1. Depression and suicide are significant areas of concern in Australia.
a) Investigate and outline the incidence of both depression and suicide in Australia. Ensure you address depression and suicide separately.
b) Using relevant literature, identify and critically discuss one community group which is at risk of depression and one different community group which is considered at risk of suicide. (for example: a particular age; social; employment or cultural group) Ensure your answer demonstrates why these groups are thought to be at risk.
Using current literature and one of the scenarios A or B which you have been provided, answer the following questions:
2. Critically discuss 2 factors that may have contributed to the development of the client's mental health concemsand risks
3. Ethical and legal considerations in health care can generate in-depth discussions from different perspectives within a professional health care team. The case study presents areas of risk regarding harm to self and others. Use literature and the case study to define and discuss the ethical principles of beneficence and non-maleficence and aspects of the Mental Health Act 2007, which are relevant to the areas of risk in the case study.
4. Identify a high priority and urgent mental health risk from the case study, and provide two relevant interventions Explain the rationale and possible impact on the client for both interventions drawing on relevant literature.(Note: the interventions should be something that you as a nurse / midwife would undertake directly with your client A referral to another service or health provider is notconsidered a suitable intervention for your work).
5. Identify a mental health problem/ need or concern from the case study, and provide two relevant interventions. Explain the rationale and possible impact on the client for both interventions drawing on relevant literature. (Note: the interventions should be something twe:lit/ate Wind( as a nurse / midwife would undertake directly with your client A referral to another service or o to Settings to ac G health provider is notconsidered a suitable intervention for your work).
Scenario
You are working as a nurse in an Accident and Emergency department. Jonathon was brought in by ambulance after his father found him semi-conscious at home. Medical examination revealed Jonathon consumed an overdose of over the counter medications. He is now alert and engaging with you. During your discussions with Jonathon, you obtain the following information.
Jonathon is a 19 year old man. He lives with his father Dennis, and younger sister, Maria, who is 16 years old. During your discussions with Jonathon, he reported he had a very positive relationship with his father. However. Jonathon has felt more distance from his father since his mum died eleven months ago. His mum was diagnosed with breast cancer 12 months before she died. Since her death, Jonathon reported his dad has been working extra hours to fund family bills. His dad leaves the house at 6-30am and doesn't return until 7-30pm most week days. His dad also works at least one weekend day. Jonathon is undertaking an electrical training course at the Technical and Further Education (TAFE) institution He is expected to be at work four days a week and at TAFE one day a week. He reports he hasn't submitted his last two assessments for TAFE, as he has been feeling very tired, with noticeably lower energy for three to four months. Jonathon has called in sick to his work place at least one day a week during the past month. He is becoming increasingly anxious that he may be asked to leave his training course due to non-submission of his assessments and reduced attendance at work. Jonathon has been in a relationship with Leah, a 20 year old female, for one year. They met while both studying at TAFE. Jonathan states that Leah has been distressed during the last month, she feels Jonathon has become increasingly emotionally distant. He admitted that has cancelled their prearranged dates and has not been answering her phone calls.
On the night of the overdose, Jonathon and Leah met in the local pub. They had an argument about the status of the relationship. Jonathon had walked home, calling into the bottle shop for some additional beers. He consumed at least six bottles of extra strength beer while at home alone. He reports he became increasingly distressed and agitated at home. He took an impulsive overdose of medications which were in the kitchen cupboard with the aim to kill himself. He is unsure of both the actual medications and the quantity of tablets which he consumed. He states he has been experiencing ruminating thoughts of suicide since his mum died. He thought about going to work early in the morning, to use the electrical equipment to kill himself. The first anniversary of his mum's death is approaching and he was thinking about suicide on the same date. He misses her terribly. He hasn't felt able to chat to his dad about his mum as his dad has been busy working. He feels he has let his mum down because he hasn't been able to cope with her death. He feels like a failure because of reduced attendance at work and non-submission of his assessments. He's felt over whelmed for the past month, since his girlfriend has been talking about finishing their relationship. At the current time, he states he wants to die.
