Mental Health: Major Depression - Case Study Example

Mental Health: Major Depression Student’s Name Institutional Affiliation Mental Health: Major Depression Mental illnesses have the potential to cause significant mortality or morbidity if sufficient attention is not given to control them. Depression is said to be experienced when an individual’s mood is low or poor with no interest in normal activities that they have previously enjoyed or activities capable of building their feelings, wellbeing, thought and behaviour (National Collaborating Centre for Mental Health [NCCMH], 2010). Depression forms the most common mental disorder in Australia other than anxiety disorders with a lifetime prevalence of about one in seven (Black Dog Institute, 2012). Approximately a million Australian adults are estimated to experience depression in a year as per Beyond Blue (2015). In this essay, Peter, a mentally ill patient diagnosed with depression, shall form the basis of identifying possible barriers to mental health care from an Australia’s perspective and how best a patient such as Peter can be managed inter-professionally. Peter’s Problem Peter has been diagnosed with major depression. This is a condition that presents with depressed mood, diminished pleasure or interest in most activities that were previously enjoyable, substantial change in weight or poor appetite, disturbances in sleep, worthlessness feelings, psychomotor retardation or ideation, indecisiveness and difficulties concentrating, and recurrent suicidal ideation (Halverson, 2015). Peter experienced at least five of these symptoms, therefore, fulfilling the diagnostic criteria of major depressive disorder as per the DSM-5 criteria (Dziegielewski, 2010). The criteria requires at least five of the mentioned symptoms to have manifested in the patient for at least two weeks. In addition, at least a symptom should be a depressed mood or decrease interest in activities (Dziegielewski, 2010). Peter's depression may also have been genetically predisposed since his family from his father's side have a history of depression especially the uncle. In addition, his father had been distant during his childhood and although it's not clear if the father suffered episodes of depression too, it is quite possible that he may have experienced depression given his distantness and heavy alcohol consumption (Halverson, 2015). Peter's symptoms have caused him significant distress and even impaired his relationship with his wife and caused him to a break from his job. Nevertheless, the temporary separation from his wife had been precipitated by her awareness of Peter's engagement in an extramarital affair with a secretary at his workplace. Peter did not want to confide to his wife about the affair and continuously felt more and more difficult to do so as the guilt over the same grew. He was unable to confront the situation allowing his personal relationship with the wife to deteriorate, hence he may benefit from interpersonal therapy (IPT) as a non-pharmacological form of management of his depression (Robertson, Rushton & Christopher, 2008; Hollon & Ponniah, 2010). With IPT, his interpersonal dispute with his wife may be resolved since he appears to be inclined to restore his relationship with his wife and resuming work actively. Management of Peter's depression shall have to be done in a stepwise manner while monitoring his progress with the use of non-pharmacological or even addition of pharmacological agents Critique of Regional Mental health Services Barriers to Mental Health Care The cost in Australia is a challenge facing people living with mental illnesses. The costs are indirect costs linked with the treatment received, direct costs associated with the care, and other extra expenses and benefits foregone (Royal Australian and New Zealand College of Psychiatrists [RANZCP], 2014). Since a number of mentally ill individuals also have comorbid diseases and disabilities, linked to or unrelated to the mental illnesses, they also have to bear the burden of costs related to these conditions (Australia Institute of Health and Welfare [AIHW], 2012). These financial constraints are aggravated by the limited funding available from the State and national governments. Although there has been increasing financial input towards mental illnesses in recent years, RANZCP (2014) assert that the input is not equivalent to the degree of mental illnesses among Australians. Due to low funding, lower-cost early interventions and preventive measures are not availed to individuals in their initial stages of mental disorders allowing for the graduation to more severe financially draining conditions (RANZCP, 2014). Despite cost, other barriers facing mental health in regional Australia include self-reliance among mentally ill patient and stigma (Prins et al., 2011). Self-reliant makes some mentally ill individuals to believe they can independently solve their mental ill issues thereby delaying their first contact with a healthcare provider in mental health. Shameful feeling or stigma associated with the diagnosis of mental illness was also a barrier to accessing care together with pessimism over the effectiveness of skill training and medication in care (Prins et al., 2011). Critique of Mental Health Care Primary prevention involves precluding the occurrence of mental illness in at-risk individuals without the illness. These include individuals engaged in alcohol and substance abuse and those with family history of mental illness (National Advisory Council for Mental Health [NACMH], 2009). Secondary prevention identifies those in their early stages of mental illness providing them early management interventions to prevent aggravation of their conditions. Tertiary prevention targets those already in their advanced stages of their mental illness with the aim of improving their prognosis and reducing mortality (Mental Health Council of Australia [MHCA], 2010). In Australian regional areas, policies and program regarding alcohol and substance abuse are in place. However, the primary preventive