Improving South Australia Mental Health Care System - Case Study Example

Adolescent Depression Name: Lecturer: Course and Code: Date: Table of Contents Table of Contents 2 Executive Summary 3 Diagnosis 4 Practice issues pertaining to the diagnosis 6 Analysis of State government policy with reference to adolescence 9 South Australia’s Mental Health and Wellbeing Policy 2007 9 Policy Strengths and Potential Gains 9 Innovative policy change 13 Conclusion 14 Works Cited 16 Adolescent Depression Executive Summary Depression affects the lives of adolescents in Australia. Depressive disorders have the potential to can severely lower the quality of the lives of the adolescents, their families and peers as well as the larger community. In Australia, nearly one in every five adolescent girls, and about one in nine adolescent boys who have high levels of depression symptoms. Whether or not the adolescents develop depressions, is influenced by the manner in which they manage their existing challenges, that is subsequently influenced by their personality, past experiences and socio-cultural backgrounds. Either way, adolescents have undergone difficult circumstances and felt suffered from social exclusions, such as the young people who are Aboriginal and Torres Strait Islander, who have either been institutionalised or homeless. This report defines diagnosis. Further, it discusses the current practice issues (including rights-based practice) pertaining to the diagnosis. Also examined include Australian Federal or State government policy (less than seven years old) with reference to the adolescents in Australia. More specifically, the report examines South Australia’s Mental Health and Wellbeing Policy. At the same time, it considers the aspects that have been implemented in addition to the potential gains or risks. Further, the report outlines how the adolescents might be affected by social exclusion, with reference to academic literature and research evidence. Lastly, based on the findings of the report, an innovative policy change is formulated to benefit the adolescents. This report concludes that there is a need of policy in Australia that entrenches a range of key policy issues aimed at improving South Australia’s mental health care system, promotion of positive mental health and recovery process for each individual including adolescents who undergo depression. The policy should also build resilience among the adolescents as well as promote help-seeking among adolescents in community organizations and school environments. Diagnosis Basically, diagnosis refers to the process of identifying the cause and nature of phenomenon, such as an illness and its symptoms. With regard to adolescent depression, Diagnosis refers to the identification of the nature and caused of the condition within the age group (Jacob 836; Kutcher et al n.p.). Basically, adolescence is a stage in human life characterised by rapid cognitive, physical and psychosocial changes. The key development task of adolescence is to develop and achieve control of mood and behaviour in a complex environment. The stage does not stop until the age of between 18 and 21 years (NHPA 37-38). At the adolescence stage, various new responsibilities, situations and expectations are encountered. Further, different manners of behaviour and ways of thinking are experienced. Adolescents deal with a range of challenges, such as reconciling what they feel they are and what they view as being socially desirable. The pursuit for identity, relationships and the desire for autonomy while seeking to fit in the environment may cause moody and impulsive behaviour that resolves as the adolescent grows (Gurian n.p.). The stress related to the transition into adolescence along with poor interpersonal skills and negative thoughts can cause changes in the moods or thinking of an individual. These constitute a mental state called depression. Depression in itself has a major significance on an adolescent’s health and development. It refers to a mental state of low moods characterized by a cynical sense of inadequacy and lack of activity. The symptoms are typically social isolation and behavioural problems. In adolescents, it is a risk factor for bipolar disorder or depression during adulthood, drug abuse and suicide (NHPA 37-38). The condition is categorised under mood disorders that is subdivide into dysthymic disorders, bipolar depression and unipolar depression. The correlation between the adverse events of life, psychological stress and episodes of depressions is unclear. Indeed, adverse events in the adolescent’s life can contribute to depression even as the condition in itself can be a cause of stressful experiences during adolescence (Jacob 836-839). Depression in adolescence may to a certain extent be similar to adult depressive disorder. Yet again, unlike adults, adolescents experiencing depression have higher rates of internalization, which means that symptoms of their depression may be more difficult to identify. In which case, in neurological sense, adolescent depression symptoms are different from that exhibited by the adults ((NHPA 38). However, adolescents tend to exhibit high irritability, self-destructive or aggressive behaviour compared to the general sadness that characterise forms of depression. Depression in adolescents may interfere with their normal developmental processes such as developing social skills, attaining independence and relationships. Typically, those at the early stage of adolescence will exhibit loss of interest, depressed moods or lack of pressure in normal activities such as social interactions or extracurricular activities. They are unusually irritable, which can be shown by being hostile or reacting angrily. They can also express their moods through physical complaints, including