Mental Health Nursing Report: Ethical and Legal Considerations

This report delves into the critical issues of depression and suicide in Australia, examining their incidence and impact. It identifies at-risk community groups for both conditions, analyzing contributing factors and ethical considerations, particularly in a case study involving a young man named Jonathan. The report explores ethical principles like beneficence and non-maleficence within the context of the Mental Health Act 2007, and proposes urgent mental health interventions. It emphasizes the importance of understanding suicidal tendencies, implementing safe clinical practices, and fostering therapeutic relationships to support individuals facing mental health challenges. The report highlights the need for continuous monitoring and family involvement in the recovery process.

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Mental Health Nursing
Student's Name
Instructor's Name:
Date:

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1. Depression and Suicide are significant areas of concern in Australia.
a. Investigate and outline the incidence of both depression and suicide in Australia.
Ensure you address depression and suicide separately.
Depression: As per the WHO survey, depression is one of the major causes of death in
adolescents and youth, between the age group of 10-19 years of age (Ricci, 2015). Although this
survey is a worldwide one, these rates are seen prevalent in Australia too, with the adolescents
having trouble coping up with the distress and ending up giving their lives to get out of the
troubles.
The most prevalent reasons that drive most teenagers to this ultimate means are either biological
reasons, and disorders such as bipolar or psychosis, or the developmental factors, such as trouble
at school and college, or problems at home. The study done on the depression rates in Australian
women, especially, found that there are several reasons for depression, and the most significant
among them is the post-natal mental condition. It is found that around 16% of women go across
this phase, where they experience what is called baby blues or the post-natal depression.
Although help is provided immediately by the primary care workers, and the constant mental
health survey by the Australian government renders new and modified policies, depression
seems to be on the rise, as per the latest predictions (Rich, 2013)
Suicide: There has been a considerable increase in the number of deaths due to suicide, between
2006 and 2012. The study conducted by the Australian Bureau of Statistics found that the death
due to suicide has increased from 10.2 per 100,000 to 12.6 per 100,000 in the year 2012(Suicide
in Australia, 2016). This rate is alarming, as is the fact that they are often triggered by the cluster
effect. When a suicide happens one particular group of people, (say youth, indigenous

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population, and so on), it seems to trigger more among the others in the group(Robinson,
2016).Although the survey reported presented with the number of suicides gives a collective
number of suicides in a year, it has been found that the rates are highest among the youth
(Longbottom, 2016)
b. Using relevant literature, identify and critically discuss one community group which is at
risk of depression AND one different community group which is considered at risk of
Suicide.
Depression:
One of the particular concerns today, facing the world (and Australia at large) is the mental
health of youth. With the adolescent and teenage population more exposed to social media,
online games and news, children face depression at a very young age. It is predicted that the
young females, at the age group of 12-20 years are twice as much prone to depression and
restlessness than the male (Pearce, 2017). This is especially true with older teenagers, at the age
group of 18-19 years, where they are more susceptible to peer pressure, stress due to social life,
and studies, bullying in the college, and so on. Social media, may also be one of the significant
reasons for young girls facing mental health challenges. This depression, as said to be developed
at a young age (at adolescent stage) contributes to the mental health in later stages of life.
Suicide:
A survey conducted in 2015 shows that the suicides in indigenous populations and Torres strait
islanders are twice as much as those in non-indigenous people (Armstrong, G., 2017). This trend
of suicide is a recent one, and mostly seen in younger members of the group. The average age, as
predicted by the survey, for suicide among the indigenous population is less than 35 years of age

