide and the content of that coverage, media advocates hope to influence the way people talk and think about a social or public policy12. Media literacy is a newer communications strategy aimed at teaching young people critical-viewing skills. Media literacy programs teach kids how to analyze and understand the media messages they encounter so they can better understand what they’re really being asked to do and think. Inferences about a program effectiveness relies on three things: (1) measures of key constructs, such as risk and protective factors or processes, symptoms, disorders, or other outcomes, and program implementation, fidelity, or participation; (2) a study design that determines which participants are being examined, how and when they will be assessed, and what interventions they will receive; and (3) statistical analyses that model how those given an intervention differ on outcomes compared with those in a comparison condition 19 In the past, practitioners and researchers saw substance abuse prevention different from the prevention of other behavioral health problems. But evidence indicates that the populations are significantly affected by these overlapping problems as well as factors that contribute to these problems. Therefore, improvements in one area usually have direct impacts on the other. According to the Substance Abuse and National Health Services Administration, not all people or populations are at the same risk of developing behavioral health problems. Many young people have more than one behavioral disorder. These disorders can interact and contribute to the presence of other disorders. Besides extensive research documenting strong relations between multiple problems, it’s not always clear what leads to what. Mental and physical health is also connected. Good mental health often contributes to good physical health. In the same way, the presence of mental health disorders, including substance abuse and dependence, is often associated with physical health disorders as well (OConnell, 2009). One major advancement that has been recently made is from The Substance Abuse and Mental Health Services Administration, adding a new search feature to its National Registry of Evidence-based Programs and Practices (NREPP) Web site. The feature allows users to identify NREPP interventions that have been evaluated in comparative effectiveness research studies. Both the Obama Administration and the U.S. Congress have championed additional investments in comparative effectiveness research to enhance public understanding about which healthcare interventions are most effective in different circumstances and with different patients. The new NREPP feature can provide added information for States and communities seeking to determine which mental health and substance abuse prevention and treatment interventions may best address their needs. The Surgeon General’s notes that â€Å"effective interventions help people to understand that mental disorders are not character flaws but are legitimate illnesses that respond to specific treatments, just as other health conditions respond to medical interventions.† (7) The two major influences that are targeted upon are risk and protective factors. According to SAMHSAs levels of risk and interventions, some risk factors are causal; others act as â€Å"proxies†, or markers of an underlying problem. Some risk and protective factors, such as gender and ethnicity, are fixed, meaning they don’t change over time. Other risk and protective factors are considered variable: these can change over time. Variable risk factors include income level, peer group, and employment status. Many factors influence a person’s likeliness to develop a substance abuse or related behavioral health problem. Effective prevention focuses on reducing those risk factors, and str engthening those protective factors, that are most closely related to the problem being addressed. Taken into consideration that preventive interventions are most effective when they are appropriately matched to their target population’s level of risk, The Institute of Medicine defines three broad types of prevention interventions, universal, selective, and indicated. Universal preventive interventions take the broadest approach, targeting â€Å"the general public or a whole population that has not been identified on the basis of individual risk† (OConnell, 2009). Universal prevention interventions might target schools, whole communities, or workplaces. Selective preventive interventions target â€Å"individuals or a population sub-group whose risk of developing mental disorders [or substance abuse disorders] is significantly higher than average†, prior to the diagnosis of a disorder (5. OConnell, 2009). Selective interventions target biological, psychological, or social risk factors that are more prominent among high-risk groups than among the wider population. Indicated preventive interventions target â€Å"high-risk individuals who are identified as having minimal but detectable signs or symptoms foreshadowing mental, emotional, or behavioral disorder† prior to the diagnosis of a disorder (6. IOM, 2009). Interventions focus on the immediate risk and protective factors present in the environments surrounding individuals. A more harsher or serious way of approaching prevention is through policy adoption and enforcement. Policy can be broadly defined as â€Å"standards for behavior that are formalized to some degree (that is, written) and embodied in rules, regulations, and procedures.