Understanding The Impact Of Culture On Mental Health Care Delivery: A Case Study Essay.

Work through the six modules outlined in Justin O’Dowd’s journey through the care pathway for his mental illness. A selection of 10 questions associated with the learning journey follow. This assignment asks you to respond to all 10 questions using the materials provided and using any other literature that will support your answers.

1.Describe how Justin’s health and well-being might be impacted by his recent life events.

2.How might Justin’s cultural interpretation of mental illness be different from your own?

3.Identify how your own attitudes and values relating to mental illness may influence any communication with Justin?
4.How can partnerships with Justin and his immediate and/or extended family be developed and maintained throughout his journey of care to enhance recovery.
5.What are the social and cultural implications for Justin leaving his home and community for assessment and treatment in the city?
6.What needs to happen to ensure culturally safe care for Justin once he is hospitalised?

7.From the information in the Mental Health Assessment and Mental State Examination, what are the identified areas of concern and the priorities of care planning for Justin?

8.Read the 1:1 intervention notes and identify the communication skills/strategies that are allowing the health professional to talk with Justin in a culturally safe and recovery focused manner.
9.Review the discharge plan and 3-month review and consider how Justin can be supported to continue on his path of recovery and maintain his well-being when he returns to his family and community.

10.After considering the issues for Justin, reflect on your own experiences of relating to people from different cultures. Consider what you have learnt from Justin's story and how your new knowledge might influence your practice.

The risk factors associated with Type-II Diabetes and Depression in Justin

Describe how Justin’s health and well-being might be impacted by his recent life events.

The case study states that the risk associated with Type-II Diabetes, had been prevalent in the O’Dowd’s family pertaining to the genetic influence. This can be counted as an important factor that led to the manifestation of Diabetes-type II in Justin. Further, the poor economic status of the family has acted as a major obstacle in availing appropriate treatment interventions. Research studies state that families belonging to lower economic groups are often exposed to a high risk of developing disorders such as Diabetes type-II (Tilamn and Clark 2014). Also, Justin had been affected by the condition at an early age and this led to harbouring depressive thoughts. The client has reported to feel low and unworthy of himself. Also, another major contributing factor for the promotion of poor mental health can be defined as the episode of bullying faced by the client in his high school. It can be said that bullying has elicited symptoms of depression in the client (Almutairi et al. 2015). Also, the case study reports that the client lost his uncle who was dear to him and this could also negatively affect the emotional equilibrium of the client. The client has reported to feel extremely active and positive about himself during his high school days, primarily because he was not subjected to episodes of bullying (Holt et al. 2015). Therefore, the factors mentioned above can be probable contributors in deteriorating the physical as well as mental health status of the client.

In close association to the case study, it has been mentioned that Justin belongs to the aboriginal community. The indigenous community perceives mental health to be an influence of balck magic and an evil spirit influence (Brooker and Waugh 2013). I am a Christian and there is stark contrast in the perception of mental health disorders between my community and the indigenous community. My community perceives mental health disorders as a condition that requires immediate attention. There is no discrimination made in the way a challenged person is perceived by the community members. In fact, there are a number of community support organizations who aim at providing assistance to the mental health patients depending upon the type of their disorder.

I am a Christian and my religion and traditional beliefs expect me to be kind and generous to all. At the same time, I have taken up the noblest profession as my career prospect. As a nursing student, I have been trained in cultural competency. Hence, according to my perspective I believe that with reference to the knowledge that has been delivered in terms of the cultural competence models used in nursing and my practicum experience, I would be able to carry out an effective and culturally safe communication with Justin.  I firmly believe that mental illness should not be associated with social stigma. It is just an unstable state of mind that can affect any individual at any age (Carey 2015). It is important to reflect upon the condition of the affected individual and support the patient in order to speed up the recovery process. It is essential to understand the underlying cause of the development of a specific mental illness and devise an appropriate recovery intervention (Ferdinand et al. 2013).

The difference in perception of mental health disorders among different communities

As has already been mentioned in the case study, the client is depressed in relation to his recent life-events. In order to devise an effective care plan for Justin, it is important to maintain a positive patient-centred approach. It can be said that because Justin does not have a social circle, the care approach should be build upon following a family-centred approach. Involving Justin’s parents would help in speeding up the recovery process. Educating the family members about Justin’s risk factor would help in designing a risk free environment for Justin (Herring et al. 2013). It would also help in ensuring that Justin is not left alone at any point of time as that would lead to the occurrence of feelings related to worthless, self-guilt and demotivation (Holt et al. 2015).  

As Justin hails from the aboriginal community. It can be said that leaving his home and community can elicit feelings related to homesickness and cultural gap. It should be noted here that Justin has already had a bad experience related to the episodes of bullying that he had faced in his High School. Hence, Justin would be concerned about the manner in which he treated on leaving his home and going to the city to avail his treatment. Studies predict that societal distance can lead to feelings that would harbour feelings of depression and anxiety (Horvat et al. 2014)

In order to ensure a culturally safe care, it is important to ensure that Justin is placed under the care of health care professionals who are culturally competent. The best recommendation could be to designate professionals belonging to the indigenous background as his immediate care givers, so to provide a culturally safe care (Kelaher 2014). This would make Justin comfortable and he would be able to trust the devised treatment procedure. He should be educated about his medical health condition and the professionals should comply with the ethical guidelines so as to provide an effective care delivery.

