To what extent is Gender taken into account in the delivery of contemporary Child and Adolescent Mental Health Care Service
This paper will aim to explore and discuss the implications and contrast of the gender of a child when accessing a mental health service. The author will aim to explore how the gender of a child can introduce considerations through the process of positive therapeutic intervention and engagement. The further consideration of risk will be discussed and this will highlight the important factors to be explored to enable the practitioner and service to remain diverse and equitable.
The concept of identity in regards to gender is imperative in understanding a developing child’s cognitions and behaviours. Identity portrays who we are as individuals and this is impacted through external relationships and social factors. Cooley’s (1964) looking glass theory aims to address the awareness of understanding how others perceive us and this can further influence individual social identity (McIntyre 2007). This highlights the subject of gender and the journey from a homosocial to a heterosocial dynamic (Gagnon and Simon 1974) which increases the focus on social norms in relation to the opposite sex.
This sexual based development increases with perceived expectation, and identities are further constructed through the use of alcohol and sexual orientated behaviours (Strasburger et al. 2009). Campbell (2000) and Peralta (2004) highlight the interchanging and developing gender role, which introduces both masculinity and femininity across social dynamics. Although it can be balanced that external factors are also at play, the role of gender becomes a predominant factor in developing behaviours (Courtenay 2000). It is important to also consider hormones changes in both gender. Males may have an increase of testosterone resulting in aggression and dominance, and oestrogen in females can fluctuate moods from high to low. These changes can affect mood and behavior.
To consider these behaviours from a mental health perspective, it is important to remain knowledgeable on the higher risk factors and the gender bias. There has been an increased risk of suicide in 15-19 year old males predominantly due to psychosocial stress (McClure 2001) and external social factors. We can further consider this from a systemic perspective and how dysfunction within families may impact on the emotional development of a male adolescent. The absence of a role model and increasing family pressures may fluctuate depressive episodes, hence, increasing the mortality rate in this group
This further highlights the sociological perception of gender in relation to both the media and societal expectations of gender. A developing male has a masculine ideal that is enforced by society and his role becomes pigmented by peer pressure and external expectation. It is an expected facet that masculinity conveys strength, which increases reluctance for a male to seek support, in fear of this being considered a weakness. This internal struggle and suppression of emotion can increase the risk of aggression and risk taking behaviors, including substance and alcohol misuse, and harming behaviors (Westwood 2008). However Barker (2006) argues that there are males who will seek support and oppose these expected norms. He further argues that it is this small sample that is able to challenge the traditional manhood values that enable appropriate early intervention and positive prognosis.
To reflect on this theory in a clinical practice setting, it is important to note that the child and adolescent nursing professional team are predominantly female.
A majority of the health service is female, and the contributions to health care processes are significant (George, 2007a, Gupta et al., 2003). In terms of equality and flexibility, this does not convey a balanced service in regards to accessing gender in relation to a practitioner. However, the team remain specialised and the thesis remains based on an individual centred model, regardless of gender, culture or race. There is no negative shared culture and relevant and appropriate guidelines have developed the care pathways, and incorporated gender specific considerations to enable appropriate interventions and risk response.
The concept of risk links appropriately with the clinical and self- awareness of the practitioner. In practice, interventions are based on the presentation of a mental health feature, although the consideration of gender focus remains imperative to enable engagement and therapeutic alliance.
The comprehension of developmental issues appears easier to relate if a female practitioner is offering intervention to a female client. This is primarily due to the gender similarities and feminine experience which can be conveyed and shared. However, as with a male client also, this can be an assumed perception and highlights a need for the practitioner to remain individual centred and not to use judgement based on their own experience or values. Regardless of gender, self- awareness is crucial in reducing transference in practice and the ability to remain holistic and realistic within the risk assessment.
Holistic practice in CAMHS incorporates a multi-disciplinary approach and this ensures that a child is supported with consideration to external factors including gender. Psychiatry is fundamentally male orientated (Rogers and Pilgrim 2010) which offers a clearer balance of gender in professionals. By using a team approach, the issue of gender can be reduced as appropriate support can be explored within the team to enable a care plan to be individualised.
In modern psychiatry, stigma is being reduced with the development of policies and reconfiguration of practice and guidelines. The thesis on health systems considers the primary purpose as promotion, restoration and maintenance of health (World Health Organisation 2001). This is still an on-going process and requires a united perspective to continue to promote and empower individuals and society to take a role in reducing gender inequalities. Only thus can the cycle of ineffectiveness, inequality and gender bias be challenged and diminished. The importance lies within educating at a professional, systemic and societal level, to ensure that a child feels able to access the appropriate support they need, regardless of gender expectation.
Barker, G. (2006) Engaging Boys and Men to Empower Girls: Reflections from Practice and Evidence of Impact. EGM/DVGC/2006/EP.3 United Nations Division for the Advancement of Women (DAW) In collaboration with UNICEF Expert Group Meeting Elimination of all forms of discrimination and violence Against the girl child Florence, Italy, 25-28
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