†13 In order to work, these standards must reflect the accepted norms and intentions of a particular community. There are six major types of policy SAMHSA uses to prevent alcohol and other drug use through economic policies, restrictions on access and availability, restrictions on location and density, deterrence, restricting use, and limiting the marketing of alcohol products. Policy can be an effective prevention strategy—as long as the laws and regulations you put in place are consistent with community norms and beliefs about the â€Å"rightness† or â€Å"wrongness† of the behavior you want to legislate14. â€Å"The key to effective enforcement is visibility: People need to see that substance use prevention is a community priority and that violations of related laws and regulations will not be tolerated.† 6 Strategies that we use today for Enforcement are through surveillance, community policing, having incentives, and penalties, fines, and detentions. There have been many areas of progress in preventive intervention research since the 1994 Institute of Medicine (IOM) report Reducing Risks for Mental Disorders: Frontiers for Preventive Intervention Research. Experimental research has greatly improved mainly due to the advances in the methodological approaches applied to intervention research. For a range of outcomes, while the different types of intervention research has increased, so has the number of studies providing economic analyses in the costs and benefits of these interventions. As the 2001 U.S. Surgeon General’s report on children’s mental health indicated, there is a current need for improved and expanded mental health services for children and adolescents (15). There is a greater need for greater access to a variety of mental health services for children including both medication for emotional or behavioral difficulties and treatments other than medication. Recent research studies have documented the increased use of psychotropic medications (16). Less is known, though, about the use of nonmedication treatments for the emotional and behavioral difficulties of U.S. children. These treatments may include community-based services such as behavioral and family therapy provided by mental health professionals in clinic and office settings and school-based services such as assessments of mental health problems, individual counseling, and crisis intervention services for students (17,18). With the information collected by the mental health service questions in the National Health Interview Survey (NHIS), it will be possible to monitor future trends in the use of both medication and other treatments for the emotional and behavioral difficulties of children. Recommended changes by the Surgeon General include: †¢ improve geographic access; †¢ integrate mental health and primary care; †¢ ensure language access; †¢ coordinate and integrate mental health services for high-need populations. (U.S. Department of Health and Human Services, 2001) 1. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 2005 Jun;62(6):617-27. 2. U.S. Census Bureau Population Estimates by Demographic Characteristics. Table 2: Annual Estimates of the Population by Selected Age Groups and Sex for the United States: April 1, 2000 to July 1, 2004 (NC-EST2004-02) Source: Population Division, U.S. Census Bureau Release Date: June 9, 2005. http://www.census.gov/popest/national/asrh/ 3. The World Health Organization. The global burden of disease: 2004 update, Table A2: Burden of disease in DALYs by cause, sex and income group in WHO regions, estimates for 2004. Geneva, Switzerland: WHO, 2008. http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_AnnexA.pdf. 4. Substance Abuse and Mental Health Services Administration. (2011). Leading change: A plan for SAMHSA’s roles and actions 2011-2014. Rockville, MD: SAMHSA. 5. O’Connell, M. E., Boat, T., Warner, K. E. (Eds.). (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. National Research Council and Institute of Medicine of the National Academies. Washington, D.C.: The National Academies Press. 6. Compton, M. T. (2009). Clinical Manual of Prevention in Mental Health (1st ed.). American Psychiatric Publishing, Inc. 7.. U.S. DHHS. 1999. Mental Health: A Report of the Surgeon General. 8. Pescosolido, B. et al. 2000.Americans’ Views of Mental Health and Illness at the Century’s End: Continuity and Change. Public Report on the MacArthur Mental Health Module, 1996 General Social Survey. Bloomington, Indiana. 9. Steadman, H.J. et al. 1998.Violence by People Discharged from Acute Psychiatric Inpatient Facilities and by Others in the Same Neighborhoods. Archives of General Psychiatry 55 (5): 393–401. 10. Borinstein,A.B. 1992. Public Attitudes Toward Persons with Mental Illness. Health Affairs 11 (3): 186–96. 11. Kotler, P. and Roberto, E. (1989). Social marketing: Strategies for changing pubic behavior. New York: Free Press. 