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Table of Contents Introduction Depression At Risk Community group (Older Adults) Suicide At risk community group (LGBTQI) Case Study: Contributing Factors Legal and Ethical Considerations Risk Priorities Mental Health Issue & Interventions Conclusion References IntroductionMental health is v...

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Table of Contents Introduction

1

Depression

1

At Risk Community group (Older Adults)

2

Suicide

3

At risk community group (LGBTQI)

4

Case Study: Contributing Factors

4

Legal and Ethical Considerations

5

Risk Priorities

6

Mental Health Issue & Interventions

7

Conclusion

8

References

9

1 Introduction Mental health is vital for the wellbeing of individuals, families and communities. Mental health related conditions, causing a person distress and limited functioning, can be caused by a multitude of factors including; biological, psychological and social interactions (Australian Bureau of Statistics [ABS], 2015). Mental health involves an individual’s ability to acknowledge their potential by contributing to society and have the resilience to cope with every day life occurrences ("beyondblue", 2018). This paper will examine the risk and prevalence of depression and suicide in the Australian community. Based on the case study scenario; the contributing factors, legalities and ethics, priorities of care and interventions necessary to assist 22 year-old patient Jill, will be examined using evidence based practice research and the concepts of nursing processes. Depression Depression classifies a mood disorder that encompasses feelings of prolonged sadness that can impact both physical and psychological functioning. With the potential to cause decreased cognitive functioning or behavioural social seclusion, the disorder can severely impact a person’s everyday capacity (Hungerford & Hodgson, 2014). One in five Australians will experience symptoms related to mental illness at some point in their life. In 2014-15 about 2.1 million Australians were affected by the mood disorder (depression), females being the higher rate (10.4% compared to males with 7.4%) (ABS, 2015). Depression is often diagnosed when a person; has a loss of interest in activities they usually enjoy and/or experience sadness and low mood every day for most of the day for more than two weeks. Psychologists will identify symptoms such as changes in appetite, sleep, energy or negative thoughts that may affect everyday life ("Depression APS", 2018). Factors contributing to depressive episodes can encompass biological mechanisms that may result from genetics, childhood trauma, physical illness including but not limited to endocrine disorders or substance abuse.

2 Psychological concepts could also precipitate depression; life events such as loss or bereavement, relationship or occupation (Hungerford & Hodgson, 2014). Depressive episodes are detrimental to the mental health and wellbeing of Australians with a predicted 45% of people experiencing a mental health condition in their lifetime; it is the leading cause of disability worldwide ("beyondblue", 2018). Treatment for depression can include cognitive behaviour therapy, intrapersonal psychotherapy, electroconvulsive therapy or psychopharmalogical interventions such as antidepressant medications (Hungerford & Hodgson, 2014). At Risk Community Group (Older Adults) Some community groups are more at risk than others when it comes to developing depression; late life depression remains a serious public health concern. Due to the development of mental health issues as a result of the accumulation of multiple risk factors, older adults tend to be at a greater risk of becoming depressed. Chronic illness and isolation can attribute to this (“beyondblue”, 2018). Depression in older adults can be associated with morbidity and mortality increase which ultimately increases other risks such as health deterioration, social decline and self-neglect. A cross-sectional study showed depression was more prevalent in older adults; especially in females, those with low economic status and people with a chronic disease, however there is limited evidence linking depression to ageing specifically (Yaka, Keskinoglu, Ucku, Yener & Tunca, 2014). The 2014-15 National health survey results in Australia, demonstrated that there was an increase of 13.7% for people with feelings of depression from about 55-64 years of age with females reporting the highest rates (ABS, 2015). Contemporary literature suggests older adults may highlight physical detriments like weight loss insomnia or memory impairment rather than complaining of symptoms of depression like sadness or hopelessness. These symptoms can be caused by numerous factors particularly associated with loss and life changes associated with ageing. As depression causes and symptoms vary greatly depending on each individual, health professionals need to understand the individual causes and experiences in order to effectively help that particular patient (Corcoran et al., 2013)

