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Mental Health : Problem Among The Australian Population

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Mental Health : Problem Among The Australian Population

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Mental Health : Problem Among The Australian Population

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Question:
Discuss about the Mental Health for Problem Among the Australian Population.
 
Answer:
Investigate prevalence/incidences of suicide /depression in various age groups and risk groups in Australia

Mental disorder is a major health problem among the Australian population.  The National Mental Health Report 2013, has evidenced that it affected 3% of the country’s population.  The most common mental illnesses are depression, anxiety, substance use, schizophrenia, bipolar, and schizo-affective disorders (AIHW, 2014).
Mental disorders ruin individuals and families, causing a disastrous effect on the community.  The illnesses disrupt cognitive, emotional and social abilities, leading to economic risks and decreased productivity  (McLachlan et al., 2013). Mental disorders of serious types will result in the patients’ isolation, stigma, and social discrimination (Morgan et al., 2011).
There is a general belief that mental illnesses, like depression, are caused by disruptions in personal life..  But, in reality, the real causes  are unknown, as different factors act in association with personal life, something either recent or past, such as family conflicts, friendship break-up, failure in love-life and exams, traumatic experiences, and many more, can cause depression in people  (Purcell et al., 2013).
The Psychological Data Survey of 2012 provides necessary information about the different types of nervous conditions.  It also reveals related data like impairments, patients and families affected, mental health services received or disrupted, suicide ideation, homelessness, demographic, and socioeconomic features (ABS, 2015).
As per a research on STB, suicide attempts share 48%, while  suicidal ideation accounts 38%.   This indicates that societal approaches will not reduce the STB risk factors  (Bruffaerts et al., 2015) causing depression, anxiety, and substance use mental disorders in 20% of Australians, aged 16-15.  The prevalence of mental disorders in the children and adolescent of 4-17 age group is an alarming 13.9%, which means one in seven Australian children is suffering from mental illnesses (Lawrence et al., 2015). 
It is estimated that 2–3% of Australians experience severe and disabling forms of mental depression and anxiety. 4-6% of the population have moderate, and 9-12% have mild mental disorders. In 2011 alone, 754 deaths occurred due to mental depression, of which most were the result of substance use (DoHA, 2013). The indigenous population has a higher risk, the factors being stigmas and environmental factors (Kolves et al., 201). The reason for these negative outcomes in the health sector was due to the prevalence of psychotic illnesses in Australia (MHSA, 2016).
A large section of women is prone to anxiety, depression, and other mental disorders. This includes antenatal and perinatal mental disorders. Though young mothers, smokers, low income groups, overweight, etc., have a higher percentage of perinatal depression, its percentage is very less, in highly educated and upper strata females (AIHW, 2012).
 
Hospitalization and recovery measures
Mental illness is a person’s disturbed behavior and inconsistent mental working, because of neurologic conditions.  Psychiatric hospitalization is essential to prevent them from suicides, and its rejection can bring setbacks (Loch, 2014). A short term hospitalization will help them from harming themselves and others, though they regard such hospitalizations as a violation of their rights (Danzer & Stone, 2015).
Therefore, it is necessary to infuse hope and recovery feeling in mental patients.  All coercive measures should be reduced, and  cooperative strategy must be adopted.  Nurse interactions are needed, allowing patients to make choices of their own, within their  capacities.  Such interventions can reduce traumatic and consequences of involuntary hospitalization and medication.  Building an honest and trusting patient-nurse relationship will invite patient’s cooperation in receiving medical help (Danzer & Stone, 2015).
Using current literature, discuss factors that may have contributed to the development   of the client’s presentation, mental health concerns and risks.    Ensure you highlight at least 2 factors.
A psychiatric presentation demonstrates a mental disorder, and its diagnoses are made with validity, specificity and inter-rater reliability.  The treatment is achieved through scientific methods.  However, medical illnesses can display symptoms relating to a psychiatric origin. After a medical condition, the symptoms of a particular mental disorder are identifiable for another mental disorder. If it is not diagnosed attentively, such a misdiagnose will place the patient in a dangerous position (Castro, & Billick, 2013).
If a medical condition is misdiagnosed as a psychiatric disorder, it can lead to complicated situations, such as denial of proper medical care to the patient, and allegations of malpractices, and ethics dereliction.  It can also bring legal action against those practitioners for negligent diagnosis (Shapiro, & Smith, 2011).
Sometimes, it may become difficult to identify patients who have non psychiatric symptoms of their mental illness, as primary mental illness and medical conditions may exist at the same time suppressing the symptoms. These happen when there is traumatic impact of prolonged psychological or physical mistreatment, resulting in Neuro-cognitive symptoms (Pollak & Miller, 2011).
The medical condition discussed herein, includes physiological consequences of all medical diseases, substance disorders, and neurological disorders, resulting in mental health difficulties.  Such conditions are visible in various peoples, who have medically risky behaviors.  Their family history will reveal mental complaint accounts, elder  persons with dual diagnosis, and people unaccustomed to medical advice.  So, errors in diagnosing medical conditions can bring negative outcomes, ethics complaints, and legal action for negligent diagnosis (Pollak & Miller, 2011).
Risk factors
The risk factors of biological, psychological, societal, and cultural levels can lead to negative outcomes.  A person’s genetic predisposition to alcohol exposure prenatally is an  individual level risk factor. Effective treatment minimizes these risk factors, by improving the protective factors.  The “Strategic Prevention Framework”  can help the nursing professionals in identifying these risk factors (SAMHSA, 2015).
Modifiable biomedical risk factors are dependent on behavioral risk factors (AIHW, 2016), whereas,  variable risk factors relate to an individual’s income level, peer group, childhood adversities, and employment status.   Preventive factors alleviate the impact of risk factors, through improved social competence.  Some of these risks and protective factors do not change over time. Targeting a single context, relating to  individuals’ risk or protective factors, will not bring the desired outcome (SAMHSA, 2015).
Most of the mental disorders are caused by genetic, psychological, and environmental  factors. Medical conditions, like heart disease, diabetes, cancer, etc., can predispose a person towards mental illness. Environmentally, adversities in living  conditions during childhood, loss of parents, poverty,  parental violence, harassment, etc., are risk factors for developing mental illnesses (Edward, 2015).
 
