Risk Factors for Julio Nunes Nesto - Essay Example

?Case Study: Julio Nunes Nesto Stress Vulnerability Bucket Time Line Significant Events Mental Health Issues Birth and growing up years A Mozambican born in Mozambique yet baptized with a Portuguese name, “JULIO NUNES NETO.” Had grown up under the colonial rule of Portugal. Stigmatised of racial discrimination. Had lived in fear, oppression and inequality. Teenage years Had attended university schooling, had been popular and had been recognised as an excellent student. Had been a well-known freedom fighter against Portuguese colonialism. Adult years Had become a professional Mining Engineer. Had travelled and worked in Portugal, Greece, Finland, Morocco, Algeria and Mozambique. Had been fluent in 11 different languages. Had been a successful single parent of 2 Children, acting practically both as father and mother. 1988 Had migrated to WA with his kids filled with high hopes for a better life for his children. Had been out of worked and was forced to receive handouts of second hand clothes and food. Had suffered racism at work, while his kids were isolated in the school. His dream turned into a curse. Had felt miserably a failure. Had felt trapped. Had felt completely isolated and disillusioned. Had felt despair, unwelcome and betrayed. 1- Formulation Form Client: Julio Nunes Nesto UMRN: ....................................... Date: ........ / ........ / ........ Predisposing Factors: Possible Sources of Biological Vulnerability Neurological development or other neurological problem: Had polio at the age of two, had become partially paralysed and unable to speak and walk Maternal viral infection during pregnancy: N/A Family history: N/A Birth trauma: Born stigmatized to be an inferior race equivalent to a slave. Possible Sources of Physiological Vulnerability Physical abuse experienced or threatened: Grew up in an environment of oppression and inequality Witnessed family violence: N/A Emotional/psychological abuse: Work discrimination; unwelcomed; frightened; betrayed; disillusioned Sexual abuse: N/A Physical or emotional neglect: Single parent of two; without wife to care for him; without relatives to run to Other trauma: Culture shock in WA; living alone in a foreign cruel society Bullying in school/community: Isolation of children in the school; lack of social support in the community possible Sources of Social Vulnerability: Poverty/deprivation: Uncertain life in a foreign highly discriminating land Alcohol and other drug use (self/others prior teens): N/A Migration (international or intra-national): Migrated to Western Australia Cultural conflict/ alienation/stigma/ lack of supports: Experiences worse condition in WA Racism: Suffered racism in the workforce, in social settings and his 2 children suffered racism at school. Other forms of discrimination: No assistance to single father parent making it almost impossible for him to find work; his children are isolated because of their skin color. Precipitating Factors: (what stressors were happening prior to becoming unwell) Oppression and discrimination in his own land Stigmatized by his Portuguese name Single parent of two growing kids Perpetuating Factors: (what stressors are still operating or what helps keep the stress going). Racial discrimination of his family in a foreign land Joblessness and lack of opportunity for a decent living for a black single-father parent in WA Shattered dream for his two kids Humiliated and frustrated Trapped in a cruelly discriminating society Current Problem List as Identified by Client: 1. Depression 2. Anxiety due to joblessness 3. Prejudice due to racial experienced discrimination 4. Frustration and anger because of failed high expectation Thoughts: This society is so cruel; it could treat children too unfairly. Racism is a large factor in mental health deterioration. I am trapped; we can no longer go back to Mozambique. Feelings: He felt completely isolated, unwelcome and betrayed. He felt despair, angry, helpless, depressed and disillusioned. He felt humiliated and a miserable failure. Behaviour: Do not like to go back to Mozambique despite their worse condition in WA. Finds employment in the mining industry. He was forced to receive handouts of second hand clothes and food. Physiology: He has strong physiology, as he has been physically tested by time since childhood. Environmental/Social Factors: Isolation: His children are isolated in the school; he felt alone as a parent with no wife or relative to support him in a foreign land. Unemployment/financial stress: Finding employment in mining where he is well-trained has been almost impossible; additional burden for being employed are his being black and a single father parent of two. Current or feared conflict/harm: He fears for the future and well-being of his children. Current or apprehended housing stress: N/A Cultural stressors: Racial discrimination; lack of social support for black family and single-father parent. Other current or feared situational crises involving self or a significant other: He fears that discrimination may affect their mental well-being. Lack of family support/high expressed emotion: No wife to help him raise his kids; no relatives to help and assist him. Relationships/friendships that are not going well: He felt betrayed by those who convinced him to come and settle in WA. Alcohol and other drug use (teen to present): N/A What I have going for me: Currently working: Mining Academic achievement/qualifications: Mining Engineer; fluent in 11 languages Keeping up friendships/ supports/social outlets family tolerance: Talented children; his son is currently studying in Murdoch University Included (not shunned) by people: Helpful African families who helped