Answers
1. Depression and suicide are significant areas of concern in Australia.
a. Surveys conducted in the Australian context reveal that common mental disorder is likely to afflict 1 out of 5 persons that account for 20% of the population. Investigation o adult population aged 16-85 years showed that 6% of the population is under the threat of getting affected by depression like affective disorder. Further major depressive disorders are found to be among the common mental disorders prevalent in case of children and adolescents aged 4-17 years with an incidence rate of 3% that showed an increase from 2.1% to 3.2%. The data depicts that depression serves as a crucial driver of both disability and morbidity in the population in addition to further accentuating the chances of occurrence of physical ailment as a co-morbid disorder (Mhsa.aihw.gov.au, 2017).
Report furnished for the year 2015 revealed suicide as the 13th leading cause of death in Australia that further showed an increased preponderance when compared with past data. For the year 2015, 12.6 deaths per 100,000 persons were reported as standardized death rate for suicide. Data further suggested that percentage of collective suicide deaths in Australia for the year 2015 was 73.2% evident in case of the most populous states of Victoria, New South Wales and Queensland. Deeper probe on the matter showed that for people belonging to the age bracket of 15-24 years and for those aged 25-34 years, suicide amounted to 33.9% and 27.7% respectively. As part of the recorded death rates due to intentional self-harm, leading cause of death in people aged 15-44 years as well as in children between 5-17 years of age was attributed to suicide while among those belonging to the age group of 45-54 years it was identified as the second vital cause of death. Males were recognized to be potentially more vulnerable to face deaths due to intentional self harm in comparison to the females, approximately three times greater than that for females (Abs.gov.au, 2017).
b. Extensive research carried out with respect to the prevalence of depression among the Australians brought to the forefront the state of extremely risky community of Aboriginals and Torres Strait Islanders who owing to their linguistically and culturally diverse background are under the threat of encountering depressive symptoms. Studies conducted on this community have revealed that impact of trauma in this vulnerable population at young age predisposes them to face the difficulties because of depression in later life. Moreover, social and emotional wellbeing have been found to be limited by factors such as social exclusion, racism and social inequality. Excessive stress due to discriminating attitude in terms of provision of healthcare and other resources also predispose them to experience depressive symptoms. Placement in public housing coupled with other factors pertaining to poor rating of both own as well as child’s health, difficult financial condition and single status also posed threat to this specific community to suffer from post natal depression and other mental health disorders (Parker & Milroy, 2014).
Assessments for risk of suicide among the Australians suggest that the young adults who encompass a bulk of the population are under the threat of getting affected by suicidal incidences. The risk of suicide in the vulnerable youth population has been evaluated in study through assessment of the impact of involuntary job loss on suicide and attempted suicide in the young adults. Findings of the study after careful analysis and adjustments made with respect to variables such as socio-economic status, marital status and diagnosis entailing an affective or anxiety disorder highlighted important issues. It displayed that involuntary job loss that lead to unemployment accounted for increased odds of suicide or attempted suicide in the concerned population of young adults belonging to the age group of 18-34 years (Milner et al., 2014).
Scenario A
2. The case scenario depicted that the client’s mental health condition and risks might have originated from a plethora of factors that are intimately associated with one another. It has been stated that Jonathan, a 19 years old youth has tried to end his life following consumption of overdose of over the counter medications. However, the causes of such actions have been found to be deep-rooted on detailed discussions with the client. In this connection, two factors may be recognized as crucial determinants that might have lead to the condition. Firstly, death of his mother 11 months ago has exerted a major influence in his life as he was unable to cope up with this unexpected loss and has expressed of missing her terribly. Relevant literature revealed that unexpected death of loved one is related to elevated risk for onset of mental health disorder in the concerned individual (Keyes et al., 2014). Jonathan has been found to experience this and inability to cope up with the sudden loss predisposed him to suffer from depression like mental health disorder that finally culminated in his attempt to suicide. Further emotional detachment from his father in the period following his mother’s death, also influenced his behavior considerably as he was not in a position to share his feelings because of paucity of time on the part of his father because of active engagements to work even on a day in the weekend. Personal crisis in relationships and mental turmoil also thwarted him thereby increasing chances of encountering depressive symptoms. He could not vent out his anger, emotions and neither was ready to share his concerns with his loved ones and family. Distance with his father apart from sudden loss of his mother might have created a void that was not immediately repairable thereby leading to adverse outcomes in mental health. Research has shown that supportive relationships with family have the potential to mitigate and prevent development of depression and anxiety particularly in the vulnerable population of youth thereby increasing their resiliency to combat mental health issues (Reivich et al., 2013). Dearth of this paternal guidance and emotional support following mother’s death in case of Jonathan might have resulted in the onset of depressive symptoms that ultimately lead to the causation of suicidal tendency.