sad facial expressions or poor eye contact (McDermott 4-8). Practice issues pertaining to the diagnosis Recognition of the basic links between impoverishment, rights denial, conflicts and vulnerability calls for the application of rights-based approaches in diagnosis and practice of a range of actors including the World Health Organization (WHO) and Australian Neuroscience and Mental Illness Research Network (ANMIRN) (Gready and Ensor 7-8) Within an emergent human rights regime, many decisions and practices are informed by the rights-based approach (Gready and Ensor 8). Rights-based approaches act in the economic, political, social and legal spheres. The approach targets regulations, rules and laws, as well as public opinions and beliefs. It might also gain legitimacy or strength from acknowledged sources such as ethical principles or from the organization (Groady and Ensor 10). Therefore, rights-based approaches pertaining to the practice are those approaches promoted by health agencies and non-governmental organizations to achieve diagnosis of depression. There are two stakeholder groups within the rights-based practice scenario, including the duty bearer (consisting of the institution obligated to fulfil the rights of the right-holder) and the rights holder (an individual who does not experience full rights. Typically, the rights-based approaches target at fortifying the capacity of the duty bearers and empowering the rights holders (IFSW n.p.). In Australia, although remarkable advances continue to be achieved in the diagnosis and management of depression, the increased worldwide prevalence of the condition has continued to challenge clinicians and researchers alike. According to the World Health Organization (WHO), depression is expected to account for the highest levels of mental disorders across the globe by 2030 (Manicavasagar 1). Studies have indicated that in Australia, substantial levels of depression affect some 20 percent individuals once they reach their adulthood. Depression is reported to also run in families, with the risk of the condition increasing in adolescents with each first degree relation who has suffered from the condition, Nearly 80 percent of suicides are found to have been preceded by mood disorders (Manicavasagar 1; IFSW 1). In Australia, the social and economic costs of depression is high, costing the economy nearly $12.6 each year. There are also substantial social and personal costs associated with depression. The associated irritability among adolescents is a major contributor to family conflicts. The most widely used classification systems in Australia for diagnosis of depression include Diagnostic and Statistical Manual of Mental Disorders, fourth edition DSM-IV and the International Classification of Diseases, tenth edition (ICD-10). DSM-IV system is both a categorical sub-typing and a dimensional system. It allows a range of severity although it also comprises three depression subtypes, namely Mild, moderate or severe Severe major depression melancholia Depression in adolescents should be viewed as being in a multi-systems context rather than just relation to a developmental phase of lifecycle. It involves family, peers, schools and depends on the individual adolescent’s interpretation of themselves and their environment, all of which are entrenched in their cultural and social context (NHPA 48). Some adolescents, such as the Aboriginal children, are in difficult circumstances since they may experience emotional, physical of sexual abuse, or witness violence, homelessness or intellectual disability. Difficult circumstances and mental health problems are correlated in a number of ways. First, they could serve as risk factor problems related to mental disorders, such as post-traumatic disorders in adolescents who homeless or have witnessed violence. The problems could as well serve as risk factors in difficult circumstances such as when the adolescents use drugs or alcohol. Whatever the nature of the mental problems, intervention policies and strategies are needed to address the adolescent needs (NHPA 46-48). WHO proclaims that everyone has the right to enjoy the highest achievable standards of mental health. In South Australia for instance, the achievement of the highest possible mental health for adolescents is supported by Mental Health Act 2009 (SA). The Act has provided greater protection of the rights of adolescents through mental health services that ensure that individuals with critical mental illnesses are able to regain their rights, dignity, self-respect and freedom in the course of their treatment or care. The Adolescents also have responsibilities with regard to their treatment and health care, such as freedoms, rights of dignity of their carers or any other mental health staff. They also have the responsibility of actively participating in their treatment and rehabilitation. Analysis of State government policy with reference to adolescence South Australia’s Mental Health and Wellbeing Policy 2007 South Australia’s Mental Health and Wellbeing Policy recognise the challenges facing adolescents and their communities due to the experience of the mental ill-health. It also aims to outline the best possible system of mental health care in addition to promoting good mental health and well-being in the community. The policy entrenches a range of key policy issues aimed at improving South Australia’s mental health care system, promotion of positive mental health and recovery process for each individual including adolescents who undergo depression (SA Health 3). Policy Strengths and Potential Gains The policy is all-embracing and integrates several national and state policies aimed at promoting mental health among individuals in a community, including the adolescents. This is since the policy