Word count/duration: There is a word limit of 1500 words. Use your computer to total the number of words used in your assignment. However, do not include the reference list at the end of your assignment in the word count. In-text citations will be included in the additional 10% word count. If you exceed the word limit by more than 10% the marker will stop marking at 1650 words or plus 10%.
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Aim: Students will apply primary health care principles to show their understanding of how they would meet the healthcare needs of individuals and their families/ significant others in the community. They will demonstrate their knowledge of principles related to stress, mental health assessment, risk assessment and management in promoting mental health and wellbeing. They will show their understanding of the lived experience of mental illness and recovery for individuals with mental health concerns and/or illnesses.
Using relevant literature critically discuss the mental health status of the client in the case study.
Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the Diagnostic and Statistical Manual of Mental Disorders V (DSM V) relevant criteria for Depression.
Critically discuss two (2) factors which have contributed to the development of the client’s current mental health status.
You should demonstrate your knowledge of the Stress Vulnerability Model and demonstrate how any history of trauma may impact on the person’s mental health. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature.
Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client’s journey of recovery.
You should demonstrate your knowledge of recovery orientated mental health theory and practice.
Case Study 1: Lucinda Okiro
Lucinda Okiro presented to the perinatal mental health service today for a mental health assessment with her daughter Emily (aged eight months). She and Emily were both well-groomed but Emily was wearing a short sleeved onesie on a cold day. Lucinda was referred for an urgent appointment by her midwife at her antenatal clinic. Lucinda complained of feeling frightened and very unhappy since she found out she was pregnant with her second child. She has known about this pregnancy for one month and is now ten weeks pregnant.
Lucinda is a 22-year-old woman who gave birth to her first child, Emily, eight months ago. There were compli- cations when Emily was born as she was a posterior presentation and labour was prolonged (12 hours). Eventually, Emily was born by a forceps extraction because although the head could be seen, the labour was not progressing. It took Lucinda a long time to feel physically ready to care for Emily. She also said she is exhausted caring for Emily and is still having difficulties sleeping even though Emily was now in a better routine. When speaking about her difficulties caring for Emily, Lucinda becomes tearful and stares at the floor, wringing her hands.
Lucinda immigrated to Sydney from Ghana in 2017 to study accounting and met her partner, Jerome (aged 24 years) who is also from Ghana, at her church. Jerome works in the local supermarket and is also studying accounting. Although he is very happy to share the care of Emily when he is at home, he has to work long hours as he is the only person who is able to bring in a wage. Lucinda hoped that her mother, who she misses very much, might come to Sydney to help her but there was not enough money to pay for her mother’s air ticket. Lucinda says she has no other family in Australia and although Jerome’s family are supportive, they live in Port Macquarie.
At the beginning of her second year at university, Lucinda was shocked to find she was pregnant but continued studying up until she gave birth. She realised after Emily was born that she would have to defer her studies for one year. She says that she feels guilty that she can’t help Jerome more by working. Lucinda is now very upset that she will have to take more time off studying and working because she is having another baby. She is also very worried and scared about the birth.
When she thinks about the birth, Lucinda starts to feel very anxious and finds that she has trouble breathing and when she told the midwife about this, the midwife referred her for further assessment. She is also finding that she feels very unmotivated and that she really doesn’t want to get out of bed in the morning. This makes her feel worse because she believes she is not being a good mother to Emily. Lucinda says that if she feels like this with one baby, she has no idea how she could cope with another baby.
Sometimes Lucinda wonders whether Emily and Jerome would be better off if she was not around but knows that she must try to keep going for the sake of her unborn baby. Today she scored 12 on the Edinburgh Perinatal Depression Scale. She denied thinking about harming herself on question 10. However, she believes that she just feels a little bit worse every day and worries that when the baby is born, she may think differently about whether she needs to remain with her family as the wife and mother. Lucinda says that she feels very lonely and really doesn’t know where to turn to get help.
Munny is a 45-year-old Cambodian man who lives in Western Sydney with his wife, Ary, and their three children, a girl Chan aged 10, and twin sons, Prak and Rith, aged 6 years. He has presented at the community centre with his wife. Ary is very worried that Munny has not been his usual self since he was interviewed by his employer six weeks ago.
Munny has worked in a large bakery for the last five years that supplies bread for large supermarket chains. He finds this job stressful because he has to start work at 1 am but he says that he enjoys his work once he gets there. However, when his employer spoke to him, he was very surprised to learn that his employer was not satisfied with his work and that if it did not improve, Munny would lose his job.
