Farkitol®+WARNING;+MAY+CAUSE+ARTIFICIAL+INSEMINATION

Farkitol® WARNING: MAY CAUSE ARTIFICIAL INSEMINATION **Name:** Anthony Laing
 * Student #:** N8097135
 * Tutor:** Katie Page

=**Topic:** =

Do the merits of psychotropic drugs outweigh the nature of adverse side effects experienced by mental health patients?
==== //“In diseases of the mind...it is an art of no little importance to administer medicines properly; but, it is an art of much greater importance and more difficult acquisition to know when to suspend or altogether to omit them.”// //-// Philippe Pinel, 1806 (as cited in Goldberg, 2005) ====

=**Artefact:** = //Viewer discretion is advised. Contains strong coarse language.// media type="file" key="Robin Williams - Live On Broadway.mov" width="360" height="360" Having problems with this video? Watch 0:00 ~ 1:15 at http://youtu.be/VwcBiCA6eeo ==== I have chosen an extract from a stand-up routine performed by comedian and actor Robin Williams. The clip is taken from his 2002 //Live on Broadway// telecast from New York City. Williams comically discusses his hopes for a new wonder drug that paralyses his mind AND body. The potential side effects of mental health medications is also explored in an absurd manner by the comedian, performing likely repercussions on ones daily life. Williams finally addresses the nature of a ‘side effect’ versus an ‘effect’, finishing with a plea for science to help rather than hinder. (Williams & Callner, 2002) ====

=**Public Health Issue :**=

====The public health issue represented through this artefact is the terrible nature of adverse side effects that can result from the use of psychotropic drugs. As Williams so comically displays, while side effects are listed in small type on the side of packaging, disastrous consequences may be experienced with significant alteration to ones everyday functioning. Further to this, a deeper issue arises as we question whether adverse effects can possibly outweigh any advantages experienced by the patient taking psychotropic drugs. These are complex issues with many differing opinions and levels of evidence which I will now begin to discuss.====

=**Literature Review:** =

====The issue of mental health is of great importance to the Australian community. Recently, the Australian Institute of Health and Welfare (AIHW) listed mental health as a National Health Priority Area (2011) due to the non-fatal burden of disease that is attributed. Mental disorders account for 13.3% of total burden of disease and injury statistics collated within Australia (Begg et al., 2007). The Australian Bureau of Statistics (ABS) found that 45% of Australians aged between 16 and 85 have experienced a mental disorder within their lifetime (2007). Such data clearly illustrates the concerning levels of prevalence and burden on society and its health.====

====Medications play a central role in treatment, as they are prescribed or recommended by the general practitioner (GP) in 66% of mental health related cases (AIHW, 2010). Also known as psychotropics, these medications have seen dramatic advancements and an accompanied explosion in usage particularly within the last twenty years (Rural Health Education Foundation [RHEF], 2008; Siskind, 2011; Siskind, 2010). Yet, there are still many unanswered questions associated with their usage that requires our focus and understanding. When faced with the question whether psychotropic drugs work, there is an inconclusive body of evidence to support their efficacy (beyondblue, 2011a).====

====Potential adverse effects from psychotropics is an area demanding attention. The Australian Department of Health and Ageing (DHA) lists known side effects of common psychotropics as the leading problem area in a comprehensive list targeted at reducing adverse drug events in mental health services (2005). Adverse physical effects tops the list of concerns expressed by parents in the decision to discontinue psychotropic use in their children (Charach, Skyba, Cook & Antle, 2006) and is also a common reason adults fail to continue treatment (Usher, 2001). Such research indicates the dilemma of understanding and managing a psychotropics side effect profiles to be of great significance within the angle of mental health medications.====