12. Wallack, L., Dorfman, L., Jernigan, D., and Themba, M. (1993). Media advocacy and public health: Power for prevention. Newbury Park, CA: Sage Publications. 13. Bruner, C. and Chavez, M. (1996). Getting to the grassroots: Neighborhood organizing and mobilization. Des Moines, IA: NCSI Clearinghouse. CSAP Community Partnerships (unpublished document). 14. Bruner, C. (1991). Thinking collaboratively: Ten questions and answers to help policy makers improve children’s services. Washington, DC: Education and Human Services Consortium 15. U.S. Public Health Service. Report of the Surgeon General’s Conference on Children’s Mental Health: A National Action Agenda. Washington, DC: Department of Health and Human Services. 2000. 16. Martin A, Leslie D. Trends in psychotropic medication costs for children and adolescents, 1997–2000. Arch Pediatr Adolesc Med. 157:997–1004. 2003. 17. Steele RG, Roberts MC (Eds.). Handbook of mental health services for children, adolescents, and families. New York: Springer, 2005. 18. Foster S, Rollefson M, Doksum T, Noonan D, Robinson G, Teich J. School Mental Health Services in the United States, 2002–2003. DHHS Pub. No. (SMA) 05–4068. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration. 2005 19. Committee on the Prevention of Mental Disorders and Substance Abuse Among Children, Youth and Young Adults: Research Advances and Promising Interventions, Institute of Medicine, National Research Council. 10 Advances in Prevention Methodology. Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities. Washington, DC: The National Academies Press, 2009.

History Of Mental Illness Health And Social Care Essay

History Of Mental Illness Health And Social Care Essay Mental illness is a general term for a group of illnesses. Mental disorders result from biological, developmental and/or psychosocial factors. A mental illness can be mild or severe, temporary or prolonged. Mental illness can come and go throughout a persons life. Some people experience their illness only once and fully recover. For others, it is prolonged and recurs over time. Mental illness can make it difficult for someone to cope with work, relationships and other aspects of their life. Definition of mental illness Mental illnesses are medical conditions that disrupt a persons thinking, feeling, mood, ability to relate to others and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder (OCD), panic disorder, post traumatic stress disorder (PTSD) and borderline personality disorder. The good news about mental illness is that recovery is possible. Mental illnesses can affect persons of any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing. Mental illnesses are treatable. Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan. In addition to medication treatment, psychosocial treatment such as cognitive behavioral therapy, interpersonal therapy, peer support groups and other community services can also be components of a treatment plan and that assist with recovery. The availability of transportation, diet, exercise, sleep, friends and meaningful paid or volunteer activities contribute to overall health and wellness, including mental illness recovery. History of Mental illness Timeline 1247: Bethlehem Hospital (more frequently known as Bedlam) opens in London to house distraught and lunatik people. 1566: The New Worlds first mental hospital is established in Mexico City. 1774: The Act for Regulating Madhouses, Licensing, and Inspection is passed in England. The law forbade a persons commitment to a madhouse without a physicians certification of that individuals insanity. 1790s: A Quaker called William Turke opens the York Retreat near York, England, an asylum for the mentally ill. The Retreat favored humane treatment; physical restraints were not used and patients were comfortably housed. 1790s: French physician Phillipe Pinel begins working at the Bicentre and Salpetriere asylums where he develops traitement morale, a form of treatment that focused on the mental origins of madness. His kind treatment of his patients brought about recovery for many 1817: Quakers in Philadelphia open the first asylum in America based on the principles of moral treatment. 1841: Dorothea Dix, a schoolteacher from Cambridge Massachusetts, becomes inspired to take up the cause of the mentally ill. She travels to several states where she lobbies state legislatures to better their treatment of the mentally ill. Over thirty state mental hospitals were opened as a result of her efforts. 1867: The Packard Law passes in Illinois. Named for Eliza Packard, a woman committed against her will by her husband after a property dispute, the law required that a patients insanity be determined by a jury before he or she could be sent to an institution. 1927: The US Supreme Court rules in Buck v. Bell that the forced sterilization of defectives, including the mentally ill, is constitutional. 1954: The Durham Rule is established by the US Court of Appeals for the District of Columbia. It states that a person accused of a crime is not responsible if the criminal act was the product of a mental disease or a mental defect. It was later rejected due to problems defining mental disease and product. 1963: Congress passes the Community Mental Health Centers Act. This leads to the closure of many large state psychiatric hospitals. 