Suicide and Depression

The prevalence of depression and suicide in Australia has reached a crescendo, which requires a higher level of commitment from mental health workers in the country. It is believed that around 2.1 million (9.7) Australian population experience some level of affective disorders (Australian Bureau of Statistics, ABS 2012). The high rate of depression can also be traced to the upsurge in cases of death from intentional self-harm which rose from 2,866 in 2016 to 3,128 in 2017 (ABS, 2017). To effectively tackle the menace of depression and suicide in Australia, there is need for a higher level of alertness and awareness from mental healthcare professionals and members of the public. According to World Health Organisation, 300 million people of all ages worldwide suffer from depression. The world health body also highlighted several factors that put people at risk of depression. These factors range from economic, social, psychological and environmental issues.
For instance, having economic, social and psychological problems can be risk factors for mental disorders. Depression in many low-income communities and countries can largely be attributed to their low purchasing power and poverty (“Depression: A Global Crises, 2012”). Being in a low-income environment can, for instance, lead to overworking to meet personal and family financial obligations. In addition to that, having no leisure time and feeling alienated from friends and family also puts a huge burden on one’s mental wellbeing which. Moreover, family medical history and social lifestyles are other contributing factors to depression and suicide cases in many Australian communities.
It is required of the members of the public and also the medical practitioners as well as social health workers to be on the lookout for mental behaviours in people, which might characterize ‘at risk’ for depression or suicide. One of the factors that put people at risk of depression is substance abuse. This factor can be categorised as a social factor. It is believed that 3 million Australians use an illicit drug, and over 40% of people (ages 14 and above) have used an illicit drug in their lifetime (Health Direct). This, the governmental body revealed can worsen depression, and sometimes leads to a vicious cycle.
Similarly, there are factors that can be considered as putting an individual at risk of suicide. Notably among these factors is mental disorder that has reached the level that put people at risk to self. For example, the Clinical Practice Guide to the Mental Health Act, (2014) highlighted the risk to self as conditions which can put a person at risk of suicide. They include self-harm, repetitive self-injury, self-neglect, missing and people absent without leave. These signs are not to be taken lightly by people around such individuals as they are symptoms of hopelessness, mental burden and feelings of worthlessness. These symptoms are directly connected to mental disorders which can lead to suicide.
The rampant cases of mental health disorders in the country has made the medical field recorded several case studies which clearly depict the causes, development and effects of depression. One of these case studies was that of Jack, a 21-year-old mechanic apprentice. Jack became depressed and attempted suicide after the death of his father and disconnection from his mother who had to spend less time with him due to her work. Cases like Jack's and others in the country have necessitated wide and intensive researches to the root cause of the frequency of depressions in the country.
Although several epidemiological, biological and sociological researches conducted have so far been unable to specifically identify the core cause of depression (Depression, anxiety and perinatal). However, in Jack’s case and other cases of that nature, some of the possible contributing factors include biological, psychological and social issues. Losing a loved one and suffering from loneliness as in the case of Jack is directly related to the concept of bereavement and loss, which is a major psychological factor in the development of depression. Psychological effects of the loss could be escalated by relationship issues and occupational redundancy considered as biological effects of depression.
Apart from psychological causes, biological issues are some of the leading causes of mental disorder and depression in Australia. While there are several identified biological factors that cause depression, however, in the case study under review, the cause is inherent in the substance abuse by the patient. Yap, Reavley & Jorm 2011, posited that “depression can also be the direct biological result of substance use." This was evident in Jack's abuse of alcohol having drunk six bottles of beer in his room due to another feeling of loss after an argument with his 20-year-old girlfriend, Jill. The third highlighted factor by the literature, "Depression, Anxiety and Perinatal" are social circumstances. The social effects in Jack's case include his poor performance at apprenticeship and schooling. His attendance and grades have suffered a major setback as a result of the psychological problems from home and his relationship. These three factors usually network in entanglement, and thereby putting the affected person at risk of a rapidly developed depressive state which usually leads to suicide thoughts and attempts.
To provide an enabling healing environment for the depressed and suicidal patients, there are legal and ethical standards which must be followed by the healthcare professionals. Medical professionals are major stakeholders in government’s national agenda in fighting the deathrate from depression and suicide. Therefore, a high level of beneficence and non-maleficence practice is required from the profession, which is usually the first point of call in depressive cases. As part of the global healthcare principle, it is mandatory for a healthcare provider to do what is in the best interest of the patient's health. This medical principle includes but not limited to creating a patient-friendly environment and showing a high degree of respect to the patient.
Since in the 1980s, people with mental health issues have been given the same rights as other Australian citizens, which include the right “to make their own decisions about their own care, and to be treated fairly and with respect” (“The Legal and Ethical”). This right is one of the bases of ethical practices expected never to be breached by a medical professional. This is to also avoid paternalism by the practitioners. Additionally, confidentiality and privacy are other ethical frameworks that must be upheld in order to protect patients’ image and profile. All these ethical and legal procedures must be adhered to by a mental healthcare provider.
