Factors Contributing to Depression and Suicide in Australia
a.
Depression: As per the WHO survey, depression is one of the major causes of death in adolescents and youth, between the age group of 10-19 years of age (Ricci, 2015). Although this survey is a worldwide one, these rates are seen prevalent in Australia too, with the adolescents having trouble coping up with the distress and ending up giving their lives to get out of the troubles.
The most prevalent reasons that drive most teenagers to this ultimate means are either biological reasons, and disorders such as bipolar or psychosis, or the developmental factors, such as trouble at school and college, or problems at home. The study done on the depression rates in Australian women, especially, found that there are several reasons for depression, and the most significant among them is the post-natal mental condition. It is found that around 16% of women go across this phase, where they experience what is called baby blues or the post-natal depression. Although help is provided immediately by the primary care workers, and the constant mental health survey by the Australian government renders new and modified policies, depression seems to be on the rise, as per the latest predictions (Rich, 2013)
Suicide: There has been a considerable increase in the number of deaths due to suicide, between 2006 and 2012. The study conducted by the Australian Bureau of Statistics found that the death due to suicide has increased from 10.2 per 100,000 to 12.6 per 100,000 in the year 2012(Suicide in Australia, 2016). This rate is alarming, as is the fact that they are often triggered by the cluster effect. When a suicide happens one particular group of people, (say youth, indigenous population, and so on), it seems to trigger more among the others in the group(Robinson, 2016).Although the survey reported presented with the number of suicides gives a collective number of suicides in a year, it has been found that the rates are highest among the youth (Longbottom, 2016)
Depression:
One of the particular concerns today, facing the world (and Australia at large) is the mental health of youth. With the adolescent and teenage population more exposed to social media, online games and news, children face depression at a very young age. It is predicted that the young females, at the age group of 12-20 years are twice as much prone to depression and restlessness than the male (Pearce, 2017). This is especially true with older teenagers, at the age group of 18-19 years, where they are more susceptible to peer pressure, stress due to social life, and studies, bullying in the college, and so on. Social media, may also be one of the significant reasons for young girls facing mental health challenges. This depression, as said to be developed at a young age (at adolescent stage) contributes to the mental health in later stages of life.
Suicide:
A survey conducted in 2015 shows that the suicides in indigenous populations and Torres strait islanders are twice as much as those in non-indigenous people (Armstrong, G., 2017). This trend of suicide is a recent one, and mostly seen in younger members of the group. The average age, as predicted by the survey, for suicide among the indigenous population is less than 35 years of age Most of these deaths are attributed to depression, substance abuse and also on the influence of others in the community, what is called the cluster suicides. Sadly though, many suicides or self-harm symptoms are also seen among females who have been hospitalized and suffering from an illness.
Ethical and Legal Considerations in Mental Health Care
In scenario A, Jonathan is a youth of 19 years, with a series of distressing events in his life. With the loss of his one parent, (his mother) and a developing distance between the other, he suddenly feels isolated and lonely. Jonathan is depressed, and with his mother’s anniversary approaching, he feels his only respite would be to end his life. Poor family cohesion, as Grenklo, T. B., et. al (2014) suggests, is one of the reasons for self-destructive behaviour in youth. A close knit family, disintegrating within a span of months, and the stress of dealing with sickness might have lead Jonathan into a turmoil. Loss of a close relative here, and who has suffered in front of him, with an illness like cancer, has made Jonathan take the fatal step, and understandably, closer to the approaching anniversary of his mother’s death.
Here, two things have happened simultaneously for Jonathan. For one, he has lost his mother, and in an illness which would have lasted for a few months at the most. Second, his father, who might himself be feeling lost due to his wife’s death, is dealing with his grief in his own way, by working overtime. Although monitory issue is also a concern, the father here might have distanced himself to deal with both his own grief and also to repay the loans. Hence, father, the one parent alive, is not there to support Jonathan or share his grief.