3 Suicide The act of people intentionally causing their own death is referred to as suicide. Suicidal behaviours are serious issues involving the Australian community, government and health services. Deliberate self-harming (DSH) behaviours are part of this, resulting in outcomes including hospitalisation and death. DSH is the generic term for a large number of behaviours that are performed to intentionally cause harm or tissue damage to the body with or without suicidal intent (Hungerford & Hodgson, 2014). In 2016 2,866 people died as a result of intended self-harm in Australia, males proved to be three times more likely to cause intentional death by self-harming behaviours than females. The standardised death rate was 11.7 deaths per 100,000 people, which has increased since 2007 (ABS, 2016). Though people that self-harm do not always wish to die, they often intend to express their emotional pain. A number of self-harming behaviours coincide with suicidal behaviours, which can cause confusion between the two; the difference however is the motivation for the act. Additionally most attempts of suicide occur as impulsive crises acts in order to escape from their current feelings and they do not necessarily hope to die (Hungerford & Hodgson, 2014). Whilst suicide only accounts for 1.8% of deaths in Australia, the percentage of youth aged 15-24 is much higher at 35.4%, generally speaking in older adults the proportion of suicide related deaths becomes smaller as it is more likely for death to result from natural causes (ABS, 2016). People suffering in difficult situations often need guidance from health care professionals to assist in develop coping mechanisms and building up resilience to create hope for the future. People with suicidal thoughts ideas or plans are often at that point as a result of seclusion and lack of support networks to help them through trying times (Hungerford & Hodgson, 2014).

At Risk Community Group (LGBT) Some populations are at greater risk of suicide attempts than others, according to the ABS, sexual minority groups such as the; Lesbian, Gay, Bi-sexual, Transgender (LGBT)

4 community reported a higher incidence of suicidal thoughts and plans including attempts in 2010 than non-LBGT youth (Skerrett, Kõlves & De Leo, 2014). Despite advantages of media coverage concerning the rights of the LGBT community and same sex couples, there is continuously a discrediting stigma resulting in mood, anxiety and substance disorders as a result of parental and peer prejudice. A history of substance abuse, depression, bulling and gender discrimination can all attain to the risk of LGBT youth suicide. Bullying and cyberbulling especially have resulted in high statistics of youth suicide evident more so in LGBT people (Johnson, Oxendine, Taub & Robertson, 2013). In the Australian context there has been a higher likelihood in the development of suicidal behaviours for sexual minority groups than heterosexual and non-transgender individuals. Studies have shown the LBGT community require targeted prevention and awareness to decrease the instance of the highrisk suicidal ideations and deaths. The relationship between suicide and sexual minorities, particularly in adolescence can be attributed to continued stigma, stereotyping, and family separation causing internalised emotional vulnerability (Skerrett, Kõlves & De Leo, 2015). Case study: Contributing Factors The presence of one or more risk factors may increase the likelihood of a person developing a mental illness and can be a result of the individuals’ personality, family interaction, situation with colleagues or the community (“beyondblue”, 2018). The development of mental illness and dysfunctional behaviours can involve things like; stress, grief, work pressure, relationship breakdown and social isolation ("What is Mental Illness?", 2018). Factors of the case study present as; work pressure, grief as a result of the recent death of the clients’ mother and relationship breakdown. 22 year-old, Jill, has reported feelings and symptoms of stress suggesting she is anxious about the pressure of work and submitting her assignments. This factor has contributed to concern for her mental health, as she is not able to cope with deadlines and facing her colleagues. In stressful situations, emotions can often be seen to reflect in behaviours and intensified by tiredness, exhaustion and feeling isolated from family or friends (Hungerford & Hodgson, 2014). Another factor contributing to the development of

