Impact of Traumatic Life Events on Mental Health
Life events have a significant impact on the mental health of an individual. As mentioned by Cleland et al. (2016) traumatic life events have been reported to be a significant contribution factor leading to date order dated mental health statements and preparing the individuals towards mental disorders such as anxiety depression and personality disorder. In case for Justin as well, the traumatic life events that he encountered while growing up had a significant detrimental impact on his mental health which can be considered as factor that propelled and accelerated his depression. Although Justin had been an active and healthy growing child in the primary school, his life started to change since his high school. He encountered bullying and racial discrimination in the high school which affected his mental health and in turn his progress in school. As discussed by Cleland et al. (2016) racial discrimination and bullying is one of the most fundamental dramatic life events that culturally diverse children have been reported to go through which had eventually in practice their mental health into the point of acquiring different mental and behavioural disorders. It has to be mentioned in this physical environment is a notable social determinant of health and a discriminatory environment undoubtedly has severe adverse effects.
As discussed by Wallace, Nazroo and Bécares, (2016), cumulative exposure of racial discrimination and bullying has incremental negative impact on mental health, especially for adolescents belonging to ethnic minorities due to the impressionable minds. Another important traumatic life event for Justin had been his father’s illness which led to him dropping out of studies and losing his apprenticeship and the death of his beloved uncle Reggie, with whom, Justin had a significantly strong bond. Bereavement of a loved one undoubtedly is one of the most severe trauma and its impact is also lasting and of much higher magnitude. Death of a loved one has a range of detrimental impact and can even lead to suicidality depending on the nature of kinship (Pitman et al., 2014). Hence, these traumatic life events have gradually affected the mental health of the patient in the case study.
The aboriginals are the first people of Australia that have been living in the Australian lands for thousands of years and this traditional community has a very distinct perception of health and wellbeing. Their traditional and deep rooted ancestral spirituality can be considered as one of the most important aspects associated with their understanding and perception of health, both physical and mental. Their understanding of health is holistic, encompassing physical, emotional, psychosocial and spiritual healthy state. As discussed by Bombay (2015), aboriginal culture depicts sound mental health as an optimal state of social and emotional wellbeing; and on the other hand, mental illness as the gaping lack of the same. On the contrary, our understanding of mental health is far from this multimodal perception. Our understanding of mental health is limited to the cause and its clinical manifestations. Although, the aboriginals recognize the mental illness as a continuum which is linked with the background, physical environment and the lived experience of the individual suffering from mental illnesses.
Cultural Perceptions of Health and Mental Illness Among Aboriginals
Aboriginals have a strong bond with their ancestral traditional and spirituals, and in most cases, their health; especially mental health and wellbeing is intricately linked with their cultural identity and spirituality. While accessing care, the lack of the cultural safety and appropriateness is one of the most fundamental aspects that contributes to extremely low mental health help seeking behavior among the Australian aboriginals. The most important aspect here is communication, which is key to developing therapeutic relationship with patients and urging their utmost co-operation and contentment. However, the western influence on the health care services might have a profound impact on the approach of the carer as well. In case of Justin, the care and communication approach plays a fundamental role in providing him comfort and willingness and hope to recover. The western model of mental health and care delivery focuses entirely on the symptomatic relief rather than holistic care. Hence, in case the traditional means of care and culturally safe communication is not provided to him, he might be offended and the recovery progress might get disrupted. Being a care provider of the western background with limited knowledge about this ethnic group, my tone of voice, posture, gesture and eye contact might be disruptive or restricting factors.
Aboriginals have a strong familial bond, their understanding of health and wellbeing of health is significantly linked with their family and loved one as well. Family support has been identified as a strong support network which can help accelerate the process of recovery for mentally ill patients and along with that, it can also help in empowering and encouraging the mentally ill to fight the illness (McCalman et al., 2017). In case of Justin as well, integration of the family members into the care can significantly improve the condition for him. Family centred care is a useful framework which can be accessed to successfully develop partnerships with the family members of Justin. As discussed by Coyne (2015), family centered care encompasses the family to have the shared decision making power and involvement in the care planning and implementation of the care provided in collaboration of the care providers. In this case, a multidisciplinary care team involving traditional healer, language interpreter, aboriginal cultural expert, cultural liaison officer and an aboriginal patient educator can help the family contribute and collaborate with the psychotherapist and mental health nurse to collaborate in Justin’s care (Mental Health Commission of NSW, 2018).
Australian aboriginals tend to have a strong view and perception towards their physical environment. They are much more comfortable and safe in their houses and they are rarely content with their surroundings in situations where they are forced to live the comfort and safety of their homes. Considering hospice stay, most aboriginals tend to avoid it and feel negatively about it due to the strange and sterile environment, the western influence of the physical environment also clashes with their traditional livings styles (Slater et al., 2015). The fear of lack of cultural safety and the loss of comfort and contentment has been reported to instill a fear making the aboriginals regarding having to stay in the hospital, especially for the vulnerable state that the mental patients are in, it can be a huge challenge for Justin to overcome as well. As per Bhi.nsw.gov.au (2018), although, the aboriginal highly rate their hospital stay, when asked about specific of care and stay, their response is usually less positive than the non-natives. Lack of information sharing, lack of cultural safety and care complications have been reported as contributing factors to this negative experience. Hence, in case proper cultural safety is not incorporated, these factors can influence the mental state of Justin and can also lead him to want to discontinue treatment altogether.