Since that incident, Munny has become less and less communicative at home. He is taking increasing amounts of sick leave and when he is not at work, he spends most of his time in bed. Now he rarely takes notice of his children, who were previously the centre of his attention, and no longer does anything around the house. Ary is also worried because Munny is not showing any interest in food and believes he has lost a significant amount of weight. Ary says that she has tried to talk to Munny but he only speaks in one word answers and says that he is fine and to leave him alone.
Ary tells you that Munny’s family were forced to move from their home into the countryside during the Khmer Rouge period in Cambodia in 1975. His father was shot by the Khmer Rouge. After that, Munny and his mother escaped but had to live in a refugee camp in Thailand until they received a visa to Australia in 1985. After finishing school in Australia, Munny started a degree in law but soon dropped out and started an apprenticeship as a baker. He was always very proud that he could support his family, including his mother.
Munny was always very close to his mother, but she died after a long battle with cancer 6 months ago. Although Munny visited his mother every day during her illness, Ary worries that he did not take time off work after she died. She says that Munny just wanted to keep going so he did not have to think about losing his mother.
When Munny comes to the centre, he was well dressed but his clothes are loose fitting. He is slumped in his chair and staring at the floor. When he is greeted by the nurse, he does not make eye contact and only gives mono- syllabic answers to any questions saying ’fine’ or ’no problems’. However, when the nurse asks if Munny has ever thought about whether life was worth living, he shook his head. When asked how his family might feel if anything happened to him, Munny simply shrugs his shoulders. Munny then asks the nurse to leave him alone because he doesn’t want to talk about anything anymore.
PROMOTING MENTAL HEALTH AND WELLBEING
Reference style: APA
Question 1: Literature to discuss the mental health status of the client in the case study:
Diagnostic and the statistical manual of the mental disorders offer one of the common standards and the languages for classifying mental disorders. According to Armour, Műllerová & Elhai (2016), this manual is generally used by the mental health professionals in determining or communicating the diagnosis of patients after the evaluation. Therefore, this manual can help the nurses in the centre to identify the present mental health condition of Munny. The case study has demonstrated the fact that Munny is one of the 45-year-old Cambodian men who have faced depression after hearing nasty remarks from the manager of his organisation. This is because the manager has told him that their organisation is not satisfied with his job. This fact has hurt Munny in the greatest extent for which he has lost all his hope. After that, he has become very frustrated that has made him very less communicative.
As Munny was very proud of his capabilities to perform his duty, therefore, the incident had created huge repercussion on his mind. As a result, he faced depression. Moreover, Munny has also suffered trauma after the death of his mother as he was very attached to his mother. These entire reasons have created a mental disorder among Munny. The latest version of the DSM is the DSM-5 that listed the categories of the disorders and eliminated the axis system (Hungerford et al. 2017). DSM-5 offers a brief overview of the different disease and the criteria for selecting the diseases (Bandelow et al. 2018). From the manual of DSM-5, it can be said that Munny has faced depressive disorders as mental disorders have been created due to the depression.
The mental status exam is one of the psychological exams that help describe the mental behaviour and state of a particular person. For facilitating the exam, subjective description from Munny and objectives observations by the nurses of Munny is necessary. There are varieties of components of the mental health exam such as behaviour, attitude, mood, speech, appearances, thought content, cognition, thought process, behaviour and judgement that helps in observing or describing the psychological functioning of the patient. Therefore, for obtaining the mental health condition of Munny, it is essential in conducting the exam by considering the components of the MSE. Behaviour is one of the components of the MSE that mainly describes how an individual behaves to respond to a particular situation (Oldham & Lee, 2015). Therefore, for identifying the exact condition of Munny’s mental health, abnormalities in the behaviour of Munny or abnormal movements in Munny need to be determined by the nurses. According to Oldham & Lee (2015), for identifying the behaviour of a person with a mental health condition, it is highly essential to identify the eye contact, psychometric activities or movements. The case study has revealed the fact that Munny was not interested in making eye contact with the nurses and offering symbolic answers to the questions asks to him. Along with that, he was not intended to move that reveals that the mental health of Munny is not good.
According to Eggert et al. (2015), mood refers to the temporary state of mind. The mood needs to be described by using the own words of the patients which need to be represented as the angry, anxious, dysphoric, euthymic or apathy (Oldham & Lee, 2015). From the case study, it has been observed that the mood of Munny is apathetic because he did not show any feeling, interest or emotions about anything. For this reason, he only gives symbolic answers to the questions asked to him. Due to this mood, he was not interested in communicating with the family member. Before the mental trauma, Munny was very communicative persons, but the depression made him less talkative.
