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8 Sep
2019

Depression and mental health | Good Grade Guarantee!

Pre-reading
Diabetes Australia – Depression and mental health
Beyondblue – Depression
Mental Health First Aid Australia – Mental Health First Aid Guidelines for Other Cultures
Note: Scroll down to find the ‘AMHFA Cultural Guidelines’ and open the PDF file.
Justin is a twenty year old Indigenous man who resides in the remote mining community of Mount Rangeway – some 820 kms north of the city and 300 kms from the nearest town. With a population of 17,000, the mining industry is the major employer in the town. Justin was born and has lived in Mount Rangeway with his parents, siblings and extended family all of his life. When Justin was 15 years old he was diagnosed with Type 2 Diabetes Mellitus (T2DM). At 20 years of age Justin developed depression in the context of recent life events. This case study follows aspects of depression, cultural and psychosocial factors.
1. Meet Justin and background
Patientinformation
MRN:835693
Surname:O’Dowd
Given names:Justin
DOB:21/06/1993
Gender:Male
Personal details
Name: Justin O’Dowd
DOB: 21/06/1993
Age: 20 years
Address: 24 Simpson Road, Mount Rangeway
Weight: 109 kgs
Height: 170 cms
MRN: 835692
Family/significant others
Jenny (mother, 58 years) and Wayne (father, 59 years), Angela (sister, 28 years), Katie (sister. 23 years) and brother, Steven (26 years).
Hobbies
Football, fishing
Past medical history
Type 2 diabetes mellitus (T2DM) 5 years
Past surgical history
Nil
Past family history
Justin’s parents, Jenny (58 years) and Wayne (59 years), are both Aboriginal Health Workers at the local Aboriginal Medical Service (AMS), also have T2DM, as has his one of his sisters, Angela (28 years). His sister, Katie (23 years) and brother, Steven (26 years) are both pre-diabetic.
Medications
Nil
Justin’s background
https://www.youtube.com/watch?v=8qeJj0GmAuM (Please WATCH VIDEO FOR BACKGROUND)
Spoken by Associate Professor Wendy Edmondson (click here fortext version of the audio).
Secretariat of National Aboriginal and Islander Child Care – Sorry business 
Here you will find a definition of ‘Sorry Business’ and information about cultural responsibilities and obligations for Torres Strait Islander and Aboriginal people.
Read Chapter 6  – 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.
2. ASSESSMENT IN COMMUNITY
Justin’s mum, Jenny, spoke with her friend, Helen, an Aboriginal mental health worker from the local Aboriginal health service, regarding her concerns about Justin.  Jenny had been encouraging Justin to make an appointment at the health service but he refused saying there was no point. Helen agreed to visit Justin at home.
When Helen visited Justin she found him in bed, at 3pm in the afternoon. The blinds were drawn in his bedroom and the television was on, although Justin did not appear to be interested in the program. Justin agreed to speak with Helen to ‘keep his mother happy’, but stated that he thought talking would serve no purpose. He was sorry that his mother was worried about him but told Helen
“…I’m not worth worrying about…”
Justin did not look at Helen when she spoke to him and his answers to her questions were barely audible.
In response to Helen’s questions, Justin reported that he felt totally lacking in motivation, had difficulty sleeping at night and needed to doze during the day because he was so tired. He had lost his appetite, but his mum insisted that he eat because he has T2DM. He says that knows he should eat regularly but he can’t be bothered. Helen was concerned for Justin’s well-being. Justin agreed he required help, and as part of a shared decision making process, consented to complete the Indigenous risk impact screen (IRIS). His score on this tool showed that he was at low risk for alcohol and other drug problems (score of 8 – cut off score: 10). However, his score for mental health and emotional well-being was high risk (score of 16 – cut off score: 11).  Helen informed Justin of his score and said she would like him to be assessed by the doctor at the AHS. Initially, Justin refused but agreed to go when Helen offered to drive him.
3. Aboriginal health clinic

Given names:Justin

At the Aboriginal health service (AHS), Justin was assessed by the doctor on duty. He noted that Justin had felt sad and lacked direction since leaving school, and that these feelings had intensified over the past year since his Uncle Reggie died. He has lost contact with his friends because every time they invited him out he declined. Justin described constantly thinking how bleak his future is: he has no job prospects, and he believes he is going to end up with complications from T2DM just like his dad, stating:
“…My parents are both Aboriginal health workers and if they can’t manage dad’s diabetes what hope do I have?…”
Justin reported difficulty sleeping, he wakes up in the early hours of the morning and can’t get back to sleep. The doctor noticed that Justin’s clothes looked too big for him. Justin acknowledged that he has lost weight over the past six months (20 kgs), although he hadn’t been trying to. When questioned about suicidal thoughts Justin denied experiencing these, but he did say that if he was run over by a truck it would be a welcome relief.
The doctor informed Justin that he was experiencing clinical depression and that he was referring him for specialist psychiatric assessment and treatment in the city. In the meantime the doctor prescribed the anti-depressant Citalopram (a serotonin re-uptake inhibitor) and advised Justin that improvements in his mood due to the medication will not occur for two to three weeks.
4. Mental health admission
Justin arrives on the acute mental health ward at City General Hospital accompanied by his mother and is taken to the interview room for assessment. 
Justin consents to his mother being present during the initial mental health assessment before she has to return home the following day.
Review the following mental health assessment documents associated with this section of the learning journey:
Mental State Examination
Please find the same enclosed with in an attachment.
Mental Health Assessment
Please find the same enclosed with in an attachment.
5. Intervention
Consistent with a recovery orientated approach, Justin’s mental health assessment was undertaken in consultation with Justin, his mother and the Aboriginal hospital liaison officer.
The following documentation consists of the care plan, multidisciplinary progress reviews (day 3 and 7) and the 1:1 intervention notes in the ‘Patient notes and results’ section.
6. Three months later
After three months, Justin had responded favourably to interventions including medication and counselling, and it was decided at the last ward round that discharge would be planned in the next few days.
Listen to the audio file describing Justin’s story and review figure 6.2 (pg 81) from: Purdie, N, Dudgeon, P & Walker, R 2010, ‘Chapter 6 – Social Determinants of Aboriginal and Torres Strait Islander Social and Emotional Wellbeing’ in Working together Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, Australian Institute of Health and Welfare, Canberra.
1. Describe how Justin’s well-being might be impacted by his recent life events.
2. How may 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

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