5 poor mental health in the case study is grief, according to the Kubler-Ross model there are five stages of grief including; denial, anger, bargaining, depression and acceptance (Hungerford & Hodgson, 2014). Jill appears to be facing depression due to her suicidal thoughts and feelings of guilt, burden and not wanting to continue life. Finally a major concern for this patient is the current potential breakdown of her relationship. It is often recent events that are more likely to trigger an individual’s depressed state. For Jill, it is the unsteadiness and growing distance of her relationship with boyfriend jack that is causing her anxiety and distress that is reflecting in her destructive behaviours, presenting serious health risks (“beyondblue”, 2018). Legal and Ethical considerations Legal and ethical requirements govern the practice of health professionals in a way that guides the care provided to patients. Although some principles are set and guide the practice for legal and ethical care nationally, each Australian state and territory encompasses its own specific mental health laws for the treatment of mentally ill people (Hungerford & Hodgson, 2014). Ethical concepts are requirements for health professionals to abide by for them to respect. Beneficence, meaning ‘to do good’, is associated with a duty of care whilst avoiding harm to patients. Nurses are to act in the best interest of the patient always this includes working within their scope, maintaining competency and committing to continual care as necessary (Peate, Nair & Wild, 2014). In the case study, the patient is at risk of committing suicide if she does not receive adequate help, therefore the nurse must act with Beneficence in order to prevent this from occurring whilst acting in Jill’s best interest. This can be done by talking to her and deciphering the route of her anxiety and distress that resulted in an intentional overdose. Another concept is Non-maleficence, meaning do no harm, which coincides with beneficence. This is a complicated concept however as in the health care scenario causing harm may actually result in the best outcome for the client for example causing pain to administer medication that will improve the condition (Peate, Nair & Wild, 2014). As a result

6 of Jill’s condition, the nurse may be required to place her under the Mental Health Act as a voluntary patient to minimise the risk of harm to self or others. Risk Priorities Before addressing patients’ behaviours it is important to complete a risk assessment to determine the current issue/s, past history, perception, cognition, insight and risks in order to formulate a response or interventions. It needs to be determined whether she already has a diagnosis, if she is able to consent to treatment and understand it and what the risk is (Hungerford & Hodgson, 2014). Based on evidence of the discussion with Jill highlighting her feelings of anxiety, distress and agitation leading to an intentional drug overdose of over the counter medication as a result of ruminating suicidal thoughts, it can be determined that Jill has no previous history of mental illness, has insight and is able to consent to treatment however at this point is a high suicide risk. Supported by her feelings of failure and overwhelmed emotion due to a declining relationship with her boyfriend, her mental health is not at an appropriate state to send her home. Therefore a nursing intervention for Jill would be Interpersonal therapy (IPT). IPT is a logical approach to assist patients to put into perspective and clarify the feelings pertaining to people within their social context. For Jill this would include identifying her feelings regarding her father and her boyfriend, Jack, through communicating her present fears and anxieties. It would also be important to address the loss of her mother and as she is facing potential loss of her relationship, to crucially determine the reasons for the suicidal behaviour and encourage positive expressions to prevent future relapse (Goldney, 2013). It may be necessary for a more intense intervention in the form of Hospitalisation of the patient, due to physiological effects of suicidal tendencies. If the patient expresses a wish to end their life in association with impulsive decisions, depression and hopelessness, there may be a need for compulsory admission under the Mental Health Act WA (2014) to reduce the risk of the patient hurting themself or others. This may be a necessary precaution as a professional clinical decision even just to impose an order to create time in which suicidal impulses may diminish (Goldney, 2013). Once hospitalised the patient may be introduced to Cognitive

7 behavioural therapy (CBT) in order to identify areas of low self worth and navigate the patients’ thoughts towards more positive ideas and with the use of motivational interviewing, attempt to create goals with the clients involvement in an attempt to minimise stress and alternative ways of thinking about themselves (Goldney, 2013). Mental Health Issue & Interventions Based on the evidence collated by the nurse upon thorough assessment, Depression is a mental health need that should be attended to for Jill’s wellbeing. When screening for depression, the Kessler 10 (K-10) self-reporting tool is the most common instrument used in Australian health services. Upon completion of the survey, health professionals can determine how exactly the mood of the patient impacts their quality of life in terms of psychological distress. Once a diagnosis for depression is determined, appropriate treatment options for the individual are explored (Hungerford & Hodgson, 2014). One option for an intervention is the use of Psychotherapy. Psychotherapy for mental disorders can be used for depressed or suicidal patients as emotional support to cope with their feelings. Coping strategies should be used in conjunction with medication and may involve family members or friends. A form of psychotherapy appropriate for Jill’s condition is Problem-solving therapy, used based on the circumstance that the patient symptoms are related to every-day problems. The patient is encouraged by the therapist to generate potential solutions and encouraged to use this in everyday life including relationships with the use of modification from the therapist if necessary (Goldney, 2013). In order to attain a positive therapeutic relationship with the patient when using the psychotherapy approach for care it is important to establish a non-judgemental, active style of listening to communicate acceptance and empathy (Hungerford & Hodgson, 2014). A second option would be pharmacological intervention. Antidepressants and mood stabilisers such as Lithium are often prescribed for depression diagnoses if their behaviours are related to the symptoms of mental illness as both have shown a reduction in suicides