builds upon the strategic reforms specified in South Australia’s Social Inclusion Plan for Mental Health Reform 2007-2012. It is also compliant with the provisions of the National Mental Health Strategy, such as the National Mental Health Policy 2009 (SA Health 3-4). The policy promotes access to information and advocacy services. For instance, it ensures that the adolescents in schools and their teachers or carers access the right information on the adolescent health care and are fully informed on their individual rights. The policy also aims to ensure that the information dispensed to the adolescents through schools about their health care and individual rights is passed in forms or languages that are culturally acceptable and that can be easily understood. The policy’s aspects of participation and decision making have been implemented across health institutions in South Australia to provide an avenue to the adolescents, who undergo depression, and their carers on adolescent’s health care. This has been aimed to promote participation of the adolescents in decision-making during the course of their treatment and to promote their optimal involvement in the social life of their community (SA Health 8-18). The policy has been instrumental in reducing stigma and discrimination of the adolescents, especially of Aboriginal and Torres Island origin, who are undergoing depression. It promotes and supports initiatives that are aimed to actively address discrimination and stigma in the community. It also supports media campaigns aimed at reducing social stigma and discrimination in the society. The policy has also promoted equality of access to mental health services in South Australia. It ensures that all age groups, including adolescents, are able to access health care that meet their specific needs regardless of their cultural backgrounds. It also instils positive attitudes towards mental health care and promotes early intervention to mitigate the burden of depression during early stage adolescence. This has been aimed at promoting improved mental health across South Australia. It has also been aimed to reduce the impact of adolescent depression (SA Health 8-18). The policy targets a range of settings including health care institutions, schools and families, which recognise that mental health is influenced by a number of factors such as social, biological and economic factors: for example social exclusion, homelessness, substance abuse and family violence (SA Health 17-18). Impacts of social exclusion to Adolescents Many adolescents with severe depression face social exclusion, discrimination and stigma. These conditions must be challenged to ensure that adolescents experience highest possible achievable mental health in a community where they are respected and valued. Promoting an environment where adolescents can fully enjoy their rights is crucial. Social exclusion can prevent the adolescents from receiving or seeking opportunities they deserve to maintain mental well being or recovery from depression (Williams and Williams 2). Depression is among the most prevalent conditions in populations globally (Sabate n.p.). In Australia, depression continues to receive more attention and has become less stigmatised in the general population as well as in scholarly literatures than has been the trend in the last many decades. Subjects on depression in the literature and media concerning health service researchers and mental health professional show significant concern over prevalence of depression, homelessness, dependence on alcohol and drugs, adolescent suicides and side effects of medications (Williams and Williams 2). A large body of research evidence has showed that adolescence is a life cycle characterised by increased significance of peer relationships, negative emotional outcomes and sensitivity to rejection (Masten et al 143). The negative effects of social exclusions on adolescent’s psychological adjustments such as depression are indeed well documented. According to Masten et al (2009, 143), peer rejection can lead to adverse physical and mental health outcomes that continue through long-term growth and development of an individual. Though social exclusion is prevalent throughout the lives of most adolescents, differences exist on individual adolescents, which may however moderate an adolescent’s depression in response peer rejection (Downey and Feldman 1327-1330). Researches have indicated that rejection sensitivity is related to behavioural and emotional sensitivity to situations of social exclusion ((Masten et al 143-146). However, behavioural studies investigating adolescents who have varying levels of interpersonal competences has been less reliable, and has recommended two relationships that link interpersonal competences and the outcomes of social exclusion. First, a number of studies have showed that interpersonally competent adolescents are less affected by social exclusion, specifically peer rejection. For instance, individual adolescents have been indicated to have less negative mood swings or shifts after experiences with social exclusion (Reijntjes et al 89-107). Additionally, researches have linked social exclusion with socially inappropriate adolescent behaviour (Rubin et al 338-349). Individual adolescents may also have more rational problems with the society in general, including their peers. Hence, they may be specifically concerned about threats to their acceptance and respond to social exclusion in a number of ways (Masten et al 143-146). The outcomes can be classified into four, namely self-esteem and self-worth, internalising behaviour such as feelings, emotions and thoughts, externalising such as through outwards expression of emotions and feelings and lastly, composite measure of depression and the problem behaviour (McPherson et al 11). Internalising behaviours comprise the thoughts, emotions, feelings as well as behaviours that the adolescent directs inwardly. The outcome of social exclusion includes social anxiety, depressive symptoms and mood shifts. Externalising behaviour include the behaviours that the adolescent directs outwardly at other people. The impact of social exclusion on externalising behaviour includes anger, aggression, violence, defiance and in some instances lying (McPherson et al 12-15). Innovative policy change While a considerable debate exists on whether the South Australia’s Mental Health and Wellbeing Policy is sufficient for South Australia, it is clear that the state government should take its responsibilities seriously in pursuing a range of options that can manage depression among adolescents (Bostock 123-126). The premise of the policy change is that the policy fails to adequately address the needs of the adolescents. There is a need for policy change to build resilience among the adolescents as well as promote help-seeking among adolescents in community organizations and school environments. The environments should promote emotional wellbeing of the adolescents as well as encourage them to seek help in case when they experience depression. School-based prevention programs to be implemented could help reduce stigma and promote help-seeking. The prevention programs aimed at the adolescents who are at high risk of adolescents such as the aboriginal children can help prevent depression from escalating to disastrous effects (Bostock 123-126). There is also a need for policy change to ensure that it provides culturally and adolescent-friendly responsive health services. This can assist the young people to engage the adolescents in supporting their participation in pursuing health. Teachers, carers or health professionals should engage in establishing rapport as well as explain confidentiality issues. They can also build trusting relationships with the adolescents. Generally, it is beneficial to engage the adolescent’s parents or carers although this would depend on the age and wishes of the adolescent. The policy should also aim to promote working collaboratively with the adolescents, and if necessary with their parents or carers, to create an effective management plan. In most instances, talking therapies or psychological therapies should be encouraged to be used as the first treatment for the adolescents who have been diagnosed with depression. In cases where the symptoms are severe or moderate and psychological therapy is not effective, medication could be considered such as prescription of antidepressant fluoxetine and selective serotonin reuptake inhibitor (SSRI) antidepressant fluoxetine. The policy should therefore take all relevant factors that decide the treatment of the depression into account. There is also a need for a policy change to ensure that the adolescents with recurrent depression are given an integrated care. Adolescents who have developed complex problems may require a range of interventions delivered by the carers or the health professionals. Conclusion Depression affects the lives of adolescents in Australia. Depressive disorders have the potential to can severely lower the quality of the lives of the adolescents, their families and peers as well as the larger community. In Australia, nearly one in every five adolescent girls, and about one in nine adolescent boys who have high levels of depression symptoms. Adolescents suffering from depression tend to exhibit high irritability, self-destructive or aggressive behaviour compared to the general sadness that characterise forms of depression. Depression in adolescents may interfere with their normal developmental processes such as developing social skills, attaining independence and relationships. It is therefore clear that depression affects the quality of life of the adolescents. Based on the perspective of an individual adolescent, depression may lead to violence social performance, drug abuse and in some cases even in adolescent suicides. Diagnosis and a number of treatment interventions are therefore necessary, meaning that extensive efforts to improve the health system in diagnosis and treatment of depression are required. However, they may not effectively treat adolescent depression as the condition needs to be managed collaboratively by the family members, the school and the general community. There is therefore a need for an effective national or state policy to promote management of the condition. In South Australia, South Australia’s Mental Health and Wellbeing Policy recognises the challenges facing adolescents and their communities due to the experience of the mental ill-health. It also aims to outline the best possible system of mental health care in addition to promoting good mental health and well-being in the community. The policy entrenches a range of key policy issues aimed at improving South Australia’s mental health care system, promotion of positive mental health and recovery process for each individual including adolescents who undergo depression. However, there is a need for policy change to build resilience among the adolescents as well as promote help-seeking among adolescents in community organizations and school environments. There is also a need for policy change to ensure that it provides culturally and adolescent-friendly responsive health services. The policy should also aim to promote working collaboratively with the adolescents, and if necessary with their parents or carers, to create an effective management plan. There is also a need for a policy change to ensure that the adolescents with recurrent depression are given an integrated care. Works Cited Bostock, William. 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