A June 2010 internal report from the Defense Department s Pharmacoeconomic Center at Fort Sam Houston in San Antonio showed that 213,972, or 20 percent of the 1.1 million active duty troops surveyed, were taking some form of psychotropic drug: antidepressants, antipsychotics, sedative hypnotics, or other controlled substances. Dr. Greg Smith, who runs the Los Angeles based Comprehensive Pain Relief Group, said he was shocked by CENTCOM s drug policy for deployed troops.
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The participants constructed mental health through building up biological factors and psychosocial aspects as opposite ends of the same spectrum, and then positioned themselves as distant from these extremes to manage issues of stake and accountability. A discourse of moral concern for service users was used to negotiate the implications of having different views of mental health from service users, enabling clinicians to manage issues of accountability and demonstrate their ability to be helpful. This suggests that clinicians should be mindful of the effects of their use of language and make the contingent nature of their knowledge explicit..
The illness trajectory of cancer makes this recognition far easier than for COPD, and as a result, many patients and their families manage at home with limited support. The Lincolnshire Respiratory Network has developed criteria to help recognize the end stage of COPD, which correlate well with recommendations from the Consultation on a Strategy for Services for COPD in England (Department of Health, 2010). However, there needs to be appropriate training to assist practitioners in their confidence to refer patients with end stage COPD to palliative care providers..