Mental wellbeing has in the recent past attracted a lot of attention from stakeholders in the health industry after they noted that holistic caring of a patient must involve ensuring mental wellness. In the past, this section of healthcare was overlooked, as mental diseases were not considered ‘illnesses’ but were rather thought to be associated with witchcraft. As a result, any person exhibiting signs of mental illness was shunned and secluded from the community and family members, until he/she passed on. Mental healthcare has as a result lagged behind in terms of providing quality care services to affected patients.
Australia is one of the countries experiencing high rates of mental illnesses, including depression and suicide. This paper will investigate the prevalence and incidence of suicide and depression in Australia. Based on the given case scenario, the paper will also discuss factors that contribute to development of mental illnesses, as well as the ethical and legal issues associated with the case scenario. The paper will also identify two nursing concerns for the case scenario given, and outline the interventions for each concern. This exercise will build on knowledge regarding mental health, the issues affecting provision of mental care services, and the available interventions for patients suffering from mental health conditions.
Prevalence and Incidence of Depression and Suicide in Australia
In Australia, suicide is a primary public health concern due to the increasing cases. Mindframe (2014) reported that between 2010 and 2014, Australia had an average of 2,577 suicide deaths per year. In 2014 alone, 2,864 people died from suicide, with 2,160 being males and 704 being females. This indicates that more males die from suicide compared to females. However, this data is not age adjusted. According to the same report by Mindframe, males above the age of 85 years committed more suicides compared to individuals from any other age group in 2014.
The age group between 40-44 years and 50-54 years rank second and third respectively on suicide rates among males in Australia (Mindframe, 2014). The lowest rate of suicide is reported among the 15-19 year age group. Among females the highest incidences of suicide were observed among women between the ages of 35 and 39, followed by females between 50-54 years (Mindframe, 2014). The lowest age specific suicide rate among the females was reported among the 0-14 year age group. Mindframe also reports that of suicide deaths accounted for 1.9% of all the deaths in Australia. There is a close correlation between suicide and depression. According to Mindframe (2014), 90% of all people who die from suicide are patients who had an existing mental illness.
Beyondblue (2016) posits that depression is the leading cause of disability globally. In Australia, 45% of all people experience a mental health condition at a point int heir lives. Beyondblue also posits that 1 million Australians experience depression every year, while 2 million people have anxiety every year. It is imperative to note that depression and anxiety and depression are different mental disorders, but it is not unlikely for the two conditions to occur at the same time. In fact, most patients suffering from depression also suffer from anxiety. According to beyondblue (2016), 1 in every 5 men experience depression at one time in their lives, while 1 in every 8 women experiences the same. Depression ranges from minor to severe, and treatment is based on the severity of the symptoms.
1% of teens in Australia attempt suicide, and 1% of all these attempts actually lead to death (Nemours Foundation, 2014). This implies that one in every 10,000 teens die from suicide every year in Australia, according to Nemours Foundation (2014). However, depressive illnesses raise these incidences, and about 15% to 30% of all the teenagers suffering from depression actually perpetuate their suicidal thoughts. Although depression is mostly a passing mood among the teenagers, lack of support, understanding, and health services makes the condition worse, leading to suicidal thoughts. NHS (2016) hypothesizes that an individual who experiences extreme sadness and bad moods everyday for more than two weeks is suffering from major depressive disorder. Severe depression is associated with high rates of suicide.
The relationship between depression and suicide is not a complex one. Depressed people have distorted way of thinking, and different perception of situations. They also have low tolerance for challenging situations, making them prone to irrational actions such as trying to take their own lives (Life is for everyone, 2015). Also, depressed persons usually have no hope, and do not find living interesting. Hopelessness leads depressed persons to fancy death, and if an intervention is not reached sooner, such patients can actualize their suicidal thoughts. Treatment of depression is vital in preventing suicide. Proper and timely diagnosis of depression is also vital in preventing occurrence of depression. Based on the severity of the depression, interventions range from counseling to hospitalization. Talk therapy is one of the most common treatment methods for countering suicidal thoughts among depressed patients.
Factors Contributing to Development of Client’s Mental Health Concerns and Risks
Edward’s health issues have deep rooted causes. According t NHS (2016) depression has no specific single cause, and development of the condition is perpetuated by varying reasons. Triggers vary from one person to the other. Despite the variance, research has indicated some common factors that promote development of depression. NHS (2016) mention stressful situations such as financial woes, divorce, grief, and illness as some of the factors that contribute to depression. University of Michigan Depression Center also lists these factors, and adds hormonal changes and genetics as other contributing factors to depression.