From the MSE score, it can be said that the identified areas of primary concern is the presence of ‘suicidal ideation’ and ‘Mood and affect’. The client has reported to feel extremely low in the mood and during the evaluation had very limited eye contact. The client has further reported to feel extremely unworthy of himself and has also reported to harbour suicidal thoughts (Parker and Milroy 2014). The client had also stated that he had a bleak future and that his existence was futile. He had terribly lost weight and experienced abnormality in his sleep pattern. Hence, the identified areas of concern would be mood and affect and suicidal ideation.

The importance of cultural competence in health care professionals

The communication style adopted by a professional to engage in the process of counselling can either elicit hope and optimism or can even lead to the worsening of the situation. It should be noted here that the health care professional engaged in the conversation with Justin is talking in a respectful manner. This can be counted as an effective example of conducting the interview in a culturally safe manner. It should also be noted that talking about suicide is a sensitive issue hence the professionals must be cautious while dealing with such sensitive themes (Rotenstein et al. 2016). Another important phenomenon is to be able to relate with the cultural and historical background of the patient (Thackrah and Thompson 2013). All these instances have been portrayed in the conversation style of the professional.

Justin had been discharged on the basis of his testimony that he had confessed to the Aboriginal Liason Hospital Officer. However, I feel that the decision of discharging Justin was not completely correct. Justin had been evaluated to be critically depressed and he had still been experiencing problems with his sleep pattern and his ability to manage his personal hygiene. Hence, it can be predicted that on going home, the situation would further worsen because Justin is still vulnerable and is not completely cured. According to my knowledge and experience, I feel that Justin must be accompanied by a home-care nurse who would accompany Justin to his home town and would help him for a while to get accustomed to his family environment. This would not only help in making the process of transition easier but would also help in making the family members aware about Justin’s present medical health status and thereby create a safe environment around him (Walker et al. 2014).

I have had the opportunity to deal with a diverse group of clients belonging to different cultural and religious background. Initially, I found it extremely difficult to be able to carry out an effective communication. However, with my clinical experience and theoretical concept on cultural safety models, I have been able to improve on my skills. The informative case study on Justin has helped in developing a clear understanding about the communication style that must be adapted while dealing with aboriginal patients. Further, it has also helped me in relating better to the indigenous patients and possess a deeper understanding about the existing policies designed to help the indigenous population base of Australia.

References:

Almutairi, A.F., McCarthy, A. and Gardner, G.E., 2015. Understanding cultural competence in a multicultural nursing workforce: Registered nurses’ experience in Saudi Arabia. Journal of Transcultural Nursing, 26(1), pp.16-23.

Brooker, C. and Waugh, A., 2013. Foundations of Nursing Practice E-Book: Fundamentals of Holistic Care. Elsevier Health Sciences.pp.117

Carey, M., 2015. The limits of cultural competence: an Indigenous Studies perspective. Higher Education Research & Development, 34(5), pp.828-840.

Ferdinand, A., Paradies, Y. and Kelaher, M., 2013. Mental health impacts of racial discrimination in Victorian Aboriginal communities. Lowitja Institute.

Herring, S., Spangaro, J., Lauw, M. and McNamara, L., 2013. The intersection of trauma, racism, and cultural competence in effective work with aboriginal people: Waiting for trust. Australian Social Work, 66(1), pp.104-117.

Holt, M.K., Vivolo-Kantor, A.M., Polanin, J.R., Holland, K.M., DeGue, S., Matjasko, J.L., Wolfe, M. and Reid, G., 2015. Bullying and suicidal ideation and behaviors: a meta-analysis. Pediatrics, pp.peds-2014.

Horvat, L., Horey, D., Romios, P. and Kis?Rigo, J., 2014. Cultural competence education for health professionals. Cochrane database of systematic reviews, (5).

Kelaher, M.A., 2014. Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities. Education, 55(56), pp.8-3.

Parker, R. and Milroy, H., 2014. Aboriginal and Torres Strait Islander mental health: an overview. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. 2nd ed. Canberra: Department of The Prime Minister and Cabinet, pp.25-38.

Rotenstein, L.S., Ramos, M.A., Torre, M., Segal, J.B., Peluso, M.J., Guille, C., Sen, S. and Mata, D.A., 2016. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama, 316(21), pp.2214-2236.

Thackrah, R. and Thompson, S., 2013. Refining the concept of cultural competence: building on decades of progress. Medical Journal of Australia, 199(1), pp.35-38.

Tilman, D., and Clark, M. 2014. Global diets link environmental sustainability and human health. Nature, 515(7528), 518.

Walker, R., Schultz, C. and Sonn, C., 2014. Cultural competence–Transforming policy, services, programs and practice. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, pp.195-220.