1966: Lake v. Cameron, a case of the US Court of Appeals for the District of Columbia Circuit , declares that patients in psychiatric hospitals have the right to receive treatment in the setting that is least restrictive. 1975: US Senate holds hearings about the use of neuroleptics (antipsychotic drugs such as Thorazine) in juvenile jails and homes for the developmentally disabled. 1979: NAMI is founded. 1988: The Fair Housing Amendments Act prohibits housing discrimination against people with disabilities, including mental disabilities. 1990: The Americans with Disabilities Act is passed. It prohibits discrimination against people with physical or mental disabilities. 2004: DuPage County begins the Mental Illness Court Alternative Program (MICAP.) 2008: Congress passes the Mental Health Parity and Addictions Equity Act. It requires that any limits to insurance coverage for mental illness be no more restrictive than those for physical health issues. 2010: Williams v. Quinn, a case heard by U.S. District Court for the Northern District of Illinois, rules that Illinois residents with mental illnesses living in nursing homes and other institutions for mental diseases (IMDs) have the right to live in integrated settings in the community Types of Mental Illness There are many different conditions that are recognized as mental illnesses. The more common types include: Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs of anxiety or nervousness, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the persons response is not appropriate for the situation, if the person cannot control the response, or if the anxiety interferes with normal functioning. Anxiety disorders include generalized anxiety disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), panic disorder, social anxiety disorder, and specific phobias. Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common mood disorders are depression, mania, and bipolar disorder. Psychotic disorders: Psychotic disorders involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations the experience of images or sounds that are not real, such as hearing voices and delusions, which are false beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder. Eating disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common eating disorders. Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders. Alcohol and drugs are common objects of addictions. Often, people with these disorders become so involved with the objects of their addiction that they begin to ignore responsibilities and relationships. Personality disorders: People with personality disorders have extreme and inflexible personality traits that are distressing to the person and/or cause problems in work, school, or social relationships. In addition, the persons patterns of thinking and behavior significantly differ from the expectations of society and are so rigid that they interfere with the persons normal functioning. Examples include antisocial personality disorder, obsessive-compulsive personality disorder, and paranoid personality disorder. Other, less common types of mental illnesses include: Recommended Related to Mental Health Adjustment disorder: Adjustment disorder occurs when a person develops emotional or behavioral symptoms in response to a stressful event or situation. The stressors may include natural disasters, such as an earthquake or tornado; events or crises, such as a car accident or the diagnosis of a major illness; or interpersonal problems, such as a divorce, death of a loved one, loss of a job, or a problem with substance abuse. Adjustment disorder usually begins within three months of the event or situation and ends within six months after the stressor stops or is eliminated. Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness, identity, and general awareness of themselves and their surroundings. These disorders usually are associated with overwhelming stress, which may be the result of traumatic events, accidents, or disasters that may be experienced or witnessed by the individual. Dissociative identity disorder, formerly called multiple personality disorder, or split personality, and depersonalization disorder are examples of dissociative disorders. Factitious disorders: Factitious disorders are conditions in which physical and/or emotional symptoms are created in order to place the individual in the role of a patient or a person in need of help. Sexual and gender disorders: These include disorders that affect sexual desire, performance, and behavior. Sexual dysfunction, gender identity disorder, and the paraphilias are examples of sexual and gender disorders. Somatoform disorders: A person with a somatoform disorder, formerly known as psychosomatic disorder, experiences physical symptoms of an illness, even though a doctor can find no medical cause for the symptoms. Tic disorders: People with tic disorders make sounds or display body movements that are repeated, quick, sudden, and/or uncontrollable. (Sounds that are made involuntarily are called vocal tics.) Tourettes syndrome is an example of a tic disorder. Other diseases or conditions, including various sleep-related problems and many