Similarly, Jonathan is facing other challenges in life, such asan inability to cope up with everyday work in his workplace. With assignments pending, and attendance lagging behind, Jonathan is worried that he might not be able to clear his training at TAFE. A Youth, especially those who have been doing well in academics or whatever field of interest, suddenly is finding it daunting to face challenges and is stressed out to keep up with their peers. This is something similar that has happened to Jonathan, and have forced him to take the ultimate decision (Longbottom, 2016). The last straw is the fight with the girlfriend, and a possible change in his relationship status. This one act had finally acted as a trigger, and have Jonathan over the edge, with his pills and drinks. Losing a parent, and then with another not able to provide support, Jonathan seems to have been depending upon his girlfriend for emotional support. Now that he is being threatened by it, and with his mother’s death anniversary approaching, (an event that seems to have triggered everything in the first place), Jonathan has developed self-destruction tendencies and might continue to do so, unless help is offered.
Jonathan in the case study, is 19 years of age. According to the Mental Health Act, 2007, he is at a stage where he can be considered an adult, and no parental supervision is required during his hospitalization. Hence, although any legal issues regarding his admission or questioning by the nursing staff in the emergency department are ruled out, there are always ethical considerations to be noted.
Identifying a High Priority and Urgent Mental Health Risk
Ethical dilemmas like doing the correct thing in a situation, is often contradicted by other constraints put forth on a medical professional. For instance, in the case of Jonathan, the problem might be that although he is 19, and can very well take decisions on his own. However, the health care professional might need to talk to an elder or a parent to relate the situation and advise on the outcomes. With the mental health of the patient not very stable, and with him susceptible to take the course of action once again, if left unattended, it becomes imperative to put forward the issue to someone close enough to monitor the situation. However, can they do so, without foregoing the legal and ethical implications, is a remarkable question to answer. As the experts say, the psychological question of treating a person, who is responsible to oneself (as an adult, Jonathan is legally responsible for himself), but, does not have the power or resources to act upon it, is confusing, and ethically questionable (Holm, 2014).
Appling the principles of non-maleficence and beneficence in ethics, although the patient has relayed the information and his wish to end his life as a confidential information to the nurse, it is imperative that the information is shared with the physician. The principle of beneficence suggests the use of information to provide a positive outcome, and thus, do good for a person (Jie, 2015). Hence, here, if the nurse has to apply the principle of beneficence and help Jonathan, the information needs to be shared with the health care professionals and relief sought, in the form of a guidance and treatment from mental health experts. The principle of non-maleficence, however, suggests performing a deed that the patient considers right, or it is beneficial for the patient, according to his own predictions. Thus, relating Jonathans wish to end his life, and seeking the help of a mental health professional is not something that Jonathan might want, and therefore, might not be to his advantage. Jie suggests, therefore, to take heed of patient’s own perspective about harm and benefit, while applying the non-maleficence and beneficence principles of ethics to a case study.
Persons withsuicidal tendencies need to be treated with a thorough understanding of their problems, and the root cause of it. Hence, certaininterventions from the nursing professionals can aid in keeping the suicidal tendencies of the patient in control.
In Jonathan’s case, he is a youth in his prime, with a promising career ahead of him, once he finishes his training. So, what made him think of the extreme step, is something that needs to be analysed. Getting to the root cause can help the nurse to work out a treatment plan. It is imperative to speak to Jonathan about his life and help him to pour out his troubles for the professionals to analyse and chart a method of treatment.
A person with suicidal tendency might be amenable to any kind of treatment, if they can make him talk to the nurse about the reasons for his suicidal attempt. Jonathan here, has shared enough information to the nurse in the emergency department about the problems he is facing in life, and has also shared that he wants to die. This thought in mind shows Jonathan has strong suicidal tendencies and needs to be addressed by constantly monitoring him, while in the hospital, and even after he goes home. A person with suicidal tendency might reveal facts like talking about death all the time, and thinking of ways to hurt themselves, and expressing feelings of hopelessness. Safe clinical practices, patient – centred interventions and interpersonal communication and collaboration, are some of the ways to aid the patients with self-destructive thoughts. (Puntil et.al, 2013). Listening carefully to the patient, and recording signs and symptoms of distress can help in taking action when required. An open talk (establishing a therapeutic relationship), can help in identifying the weaknesses and also in finding the cause for suicidal tendencies.