them settle in WA. Financial /economic circumstances OK: He has the professional qualifications and experience that would land him a stable job; in fact currently his son is studying in Murdoch University Other: A growing awareness and positive attitude towards accessible mental health care and CALD needs in Australia both in the Metropolitan and rural areas. Strengths and Personal Qualities: An experienced mining engineer Fluent in 11 languages A born fighter Resilient to physical difficulties having the oppression of growing up in colonial times Strong character as he was able to raise his two children by himself Knows even domestic chores A good father Determined to give his children a good llife 2- Risk Factors for Julio Nunes Nesto (JNN) The chronic experience of JNN and his two children to racial discrimination puts him in a high risk of mental disorder. Studies (Crocker, 2007; McKenzie 2006) have shown compelling and growing evidence that racism may put victims to a higher risk of mental distress and illness. In the case of JNN these risks can be identified as follows in order of severity: a. Clinical Depression Rationale: JNN’s consistent subjection to racial discrimination compounded by his children’s similar negative experiences in Australia puts him at the highest risk of clinical depression, also called major-depressive disorder or unipolar depression, because stressful life events like chronic racial discrimination causes major depression (Hammen, 2005, p. 295). This finding has been supported by several studies involving minority ethnic groups, showing higher rates of major depression due to racial discrimination (Bhugra & Ayonrinde, 2010, p. 48). In fact, “the most widely documented association between racial life events and mental illness has been that of the onset of depression” (Bhugra & Ayonrinde, 2001, p. 105).) b. Anxiety Disorder Rationale: As anxiety disorder is fear based (Strong, 2003, p. 8), the strong fear and worries that JNN confront and carries with him everyday due to racism and his financial difficulty are enough factors to put him at risk of anxiety disorder. Several studies (Pernice & Brook, 1996; Thompsom, 1996, & Jones et al., 1996) have identified racial discrimination a crucial factor causing high levels of anxiety (cited in Bhugra & Ayonrinde, 2001, p. 107). Furthermore, longitudinal evidence also suggests that depression, which is strongly associated with racial discrimination, also causes anxiety disorders (Fombonne, 1995, p. 572, cited in Asthana & Halliday, 2006, p. 228). c. Post-traumatic Stress Disorder d. Psychosis e. Damage of self-esteem f. Psychosomatization g. Substance Abuse h. High risk of Violence 3- Agencies Recommendable for JNN Among the existing mental health services in Busselton, the two agencies I find most recommendable to JNN are the South West Mental Health – Busselton (SWMH) and the Anglicare Financial Counselling, Busselton (AFC). 3- Summary a. South West Mental Health – Busselton is located at 18 West Street, Busselton WA 6280, PO Box 1439, Busselton WA 6280. The services it offers are community mental health to people suffering from serious mental illness/disorder. Aside from this, it also provides counselling to anyone seeking general information about mental illness/disorder. Though it resides Busselton, its services extends to three areas such as Busselton, Dunsborough, and Yallingup. To effectively care for its patient needs, its services are provided by a competent multidisciplinary clinic team of consultant psychiatrist, medical officer, nurses and social workers. Knowing that the occurrence of mental health illness is unplanned, aside from its 9am to 4pm clinic hours, SWMH also opens after-hours service via Rural Link with automatic stitch over on clinic numbers. Unless the case is not an emergency, which is a priority through the local District Hospital, the clinic prefers planned appointment times with referrals from the patient’s GP, another medical professional or agency. b. Anglicare Financial Counselling, Busselton is located at St Mary's Centre, 119-121 Queen Street, Busselton WA 6280. It offers advocacy and legal, community and support, and counselling to individuals and families, and even communities if needed, experiencing financial difficulties – low income earner, struggling or in financial crisis. As such, this agency helps clients with debt negotiation, budgeting, bankruptcy, superannuation release and accessing entitlements. Meaning it does help in making people assess their financial position, understand and address their financial problems, deal with their creditors, develop the budget most appropriate to their status, access relevant government support, and be informed about consumer credit and bankruptcy. In short, it helps people be in control of their financial life. It is not therefore a charity institution that it does not help in providing emergency relief like food and petro vouchers. Although for this purpose this agency recommends Anglicare WA’s Emergency Relief service. To avail their services, which open from 9am to 4:30pm on weekdays, client has to make an appointment only by phone and has to wait for two weeks. Most importantly, AFC provides these services throughout Western Australia for free and with confidentiality. 