measures have been cited by some residents in communities as not relevant to their needs meaning that community members or representatives were not consulted in establishing the preventive measures (Drug-Free Australia (DFA), 2009). Secondary and tertiary prevention require sufficient accessibility to mental health services and provision of various treatment and management options. This requires sufficient State, Territorial or National government funding which has been limited as explained by RANCP (2014). However, the financial barriers are not experienced in all countries as Prins et al. (2011) asserts that Dutch patients experience less mental illness prevention related costs. Australia ranked middle in financial facilitation of mental health services among countries such as Canada, Netherlands, New Zealand, US, UK, France and Germany (Prins et al., 2011). Government input in mental health including improving accessibility to mental health services in regional cities and increasing research funding for preventive initiatives in mental health are known efforts that promote mental health prevention (Jacka & Reavley, 2014). In addition workplace mental health improvement initiatives such as cognitive behavioural therapy based methods and policies on improving the food environment can aid in primary, secondary and tertiary prevention of mental health (Jacka & Reavley, 2014). Peter’s Pressing Concerning and their Management Peter has had his relationship with his wife deteriorate over time. He has lost interest in her and in virtually all other activities that used to excite him before. Despite his wife’s efforts to cheer him up. He has admitted to his doctor that he had been having an affair with a secretary in the construction company he works for. He has, however, failed to open up to the wife about it leaving her to keep guessing and raising her suspicions. The only time he came close to admitting his stray marital character is when he had a heated argument with his wife over his nonchalant withdrawn attitude so much that the wife accused him of having an affair. Peter, nevertheless denied it only admitting to seeking support from his secretary back at work. This is what culminated to his wife demanding him to leave their marital home. Peter has had his broken relationship with his wife send him to depression. He appears to have depression with melancholic features since his depression is worse during morning hours, with loss of pleasure in virtually every activity, significant anorexia and loss of weight and excessive guilt (Halverson, 2015). Peter’s major issue is depression while his wife, Gail, is in shock and angered by his supposed affair with his secretary at work. He may benefit from both pharmacological and non-pharmacological interventions while the wife may benefit more from non-pharmacological interventions. The possible non-pharmacological interventions include psychotherapies such as IPT, CBT and behavioural activation (BA) (Kendrick & Peveler, 2010). These are administered to patients on an outpatient basis allowing the patients to engage in his other significant activities such as work. IPT CBT and BA have been labelled ‘efficacious and effective’ meaning that there exists at least two research settings’ quality evidence that demonstrates that each of this form of therapy is superior to another bonafide form of treatment, pill or psychological placebo (Cujipers, 2015; Halverson, 2015). IPT can be beneficial to both Peter and Gail through a 16 session therapy. Its form of treatment has a more structured approach compared to other forms of dynamic treatments, but less compared to cognitive and behavioural approaches (Hollon & Ponniah, 2010; Halverson, 2015). As postulated by Law (2011), it is based on the attachment theory since there is a lot of emphasis placed on the significance of the patient's interpersonal relationship to prevailing form of depression. The social learning theory also forms a significant basis for IPT since the theory suggests that interpersonal relationships together with social skills contribute to depression development and its sustenance (Law, 2011). Areas that would be emphasised in the course of managing Peter include interpersonal disputes between him and the wife, his interpersonal deficits and role transition. The sessions would assist Peter to gradually resume engagement in activities that previously excited him, limit his guilty ruminations and enhance relationship with Gail to interrupt and reverse his depression (Law, 2011; Halverson, 2015). Response patterns that incorporate interpersonal communication shall be developed to support Peter and Gail in coping with future stressful situations as this enhances engagement in supportive social network that ameliorate the impact of stressing events (Cujipers, van Straten, Anderson & van Oppen, 2008). Nevertheless, research evidence shows that IPT alone may not be as effective as a combination of IPT and pharmacotherapy in management of depression (van Hees, Rotter, Ellermann & Evers, 2013). This informs the need for additional pharmacological therapy, especially, for Peter even when managing using IPT. CBT is another form of psychotherapy proven to be effective in the management of depression as illustrated by DeRubeis, Siegle and Hollon (2008). Since Peter has a negative view of himself, the future and the world, he is a suitable patient for such kind of cognitive therapy. Through this therapy, cognitive restructuring and behavioural strategies shall be instrumental in altering Peter’s maladaptive schemas and negative thoughts (DeRubeis, Siegle and Hollon, 2008). Behavioural activation places significant emphasis on the impact of negative and positive reinforcement towards depression. It has been suggested to be as effective as complete CBT package. It postulates that depressed individuals prefer avoiding problems rather than confront them and can benefit from positive reinforcements, as it is observed with Peter (Halverson, 2015). BA has exhibited efficacy in the management of major depression as demonstrated by