__Merits of psychotropic drugs__
====Psychotropics are prescribed by GPs or psychiatrists aimed at alleviating the symptoms of their specific disorder. One specific drug class is the antidepressant which is focused on reducing depressive symptoms. Antidepressants generally act to increase energy levels, decrease fatigue and reduce suicidal thoughts in an effort to re-engage social, occupational and relationship functioning (Keltner & Folks, 2005). While these merits sound like the ultimate relief for those suffering mental illness, due to the extreme individuality of each case there are concerns about the overall efficacy of antidepressants. An analysis of the largest ever antidepressant effectiveness trial conducted in 2006 states a failure to yield sustained positive effects in the majority of participants (Pigotta, Leventhalb, Altera & BorenbAlter, 2010). Following these conclusions the authors suggested a review of clinical guidelines in administering of antidepressants by clinicians.====

====Another class of medication is the antipsychotic, joining modern medicine in 1952 (Goodwin et al. 2009). They are generally administered in the management of disorders including schizophrenia, bipolar and acute/chronic psychoses (Keltner & Folks, 2005). Focus is on maintaining a relatively normal lifestyle and functionality for the individual (Dulworth, 2010) by improving communication with others, diminished hallucinations and less mental confusion (Keltner & Folks, 2005). A qualitative study interviewing sufferers of schizophrenia highlighted their quest for a more “normal” life as the prime motivation for taking such medications (Usher, 2001). Once again, a substantial number of those suffering from the disorder report little if any benefits from the medication (Keks, 2004; Usher, 2001). Keltner and Folks (2005) suggests that 75% of patients taking antipsychotics experience some symptom reduction, while Usher (2001) indicates between 10-20% of sufferers do not have substantial improvement. The emotional, physical and financial resources in taking psychotropics are immense, with patients often feeling personally responsible for the failure of treatment (Usher, 2001).====

__Evidence of adverse side effects__
====Over the previous two decades there has been considerable advancements in the development of psychotropic medicines (RHEF, 2008). Creation of the newer atypical antipsychotics resulted in a decreased side effect profile, lessening the chance of adverse extrapyramidal effects including the physically debilitating and emotional stigmatizing tardive dyskinesia (Keks, 2004). The older typical antipsychotic drugs are still available for prescription at a lower price, posing access issues for those financially disadvantaged. The World Health Organization (WHO) indicates while newer medications may have decreased side effect profiles, there is no significant rise in efficacy combined with a general cost increase (WHO, 2001).====

====General side effects experienced by the patient often occur within the first month of administration as the body adapts to the pharmacological effects (Keks, 2004). Psychotropics have been studied in randomised controlled trials and through qualitative research finding a variety of initial effects including nausea, vomiting, tachycardia, tremor, increased cough, reduced appetite, blurred vision, sleepiness, sweating and middle ear infections (Floersch et al., 2009; Berard, Fong & Carpenter, 2006; Emslie, Wagner & Kutcher, 2006). Patients taking antipsychotics were interviewed (Craft, 2001) and expressed their feelings of loosing trust and control of their own body, constantly unsure of how it would react. This loss of self-control had a significant emotional impact on the subjects interviewed.====

====Adverse side effects that increase the morbidity and mortality are of great concern for the patient. Stone and Jones (as cited in beyondblue, 2011a) research found a trend of increased suicidal thinking and behaviour for young adults taking new and old generation antidepressants. Further examples sourced from academic research suggest usage of psychotropics may lead to; an increased risk of diabetes (Proietto, 2004), obesity (Mahli, Mitchell & Caterson, 2001; Proietto, 2004), an increased risk of falls particularly within the elderly (Van Leuven, 2010) and the danger of potentially fatal side effects such as cardiovascular toxicity (Pacher & Kecskemeti, 2004) and Serotonin Toxicity Syndrome (Khavandi, Whitaker & Gonna, 2008). Death from cardiovascular disease by those suffering mental illness and prescribed medication has been shown to be a growing risk, particularly over the last two decades (Goodwin et al., 2010). Issues also exist related to the concurrent use of psychotropics (polypharmacy) with other medications the patient may be administering. A prime example taken from the Australian Therapeutic Goods Administration (TGA) links the concomitant use of St Johns Wort and certain psychotropics with potential adverse neurological reactions (TGA, 2001).====