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Most of these deaths are attributed to depression, substance abuse and also on the influence of
others in the community, what is called the cluster suicides. Sadly though, many suicides or self-
harm symptoms are also seen among females who have been hospitalized and suffering from an
illness.
2. Critically discuss 2 factors that may have contributed to the development of the client's
mental health concerns and risks.
In scenario A, Jonathan is a youth of 19 years, with a series of distressing events in his life. With
the loss of his one parent, (his mother) and a developing distance between the other, he suddenly
feels isolated and lonely. Jonathan is depressed, and with his mother's anniversary approaching,
he feels his only respite would be to end his life. Poor family cohesion, as Grenklo, T. B., et. al
(2014) suggests, is one of the reasons for self-destructive behaviour in youth. A close knit
family, disintegrating within a span of months, and the stress of dealing with sickness might have
lead Jonathan into a turmoil. Loss of a close relative here, and who has suffered in front of him,
with an illness like cancer, has made Jonathan take the fatal step, and understandably, closer to
the approaching anniversary of his mother's death.
Here, two things have happened simultaneously for Jonathan. For one, he has lost his mother,
and in an illness which would have lasted for a few months at the most. Second, his father, who
might himself be feeling lost due to his wife's death, is dealing with his grief in his own way, by
working overtime. Although monitory issue is also a concern, the father here might have
distanced himself to deal with both his own grief and also to repay the loans. Hence, father, the
one parent alive, is not there to support Jonathan or share his grief.

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Similarly, Jonathan is facing other challenges in life, such asan inability to cope up with
everyday work in his workplace. With assignments pending, and attendance lagging behind,
Jonathan is worried that he might not be able to clear his training at TAFE. A Youth, especially
those who have been doing well in academics or whatever field of interest, suddenly is finding it
daunting to face challenges and is stressed out to keep up with their peers. This is something
similar that has happened to Jonathan, and have forced him to take the ultimate decision
(Longbottom, 2016). The last straw is the fight with the girlfriend, and a possible change in his
relationship status. This one act had finally acted as a trigger, and have Jonathan over the edge,
with his pills and drinks. Losing a parent, and then with another not able to provide support,
Jonathan seems to have been depending upon his girlfriend for emotional support. Now that he is
being threatened by it, and with his mother's death anniversary approaching, (an event that seems
to have triggered everything in the first place), Jonathan has developed self-destruction
tendencies and might continue to do so, unless help is offered.
3. Ethical and legal considerations in health care can generate in-depth discussions from
different perspectives within a professional health care team. The case study presents areas
of risks regarding harm to self and others. Use literature and the case study to define and
discuss the ethical principles of beneficence and non-maleficence and aspects of the mental
health ACT, 2007, which are relevant to the areas of risk in the case study.
Jonathan in the case study, is 19 years of age. According to the Mental Health Act, 2007, he
is at a stage where he can be considered an adult, and no parental supervision is required
during his hospitalization. Hence, although any legal issues regarding his admission or
questioning by the nursing staff in the emergency department are ruled out, there are always
ethical considerations to be noted.

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Ethical dilemmas like doing the correct thing in a situation, is often contradicted by other
constraints put forth on a medical professional. For instance, in the case of Jonathan, the
problem might be that although he is 19, and can very well take decisions on his own.
However, the health care professional might need to talk to an elder or a parent to relate the
situation and advise on the outcomes. With the mental health of the patient not very stable,
and with him susceptible to take the course of action once again, if left unattended, it
becomes imperative to put forward the issue to someone close enough to monitor the
situation. However, can they do so, without foregoing the legal and ethical implications, is a
remarkable question to answer. As the experts say, the psychological question of treating a
person, who is responsible to oneself (as an adult, Jonathan is legally responsible for
himself), but, does not have the power or resources to act upon it, is confusing, and ethically
questionable (Holm, 2014).
Appling the principles of non-maleficence and beneficence in ethics, although the patient has
relayed the information and his wish to end his life as a confidential information to the nurse,
it is imperative that the information is shared with the physician. The principle of
beneficence suggests the use of information to provide a positive outcome, and thus, do good
for a person (Jie, 2015). Hence, here, if the nurse has to apply the principle of beneficence
and help Jonathan, the information needs to be shared with the health care professionals and
relief sought, in the form of a guidance and treatment from mental health experts. The
principle of non-maleficence, however, suggests performing a deed that the patient considers
right, or it is beneficial for the patient, according to his own predictions. Thus, relating
Jonathans wish to end his life, and seeking the help of a mental health professional is not
something that Jonathan might want, and therefore, might not be to his advantage. Jie