Question 2: Critically discuss two different factors that contributed to the development of the mental health status of the client
The mental condition of a patient becomes distorted if they become affected by various factors, such as biological vulnerabilities or stress. For the identification of these factors, the stress-vulnerability model needs to be applied. According to Cheng, Walsh & Schepp (2016), the stress-vulnerability model helps understand the causes of psychiatric disorders, the impact of the disorders and the treatment of the psychiatric disorder. Stress vulnerability model demonstrated the fact that there are mainly two different factors, such as stress and biological vulnerabilities that contributed to the development of mental disorders among patients.
As mentioned by Riboni & Belzung (2017), some people are biologically vulnerable to various physical illnesses such as asthma or heart diseases. In the same way, the psychiatric disorder can be created due to heredity. Some people are there who are biologically vulnerable to various mental disorders such as significant depressions, bipolar disorders, anxiety disorders or schizophrenia. The biological vulnerability can be determined by different factors such as complexity during birth, genetics or childhood experiences (Nahum-Shani, Hekler & Spruijt-Metz, 2015). However, it is the vulnerability of some people to be affected by some particular disorders. From the childhood history of the patient Munny, it becomes clearer that Munny has a stressful past. In his childhood, Munny’s family were moved to the countryside from their home during the period of Khmer Rouge. During that time, the father of Munny was shot. Munny and his mother became successful in escaping from the countryside and started to live in the refugee camp. They came to Australia after getting visas. Due to the stressful past of Munny, he faced mental stress which creates a psychiatric issue among him. The stressful history of Munny makes him more prone to withstand anxiety and depression. Therefore, it can be said that Munny tends to form mental illness. However, vulnerability to psychiatric disorders is genuinely biological, but it can be reduced by using some specific drugs.
Stress in daily life can create a worse condition in the biological vulnerability that can cause relapses (Ritov et al. 2017). Stress refers to the feeling of physical or emotional tension. Stress is the reaction of the body that mainly creates when a person faced demand or challenges (Nestler et al. 2016). Stress generally came from the thought or events that make a person angry, frustrated or nervous. As an example of a seriously stressful event, getting fired from a job, losing nearest people, becoming a crime victim or developing a conflict with the close people can be mentioned. Stresses are generally associated with adverse events; however, a positive experience or events can create a stressful incident (Killikelly et al. 2019). The case study has revealed the reason behind the stressful condition of Munny. Munny was very proud of his job. Though he has identified his job as stressful, he loved to perform his role. In that situation, his manager told him that their organisation is not satisfied with the performance of Munny. This fact has hurt Munny very much and creates a severe depression among him. Previously, Munny was very confident about his capacity, but the dissatisfaction of his manager has destroyed her self-esteem and confidences. After losing his faith, Munny has become frustrated that has created a depression disorder among him. After the incident, he stopped talking to his closed ones and reduced his food consumptions.
Moreover, he has lost his interest to provide an excellent answer to the question that is asked to him. Along with that, Munny had lost his interests to be with his family. Previously, he enjoys the company of his family, but after the incident, he lost his interests in anything.
Question 3: Critically discuss empowerment, respect and hope principle that positively contributes to the journey of recovery for the patient:
Hope, empowerment and respect are the three principles that create a significant impact on the recovery of a patient. Recovery-oriented mental health services have promoted a culture of optimism as well as hope that ensures that people feel welcome, valued, importance as well as safe (Heidari & Ghodusi, 2015). By supporting persons in their activities and communicating the positive expectation, it is possible in maintaining hope. Hope can be one of the essential elements in gaining recovery of Munny whose personal story has been discussed in the given case. For treating Munny, it is necessary to keep his hope alive so that he can gain his mental strengths. The care worker must create hope among Munni so that he can recover his health with efficiencies.
Empowerment is one of the essential principles of the mental health sector that drives the way by which the workers of mental health support people who needs services related to mental health. Therefore, by the principle of empowerment, care workers should inform the patient and their families about the available process of treatments so that they can select the best possible treatment (Tambuyzer & Van Audenhove, 2015). For treating Munny, the authority of care home must provide every detail of treatment to Munny and his family so that they can select the best treatment processes according to their financial strength. Therefore, it can be said that empowerment can support the family of Munny in making informed choices as well as decisions.
Development of a respectful relationship is highly essential in offering a foundation of support to the people who have mental illnesses (Koblinsky, Schroeder & Leslie, 2017). Therefore, for treating Munny, the mental health care worker must form a person-centred approach that prioritises the rights of Munny and help him in achieving recovery. For the formation of a respectful relationship, the health care workers of Munny should recognise as well as respect the cultural, social and spiritual belief of Munny.