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For long, people have been involved in establishment of the causes of mental illness. From the19th century psychologists have discussed the issue, which consequently led to the establishment of ten psychological theories, five of them are mutually accepted at the moment. These five presumptions include; the Biological approach, The Learning approach, The Cognitive approach, Sociocultural approach and the Psychodynamic approach. To begin with is an overview of different theories of psychoanalytic.
Freud's psychoanalytic theory, presents a radically new way of analyzing and treating "abnormal" grown-up behavior. Earlier suggestions happened to overlook deeds and look for a physiological description of "abnormality". The novelty of Freud's approach was in acknowledging that a neurotic deed is not accidental or hollow but goal-directed. Therefore, by explaining the purpose behind what is referred as "abnormal" behavioral patterns, the analyst was offered a means for understanding behavior as significant and educational, without denying its physiological aspects.
Cognitive psychology according to Balota &Marsh (2004) is defined “as the study of all processes by which a sensory input is transformed, reduced, elaborated, recovered and used” (p.1). They further said that cognitive psychologists are interested in the processes by which patterns and objects are recognized, attended, remembered, imagined, and linguistically elaborated. Andrade & May (2004) on the other hand define cognitive psychology as the “study of the mental processes underlying our ability to perceive the world, to understand and remember our experiences, to communicate with other people, and to control our behavior” (p.1). Andrade & May continue to say that cognitive psychology “comprises of areas such as perception, attention, memory, knowledge, language, problem solving, reasoning and decision making, and aspects of intelligence, emotion and consciousness” (p.1).
There are four key milestones in the development of cognitive psychology as a discipline. These milestones include; philosophical underpinnings, the beginnings of modern psychology, behaviorism, the computer metaphor and information processing, and the abstract constructs in other fields. Philosophical underpinnings are the pursuit of knowledge in all its forms. This milestone was very crucial because according to the Willingham (2007) knowledge is central to philosophy; hence philosophers have been interested in how it is acquired. Willingham therefore outlined that “cognitive psychology seeks to establish how knowledge is acquired through the following areas associated with our cognition” (p.7).
Philosophical underpinnings milestone includes cognition aspects such as; perception, memory and nature and nurture. Perception according to the article establishes how we gain access to knowledge about the world immediately around us or our environments (Willingham, 2007). With memory this tries to establish how individuals retain knowledge about the world in our minds for later use or application in our lives. On the other hand nature and nurture establishes the origin of the knowledge, and if knowledge is gained through life experiences or if it is innate. Nurture therefore determines if one is serving to release or activate knowledge he or she was born with (Willingham, 2007). Many renaissance philosophers borrowed most metaphors from other sciences while discussing the mind (Willingham, 2007). For example Hobbes was influenced by Galileo’s movement studies and believed that thought was motion of the nervous system on which he based his argument on (Willingham, 2007)
The beginning of modern psychology establishes that intellectual apparatus were in place to start a science of the human mind since 17th and 18th centuries. According to the article Wundt founded the discipline of psychology not because he started a lab but because he did what was necessary to get the science going. Willingham thus stated that “the most important developments during this period were the view point that came to be known as structuralism because the goal was to describe the structures that comprise thought” (p.15)Another viewpoint was established by William James known as functionalism because it emphasis was not on mental structures but on the function of mental processes. Apart from the above developments Wundt championed introspectionism, a method of study in which people tried to follow their own thought processes. As a result Wundt left a legacy because he worked the theory of psychology which he published. To date his thinking remains influential in the academic linage (Willingham, 2007).
Behaviorism was an important milestone in the development of cognitive psychology. This is because it is based on two principles which are based on the views of other psychologists. Firstly they should focus only on what is observable and secondly, behavior should be explained, and not thought or consciousness (Willingham, 2007). Watson suggested that behavior was one of the basic building blocks of cognitive psychology. Willingham further states that behaviorism worked well because researchers using these methods obtained interesting experimental results (2007). In the end, however, behaviorism was found lacking and was replaced by cognitive psychology. Because of the findings made by the psychologists they could feel they were being scientific when they emphasized behavior because it is observable. On the other hand everyone could agree on what a person does, but it is much more difficult to say anything about a person’s mental processes (Willingham, 2007). These factors made behaviorism very successful.