forms of dementia, including Alzheimers disease, are sometimes classified as mental illnesses, because they involve the brain. Causes of Mental Illness Were aware of several different forms of mental illnesses, right from bipolar disorder to schizophrenia to compulsive disorders. How often we come across murders carried out by mentally unstable people! In fact, there are scores of famous people with bipolar disorders. Mental illnesses are especially common in the United States. Approximately 26.2 % Americans above 18 years of age are believed to suffer from mental disorders every year, thereby conducing to one of the leading causes of disabilities in the US and Canada. But what causes mental illness? Mental illness is a condition affecting the brain, that influences the way a person thinks, feels, behaves and relates to others around him or her. The symptoms of mental illness may range from mild depressive symptoms to severe behavioral problems. Genetic Factors Depression and mental illnesses are often passed on from one generation to another through the genes. This means, a person with a family history of mental illness is more vulnerable to develop a mental illness. It is believed that mental illness is associated to various abnormalities in not just one, but several genes. This is the reason why the person inherits the vulnerability to develop this illness, but does not inherit the illness itself. When such people go through horrendous situations the balance of their mind tips and they get engulfed by mental illnesses. . Physical Factors People who have landed up injuring their head several times in accidents, are seen to damage certain areas of their brain and central nervous system, that lead to mental illnesses. Trauma occurring at the time of birth can also cause damage to the brain. Moreover, disruption of early fetal brain development can also lead to conditions like autism, etc. Some biological factors such as chemical imbalance in the brain, are also associated to mental illnesses. The chemicals called neurotransmitters help nerve cells in the brain to transfer impulses, thereby facilitating communication. However, when this balance tips, messages are not transferred correctly, leading to mental illness. Diseases affecting the brain such as Huntingtons chorea, multiple sclerosis and infections like Tuberculous meningitis, Encephalitis lethargica, etc. also result in mental illnesses. Psychological Factors People who have gone through harrowing experiences in their lives like emotional, physical, sexual abuse, domestic violence or bullying are often unable to cope with their traumatic past. Sometimes, the death of a loved one, betrayal or neglect during childhood years, also mars the persons emotional state of mind. This sometimes can be the reason of mental illness of a person. Social and Environmental Factors Poverty, living in a difficult and unsafe environment like in war zones, residing in earthquake prone and other natural disaster-prone areas, living in neighborhoods plagued by gangsters, etc. can lead to mental illnesses. These people develop a constant fear that conduces to mental illness. Moreover, unhealthy environment factors at home, such as growing up in a dysfunctional family, with narcissistic parents or neglecting parents can cause the balance of the childs brain to tip. The persons appearance regarding height and weight also causes depression in certain people. Mental illnesses should be not confused with mental retardation. People with mental illnesses do not exhibit limitations in mental, cognitive and social functions. Thus, causes of mental retardation and causes of mental illnesses are obviously different. The above mentioned causes cannot be viewed in isolation. Its when two or three different factors come together, such as past abuse and present horrendous situation come together, that it often causes the mental illness. It is important to not look upon people with mental illnesses with disdain and ostracize them. What they need is unconditional love. Espouse them and help them out of their pits of depression. The symptoms of mental illness A person with a mental illness can experience problems with their thinking, emotions and/or behaviour. These changes may happen quickly, or they may be gradual and subtle. It may take time to understand and identify what is happening. Psychotic symptoms These symptoms can include: Thoughts and feelings that are out of the ordinary or difficult to understand, such as thought of being persecuted or under surveillance for which there is no proof Experiencing sensations (seeing, hearing, smelling, tasting something when there is nothing there that others can identify) Odd behaviour. Schizophrenia is a psychotic illness. Mood symptoms Some of the symptoms of a changed mood may include: Persistent and pervasive feelings of sadness, elation, anxiety, fear or irritability Changes in sleep patterns Changes in appetite Loss of interest in things that were previously enjoyable Periods of increased or decreased activity, where things may be started and not finished Difficulty thinking and concentrating Excessive worries Changes in use of alcohol and other drugs. Exact causes are unknown Many mental illnesses are