====The culmination of this research in presenting possible adverse reactions to psychotropics highlights the importance of an informed choice by both patient and practitioner, on a case-by-case, individual basis. Usher (2001) found through qualitative research methods that while patients learn to live with their medication side effects, the untoward effects do have the ability to cause greater stress than the illness itself. To employ the third Law of Motion by Newton, it seems for every positive therapeutic action, an inherent equal and opposite reaction can occur sparking adverse effects (Dulworth, 2010). Careful consideration by practitioners in weighing up the necessity of psychotropics, combined with an informed, educated patient, may assist in allowing the reduction of harmful effects of medication. It appears an underlying factor in achieving this outcome is for the increase in high quality, targeted academic research and study within the area.====

__Methodologies and Limitations of Research__
====The body of evidence in regard to psychotropic use is ever rapidly changing. Most studies focus upon individual factors or specific medications, not allowing for broad, generalised statements about mental health medications (Hamrin, McCarthy & Tyson, 2010). The Clinical Practice Guidelines for mental illness in the perinatal period, begins its medication chapter reinforcing the dynamic nature and paucity of evidence, negating any assurance in regards to the information provided (beyondblue, 2011b). The evolving nature of evidence within this field of mental health services demands practitioners constantly keep informed with the latest developments in research.====

====The methodologies of academic studies can include limitations that may effect final results. Predominantly I found researchers are extremely forthcoming in noting limitations of their studies, being important for future improvement and developments on the issue. For example, linking antipsychotic usage to metabolic disorders is performed by studying groups of psychotic sufferers (American Diabetes Association [ADA], American Psychiatric Association [APA] & American Association of Clinical Endocrinologists [AACE], 2004). However, characteristics of those with mental illness, such as sedentary lifestyle, may also contribute and none of the studies assessed by the ADA, APA and AACE controlled for major diabetes risk factors (2004). Studies that evaluate the metabolic and cardiovascular effects of antipsychotics have been performed while taking only one medication, yet many sufferers take multiple psychotropics (Goodwin et al. 2010). Evidence exists which indicates a possible reduction in metabolic side effects (e.g. diabetes) when different antipsychotics are used in combination (Fleischhacker et al., 2008). Small sample sizes, very short follow up periods, and the wide variety of medications available combined with their unique effects were all research limitations observed within the Clinical Practice Guidelines of depression in adolescents and young adults (beyondblue, 2011a). It is crucial that researchers identify these limitations in order to effectively and efficiently build upon our current foundation of knowledge.====

=**Cultural & Social Analysis:** = = = ====While mental health medications can hold the power to vastly improve ones wellbeing, concerns of a modern day psychotropic drug culture are held by some. Commentators sight the success of the advertising models employed by the pharmaceutical and psychiatry industries in promoting the rise of psychotropic spending (Moynihan, Heath & Henry, 2002; Rubin, 2004). Rubin (2006) observes the power that popular culture, including music, movies and television, holds in commodifying mental illness and marketing of psychotropics. //Prozac// and //Zoloft// are prime examples of brand-name psychotropic drugs that feature predominantly and have widespread recognition. While the issues that surround psychotropic usage within the mental health community populate academic journals and research texts, following my personal research into the news media they are one the edge of silence regarding this topic. The most recent address by the media was Federal Member of Parliament (MP) Andrew Robb and his headlining claim that 20% MPs are taking some type of antidepressant (Kelton & Kemp, 2011). Mr. Robb, who suffers from depression, was supported by controversial //beyondblue// chairman Jeff Kennett who confirmed the anecdotal figure of 20% may well be accurate (Kelton & Kemp, 2011).====

