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Social Determinants Of Social And Emotional

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Question:

Discuss about the Social Determinants of Social and Emotional.
 
 

Answer:

Introduction:

Justin’s journey was not smooth growing up. Belonging to a community that was culturally distanced from the mainstream way of Australian life, Justin had difficulty coping with the bullying at high school. At 16, Justin had to drop out from school owing to his father’s ill health (Healthinfonet.ecu.edu.au, 2017). When his father’s health improved and Justin began to look for jobs and even started working as a transport driver, another incident happened that changed his life. Uncle Reggie, who was very close to him, passed away from heart attack. This event shook Justin from the core and he was unable to recover from the shock. His well-being was hugely impacted by this incident.

All these life-events deeply affected Justin’s well-being. Purdie, Dudgeon and Walker (2010), have identified certain factors that affect the well-being of Aboriginal peoples especially children. These comprise educational experience and alteration, parting from parents, death of close ones and so on.  Justin’s life was affected by these factors as mentioned. He had a difficult transition to high school and had to drop out and he had lost his family member as well.

Justin comes from the Aboriginal community and hence his upbringing would be different from other Australians. His culture, tradition and ideologies would also be unique to Aboriginal peoples. This leads to the fact that Justin’s mental health is bound to be interpreted differently by Aboriginal peoples and those by other Australians (Browne et al. 2012, p. 59). According to the Aboriginal peoples, their way of interpreting emotion and social well-being is markedly different from the Western understanding of psychological healthiness. To the Aboriginal peoples, an individual’s culture, his spirituality, family, ancestry and community form the core of his life. Any disturbance or alteration in any of these facets may lead to mental illness.

Justin’s later predicament was due to the disturbances in his social life. First was his unwanted experience in high school where he used to be bullied. Then his father’s ill health forced him to drop out of school. Thirdly, he lost his interest in searching for or doing any job, as he could not achieve his desired goal.  His mental health deteriorated further after the death of his uncle (Harlow & Clough 2014, p. 310). All these indicate the difference in the interpretation of mental health of Aboriginal peoples being different from others.

 

In order to help Justin come out of his mental trauma, one has to understand the complexities of his problem. To Aboriginal peoples, material belongings hold little value as do emotional and psychological possessions (Kelaher, Ferdinand & Paradies 2014, pp. 45-6). One has to acquire the understanding of the values and traditions of Aboriginal peoples to communicate with him. To a common Australian, it might be difficult to comprehend the desires and necessities of an Aboriginal individual, as their way of life is very different from others. In addition, the impact of the low socio-economic condition of Aboriginal peoples also contributes to their mental illness (Beyondblue.org.au 2017). However, those belonging to a socio-economically sound family might not value the Aboriginal people’s problems and it leads to a gap in communication.

Justin too had to face communication problems with his peers during high school that lead to him being bullied. This provides an instance that Aboriginal peoples need to be talked to in the way they can comprehend. Thus, if a healthcare practioner wants to communicate with Justin regarding his mental illness, one has to first recognize his actual problem and value his social and economic background (YouTube 2017). Once the attitude towards Aboriginal peoples altered, it would be easier for the healthcare practitioner to communicate with Justin and help him.

Answer 4: Family connection is most valued in Aboriginal cultures. Family gives them a collective identity. When a child goes through the phase of depression, it is important for the healthcare practitioner to contact his family and develop a bond with them. Family might include uncles, aunts and cousins as well. In case of Justin, his extended family was more close to him than even his immediate family. He was devastated by the death of his Uncle Reggie.

To help Justin recover from his mental condition, it is imperative for the health care staff to develop a good bond not only with Justin but also with his family. A healthcare practitioner has to follow certain things in order to establish a partnership or bond with Justin and his family. Respect towards their social and cultural background should be the top priority for a healthcare practitioner in order to develop partnership with Justin or his family. The healthcare practitioner must understand the fact that Justin has great value and respect for his family and community (YouTube 2017). Keeping this mind, he or she can approach Justin and start conversing with him on these topics. The same thing can be done to develop bond with Justin’s immediate and extended family. This would certainly assist in speeding up Justin’s recovery process.

 


It is not easy for a healthcare practitioner to advice an Aboriginal child to visit a doctor outside his community and go to the city. There are strict norms and rules that bind the community and its children. Justin too belongs to this community and hence, being taken to the city for further treatment might have some serious implications – both social and cultural. The Aboriginals and Torres people have a Child Placement Principle that incorporates the bindings and conditions for a child to be taken away from his family and community. According to this principle, the families of Aboriginals and Torres Strait Islander community must be informed prior to the child being taken away from them (Supportinghealthcare practitioners.snaicc.org.au 2017). The end decision remains with the family of the child whether he could leave or not.  Justin being an Aboriginal cannot be simply taken to the city for treatment. Several factors have to be considered before his placement. The healthcare practitioner has to make sure that his extended family or kin, any member within the community, or any member from another Aboriginal peoples group accompanies him to the city.