Using current literature, discuss the ethical and legal issues related to your scenario (ensure you discuss at least one ethical issue and at least one legal issue).        Your work should include reference to ethical principles.
Nursing extends preventative, curative, and supportive care to clients. They also provide restorative and palliative care, and maintain professional relationships with their patients, families, and communities (Nursing and Midwifery Board of Australia, 2016). Nursing ethics affirms moral judgment, by protecting human dignity and recognizing  patients’ belief, as well as privacy (Shahriari et al., 2013). 
For collecting information from Lorraine, the nurse practitioner, being convinced of own competence, respected her dignity to use her self determination, adhering to the Nonmaleficence principle of nursing. And, assuring no harm, gave  medication, honoring the Beneficence and Autonomy Principles. Lorraine was given treatment equality, and extended quality care with dedication, resonating the principles of Justice, Fidelity, and Totality and Integrity (Phang, 2014).
Ethical issues
Ethics is the process of perception, critical thinking, and analysis of information, gathered from keen observation and experience.  As such, critical thinking and related procedures are vital in nursing practice (Papathanasiou et al., 2014). According to the Nursing and Midwifery Council (NMC, 2015), nurses should  honor patients’ confidentiality right.  When Lorraine came to the GP surgery, she was emotionally inconsistent, and was presenting symptoms of mental disorder.  An assessment of the disorder could be possible only if she could reveal her personal information (Scenario B), after committing protection of confidentiality.
This obligation, being ethical, restricts the nursing professional from disclosing patient information to others.  But, the efforts to keep confidentiality are overshadowed with all the information going to records electronically, posing a greater challenge to it.  As per the “Health Information Portability and Accountability Act of 1997” (HIPAA), medical institutions must protect the electronic information of the patient (Bord et al., 2014).  Since, information technologies are developing fast, anyone can collect a patient’s information, and publicize it on social media, jeopardizing and breaching privacy and confidentiality (John, 2016).
Legal issues
Confidentiality is pivotal in building trust with patients in improving their welfare. It was on that basis, The Mental Health Act, 2014, was  amended, incorporating mental health principles.  According to it, a provider of mental health service must respect the provisions of the Act, and make it mandatory to provide the service in the least restrictive manner with apt supportive decision making, promoting recovery.  But, how far this Section can be relied upon is still not experimented.  However, it underlines that when people who are responsible make decisions, such actions need to have some risks too (Victoria Aid, 2016).
In addition is the privacy and confidentiality rights.  The rights demand cautious balancing to cope with augmented recognition of the support-people’s role in helping decision making  (Victoria Aid, 2016). Health professionals are shackled with ethical and legal responsibilities to keep patient confidentiality.  A breach of it will land the professional in disciplinary action and invite a lawsuit from the patient (Legal Service Commission of South Australia, 2016). Accidental breaches will be frequent, if assessments are done in open space. Likewise, utilization of computerized documentation will increase the dissemination risk to patient information (Blightman et al., 2013).
Identify 2 nursing/midwifery concerns/needs with evidence from your chosen scenario. These should be directly related to the person’s mental health    presentation.  Ensure you discuss why you have included these two particular concerns or needs.  Your risk identification should be focused on the next 1-5 days of nursing/midwifery     care for your client.
Lorraine was tearful, restless, and in low mood, while diagnosing at the GP.  She  complained of panic attacks with suicide ideation. She was shaking, sweating, and breathing rapidly all the time.  The author understood she was under stress, and having competence in giving medication, the initial thought was to get directions from the physician whether to give her a sudden relief, in line with the ethical principle of Beneficence.  But, leaving the internal conflicts to subside, the author went through the client’s presentation, took answers to the questionnaire, assessed it, and conducted the diagnosis.  After clinical testing, appraised the treatment processes, and initiated the support systems, and contacted the physician for instructions.
When Lorraine revealed that she was pregnant, the author was caught in an ethical dilemma, knowing that an antidepressant would give a sudden relief; but, the moral reasoning brought confusion, such that the autonomy and non-maleficence principles began conflicting with the Principles of Beneficence and Justice. Because, as per physician’s direction, if antidepressants, like SSRI or venlafaxine were given to pregnant women predisposed to depression, it would increase risks in birth defects. And, if left untreated, it would bring adverse effects to the mother and infant (Pearlstein, 2015).
Another problem was whether Lorraine would accept the medication, because, she revealed earlier that she had discontinued the previous treatment, due to “spaced out”. Moreover, she had stigma problems, which could affect her decision making. So, the author was doubtful about her capacity to hold its legal responsibility, and the reasonableness in applying the Autonomy principle.  Therefore, the author adopted a paternalistic approach, thinking that it would be justified as supporting with the principle of beneficence (Bhanj, 2013).
 