====The elderly are a population that is more likely to receive psychotropics than its younger counterparts, with a disproportionately high use of antipsychotics in particular (Gareri et al., 2006). Research into hypertension and diabetes occurrence within psychiatric patients aged 67 and over found significantly higher associations between specific drugs and these obesity-related conditions (Kisley, Cox, Campbell, Cooke, Gardner, 2009). The study reinforces the importance of clinical decision-making in choosing a psychotropic specific to ones age, or withdrawing treatment altogether in order to minimise morbidity factors. Further to age, gender and ethnicity may impact upon ones access to psychotropics. A study in New Zealand analysing prescription records found a trend of uneven spread between elderly users of mental health medications (Norris et al., 2011). The findings concluded age, gender and ethnicity have significant impacts on whether a prescription was obtained from their GP, with an increased prescription rate due to age, while decreased rates were observed in males and patients of Maori decent. A similar Australian study echoed these results concluding that not all our social strata has equal access to psychotropic treatments (Page et al., 2009).====

====Children receiving psychotropic medication is a contentious social issue. Parental groups, researchers and clinicians continue the debate regarding adolescent psychotropic usage as prescription rates increase (Cooper et al., 2006). Findling and Wiznitzer (2003) argue that due to their differences in medication response compared to adults, research is required to specifically target side effect and efficacy concerns of children. In a study interviewing twenty adolescents about their psychiatric medications, only three reported minimal or absent adverse effects (Floersch et al., 2009). Side effects also have a significant role to play in psychiatric medication adherence. Hamrin, McCarthy and Tyson (2010) found that concerns by parents relating to adverse physical effects experienced by their children was often great enough to effect medication initiation or adherence. Universally it can be said that parents only wish what is best for their child. Adverse side effects and concerns about the social stigma attached to the medication are barriers for parents in continuing drug administration, even after symptom reduction is achieved (Charach, Skybar, Cook & Antle, 2006).====

=**Artefact Analysis & Learning Reflection:** = = = ====The artefact I have chosen represents the fierce craving by society for the //‘wonder drug’// that will remove you from reality, wash away our everyday stresses and provide better living through chemistry. Even if this living involves having to endure significant alterations to our lives through adverse side effects. The excerpt provides a comical, yet realistic example of how a side effect may affect upon ones everyday life. Personally, I begin to question society, both practitioner and patient, as it continues to medicate irrespective of such consequences. Through my research I have also become aware of the patients who respond well to psychotropics, possibly meaning the difference between living a fulfilling life or being severely disabled. I have become informed of the complexities involved in the prescription process that face mental health clinicians on a daily basis. A minefield of navigating polypharmacy, new versus old generation psychotropics, scientific research bias, effects of social stigma and demographic access issues that have developed over time. It appears that a focused individual approach to the mental health patient would be of most assistance, rather than blanket clinical procedures and health policies. Expert, educated and informed decision making by clinicians in determining whether pharmacological treatment is warranted should be performed on a case by case basis. The importance of non-pharmacological therapies cannot be underestimated, including psychological therapy which has proven to assist in stabilizing some mental health disorders (Goodwin et al., 2009).====

====This assignment has fostered my academic research skills after many hours of examining peer-reviewed articles and searching online databases. By appreciating the limitations and suggestions for future research, new angles and research opportunities can be developed assisting the field in greater understanding. Creating this Wiki has promoted my consideration of the innate complexities of the mental health system, which can be applied more broadly to the health system in general. The media plays quite a minor role within my angle of mental health treatment, confirming that significant and heavily debated issues often escape the public eye. This requires deep and targeted research to discover the body of evidence one requires to make an informed opinion. This analysis also cultivated my appreciation for the individual within the health system, requiring targeted assistance for their unique circumstances as opposed to umbrella protocols or policies.====

= = =Links: =

[|www.health.qld.gov.au/rbwh/docs/**medication**_1.pdf]
 * Queensland Government Medication Fact Sheet:**

[]
 * World Health Organization: Improving Psychotropic Access Document**

[]
 * beyondblue Antidepressant Information:**

=**References:** =

American Diabetes Association., American Psychiatric Association., & American Association of Clinical Endocrinologists. (2004). Consensus development conference on antipsychotic drugs and obesity. //Diabetes Care, 27//(2), 596-601.