Looking at the history of Aboriginal children being separated from their families, taking Justin to the city for treatment following the principle is mandatory.

Cultural safety refers to the treatment provided by the healthcare professionals where they acknowledge the cultural beliefs of the patients while treating them (Jorm et al. 2012, p. 118). While treating the Aboriginal people feel distanced from the mainstream health services for the reason that they were not valued and respected. Thus, the health practitioner must keep this in mind and approach Justin accordingly. Once Justin is taken to the City General Hospital, it has to be made sure that he receives complete mental and emotional support from the nursing staff.

It is important to remember for the health practitioners that Justin hails from the Aboriginal community and thus his cultural beliefs would be different from them. It is not mandatory for the practitioners to do thorough research on the cultural beliefs and practices of Aboriginal people (Heffernan et al. 2012, p. 37). However, they must recognize and respect his culture and the beliefs associated with it. Justin must feel a sense of comfort while in the hospital where he shall find that the health practitioner does not suspect or laugh at his ideas, cultural beliefs or concerns.

 


The areas of concern as mentioned in the Mental State Examination of Justin are: weight loss, slow to respond, disinterested in life, feeling of worthlessness, tendency to harm self, diurnal mood variation. Overall, Justin clearly demonstrated the symptoms of clinical depression (Werner & Stawski 2012, p. 300). Justin expressed with limited words when asked about his present condition and confessed that he did not wish to be treated.  He also revealed that he often intended to end his life but gave up the idea for the sake of the well-being of his parents and his community.

The concerned doctors have identified certain areas as top priorities for Justin’s treatment. Justin will be observed through observation levels of 15 minutes giving specific attention to his interactions, behavior and actions. All the objects that might prompt Justin to harm himself shall be removed from his reach (Hunter 2014). Continuous care to be provided to Justin by establishing a therapeutic relationship. He will also be given the opportunity and the environment to identify his weaknesses and strengths. The staff will encourage Justin to establish supportive relationships beyond the confinements of the hospital. Prescribed medication shall also be administered.

In order to communicate with a patient suffering from clinical depression, a health professional must be extremely careful not to be loud or authoritative (Doyle 2012, p. 50). Establishing a rapport while interacting, using the appropriate language and gesture, maintaining correct eye contact are amongst some of the basic skills required for a health professional to communicate with Aboriginal people going through depression (Health.qld.gov.au 2017). The healthcare professional must demonstrate a cultural understanding of the Aboriginal people.

John Brody, the health professional, made sure to meet and greet Justin in a friendly and warm manner. He encouraged Justin to share his feelings in the beginning and be open about it. The health professional managed to form an environment where Justin could freely share his thoughts, beliefs, and concerns about his present predicament (Swain & Gale 2014, p. 1242). He ensured avoiding jargons and complicated sentences that might confuse Justin.

It is bounding on a health professional to approach a patient with clinical depression in a friendly manner and establish a bond with the individual (YouTube 2017).

 


Justin was admitted to the City Hospital in April of 2014 on grounds of clinical depression and suicidal ideation. After three months, Justin showed signs of marked improvement and was deemed fit to be discharged. Justin was advised to consult the Community Mental Health Nurse, visit Aboriginal Health Service GP and Aboriginal Health Worker as follow up. This would assist him in recovering further after going back home. Under the relapse prevention plan, it was advised the Aboriginal Health Worker would visit Justin after discharge on weekly basis. The recovery plan mentioned involvement of Justin’s family in helping him re-engage with his tradition, culture and law. He is to be encouraged to take up his old job or find a new one as he wishes (Weller, Boyd & Cumin 2014, p. 150). His medication is to be reduced gradually after he displays signs of total recovery. In the three months under observation and treatment, Justin showed an improved zeal to participate in various activities and interact with the hospital staff and other people. Adding to that, Justin has also displayed a positive frame of mind and has expressed his desire to work after he returns home.

To an individual aloof from the culture and traditions of the Aboriginal people, it is difficult to relate to their problems or troubles. I had the experience to meet some people from different cultures especially the Aboriginal community. With each meeting, I discovered very different and fascinating things about those cultures and developed an interest to know more about them. Moreover, it is important in my practice that I learn and know about people from different cultures so that I could assist them better. Illness like T2DM or clinical depression is not confined to any particular culture but the rate of occurrence tends to be higher in some. Justin’s case affirms this notion. The Aboriginal people’s way of life compels one to be involved in certain rituals and ceremonies that often compromise one’s health. Justin was diagnosed with T2DM at an early age of 15, which is a rare occurrence in non-Aboriginal cultures (Aguilar et al. 2012, p. 210). Further, his journey from being a clinical depression patient to a healthy person demonstrated how people from different cultures needed to be cared.