Relevant Interventions for Urgent Mental Health Risks
Another fact, which can help in Jonathan’s case is to teach the family and primary care provider about possible symptoms to monitor and provide hotline numbers to contact emergency, if and when help is required. Keeping a track of things that looks like the person’s reactions and his erratic behaviour during the hospital stay is easier for a nurse, since he is under 24 hour supervision of medical professionals. However, doing it at home is the responsibility of the parent, or any primary care provider. Although Jonathan might not require a 24 hour care, the family members need to be taught about certain aspects to look for, to identify potential risk and prevention. Keeping self-medications out of reach and things like, monitoring, for any signs of depression, and not leaving patients to be alone for too long, might help (Sarah, 2015).Questioning the family members after narrating them with the preparatory actions to be taken can keep them ready for action, when required. This can help the family members to be alert for any small signs to take instant preventive action. Also, in the case of Jonathan, with his case history, the family members should be taught to keep medications away from his reach, and also any other material susceptible to suicide.
Finally, gaining the trust of both the patient and the family members can be a significant and essential intervention to prevent Jonathan from taking this course of action again. Since the family members and the girlfriend, are going to play a significant role in the Jonathans treatment plan, it is essential to involve them at each stage to make the effort successful. Referring them to mental health care agencies and counselling the patients through external source can be the next course of action.
Anxiety is one of the mental health concerns that needs to be addressed due to its potential risks, if left uncontrolled. Anxiety, can be defined as an uneasy or a vague feeling of dread and discomfort, and always accompanied by an automatic response. The source of anxiety in a person is unknown, and usually is a signal or an apprehension for an impending danger. Since everyone is susceptible to anxiety of one magnitude or another. Anxiety interferes with the ability of a person to act normally during a situation and thus, the person can lose concentration, and show visible signs of distress outwards, such as tremors and tachycardia (Lader, 2015)
One of the most significant factors in the treatment of a patient with an anxiety disorder is to maintain calmness while talking to the client, and remain with them, while they are in a highly anxious state. Anxiety can lead to serious threats to self and thus, it is essential to bring them out of that situation. Also, a client will calm down and feel secure, if the person handling them is calm and collected. Talking to them softly, and addressing the concerns they might have, regarding the apprehension, can help them open up to suggestions and treatments. A nurse can recognize the three facts by gaining the trust of the patient – ABC – Alarms, Beliefs based upon previous incidents which has resulted in the present condition and Coping mechanisms, which can be identified as effective, or not over a period of time (Bystritsky, 2013) These facts, then can be applied in the treatment process, to help patients deal with their disorder.
Identifying Mental Health Problem/Need and Relevant Interventions
Similarly, anxiety, as Nathan and Gorman (2015) believe, can be treated with the use of CBT- cognitive behavioural therapy. Putting the client’s perspective into place, recognizing the patterns of anxious behaviour and incorporating methods to transform those thoughts into positive outputs can help a patient in overcoming the fears and anxiety.
A highly anxious patient might pose a threat to not only himself, but others around. Similarly, their anxiety might escalate, in such instances. Also, a client will calm down and feel secure, if the person handling them is calm and collected.Hence, applying the CBT can be a challenging process, unless the nurse can talk to them softly, and write downthe situations which causes apprehension and uncertainty. CBT has been applied to patients with extreme depression symptoms and suicidal tendencies, and have been found to be beneficial in both cases.Applying CBT involves teaching the patients about the coping mechanism and helping them to change their outlook to a positive one. A person, afraid of the dark, or getting anxious in a crowded room can either get out of the room, or learn to block out the crowd with defence mechanism. Although, since each patient is unique, and each situation differently, as Kaczkurkin and his co-authors (2015) concludes, itis essential to determine which component can be used in what situation, to make it effective.