Australian Bureau of Statistics. (2007). //National Survey of Mental Health and Wellbeing: Summary of Results, 2007//. Retrieved from http://www.abs.gov.au/AUSSTATS/abs@.nsf/Latestproducts/4326.0Main%20 Features32007?opendocument&tabname=Summary&prodno=4326.0&issue=2 007&num=&view=

Australian Department of Health & Ageing. (2005). National safety priorities in mental health: a national plan for reducing harm. Retrieved from http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-safety-toc~mental-pubs-n-safety-3~mental-pubs-n-safety-3-adv

Australian Institute of Health and Welfare. (2010). //Mental health services in Australia 2007-08: Mental Health Series (number 12).// Retrieved from Australian Institute of Health and Welfare website http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442457209

Australian Institute of Health and Welfare. (2011). Mental health. Retrieved September 29, 2011 from http://www.aihw.gov.au/mental-health-priority-area/

Begg, S., Vos, T., Barker, B., Stevenson, C., Stanley, L., Lopez, AD. (2007). //The burden of disease and injury in Australia 2003//. Retrieved from Australian Institute of Health and Welfare website www.aihw.gov.au/publication-detail/?id=6442467990

Berard, R., Fong, R., & Carpenter, D.J. (2006) An international;, multi-center, placebo-controlled trial of paroxetine in adolescents with major depressive disorder. //Journal of Child Adolescent Psychopharmacology, 16//(1), 59-75.

beyondblue. (2011a). //Clinical Practice Guidelines: Depression in adolescents and young adults.// Melbourne: beyondblue: the national depression initiative.

beyondblue (2011b) //Clinical practice guidelines for depression and related disorders – anxiety, bipolar disorder and puerperal psychosis – in the perinatal period. A guideline for primary care health professionals.// Retrieved from beyondblue website http://www.beyondblue.org.au/index.aspx?link_id=6.1246&tmp...

Charach, A., Antle, J., Skyba, A., & Cook, L. (2006). Using stimulant medication for children with ADHD: what do parents say? A brief report. //Journal of the Canadian Academy of Child and Adolescent Psychiatry//, //15//(2), 75-83.

Cooper, W.O., Arbogast, P.G., Ding, H., Hickson, G.B., Fuchs, D.C., & Ray, W. A. (2006). Trends in prescribing of antipsychotic medications for US children. //Ambulatory Pediatrics//. //6//(2), 79–83.

Dulworth, S. (2010) Psychotropic medications: Panacea or pandora’s box? //Managed Care Outlook, 23//(5), 2-4.

Emslie, G.J., Wagner, K.D., Kutcher, S. (2006). Paroxetine treatment in children and adolescents with major depressive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. //Journal of the American Academy of Child and Adolescent Psychiatry, 45//(6), 709-719.

Findling, R.L., & Wiznitzer, M. (2003). Why do psychiatric drug research in children? //Lancet, 361//(9364), 1147–1148.

Fleischhacker, W., Heikkinen, E., Olie, P., Landsberg, W., Dewaele, P., McQuade, R., Hennicken, D., (2008). Weight change on aripiprazole–clozapine combination in schizophrenic patients with weight gain and suboptimal response on clozapine: 16-week double-blind study. //European Psychiatry//, //23//(7), S114–S115.

Floersch, J., Townsend, L., Longhofer, J., Munson, M., Winbush, V., Kranke, D., … Findling, R. (2009). Adolescent Experience of Psychotropic Treatment//.// //Transcultural Psychiatry//, //46//(1) 157-179. doi: 10.1177/1363461509102292

Gareri, P., De Fazio, P., De Fazio, S., Marigliano, N., Ferreri Ibbadu, G., De Sarro, G. (2006). Adverse effects of atypical antipsychotics in the elderly: a review. //Drugs & Aging, 23//(12), 937–956.