Computer Metaphor and information processing milestones were very important in the study of the cognitive psychology. The computer uses representations in terms of symbols were processes manipulate the representation in a number of ways (Willingham, 2007). Using the same approach it is possible to think of humans as processors of information were by one can set a number of questions for the study of mind. He also said using the approach that computers have hardware and software the same approach has been fruitful for neuroanatomists studying the hardware and cognitive psychologists studying the software of the brain. The metaphor later proved very powerful and became known as the information processing model (Willingham, 2007). This according to Willingham it was based on the assumptions that: firstly humans are processors of information, just as computer are real processors of information (2007). The capability of human to process information supports the behavior and thought of human. Secondly it is based on the fact that since information processing occurs in isolated modules and is organized in stages as it is with human decision making (Willingham, 2007).
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Behavioral observation is important in the development of cognitive psychology because there is currently no way to observe these processes directly but we infer the existence of these processes based on people’s behavior. Another importance is the complex behaviors in which animals engage even though they have little opportunity for practice or reward. Through these experiments based on the behaviors of animals it has contributed largely in the study of cognitive psychology. In addition, according to Willingham (2007), behaviorism in the development of cognitive psychology, like almost every other science, sought to simplify complex subject matter by finding basic, irreducible units. Moreover the philosophy underlying behaviorism was appealing because it was very straight forward hence psychologists could feel they were being scientific when they emphasized behavior because it was observable (Willingham, 2007).
Behavioral observation makes contact with the objective, observable in the real world. Descriptive research thus describes some behavior as it is found in the world (Willingham, 2007). According to Willingham found out that “three commonly used methods are descriptive: naturalistic observation, case studies, and self-report” (p.43). He further says that although methods never provide decisive data for cognitive psychologists that are or tell us which candidate theory is correct but they can provide inspiration for other types of work, or highlight behavioral phenomena that had been ignored previously (Willingham, 2007). Therefore, Behavioral observation has made significant contributions in various forms of research and more so in the development of cognitive psychology.
It is important to note the society’s obligation needed to ensure access to a basic level of health care for all individuals and how it can be attained. According to FAO legal office human rights experts have found three levels at which the state’s human rights obligations works; states must respect, protect and fulfill their subjects‘rights. Obligations can be divided further into obligations of outcomes and obligations of conduct, the latter being the focus of legislative action. This primary analysis already gives some guidance as to the types of action that a state may take through national legislation. This is because health care reform is a volatile subject and people must be ready to express dissatisfaction with its access as well as costs. The society should be ready to set proper values and in one away adjust its current values to the new set and at the same time the society should adjust its expectations.
FAO legal office continues to explain that, the congress may be reluctant to impose hard choices on the beneficiaries of the health care reforms with the much support of the public and society as a whole. FAO legal office says that the four elements of change will come only when the sellers of the services have incentives to provide only what the payer needs, at higher quality for a price that better reflects the value of the service. It is therefore the obligation of the society to ensure that they are getting good services in return of what they have paid for.
To the society health care issue is becoming an important political issue because people are becoming concerned about the cost of care and the future of their coverage as FAO legal office explains. However they noted that intensified political debate may create confusion because public views are unformed about many aspects of the health care reform. He also indicated that the society should understand that many of the health care costs are the result of drugs, homicides, obesity, bad diets, alcoholism, smoking and other cultural causes which can in a way be controlled. This means that if the society does not contain some of the causes the country will end up with a health care system that is very complicated and expensive according to FAO legal office.
Health care system is very crucial and therefore it is equally important to determine whether it is wise to allow government to take a more aggressive economy or continue exerting market driven approach in an effort of bringing forth reforms. The economy should not be allowed to continue exerting market driven reforms on the health care system but instead the government should take a role of reshaping it. This is because it is believed that health care is the big independent industry through which policy making in health care in Australia involves a complex network of decisions made by different institutions and political actors across a broad spectrum of public and private sectors. These actors include federal, state, and local governments in the public sector. It should be noted that private sector involves health care providers such as hospitals, and nursing homes, health care professionals, health care purchasers for example insurance companies, industries and consumers. Therefore the control of all this sectors and institutions should not be left to the economy to play the role of reshaping the health care system.
To the patients this practice has also increased transport times for ambulance patients, inconvenience and dissatisfaction for the patients and their families and increased frustration among medical staff. The magazine “Hospital emergency department’s crowded conditions vary among hospitals and communities” continues to say that “it has resulted to delays in treatment, and also some reported cases of compromised patient care, poor outcomes which result from crowded conditions in emergency departments” (p. 5).
The implications of using hospital emergency departments to the patients is delayed time of being attended to because the medical conditions of patients can range from mild injuries such as ankle sprains to serious traumas for example automobile accidents. It can also include patients with chronic conditions such as asthma or diabetes. Another effect is that the space, equipment and medical personnel resources required to treat patients may be suppressed. This in turn reduces the quality of health care provided by the emergency departments.