I have learnt I need to be aware of the different cultural backgrounds while dealing with patients and must respect and value them. It is imperative for me to make them feel comfortable and culturally safe by demonstrating knowledge and respect about their culture and their feelings.

 

References:

Aguilar, A, Stupans, I, Scutter, S & King, S 2012, ‘Exploring professionalism: The professional values of Australian occupational therapists’, Australian Occupational Therapy Journal, vol. 59, no. 3, pp.209-217.

Beyondblue.org.au. 2017. Beyondblue, [online] [Accessed 20 Nov. 2017], Available at: <https://www.beyondblue.org.au/the-facts/depression>

Browne, AJ, Varcoe, CM, Wong, ST, Smye, VL, Lavoie, J, Littlejohn, D, Tu, D, Godwin, O, Krause, M, Khan, KB & Fridkin, A 2012, ‘Closing the health equity gap: evidence-based strategies for primary health care organizations’, International Journal for Equity in Health, vol. 11, no. 1, p.59.

Doyle, K 2012, ‘Measuring cultural appropriateness of mental health services for Australian Aboriginal peoples in rural and remote Western Australia: a client/clinician's journey’, International Journal of Culture and Mental Health, vol. 5, no. 1, pp.40-53.

Harlow, AF & Clough, A 2014, ‘A systematic review of evaluated suicide prevention programs targeting indigenous youth’, Crisis: The Journal of Crisis Intervention and Suicide Prevention, vol. 35, no. 5, p.310.

Health.qld.gov.au 2017, [online] Health.qld.gov.au, [Accessed 23 Nov. 2017], Available at: <https://www.health.qld.gov.au/__data/assets/pdf_file/0021/151923/communicating.pdf>.

Healthinfonet.ecu.edu.au 2017, Review of diabetes among Aboriginal and Torres Strait Islander people « Reviews « Diabetes « Chronic conditions « Australian Indigenous HealthInfoNet. [online] Healthinfonet.ecu.edu.au, [Accessed 20 Nov. 2017], Available at: <https://www.healthinfonet.ecu.edu.au/chronic-conditions/diabetes/reviews/our-review>.

Heffernan, EB, Andersen, KC, Dev, A & Kinner, S 2012 ‘Prevalence of mental illness among Aboriginal and Torres Strait Islander people in Queensland prisons’, Medical Journal of Australia, vol. 197, no. 1, p.37.

Jorm, AF, Bourchier, SJ, Cvetkovski, S & Stewart, G 2012, ‘Mental health of Indigenous Australians: a review of findings from community surveys,’ Medical Journal of Australia, vol. 196, no. 2, p.118.

Kelaher, MA, Ferdinand, AS & Paradies, Y 2014, ‘Experiencing racism in health care: the mental health impacts for Victorian Aboriginal communities’, The Medical journal of Australia, vol. 201, no. 1, pp.44-47.

Purdie, N, Dudgeon, P & Walker, R 2010, ‘Chapter 6 - Social Determinants of Social and Emotional Wellbeing’ in Working together Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, Dept. of Health and Ageing, Australian Council for Educational Research, Kulunga Research Network, Telethon Institute for Child Health Research Australian Institute of Health and Welfare, Canberra.

Supportinghealthcare practitioners.snaicc.org.au 2017. Child Placement Principle - Supporting Healthcare practitioners (SNAICC). [online] Supporting Healthcare practitioners (SNAICC). [Accessed 20 Nov. 2017], Available at: <https://www.supportinghealthcare practitioners.snaicc.org.au/rights-of-the-child/child-placement-principle/ >

Swain, N & Gale, C 2014, ‘A communication skills intervention for community healthcare workers reduces perceived patient aggression: A pretest-postest study’, International journal of nursing studies, vol. 51, no. 9, pp.1241-1245.

Weller, J, Boyd, M & Cumin, D 2014, ‘Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare’, Postgraduate medical journal, vol. 90, no. 1061, pp.149-154.

Werner, S & Stawski, M 2012, ‘Mental health: Knowledge, attitudes and training of professionals on dual diagnosis of intellectual disability and psychiatric disorder’, Journal of Intellectual Disability Research, vol. 56, no. 3, pp.291-304.

Youtube.com 2017. Aboriginal Mental Health and Suicide Prevention - Dr Tracy Westerman. [online] YouTube, [Accessed 20 Nov. 2017], Available at: <https://www.youtube.com/watch?v=bn1QjGn4xnM&feature=youtu.be>

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