References
Armstrong, G., Pirkis, J., Arabena, K., Currier, D., Spittal, M. J., & Jorm, A. F. (2017). Suicidal behaviour in Indigenous compared to non-Indigenous males in urban and regional Australia: Prevalence data suggest disparities increase across age groups. Australian & New Zealand Journal of Psychiatry, 000486741770405. doi:10.1177/0004867417704059
Bystritsky, A., Khalsa, S. S., Cameron, M. E., & Schiffman, J. (2013, January). Current Diagnosis and Treatment of Anxiety Disorders. Retrieved September 02, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628173/
Grenklo, T. B., Kreicbergs, U., Valdimarsdóttir, U. A., Nyberg, T., Steineck, G., & Fürst, C. J. (2014, April 04). Self?injury in youths who lost a parent to cancer: a nationwide study of the impact of family?related and health?care?related factors. Retrieved September 02, 2017, from https://onlinelibrary.wiley.com/doi/10.1002/pon.3515/full
Lawrence , D., Johnson, S., Hafekost, J., Haan, K. D., & Sawyer, M. (2015, August). The Mental Health of Children and Adolescents . Retrieved September 1, 2017, from https://www.health.gov.au/internet/main/publishing.nsf/Content/9DA8CA21306FE6EDCA257E2700016945/%24File/child2.pdf
Holm, A. L., & Severinsson, E. (2014). Reflections on the ethical dilemmas involved in promoting self-management. Nurs Ethics, 21(4), 402-413.
Jie, L. (2015, December). The patient suicide attempt – An ethical dilemma case study. Retrieved September 01, 2017, from https://www.sciencedirect.com/science/article/pii/S2352013215000149
Lader, M. (2015, January 01). Generalized Anxiety Disorder. Retrieved September 02, 2017, from https://link.springer.com/referenceworkentry/10.1007%2F978-3-642-36172-2_317
Longbottom, J. (2016, November 29). Suicide rates for young Australians highest in 10 years. Retrieved September 01, 2017, from https://www.abc.net.au/news/2016-11-30/system-for-suicide-prevention-rates-highest-10-years/8076780
Nathan, P. E., & Gorman, J. M. (2015). A guide to treatments that work. Oxford: Oxford University Press.
O’Connor, P. J., Martin, B., Weeks, C. S., & Ong, L. (2014, April 09). Factors that influence young people’s mental health help seeking behaviour: a study based on the Health Belief Model. Retrieved September 02, 2017, from https://onlinelibrary.wiley.com/doi/10.1111/jan.12423/full
Puntil, C., York, J., et al. (2013). Competency-Based Training for PMH Nurse Generalists. Journal of the American Psychiatric Nurses Association, 19(4), 205-210.
Ricci, C. (2015, August 26). Mental health rates a key influence on young people’s education outcomes. Retrieved September 01, 2017, from https://www.smh.com.au/national/education/teenage-depression-and-suicide-rates-make-mental-health-an-education-issue-20150826-gj883d.html
Rich, J. L., Byrne, J. M., Curryer, C., Byles, J. E., & Loxton, D. (2013). Prevalence and correlates of depression among Australian women: a systematic literature review, January 1999- January 2010. BMC Res Notes, 6, 424.
Robinson, J., Too, L. S., Pirkis, J., & Spittal, M. J. (2016). Spatial suicide clusters in Australia between 2010 and 2012: a comparison of cluster and non-cluster among young people and adults. BMC Psychiatry, 16, 417.
Sarah, B. R. (2015, June 11). Nursing Care Plan and Diagnosis for Risk for Self Harm Related to | Suicide, Depression Nanda Nursing Interventions and Outcomes. Retrieved September 01, 2017, from https://www.registerednursern.com/nursing-care-plan-and-diagnosis-for-risk-for-self-harm-related-to-suicide-depression-nanda-nursing-interventions-and-outcomes/
Strauss, C., Cavanagh, K., Oliver, A., & Pettman, D. (2014). Mindfulness-Based Interventions for People Diagnosed with a Current Episode of an Anxiety or Depressive Disorder: A Meta-Analysis of Randomised Controlled Trials. Retrieved September 02, 2017, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0096110
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