3- Rationale JNN’s situation can be described as in high risk of mental illness/disorder and in financial difficulty – common to immigrants in Australia especially Blacks. As such, he badly needs these two agencies described above to help him better his well being. This is so because his two situations are interrelated, that both have to be addressed properly. Meaning, his mental well being cannot be successfully improved if he remains in financial distress. In fact the American Psychiatric Association (APA, 2002) has recognised that financial distress is one of the risk factors of mental illness specifically depressive disorders (cited in Hayne, 2010, p. 393), of which Julio Nunes Nesto is of highest risk. Conversely, he cannot be in the best position to improve his financial situation; if his mental health is not improved. Thus SWMH is the best agency there is to help him improve his mental wellbeing, while AFC will help him get out of his financial difficulty and be in control of his financial situation. From among the agencies in Busselton, I chose SMWH to address Julio Nunes Nesto’s mental health risk because of three important points: (1) it is most accessible to him; (2) it offers a wide-range of services from counselling to treatment, which could be acceptable for Julio since it does not automatically imply that he has a mental disorder; and (3) it has a competent multidisciplinary team of experts that could better understand and address Julio’s predicament. To improve his financial situation, I chose AFC because of three important points: (1) it is free; (2) it has a wide range of services that could address all finance-related problems of JNN; and (3) it has links to other services that JNN may also need such as emergency relief and aboriginal community services. 3- Comment: Mental Health and CALD Services in the Rural and Perth Metropolitan Area Mental health and CALD services in the rural and Perth metropolitan area may be assessed based on three social realities that make up Australia today: (1) the prevalence of mental disorder in both areas; (2) the existence of aboriginal communities, which in fact Australia claims to be its heritage; and (3) the increasing presence of migrants from different countries possessing with them varied norms, beliefs, and practices that in one way or another affect Australia’s mental health services, as these may contradict Australia’s. For the first point, the prevalence of mental disorder in Australia appears to be alarmingly high. Data from the Australian Bureau of Statistics (ABS, 2007) revealed that in 2006, twenty-per cent of Australian populations (more or less 3.2 million Australians) whose ages range from 16 to 85 years old live with mental disorder. Data from the Burden Disease and Injury in Australia strongly supports this finding, showing that mental disorders primarily cause disability burden in this country. This, the report furthers, accounts for more or less ‘24% of the total years lost’. (cited in, Australian Institute of health and Welfare, 2011) The distribution of the prevalence of mental disorder in the rural and remote Australia (like Busselton) compared to its major cities (like the Metropolitan Perth) according to Jelinek, Weiland, Mackinlay, Hill and Gerdtz (2011) is higher. Yet they further that when it comes to mental services, rural Australians cannot avail timely, effective and appropriate help. Aside from lacking specialist mental health services there are reports not only of sub-standard mental health services but also discriminating attitudes from rural emergency department staff. Such grim reality only shows the dismal condition of health services in the rural and remote Australia especially so that EDs are the only place where these rural mental patients can avail 24-hour services. (p. 1) As Byrne and Neville (2009) similarly noted, “there is a dire shortage of specialist mental health professional and often a high turnover of staff [and] knowledge and interest regarding mental health issues among generalist healthcare staff is often limited” (p. 64) Meaning mental patients in Australia’s remote and rural areas are left at the mercy of these prejudicial general practitioners or career medical officers. As such, the very place that should alleviate the ill mental condition of the patient is on the contrary worsening it. This unhealthy mental health services in the rural areas put mental patients at higher risk of associated diseases (National Rural Health Alliance, 2009, p. 1). In fact, as I browse for mental health services in Busselton that I could recommend to JNN, I found that compared with Perth, there are not much of mental health services that I could choose from. Aside from this, mental health services in Perth are much more complete and sophisticated compared with those found in Busselton. Honestly, the mental health clinic in Busselton I found best for his case is actually not the ideal to address his mental health condition. This only shows that there is a gap on Australia’s mental health care in its rural and metropolitan areas. The good thing though is that the Australian government has recognised this dismal reality and has committed itself to improve its mental health access services (AIHW, 2011). For the second point, Byrne and Neville (2009) noted the importance of looking into the figures of indigenous Australians when addressing the mental health needs of Australians living in rural and remote areas. From a countrywide perspective, it could be noted that Australia’s indigenous people constitute 2.5% only of its total population. Notably though, they constitute 12% of the rural population and 45% of the remotest areas. (p. 62) These figures alone clearly call for the need of mental health services responsive to the specific needs of people from CALD (culturally and linguistically diverse) backgrounds. Aside from this, the problem of monoculture practices of healthcare providers continues, which immediately put a barrier between them and CALD consumers. According to Kljajic (2009) depression, anxiety and related mental illnesses are highly prevalent in CALD. She furthers that many of those suffering from these mental illnesses