thought to have a biological cause. What are the exact causes , its unknown. The relationship between stress and mental illness is complex, but it is known that stress can worsen an episode of mental illness. Treatment: Extraordinary advances have been made in the treatment of mental illness. Understanding what causes some mental health disorders helps doctors tailor treatment to those disorders. As a result, many mental health disorders can now be treated nearly as successfully as physical disorders. Psychological treatment Psychological treatments are based on the idea that some problems relating to mental illness occur because of the way people react to, think about and perceive things. They are particularly relevant to many people with anxiety disorders and depression. Psychological treatments can reduce the distress associated with symptoms and can even help reduce the symptoms themselves. These therapies may take several weeks or months to show benefits. Different psychological therapies used in the treatment of mental illness include: Cognitive behaviour therapy (CBT) examines how a persons thoughts, feelings and behaviour can get stuck in unhelpful patterns. The person and therapist work together to develop new ways of thinking and acting. Therapy usually includes tasks to perform outside the therapy sessions. CBT may be useful in the treatment of depression, anxiety disorders and psychotic disorders such as bipolar and schizophrenia. Interpersonal psychotherapy examines how a persons relationships and interactions with others affect their own thoughts and behaviours. Difficult relationships may cause stress for a person with a mental illness and improving these relationships may improve a persons quality of life. This therapy may be useful in the treatment of depression. Dialectical behaviour therapy is a treatment for people with borderline personality disorder (BPD). A key problem for people with BPD is handling emotions. This therapy helps people to better manage their emotions and responses. Treatment with medication Medications are mainly helpful for people who are more seriously affected by mental illness. Different types of medication treat different types of mental illness: Antidepressant medications about 60 to 70 per cent of people with depression respond to initial antidepressant treatment. These medications are now also used (in combination with psychological therapies) to treat phobias, panic disorder, obsessive compulsive disorder and eating disorders. Antipsychotic medications are used to treat psychotic illnesses, for example schizophrenia and bipolar disorder. Newer antipsychotic medications may have some side effects, but tend to have fewer of the effects that were associated with the older medications, for example stiffening and weakening of the muscles and muscle spasms. Mood stabilising medications are helpful for people who have bipolar disorder (previously known as manic depression). These medications, such as lithium carbonate, can help reduce the recurrence of major depression and can help reduce the manic or high episodes. Other forms of treatment Effective treatment involves more than medications. Treatment may also involve: Community support including information, accommodation, help with finding suitable work, training and education, psychosocial rehabilitation and mutual support groups. Understanding and acceptance by the community is very important. Electroconvulsive therapy (ECT) this treatment can be a highly effective treatment for severe depression and, sometimes, for other diagnoses when other treatments have not been effective. After the person is given a general anaesthetic and muscle relaxant, an electrical current is passed through their brain. Hospitalisation this only occurs when a person is acutely ill and needs intensive treatment for a short time. It is considered better for a persons mental health to treat them in the community, in their familiar surroundings. Involuntary treatment this can occur when the psychiatrist recommends someone needs treatment but the person doesnt agree. In general, people receive involuntary treatment to ensure their own safety or that of others. Mental illness in Pakistan: Mental health in Pakistan has remained a subject of debate since the last few years. The incidence and prevalence have both increased tremendously in the background of growing insecurity, terrorism, economical problems, political uncertainty, unemployment and disruption of the social fabric. 