Dimidjian et al. (2006) and even can result in greater improvement than the use of use cognitive therapy. Through a counselling session, he can open up his issues which revolves around disappointing the wife and gradually accept his mistake and work on how to move on from the situation. Peter’s readiness to go back home and resume work means he is ready to talk to his wife about the issues. Similarly pharmacological management of depression has proven efficacy and would be applicable to Peter to prevent the deterioration of passive suicidal thoughts to active. However, the choice of medication used shall depend on the anticipated safety to the patient and tolerability to enhance compliance and adherence to therapy. A combination of pharmacological and psychotherapy has shown better treatment outcome than either form of therapy alone hence Peter can benefit from both (Khan, Faucett, Lichtenberg, Kirsch & Brown, 2012). Inter-professional Team Care Management of disease, conditions including mental disorders is best met when the inter-professional team's input is embraced. Research demonstrates that provision of healthcare is best achieved when different health care professionals serving in different but related capacities work together in planning, strategizing and providing care to patients (Knowles et al., 2013). The inter-professional team significant in mental health care for clients such as Peter and Gail include general practitioners, psychiatrists, family practitioners, psychologist, pharmacists, nutritionists, nurses and carers. All these members may be present in one health care centre such as in secondary or tertiary health care or the services of each member can be sought through referral where necessary. The significance of the members of the inter-professional team is based on the fact that different health professions have a specific role to play depending on the education gained in their specific careers (Knowles et al., 2013). Health issues not in a given profession are handled by an individual specialised in that area of practice to better patient outcomes. A psychiatrist would be especially instrumental if Peter's symptom aggravate such that he develops mania, psychosis, active suicidal ideation or deterioration in his physical health. In such a case, his general practitioner shall have to refer him to a psychiatrist for advanced care (Halverson, 2015). In the provision of specialised psychotherapy such as CBT and IPT, psychologists' involvement would be necessary since they are better qualified in undertaking psychological assessment and step-wise timely provision of these forms of care. A pharmacist would be significant in the management of medication of Peter or Gail. It's known that pharmacological management of depression using drugs such as "selective serotonin reuptake inhibitors [SSRIs], monoamine oxidase inhibitors [MAOIs], and tricyclic antidepressants [TCAs]" is associated with side effects, “adverse drug reactions and drug interactions” (Kendrick & Peveler, 2010). These may affect the patient's adherence to therapy and worsen the outcome. Advice from Pharmacists regarding the suitability of these medications and any other medication that Peter or Gail may be prescribed would be instrumental in improving patient compliance and patient outcome. Some of these drugs such as MAOIs have the potential interact with certain foods such as foods that have a high content of tyramine (Halverson, 2015). These foods include sour cream, overripe fruit, and raisins. A nutritionist working together with the pharmacist is the suitable health professional to guide the clients on the right diet to consume in such a case. Conclusion Mental illness’ prevalence in Australia is bound to increase if sufficient measures including State, Territorial or Government support is not provided in the primary, secondary or even tertiary prevention of these illnesses. In some regional cities of Australia, accessibility to mental health services is limited. Residents of such places such as Peter have to seek help from general practitioners. In spite of the inaccessibility, there have been complaints of the high, sometimes unaffordable, financial cost associated with seeking mental health services in regional cities that have compounded the unmet needs of mentally ill patients. The demerit of such inaccessibility is that individuals with mental illnesses end up seeking mental health services when they are in their advanced stages of the disease. This may affect the treatment outcome compared to when the services are sought early in the initial stages of the illnesses. Various treatment options are available for mental illnesses such as depression. These include pharmacological and non-pharmacological forms of treatment. The latter include psychotherapies some of which, such as CBT, BA, and IPT, have proven effective in the management of depression. However, treatment outcomes have been demonstrated to be better if a combination of pharmacological and psychotherapies are used together. These treatment measures often are prolonged forms of therapy lasting for weeks and even months based on patients’ response. To obtain the best results from these forms of treatment, the inter-professional team should be engaged. This is because management of mentally ill patients involves a variety of measures some of which may not be sufficiently provided by one given profession but by a team of professions. Nevertheless, the earlier the management measures are initiated, the better the treatment outcome. References Australia Institute of Health and Welfare. (2012). Comorbidity of mental disorders and physical conditions 2007. Canberra: AIHW. Beyond Blue. (2015). The facts, depression and anxiety are common conditions. Retrieved from https://www.beyondblue.org.au/the-facts Black Dog Institute. (2012). Facts and figures about mental health and mood disorders. Retrieved from http://www.blackdoginstitute.org.au/docs/Factsandfiguresaboutmentalhealthandmooddisorders.pdf Cujipers, P. 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