Challenges in Providing Culturally Appropriate Care for Aboriginals
Cultural safety is a very important aspect of care and it entails a number of different factors, which needs to be taken into consideration while providing care to an aboriginal. It can be defined as the acceptance to the different cultural differences and respect for the unique cultural identity (Hungerford, 2014). For Justin as well, care needs to be taken to communicate with in a culturally respectful manner. The freedom of choice and empowerment should be provided to him which will help him feel valued and respected. The concepts of traditional healing should also be incorporated with the collaboration of a cultural liaison expert to help in enhancing comfort and contentment during his stay. The six principles of recovery model of care also integrates the aspects of culturally safety excellently. The care providers must respect the uniqueness Justin represented and his cultural identity, respect and honor his real choices, respect his attitudes and rights, safeguard his dignity and respect in care activities, encourage partnership and communication from both the patient and his family members (Health.gov.au, 2018) .
Mental health assessment can be defined as the tool that helps in identification of the mental state that the patient is in and how it affects the mental state of the patient, the exact severity range and helps in determining the treatment trajectory that the patient will require to recover. For Justin, the mental health assessment carried out by Helen, it was discovered that he was most at risk of mental and emotional wellbeing, with the score of 16 – cut off score: 11. The assessment data revealed that Justin had severe self-loathing and lack of sense of self-worth which had been evident from the comments he had been making such as “I am not worthy of worrying about”. Hence, from the mental health assessment score and the different characteristics that have been identified, the risk for self-harm and suicidal ideation. His difficulty to sleep at night indicates the onset of insomnia which has the potential to further complicate his depression (Health.gov.au, 2018). While planning his care, the four key principles of recovery model of care, person 1st and holistic care, supporting personal recovery, organizational commitment and workforce development, and action of the social inclusion and the social determinants of mental health. In this case, care plan must incorporate motivational interviewing and behavioral therapies. Along with that he will need suicide prevention activities as well in his care planning along with collaboration from weight and glucose management care (Parnell, Morris & Jacobs, 2017).
There had been seven session of 1:1 interventions. In the first case, Justin had been expressing his self-loathing for being admitted to the facility however it has been recognized that the care provider did not have knowledge of aboriginal perspectives which was identified and taken into account. The care provider respected his choices and only communicated with him when he wanted to communicate which is a commendable patient centred effective communication technique (Parnell, Morris & Jacobs, 2017). This strategy helped Justin to increase the willingness to talk although his suicidal ideation seemed to intensify. The communication strategy was strength focused which helped him focus on his recover.
Family-Centred Care for Mentally Ill Patients
In order to support Justin to be able to continue on the track of recovery from the depression and maintain optimal well-being after returning back to his family and community, keeping him active and also his mind engaged in some or the other tasks is important. The interdisciplinary members, such as dietician, fitness trainer, and occupational therapist with the collaboration of the psycho-therapist can help him remain active and focussed on his recovery track, after he comes back home (Health.gov.au, 2018).
This activity had given me the opportunity to explore the acre scenario for a culturally diverse patient going through severe depression. I have acquired a wealth of knowledge and expertise regarding how to manage a culturally diverse patient. It has to be mentioned that the physical environment, communication and care approach has a strong impact on the mentally ill patient. This activity has also provided me with the opportunity to understand the impact of the traumatic life events on psyche, along with that following Justin across his self-care journey provided me with the opportunity to understand how to integrate cultural safety in care and family can be incorporated in care planning for accelerated recovery. There is a profound role of the interdisciplinary care members in mental health practice, how they can collaborate with the patients and their family members to support the patient through his journey, even after discharge (McGough, Wynaden & Wright, 2018). This experience changed my mind-set drastically about the care planning and intervention for culturally diverse patients, I have understood a more holistic approach based of optimism and support can provide better care outcomes for patients suffering from mental disorders.
References:
Health.gov.au, (2018). A national framework for recovery-oriented mental health services. Australian health Ministers’ advisory council. [Online] Retrieved from https://www.health.gov.au/internet/main/publishing.nsf/content/67d17065514cf8e8ca257c1d00017a90/$file/recovgde.pdf [Accessed on 3rd Oct]
Bombay, A. (2015). A call to end mental health disparities for Indigenous people. The Lancet Psychiatry, 2(10), 861-862.
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Coyne, I. (2015). Families and health?care professionals’ perspectives and expectations of family?centred care: hidden expectations and unclear roles. Health expectations, 18(5), 796-808.
Health.gov.au, (2018). Department of Health | Principles of recovery oriented mental health practice. [Online]. Retrieved from https://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-i-nongov-toc~mental-pubs-i-nongov-pri. [Accessed on 3rd Oct]
Hungerford, C. (2014). Recovery as a model of care? Insights from an Australian case study. Issues in Mental Health Nursing, 35(3), 156-164.
McCalman, J., Heyeres, M., Campbell, S., Bainbridge, R., Chamberlain, C., Strobel, N., & Ruben, A. (2017). Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review. BMC pregnancy and childbirth, 17(1), 71.
McGough, S., Wynaden, D., & Wright, M. (2018). Experience of providing cultural safety in mental health to Aboriginal patients: A grounded theory study. International journal of mental health nursing, 27(1), 204-213.
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Pitman, A., Osborn, D., King, M., & Erlangsen, A. (2014). Effects of suicide bereavement on mental health and suicide risk. The Lancet Psychiatry, 1(1), 86-94.
Slater, T., Matheson, A., Ellison-Loschmann, L., Davies, C., Earp, R., Gellatly, K., & Holdaway, M. (2015). Exploring M?ori cancer patients’, their families’, community and hospice views of hospice care. International journal of palliative nursing, 21(9), 439-445.
Wallace, S., Nazroo, J., & Bécares, L. (2016). Cumulative effect of racial discrimination on the mental health of ethnic minorities in the United Kingdom. American journal of public health, 106(7), 1294-1300.
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