Goldberg, J. (2005). Benefits and limitations of antidepressants and traditional mood stabilizers for treatment of bipolar depression. //Bipolar disorders//, //7//(s5), 3-11.

Goodwin, G., Fleischhacker, W., Arango, C., Baumann, P., Davidsone, M., de Hertf, M., … Zoharo, J. (2009) Advantages and disadvantages of combination treatment with antipsychotics. //European Neuropsychopharmacology//, //19//, 520–532. doi:10.1016/j.euroneuro.2009.04.003

Hamrin, V., McCarthy, E., Tyson, V. (2010). Pediatric psychotropic medication initiation and adherence: a literature review based on social exchange theory. //Journal of child and adolescent psychiatric nursing//, //23//(3), 151-172.

Keks, N. (2004). Are atypical antipsychotics advantageous? – the case for. //Australian Prescriber, 27//(6), 146–149.

Keltner, N., & Folks, D. (2005). //Psychotropic Drugs//. (4th ed.). St Louis, Missouri, USA: Elsevier Mosby.

Kelton, G., & Kemp, M. (2011, September 8). One in five MPs is depressed. //The Advertiser.// Retrieved from http://www.adelaidenow.com.au/one-in-five-mps-is-depressed/story-e6frea6u-1226131737220

Khavandi, A., Whitaker, J. & Gonna, H. (2008). Serotonin toxicity precipitated by concomitant use of citalopram and methylene blue. //Medical Journal of Australia, 189//(9), 534-535.

Kisely, S., Cox, M., Campbell, L.A., Cooke, C., & Gardner, D. (2009). An epidemiologic study of psychotropic medication and obesity-related chronic illnesses in older psychiatric patients. //Canadian journal of psychiatry//, //54//(4), 269-274

Malhi, G., Mitchell, P., Caterson, I. (2001). ‘Why getting fat, Doc?’ Weight gain and psychotropic medications. //Australian and New Zealand Journal of Psychiatry, 35//(4), 315-321.

Moynihan, R., Heath, I., & Henry, D. (2002) Selling sickness: The pharmaceutical industry and disease mongering. //British Medical Journal, 324//(7342), 886-890.

Norris, P., Horsburgh, S., Lovelock, K., Becket, G., Keown, S., Arroll, B., … Crampton, P. (2011). Medicalisation or under-treatment? Psychotropic medication use by elderly people in New Zealand. //Health sociology review//, //20//(2), 202-218.

Pacher, P., Kecskemeti, P. (2004) Cardiovascular side effects of new antidepressants and antipsychotics: New drugs, old concerns? //Current Pharmaceutical Design, 10//(20), 2463-2475.

Page, A.N., Swannell, S., Martin, G., Hollingworth, S., Hickie, I.B., & Hall, W.D. (2009). Sociodemographic correlates of antidepressant utilisation in Australia. //Medical Journal of Australia, 190//(9), 479-483.

Pigotta, E., Leventhalb, A., Altera, G,. & BorenbAlter, J. (2010). Efficacy and effectiveness of antidepressants: Current status of research. //Psychotherapy and psychosomatics//, //79//(5), 267-279.

Proietto, J. (2004). Diabetes and antipsychotic drugs. //Australian Prescriber,// 27(5), 118-119.

Rural Health Education Foundation. (2008). //Psychotropic Drugs: What’s Safe and What’s Not?// [Audio podcast]. Retrieved from http://www.rhef.com.au/programs/program-1/?program_id=29#

Rubin, L.C. (2004). Merchandising madness: Pills, promises, and better living through chemistry. //Journal of popular culture//, //38//(2), 369-383

Rubin, L.C. (2006). Psychotropia: Medicine, media, and the virtual asylum. //Journal of popular culture//, //39//(2), 260-271

Siskind, D. (2010). Patterns of antipsychotic medication use in Australia 2002-2007. //Australian and New Zealand journal of psychiatry//, 44(4), 372-378.