In the health sector, one of the major changes was the shifting in utilization from inpatient hospitalization to ambulatory care services. There are major factors which have contributed to this shifting. Also following the shifting there are implications for hospitals, consumers (patient), and also health care delivery system as a whole.
Inpatient hospitalization has not been adequately addressing the unique care delivered in ambulatory settings. According to “Centre for Health program evaluation article”, this is because of the different nature of inpatient and outpatient services. Berman in his article “organization of ambulatory care provision: a critical determinant of the health system performance in developing countries” say that inpatient hospitalization is focused on high cost services provided to a relatively small number of people within a limited number of well defined facilities. This article indicated that “ambulatory care is better in terms of its cost, volume, and location of service” (p. 244).
“Centre for Health program evaluation article” shows the major cost differential between inpatient hospitalization and ambulatory care affects the cost benefit ratio of ambulatory care. This is because it reduces hospitalization and shortens the lengths of stay. The design of a cost effective ambulatory care systems depends on understanding the right location of service in order to attend to many patients at a time as explained in the “Centre for Health program evaluation article”. The implication of this shift is that it provides an effective way of attending to those patients who cannot afford inpatient hospitalization. The shift also ensures that there is at least equitable access to health care to many people because of affordable costs and location of service.
An acceptable quality of health care can be assured through the involvement of both the public and private sector as many scholars have argued. According to Healy, Sharman, & Loguke (2006) preventive health care should be compounded by the government programs that discourage the behavior which causes these preventable diseases. To ensure quality access to health care the government deal with runaway budget deficits and public spending on health and contain these costs.
The congress should also approach the issue of health care much like all other social welfare issues with changes and benefits targeted to specific groups to access quality health care (Healy, Sharman, & Loguke, 2006). Healy, Sharman, & Loguke (2006) continues to say that there should be commitment to the overall policy on health and a consensus on who is responsible for providing it.
This type of data has its efforts geared towards measuring the impact of health care on patient outcomes. Data gathered according to Grieve, Sekhon, Hu, and Bloom can be used to indicate which providers of health care achieve the best clinical, functional and satisfaction outcomes at lowest costs, holding providers accountable for achieving outcomes and maintain affordable costs. The data can be used for identifying opportunities for improvement and also identifying benchmarking sources (Grieve, Sekhon, Hu, & Bloom, n.d).
Physicians have established that participation in hospital peer reviews activities a most unpleasant responsibility. However this has experienced some challenges in entire process. Emery, Auld, & Lu, indicated that medical care cannot be provided without physicians and each physician should demands professional autonomy. He continues to say that increased bureaucratization can help physicians to be more productive by freeing them from the need to perform tasks other than clinical judgment. Emery, Auld, & Lu, continues to say that this may also improve the quality of the quality and appropriateness of the care.
According to Emery, Auld, & Lu, one way to formalize the review process in the interest of increased efficiency is to transform it into the kind of a quality assurance program that the hospital intends to achieve. In order to ensure that high quality is achieved physicians should be excluded from the review process. One major implication of involving the physicians in the hospital review activities is that it may not bring heavy pressure to bear on miscreants and they may end up being reluctant in their duties. Emery, Auld, & Lu, indicated that hospital “peer review activities, monitoring and control can be accomplished efficiently if they use quality assurance processes which are formalized” (p. 98).
National Committee on Quality Assurance (NCQA) which an organization for crediting the manage care, rapidly came up as a standard of excellence in the industry. Nevertheless there are advantages and disadvantages credentialing by a self-regulating organization to a managed care organization and even to consumers.
Credentialing by the National Committee on Quality Assurance is very important in ensuring that the industry provides quality medical care to the society. A major demerit of leaving this task to the National Committee on Quality Assurance is that it may interfere with the practice of medicine especially when physicians are required to ensure quality by group of people who may not be physicians (Emery, Auld, & Lu,). The second reason is that meaningful problem identification systems, such as a complete system of continuous may not have been in place for a long time and therefore people may develop lack of trust (Emery, Auld, & Lu,).
In conclusion, the history of America public health is a fascinating study of civilized society’s attempts to deal with the issue of financing, quality, delivery and insurance (Emery, Auld, & Lu,). According to Emery, Auld, & Lu, throughout history health care system has reflected the state of knowledge at the time regarding the practices employed for control of the health care systems and the dominant social ideologies of political jurisdictions. As the Australia government walks towards the direction of ensuring access to affordable health care to its citizens through integrating the key players in the health system that is financing, quality, delivery and insurance the society should be ready to own up the reforms and the whole process.
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