8 with consistent use. It is important to explain to the patient that the medication they are on could take up to three weeks before they start to feel better. It is the role of the nurse to then educate the patient on any information pertaining to dosage, frequency and side effects they may experience whilst on the medication (Hungerford & Hodgson, 2014). The duration of treatment of antidepressants is important and should only be used for four to six months for the first episode of major depression, additionally newer medications should be used to reduce the risk of drug toxicity (Goldney, 2013). Conclusion Mental health involves the wellbeing of individuals in the community and includes families, it is the ability to bounce back and cope with stressful circumstances and life events. Issues pertaining to a person’s mental health can be biological, psychological or social and are a growing concern for the Australian healthcare industry. As discovered from the case study analysis, mental health issues can impact the lives of others as well as the individual and can lead to depression and even suicide if untreated. It is important for health care professionals to identify and assist patients presenting with mental health concerns. Contributing factors, legal and ethical considerations and interventions for the treatment of patient Jill have been discussed and using the best available current evidence regarding current Australian research.

References Australian Bureau of Statistics. (2016). Causes of death, Australia, 2016 (Cat. No. 3303.0). Retrieved from http://www.abs.gov.au Australian Bureau of Statistics. (2015). National Health Survey: First Results, 2014-15 (Cat. No. 4364.0.55.001). Retrieved from http://www.abs.gov.au Beyondblue. (2018). beyondblue.org.au. Retrieved from https://www.beyondblue.org.au/thefacts/what-is-mental-health

9 Corcoran, J., Brown, E., Davis, M., Pineda, M., Kadolph, J., & Bell, H. (2013). Depression in Older Adults: A Meta-Synthesis. Journal Of Gerontological Social Work, 56(6), 509534. doi.org/10.1080/01634372.2013.811144 Depression APS. (2018). Psychology.org.au. Retrieved from https://www.psychology.org.au/for-the-public/Psychology-Topics/Depression Goldney, R., (2013). Suicide prevention (2nd ed.). UK: Oxford University Press. Retrieved from https://ebookcentral.proquest.com/lib/ECU/reader.action? docID=1318292&query= Hunger f or d,C. ,&Hodgson,D. ,( 2014) .Ment alheal t hcar e:ani nt r oduct i onf orheal t h pr of ess i onal si nAus t r al i a(2nded. ) .J ohnWi l e y&Sons .Ret r i ev edf r om ht t ps : / / ebook c ent r al . pr oques t . com

Johnson, R., Oxendine, S., Taub, D., & Robertson, J. (2013). Suicide Prevention for LGBT Students. New Directions For Student Services, 2013(141), 55-69. http://dx.doi.org/10.1002/ss.20040 Peate, I., Nair, M., & Wild, K. (2014). Nursing Practice: Knowledge and care (1st ed.). John Wiley & Sons. Retrieved from https://ebookcentral.proquest.com/lib/ECU/reader.action?docID=1765076&query= Protective and risk factors. (2018) beyondblue (pp. 2-4). Retrieved from https://www.mindmatters.edu.au/docs/default-source/learning-moduledocuments/j4633_mm_module1-3-protectiveriskfactors_v2.pdf Skerrett, D., Kõlves, K., & De Leo, D. (2015). Are LGBT Populations at a Higher Risk for Suicidal Behaviors in Australia? Research Findings and Implications. Journal Of Homosexuality, 62(7), 883-901. doi.org/10.1080/00918369.2014.1003009 Skerrett, D., Kõlves, K., & De Leo, D. (2014). Suicides among lesbian, gay, bisexual, and transgender populations in Australia: An analysis of the Queensland Suicide Register. Asia-Pacific Psychiatry, 440-446. doi.org/10.1111/appy.12128 What is Mental Illness?. (2018). Department of Health. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/Content/Mental+Health+and+W ellbeing-1 Yaka, E., Keskinoglu, P., Ucku, R., Yener, G., & Tunca, Z. (2014). Prevalence and ...