Siskind, D. (2011). Psychiatric drug prescribing in elderly Australians: time for action. //Australian and New Zealand journal of psychiatry//, 45(9), 705-708. doi: 10.3109/00048674.2011.594947

Therapeutic Good Administration. (2001). Important interactions between St John's Wort (Hypericum perforatum) preparations and prescription medicines. Retrieved on October 2, 2011 from http://www.tga.gov.au/safety/alerts-medicine-stjwort-000313-hp.htm

Usher, K. (2001). Taking neuroleptic medications as the treatment for schizophrenia: A phenomenological study. //Australian and New Zealand Journal of Mental Health Nursing,// //10//(7), 145–155.

Van Leuven, K. (2010) Psychotropic medications and falls in older adults. //Journal of Psychosocial nursing,// //48//(9), 35-43.

Williams, R. (Writer/Stars), Callner, M. (Director). (2002). //Robin Williams: Live on Broadway// [DVD]. USA: Cream Cheese Films.

World Health Organization. (2001). //The World Health Report 2001. Mental health: New Understanding, New Hope//. Retrieved from World Health Organization website www.who.int/whr/2001/main/en/index.htm

=Learning Engagement & Reflection: =

http://healthculturesociety.wikispaces.com/Chlamydia%2C+MTV+and+Pornography+–+Generation+Y’s+Sexual+Revolution
==== Firstly, a great original title. It really pulled me into reading your page from the many hundreds available. To suggest a revolution is upon us is quite a significant statement, but you have backed up your opinion with many quality references. ====

==== The artefact you have chosen is an exceptional representation of the overtly sexualised images that are pushing the boundaries in todays western society. Well done on writing a clear, concise and well-read review of the research in regards to STIs, giving me an excellent overview of the (silent?) public health crisis we currently experiencing. Although their research may not be as controlled or easy to obtain, I'd be interested in knowing the rates of STIs in populations that may not be subjected to the same mass media sexualisation such as India, South East Asia or African nations. ====

==== The three points raised within your cultural/social analysis are all factors that ring true as a Gen Y myself. Combined with the research you have completed this builds an excellent level of understanding the possible social and cultural influences for the reader. As you say, there are many theories behind Gen Ys change in sexual behaviour. I wonder if one relates to an increase in complacency thanks to the advances in modern medicine, or ineffective/obsolete sexual education in schools during the 1990s. ====

==== Overall, a professionally written and thoroughly researched Wiki providing me with a wealth of new information and a greater understanding of the dramatic impact social and cultural changes can have upon public health. WELL DONE. ====

http://healthculturesociety.wikispaces.com/%27Face+of+Evil%27+-++The+Stigma+Associated+with+Mental+Illness
==== It's great to read an in-depth, well researched discussion about the need for reducing stigma and its importance in addressing the issues surrounding mental health. Personally, it appears to be an issue relatively undervalued particularly by our politicians. As you question, what good is increased spending on facilities if those requiring them are too ashamed to utilise the services? As mentioned, applause must go out to the NGOs who are actively promoting for the reduction of stigmatisation. ====

==== An interesting point regarding the criminalising of mental illness was explained, suggesting the involvement of police rather than the mental health system responding to emergencies, contributes to higher levels of incarceration. Maybe this is where our system could be improved through the 24hr on-call availability of mental health professionals, or even plain clothed police officers specifically trained to deal with these situations. I think we can all agree when someone suffering a mental illness is threatening the personal safety of themselves or others, emergency services like the police or ambulance should be involved in some capacity. Unfortunately, the training and skills of detaining or sedating a patient is often necessary in transporting them to a local mental health service for the necessary help. ====

==== Well done on a very academic and well-read social and cultural analysis. Your artefact sounds a compelling read, something I'd be interested in too. It exceptionally represents the lone sufferer of mental illness, prompting many questions of how to avoid such tragedies in Australia's future. ====