Edward has gone through challenging situations in his life, such as the loss of his youngest son. His son died from suicide, and it has taken a toll on Edward’s mental health. In addition to grief, Edward is also concerned about his family’s togetherness. He attributes this lack of togetherness to the loss of his son, Thomas. Grief is one of the factors that contributed to Edward’s mental health concerns and risks. Edwards is also experiencing a difficult time period as his farm faces a threat of extinction. In their earlier years, Edward’s sons and his wife helped out on the farm, which is their main source of income. He is increasingly unable to meet the demands of his far, and his sons are no longer interested in managing it. He is therefore apprehensive about his family’s financial future, a factor that has contributed to his current state of mental health.
Ethical and Legal Issues Associated with the Case Scenario
Ethical and legal issues are a common occurrence in the healthcare arena, and mental healthcare is no exception. One of the main legal concerns when attending to a mentally ill patient is the observance of patient’s rights (Andrew, 2016). A mentally ill patient should be accorded the same human right as the other patients. He/she requires informed consent before administration of any intervention. A mentally ill patient should only be considered incompetent to make medical decisions on his/her own if legally proven to be incompetent. Caregivers should also observe the autonomous right of the patient, where the patient has a right to accept or withhold treatment.
Beyondblue (2016) notes that cases of involuntary seclusion and hospitalization are rampant among the mentally ill patients and this amounts to infringement of human rights. Confidentiality is also another ethical and legal issue that arises when providing care to mentally ill patients. A patient’s medical information should be protected from unauthorized access, and only shared with members of medical team attending to patient. Beyondblue (2016) also reports that nurses are responsible for warning potential victims of mental patients about the looming dangers. Healthcare facilities have the responsibility of instituting committees to ensure that patients’ rights are not overlooked. This institution is vital in ensuring that ethical and legal ramifications do not arise against the care providers and facilities.
Nursing Concerns/Needs from the Case Scenario
Edward is a troubled man, as he has undergone some challenging life events. He feels guilty for not attending his parents’ burials, and carries this guilt with himself every day. He is also apprehensive about his distance with his sisters, and now the seemingly increasing distance between him, his children, and his wife. It is evident that all his life, separation from people he loves is a constant. He recently lost a son to suicide, and this has taken a toll on his health, as he is not sleeping well. He has also lost a lot of weight in a period of four months without any effort. He is also experiencing a challenging financial situation, as his farm is losing income. He had hopes that his sons would take up farming and continue with his work, but the remaining one is not interested in farming. There is a need to institute an intervention for Edward, as it is clear he is depressed and considering suicide.
The greatest nursing risk and concern for the patient at this point is the possibility of suicide. Not only has he conceptualized the idea of the grave actions, but he is also more inclined to carry out his thoughts as he is mentally unstable. Edward has lost hope for the future, and this increases his chances of committing suicide. This is because hopelessness, coupled with other factors such as traumatic events, is one of the major causes of suicide. There is need, therefore, to help Edwards come to terms with his losses, and to accept his losses. Sozeri-Valma (2012) posits that age is an important factor to consider in depression. This is because depression among people above the age of 60 has different etiology, presentation, response to treatment, and prognosis.
Another nursing concern for this patient is the risk for self neglect related to the symptoms of depression that is evidenced by weight loss, not eating, lack of sleep, low self esteem, and unemployment. Self-neglect refers to failure to take care of oneself, which consequently leads to harm to ones physical and mental health (Yukon, 2016). Self-neglect can also cause refusal for treatment among the patients. His sudden loss of weight without effort is a clear indication that Edward could be neglecting himself by skipping meals. Although the lack of sleep may not be intentional, it is a sign of self-neglect, as it has the potential to cause physical and mental harm to Edward.
Evidence-Based Nursing Interventions for the Nursing Concerns
One of the concerns identified is the risk of suicide for Edwards. Cognitive Behavior Therapy or talk therapy, commonly known as CBT, is described by Hayes (2012) as an effective treatment for depression. It is an evidence-based intervention that involves helping a patient to recognize and correct negative thinking. CBT is rooted in the belief that mood is related to the line of thoughts of an individual, and that correcting this line of thought can correct the moods of a patient.
Talk therapy can also involve family members if the patient approves. As a nurse, I would recommend the best therapist to Edwards, in addition to educating him on the importance of the therapy. Another intervention that I would recommend for Edwards is joining a support group, where he can interact with people going though traumatic events similar to his. A strong support system provides the patient with an opportunity to learn about overcoming challenging events from others who have lived through such experiences.
Self-neglect was identified as another nursing concern for the patient. As a nurse, I would adopt the strategy of health literacy for Edwards and his family to help him accept his diagnosis and the subsequent treatment. Health literacy, according to WHO (2016) helps individuals gain motivation to access health services because it improves the patients’ social and cognitive skills. This intervention would help Edward to acknowledge that he has a problem that can actually be managed through treatment. The approach would also be important in promoting adherence to treatment, especially counseling, as it takes place over a period of time. I would personally undertake the role of educating the patients on the diagnosis, treatments, and prognosis of the disease.
References
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