3. The situation relevant to Jonathan as represented in the case study exhibits threats of certain risks that might thwart the existence of the individual. It has been stated in course of the case study that Jonathan suffered a major setback following the premature death of his mother that further reflected in his performance at workplace. Consecutive detachment with his father due to his heavy work schedule also put him under stress. Reduced attendance in workplace in addition to non-submission of allotted assignments for the electrical training course at the Technical and Further Education (TAFE) institution further de-motivated him and increased his propensity to suffer from depressive symptoms and other mental health issues. Therefore, in order to combat the risk factors associated with his condition compliance to certain ethical principles is indispensable. Interventions applied in this case must resort to the fundamental bioethics principles such as beneficence and non-malfeasance. The healthcare professionals by means of conforming to the virtue of beneficence must take actions in the best interest of the client. The practitioner must stringently follow ethical considerations so that the best available practice is followed in order to mitigate issues relevant to the client for harboring positive outcomes. Welfare of the affected person must be emphasized in the process (Beauchamp, 2016). Moreover, it has been recommended as part of the bioethical principles that efforts must be undertaken so that no harm is caused to the patient on account of following the principle of non-malfeasance. Infliction of minimum or no harm should be directed through healthcare service delivery and informed choice decisions thereby ameliorating chances of intentional harm to the patient. Thus, conformity with this virtue will ensure optimum outcomes for the client (Tepper, 2017). Both these virtues are to be maintained and attended to for Jonathan by the nurses and practitioners so that optimum care may be directed to the patient with sufficient scopes for improvement with reduced risk for adverse results.
Treatment modalities with respect to the case as seen in case of Jonathan must be addressed properly. Provision of adequate care and treatment must be ensured for the mentally ill patient Jonathan in compliance with the existing Mental Health Act 2007 thereby facilitating the recovery process. Other provision of community care facilities alongside appropriate hospital care facilities must be rendered effectively. Access to proper care must be done in alliance with protection of the civil rights of the person. Moreover, decision making processes must include the participation of the persons who are responsible for caring for the client so that the recovery is accelerated and positive benefits may be procured from such engagements. Prior to administering medications or any other invasive methods for assessment of his clinical condition, necessary consent and approval must be sought from his family members. These people will be responsible for taking decision on his behalf because of his non-allegiance and diminished state of mind. Informed consent rather than verbal approval must be encouraged to document the family members’ willingness and passage of rights to continue with the therapeutic interventions meant for Jonathan in a legally acceptable manner (Legislation.nsw.gov.au, 2017). For Jonathan, his near family comprising of his father and sister must be allowed to take part in decision making to foster improved care. Therefore, careful attention to these aspects of the Act relevant to the areas of risk will ensure optimum care and treatment for the concerned client in the case study.
4. Jonathan in accordance with the proceedings of the case study showed high degree of risk to commit suicide and inflict self-harm. Thus, in order to abate this high-risk behavior of attempt to suicide, the nurses may resort to suitable intervention strategies. As a psychiatric nurse, it is crucial to cater to development and maintenance of a collaborative, therapeutic relationship with the client might offer help to the distressed patient who is susceptible to resort to suicidal tendency. Appropriate recording and documentation in determining the priority of care through clinical reasoning, support and judgment will enable in abiding by the standards of care to render safety and evidence based practice in managing the patient situation. Evidence based interventions to combat suicidal tendencies through nursing focus will thus elicit good responses (Hadlaczky et al., 2014). Once the client will accept the therapeutic association with the psychiatric nurse, it will be easier to gain the therapeutic benefits out of the applied interventions. Further, counseling of the family members for the sake of restricting the unauthorized access to potent lethal prescription medications might be an effective intervention for the client. For Jonathan, his father may be informed about his present condition and made aware about the potential risk factors that thwart his mental state due to predisposition to suicidal tendency. Recruitment of family members will harbor positive outcomes for Jonathan as he will spend most of his time with them and therefore assessing change in his immediate behaviors will be easier for them. As per the National practice standards for the mental health workforce 2013, Standard 2 states working with people, families and caregivers through adoption of recovery-focused techniques (Health.gov.au, 2017). This may be applicable in this particular case indicating positive outcomes. Hence, evidence based nursing interventions in addition to incorporation of family members may thus be indicative of reliving the suicidal burden in the concerned person, Jonathan.