However, while is recommended to respect the patient's rights as stated under the ethical framework, it is expected that healthcare professionals use their discretion in treating and dealing with the patient. As a registered nurse attending to Jack who has attempted to harm himself as presented in the case study, it is required that complete risk management in mental health treatment is followed. The risk management must be based on the patient's individual's history and his present conditions. The aim is to minimise the possibility of adverse events within the context of overall management of the patient to protect the health practitioner and others that might be at risk of the patient's mental health behaviour (Clinicians’ Practice Guide to the Mental Health Act 2014).
A high priority mental health risk in Jack’s situation is depression which is a high profile mental problem. Major symptoms of depression as shown by Jack include "substantially [impaired] ability to function at work or school and to cope with daily life" (World Health Organization, 2018). Evidently, Jack's condition requires nursing interventions. Some of the intervention relevant intervention is Jack's case is a therapeutic relationship or alliance which can be done in various ways like engaging with the patient and asking relevant questions
The interpersonal engagement is recommended and supported by most world medical bodies. For instance, it is stated in the Clinical Guidelines for Depression provided by the Royal Australian and New Zealand College of Psychiatrists (2004) that “that a sound alliance between the health professional and person is essential prior to the commencement of other treatment interventions.” Obviously, top among Jack’s needs is low self-esteem. Having had feelings of worthlessness and loneliness from his psychological problems, an interpersonal nursing intervention will tremendously impact positively in his responsiveness to treatments and recovery process. The rationale behind the intervention is to stimulate a positive therapeutic effect on the patient and improve his self-esteem. Essentially, such interventions show a high level of acceptance, value and give a sense of self-worth.
To adequately care for the patient in the case study, it is of the utmost importance that a clinician identified his mental needs and commit to helping him meet them. Social and Psychological needs have been identified to be some of the major mental needs of youths. Failure to have these needs met by their friends and families are some of the causes of the prevalent youth depression and mental health. Jack's psychological needs include the need for a sense of belonging and inclusion. These needs must have been triggered by the distance he felt from his mother.
However, as recommended by the Clinician's Practice Guide to Mental Health, 2014, a mental psychological disorder must not be treated in isolation. Other associated physical and social issues including all foreseeable side-effects need to be addressed by the primary health providers. To this end, Jack's other need which must be attended to, is the physical damage which the abuse of alcohol must have caused his body.
In essence, to address these physical and psychological needs of the patient, one of the relevant interventions is to provide protected time to engage the patient in a discussion about his current thoughts and feelings ("Depression, anxiety and perinatal"). The discussion should centrally focus on the patient’s concerns and mood with the view to help him feel better. David Horgan, a consultant psychiatrist believed that “anecdotally useful means of obtaining a quick global view is by asking the patient to rate the subjective complaints related to their mental status on a scale of 0-10. The ratings, according to Horgan could bother on the patient’s current stresses, depression, anxiety and fear, hopelessness about their situation, and suicidal thoughts. The rationale behind such intervention is “to demonstrate acceptance and also reinforce comprehensive care” (“Depression, anxiety and perinatal”). Another intervention is to establish the root cause of the patient's depressive mood, which in Jack's case can be traced to a recent bereavement. By establishing the root cause, the primary health professional will have the lead on how best to provide care that will aid the patient’s quick recovery. This intervention has its rationale based on how it helps in “screening and diagnosis of depression in people admitted to hospital”.
In conclusion, depression and other mental health disorders have become a global concern, which requires collective effort to tackle and manage. More than ever before, mental health professionals are saddled with an enormous responsibility to proffer the best methods to prevent and manage the conditions. Also, a higher premium must be placed on carrying out more studies that will assist mental healthcare provides improve their services.

References
Causes of Depression: Health Direct. https://www.healthdirect.gov.au/causes-of-depression
Clinicians’ Practice Guide to the Mental Health Act 2014: Government of West Australia Chief Psychatrist. (3), 20-57.
Depression, Anxiety and Perinatal Mental Health, (7), 247-278.
Depression: A Global Crisis (2012). World Federation for Mental Health. World Health Organisation https://www.who.int/mental_health/management/depression/wfmh_paper_depression_wmhd_2012.pdf
Depression: Key Facts (2018). World Health Organisation. https://www.who.int/news-room/fact-sheets/detail/depression
Horgan, D. (2002).Practical management of the suicidal patient. Australian Family Physician, Vol. 31, (9), 1-4.
Intentional self-harm, key characteristics (2018). 3303.0 - Causes of Death, Australia, 2017. Australian Bureau of Statistics. https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/3303.0~2017~Main%20Features~Intentional%20self-harm,%20key%20characteristics~3
The Legal and Ethical Context of Mental Health Care, (3) 91-122