1 Sinking below poverty line by almost 39% of the individuals is an alarming factor worth noting. Many people are now presenting to psychiatrists probably because of the growing awareness through the good work of media. Though there are many things which can be done to improve the mental health of the people in the areas of social environment, economic improvement and political harmony etc. but the important subject for debate is that, how far we are in the areas of education, service and research related to mental health having direct impact on the patient population. From 1947 to 2005, almost 58 years have passed since the independence of the country and many countries with this age have done w onders in overall upkeep of health care and specially the mental health. The scenario though is improving, but is it at the required pace? If we first take the area of education by virtue of which we train our future doctors who in turn can become navigators helping us in sailing smoothly through the heavy storm of up surging mental illnesses, we find lacunas which are evident when it comes to ultimate care of patients. With the exception of very few institutions, the subject of behavioral sciences which has been introduced by the PMDC in the early years of medical teaching is not being taken serious enough, low number of behavioral scientists cannot alone be blamed for this, there are no structured rotation programmes for senior medical students which means a calendar indicating topics, patient sessions, log book and evaluation strategy with weightage in the final year marking system. Low interest by students in the subject of psychiatry despite few institutions model teaching/trai ning programme is understandable in view of no separate paper in psychiatry and very low representation in the paper and clinico-orals of the subject of General Medicine. Regarding the departments, are we fulfilling the international requirements of a good department of psychiatry with full-fledged faculty in all hierarchies? The answer is simply no. Regarding the postgraduate education, how many recognized centers follow structured programmes emphasizing adequate patient exposure, ongoing continuing medical education programmes, research, exposure to subspecialties like, child, geriatric, forensic and rehabilitation psychiatry etc., is there a rural exposure, is there training in cultural issues, is there emphasis on liaison service and multidisciplinary team approach, is there a standard methodology for continuous monitoring and evaluation with resultant weightage in postgraduate exit examinations, is there training in audit and psychiatric administration, the answers to most of t hese questions will remain unanswered nationally. It is precautionary not to say a word about the selection criteria of evaluators and examiners lest it is not politically biased and motivated. It is also worth noting that during postgraduate training how many of the prospective specialists are monitored and assessed for culturally relevant mental state examination, adequate case note management, observation of prescribing practices and its justification, communication skills etc. Once certified, there is no provision of higher specialist training for a period of at least three years on the pattern of UK with evaluation of practice-based efficiency, infact, the UK model is worth adopting. 2 There is no trend for CME credit maintenance and hence no programme specifically designed for psychiatrists though there are many such programmes for the general practitioners of course with no condition of maintaining credit certification, this is mostly prompted by the pharmaceutical companies with a view of improving sale as evidence has shown that the knowledge of even most common disorder depression was not adequate among general practitioners. When we come to service, though the major teaching hospitals have established separate departments of psychiatry but in most of the cases they are not well equipped specially in terms of psychiatric manpower both skill and number wise. Still Pakistan has very low number of psychiatrists and these too are continuously being drained by the developed countries especially by the western world where they are being offered an attractive package and lifestyle that the question remains as to who comes back and serves the nation. 4 It is not surprising that there are a large number of Pakistani psychiatrists in United Kingdom, United States, Canada, Australia and New Zealand apart from those in Middle East, Africa and South East Asia. It seems that soon we shall become a psychiatrists exporting region like our neighbour India thus causing further deepening of the problem related to the already existing scarcity of psychiatrists. 5 Also, at the same time it is vitally important to abolish the feudal psychiatry which fortunately is being eroded by young generation of psychiatrists. There is also acute shortage of allied mental health professionals. In view of poverty, low health budget, high cost of medicines there is huge economic burden on the patients. 6 The hospitals also dont follow the intake/admission criteria, no separate unit for subspecialties, no appropriate long stay units, no exit/discharge criteria, no rehabilitation services, no exchange of information between psychiatrists and family practitioners, no proper advertisement of available services, no concept of day centers, day hospitals, ill developed community services, no central registry of patients and set policy for management systems in the psychiatric set ups and finally no internal referral system. As far as research is conc erned, there is still low representation in local accredited journals and very low in international journals. 