do not access mental health services due to the following reasons: “Language barriers, lack of knowledge, financial concerns, fear of being locked away, stigma, guilt and religious and cultural barriers present special challenges.” (p. 1). As in the case of JNN, this may also be true, especially so that given his former reputation as a relatively successful mining engineer in Mozambique to be labeled insane could be devastating. If Busselton lacks mental health services for general mental clients, I did not find any mental health services for CALD here. Actually this is what I was seeking for JNN. And ironically, I found some in Perth such as the Multicultural Services Center of W.A. Inc., and the West Australian Transcultural Mental Health Service. Such condition only shows the gap in medical health services between the metropolitan areas and rural/remote Australia, where those who most needed mental health services live. To address CALD concerns, the Australian government funded a national program, called Multicultural Mental Health Australia (MMHA). This aims “to improve awareness of mental health and suicide prevention in CALD… through policy advice, public promotion, resource development and community capacity building,” with the ultimate hope of empowering CALD consumers and carers. (MMHA, 2010, par. 1-2) This is a good start but this has to be seen in practice whether or not it could be implemented efficiently, especially so that racism remains high in this country. For the third point, Australia has long been recognised to be highly diverse culturally and linguistically with a ratio of 1:3 having different cultural and linguistic background, with 2.5 million originating from non-native English speaking countries, and with 15% of its population is either bilingual or multi-lingual (Services for children and Youth, n.d., p. 429). Kljajic (2009) cites that according to the World Health Organisation (WHO) there are approximately 50% of migrants worldwide who suffer from mental health issues most commonly due to being caught in the crossfire and/or being forced to abandon their families. Also, Australia’s 2006 census shows that 25% of immigrants to Australia have been mentally ill. Most of them originate from war-torn and impoverished countries. The culture shock that they experience once they come and settle in Australia worsens their mental health condition. And structural and cultural differences bar them from accessing mental health service. (p. 1) Unfortunately, this is more challenging for those living in rural areas. For example in the case of JNN, there are no available services for refugees and migrant in Busselton. Yet, there are some in the Perth Metropolitan area. The obvious gap in mental health services in the rural and remote Australia compared with Perth Metropolitan area implies the following sad reality in Australia’s health program: (1) imbalance distribution of Australia’s health fund; (2) insufficient assessment of Australia’s mental wellbeing especially of the marginalised and disadvantaged groups; and (3) discrimination in providing mental health services. References Asthana, S. and Halliday, J. (2006). What works in tackling health inequalities?: Pathways, polices and practice through the lifecourse. UK: The Policy Press. Australian Institute of Health and Welfare (AIHW). (2011). Mental health. Australian Government. Retrieved from http://www.aihw.gov.au/mental-health/ Bhugra, D. and Ayonrinde, O. (2001). Racial life events and psychiatric morbidity. In D. Bhugra and R. Cochrane, R. Psychiatry in multicultural Britain (pp. 91-111). Britain: The Royal College of Psychiatrists. Bhugra, D. and Ayonrinde, O. (2010). Racism, racial life events and mental ill health. In R. Bhattacharya, S. Cross and D. Bhugra (Eds.). Clinical topics in cultural psychiatry (pp. 39-51). London: The Royal College of Psychiatrists. Byrne, G. And Neville, C. (2009). Community mental health for older people. NSW: Elsevier Australia. Crocker, J. (2007). The effects of racism-related stress on the psychological and physiological well-being of non-whites. Rivier Academic Journal, 3 (1), 1-3. Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology 1, 293-319. Hayne, Y. M. (2010) Chapter 20: Mood Disorders. In Austin, Psychiatric and mental health nursing for Canadian practice (pp. 388-430). Baltimore, MD: Lippincott Williams & Wilkins. Kljajic, K. (2009 October). Depression and anxiety in the CALD community. Health Voices: Journal of the Consumers Health Forum of Australia, 5, 1-2. Retrieved from https://www.chf.org.au/pdfs/hvo/hvo-2009-5-depression-anxiety-CALD-community.pdf Jelinek, G. A., Weiland, T. J. Mackinlay, C., Hill, N., and Gerdtz, M. F. (2011). Perceived differences in management of mental health patients in remote and rural Australia and strategies for improvement: Findings from a national qualitative study of emergency clinicians, 2011, 1-7. doi:10.1155/2011/965027. McKenzie, K. (2006). Racial discrimination and mental health. Psychiatry 5 (11), 383-387. Multicultural Mental Health Australia (MMHA). (2010 July 20). Multicultural Mental Health Australia. Retrieved from http://www.dhi.gov.au/Multicultural-Mental-Health-Australia/home/default.aspx National Rural Health Alliance (NRHA). (2009 August). Mental health in rural Australia. Factsheet 18. Retrieved from http://nrha.ruralhealth.org.au/cms/uploads/factsheets/fact-sheet-18-mental-health.pdf Services for children and youth, older people and CALD communities. (n.d.). Retrieved from http://www.aph.gov.au/senate/committee/mentalhealth_ctte/report/c15.pdf Strong, K.V. (2003). Anxiety disorders: The caregivers: Information for support people, family & friends, (3rd Edition). USA: Oakminster Publishing. Read More