5. The mental health need or problem that may be recognized in course of the case study is that of depression. Interventions that cater to mitigation of this problem must acknowledge the acceptance and awareness pertaining to self-promoting positive concept of self through identification of strengths and prudent objectives that are indicative of recovery from depression. Encouragement must be given for the client to verbalize his feelings, worries and resentments through open-ended questions and thorough discussions. Exhibition of empathy for the client will enable him to open up and share his concerns that will further aid in the recovery process and in combating the depressive symptoms. Moral support and appraisal of his strength will boost up the confidence and morale of the patient thereby aiding in quicker recovery. Depression being a legitimate illness must not be ignored and adequate attention and prompt intervention through support and encouragement must be given so that the affected person seeks necessary medical assistance to successfully combat the situation. Timely referral to psychiatrist will ensure that the patient is receiving the most suitable therapy to do away with the depressive symptom (Fortinash & Worret, 2014). Further, behavioral modifications through cognitive behavioral therapy (CBT) that serves as a noble approach in the form of psychotherapy to combat the negative patterns of perception regarding self and paraphernalia for treating depression like mood disorders. Risks for self-directed violence, impaired social interaction, disturbed perceptions, and low self-esteem may be effectively addressed by CBT approach whereby psychological needs and promotion of health and wellness may be further promoted. Adaptive responses are sharpened through CBT is capable of triggering emotional arousal and subsequent processing (Greenberg, 2017). Jonathan is likely to be benefited by this approach ad improved symptoms may be reflected in his personal relationship status as well as improvement in his workplace behavior and attitude. Further thoughts of suicidal tendencies may be effectively mitigated by catering to the depressive symptoms that may further lead to adverse outcomes in the client. Unwanted behavior patterns might be well tackled through employment of this CBT nursing intervention. Thus, timely referral to psychiatrist through insight and prudence apart from adopting the CBT approach may be considered as the relevant interventions in this case.
References
Abs.gov.au. (2017). 3303.0 - Causes of Death, Australia, 2015. Abs.gov.au. Retrieved 3 August 2017, from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2015~Main%20Features~Intentional%20self-harm:%20key%20characteristics~8
Beauchamp, T. L. (2016). Principlism in Bioethics. In Bioethical Decision Making and Argumentation (pp. 1-16). Springer International Publishing.
Fortinash, K. M., & Worret, P. A. H. (2014). Psychiatric Mental Health Nursing-E-Book. Elsevier Health Sciences.
Greenberg, L. S. (2017). Emotion-focused therapy of depression. Person-Centered & Experiential Psychotherapies, 1-12.
Hadlaczky, G., Hökby, S., Mkrtchian, A., Carli, V., & Wasserman, D. (2014). Mental Health First Aid is an effective public health intervention for improving knowledge, attitudes, and behaviour: A meta-analysis. International Review of Psychiatry, 26(4), 467-475.
Health.gov.au. (2017). National practice standards for the mental health workforce 2013. Health.gov.au. Retrieved 3 August 2017, from https://www.health.gov.au/internet/main/publishing.nsf/content/5D7909E82304E6D2CA257C430004E877/$File/wkstd13.pdf
Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. American Journal of Psychiatry, 171(8), 864-871.
Legislation.nsw.gov.au. (2017). Mental Health Act 2007 No 8. Legislation.nsw.gov.au. Retrieved 3 August 2017, from https://www.legislation.nsw.gov.au/acts/2007-8.pdf
Mhsa.aihw.gov.au. (2017). Prevalence, impact and burden. Mhsa.aihw.gov.au. Retrieved 3 August 2017, from https://mhsa.aihw.gov.au/background/prevalance/
Milner, A., Page, A., Morrell, S., Hobbs, C., Carter, G., Dudley, M., ... & Taylor, R. (2014). The effects of involuntary job loss on suicide and suicide attempts among young adults: Evidence from a matched case–control study. Australian & New Zealand Journal of Psychiatry, 48(4), 333-340.
Parker, R., & Milroy, H. (2014). Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, 2, 25-38.
Reivich, K., Gillham, J. E., Chaplin, T. M., & Seligman, M. E. (2013). From helplessness to optimism: The role of resilience in treating and preventing depression in youth. In Handbook of resilience in children (pp. 201-214). Springer US.
Tepper, J. E. (2017). Ethics in Clinical Care. International Journal of Radiation Oncology Biology Physics.