7 Though there has been an increase in lay and scientific write-ups recently but it is still far from satisfactory state. Papers are produced for promotions and that too are for the sake of papers, matter of keeping up standards are ignored. The Journal of Clinical Psychiatry published regularly from Lahore once upon a time disappeared eventually. The first journal of Pakistan Psychiatric Society called JPPS was published in the year 2003, which was blocked politically and was not reproduced again. . It appears that still we are far behind in achieving the standards and in order to improve the existing scenario some steps are essential. In order to bring improvement in psychiatric education, it is important to pay emphasis on the subject of behavioral sciences, design an appropriate undergraduate training program in line with one of the international modules, inculcation of research interest among medical students, either introduction of a separate paper of psychiatry or at least 25% of weightage in the paper of medicine, at postgraduate level more structured training program with exposure to subspecialties, designing a postgraduate curriculum and module, introduction of audit of training and performance, provision of higher specialist training at the level of specialist registrar, private-public partnership in provision of services, mobilization of more resources for mental health and maintaining of records. There is a need for development of research culture especially in the a reas of need assessment is also necessary. Along with these efforts the medical fraternity can force the government to allocate a higher budget, reduce poverty, bring social justice and harmony, improving political scenario. It is also advisable to create better incentives for the mental health professionals in order to avert brain drain. Efforts for providing a conducive environment to the public to help in promoting sound mental as well as physical health are imperative. Literature Review Anxiety and depressive disorders are common in all regions of the world. 1 They constitute a substantial proportion of the global burden of disease, and are projected to form the second most common cause of disability by 2020.2 This increased importance of non-communicable diseases such as anxiety and depressive disorders presents a particular challenge for low income countries, where infectious diseases and malnutrition are still rife and where only a low percentage of gross domestic product is allocated to health services.3 These disorders are also important because of their economic consequences. 4 With an estimated population of 152 million, Pakistan is the sixth most populous country in the world. It is projected that, by 2050, the population will have increased to make it the fourth most populous country.5 There is a need to develop an evidence base to aid policy development on tackling anxiety and depressive disorders. We therefore conducted a systematic review as no such work existed to our knowledge. Our main questions were (a) what the estimated prevalence of anxiety and depressive disorders is in Pakistan and how this compares with estimates from other low income countries; (b) what the associated social, psychological, and biological factors are; and (c) what evidence exists for effectiveness of treatment or prevention in this population. Prevalence of anxiety and depressive disorders the prevalence of anxiety and depressive disorders estimated in the studies. The overall mean prevalence in men and women in the six studies of random community samples (n = 2658) was 33.62%, with the point prevalence varying from 28.8% to 66% for women (overall mean 45.5%) and from 10% to 33% for men (overall mean 21.7%). Women aged 15-49 were studied in a paper with 28.8% prevalence, while young men with a mean age of 18 participated in a study reporting 33% prevalence. Only one study reported adjusted prevalence with 95% confidence intervals. For those presenting to traditional or faith healers (n = 511), the prevalence of anxiety and depressive disorders among men varied from 2.65% to 27%, and among women from 11.5 % to 52%. Three studies looked at total psychiatric morbidity in primary care (n = 774). One described women in a rural area, with a prevalence of 50%, while another described 18% prevalence for men and 42.2% for women in an urban area. The third study, with a prevalence of 38.4%, did not specify participants sex. Of those presenting to psychiatric outpatients (n = 2430), the prevalence varied between 32% and 66.3%. There were two studies on psychiatric inpatients, one reported a prevalence of depressive illness of 37% (n = 2620), while the other reported 19.1% (n = 177). Comparison with other low income countries Using stringent criteria, Harding et al reported an overall frequency of anxiety and depression of 13.9% in four developing countries.9 Community studies from Africa have reported prevalences of 24% in rural Uganda and 20%-24% in rural South Africa. Among patients attending primary care, the prevalence varied from 8% to 29%. Patients attending primary care in India showed prevalences between 21% and 57%. In relation to risk factors, Abas and Broadhead found a significant association with formal employment, below average income, overcrowding, and certificate of secondary education in urban Zimbabwe.In the same study, they also found a significant association with humiliation or entrapment and with death or other l