For each nursing problem you have identified in Question 4, outline and describe TWO evidence based nursing interventions to support the person and how would         you do it?
Mental health care promotes mental wellbeing of patients (Scott et al., 2012), through evidence based nursing interventions. Considering the state Lorraine is in, the author will  communicate in a proactive way to calm her down, and build trust. After observation, she will be given a questionnaire to answer.  
An informed consent will be secured, and check again to know her voluntary acceptance of treatment and medication.  If it is affirmative, steps for immediate interventions will be taken with the guidance of the physician to alleviate her mental health problems. The models intended for this purpose are psychological, social, biological, and biopsychosocial interventions.
Psychological intervention
This intervention encompasses counseling, conflict solutions, creative therapy, cognitive and spiritual interventions, education, etc.  On the first day, Serotonin and norepinephrine reuptake inhibitors (SNRIs) will be given to Lorraine for tranquilizing her, and lessen the chances of harming her baby.  After medication, she can sleep, under observation by the nursing assistant (Zauszniewski et al., 2012).
Counselling, education, training, conflict solutions, etc., will be done the next day (Zauszniewski et al., 2012).  During the 1-5 days, the progress will be checked and recorded.  If  it does not work properly, systemic changes will be made. Medication will be continued, and if improved, the patient will be discharged, with instructions to continue medication. 
Social Intervention
Social Intervention involves the patient’s environment and the stress factors.  Counseling, environmental management, vocational and creative rehabilitation, skills training, home visit, etc., are priorities in this intervention (Zauszniewski et al., 2012). The treatment will be continued throughout the five days, and the progress will be recorded. The patient will be trained in vocational and creative activities.  The medication, if needed, will be continued, according to the advice of the physician.
 
Biological Intervention
The  biological model concentrates on activities, nutrition, medication management, etc., and seeks the support of psychopharmacology and light therapy, along with transcranial magnetic stimulation. Repeated magnetic stimulation improves depression (Zauszniewski et al., 2012). The result will be checked daily, and if the patient has no progress at the end of 5 days, guidance will be sought from the physician for systemic changes.  Medication will be regulated, corresponding to patient’s improvement. 
Biopsychosocial Intervention
This collaborative intervention model is an amalgamation of the aforesaid three interventions to derive better outcomes (Zauszniewski et al., 2012). The details of progress will be recorded daily, and medication continued throughout the five days.  If illness improved,  the patient will be discharged with instructions.
During the five days, constructive feedback from the client will be obtained for all of the above interventions, by building up trust, harmony, and support.  Special attention will be given to caring for the patient’s needs.  A change in the environment will be done to relieve stress.  Irrespective of the places, a discharge plan will be prepared for the patient, each day.
 
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