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suggests, therefore, to take heed of patient's own perspective about harm and benefit, while
applying the non-maleficence and beneficence principles of ethics to a case study.
4.Identify a high priority and urgent mental health risk from the case study and provide
two relevant interventions. Explain the rationale and possible impact on the client for both
interventions drawing on the relevant literature.
Persons withsuicidal tendencies need to be treated with a thorough understanding of their
problems, and the root cause of it. Hence, certaininterventions from the nursing professionals can
aid in keeping the suicidal tendencies of the patient in control.
In Jonathan's case, he is a youth in his prime, with a promising career ahead of him, once he
finishes his training. So, what made him think of the extreme step, is something that needs to be
analysed. Getting to the root cause can help the nurse to work out a treatment plan. It is
imperative to speak to Jonathan about his life and help him to pour out his troubles for the
professionals to analyse and chart a method of treatment.
A person with suicidal tendency might be amenable to any kind of treatment, if they can make
him talk to the nurse about the reasons for his suicidal attempt. Jonathan here, has shared enough
information to the nurse in the emergency department about the problems he is facing in life, and
has also shared that he wants to die. This thought in mind shows Jonathan has strong suicidal
tendencies and needs to be addressed by constantly monitoring him, while in the hospital, and
even after he goes home. A person with suicidal tendency might reveal facts like talking about
death all the time, and thinking of ways to hurt themselves, and expressing feelings of
hopelessness. Safe clinical practices, patient - centred interventions and interpersonal
communication and collaboration, are some of the ways to aid the patients with self-destructive

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thoughts. (Puntil et.al, 2013). Listening carefully to the patient, and recording signs and
symptoms of distress can help in taking action when required. An open talk (establishing a
therapeutic relationship), can help in identifying the weaknesses and also in finding the cause for
suicidal tendencies.
Another fact, which can help in Jonathan's case is to teach the family and primary care provider
about possible symptoms to monitor and provide hotline numbers to contact emergency, if and
when help is required. Keeping a track of things that looks like the person's reactions and his
erratic behaviour during the hospital stay is easier for a nurse, since he is under 24 hour
supervision of medical professionals. However, doing it at home is the responsibility of the
parent, or any primary care provider. Although Jonathan might not require a 24 hour care, the
family members need to be taught about certain aspects to look for, to identify potential risk and
prevention. Keeping self-medications out of reach and things like, monitoring, for any signs of
depression, and not leaving patients to be alone for too long, might help (Sarah,
2015).Questioning the family members after narrating them with the preparatory actions to be
taken can keep them ready for action, when required. This can help the family members to be
alert for any small signs to take instant preventive action. Also, in the case of Jonathan, with his
case history, the family members should be taught to keep medications away from his reach, and
also any other material susceptible to suicide.
Finally, gaining the trust of both the patient and the family members can be a significant and
essential intervention to prevent Jonathan from taking this course of action again. Since the
family members and the girlfriend, are going to play a significant role in the Jonathans treatment
plan, it is essential to involve them at each stage to make the effort successful. Referring them to

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mental health care agencies and counselling the patients through external source can be the next
course of action.
5. Identify a mental health problem/need or concern from the case study, and provide two
relevant interventions. Explain the rationale and possible impact on the client for both
interventions, drawing relevant literature.
Anxiety is one of the mental health concerns that needs to be addressed due to its potential risks,
if left uncontrolled. Anxiety, can be defined as an uneasy or a vague feeling of dread and
discomfort, and always accompanied by an automatic response. The source of anxiety in a
person is unknown, and usually is a signal or an apprehension for an impending danger. Since
everyone is susceptible to anxiety of one magnitude or another. Anxiety interferes with the
ability of a person to act normally during a situation and thus, the person can lose concentration,
and show visible signs of distress outwards, such as tremors and tachycardia (Lader, 2015)
One of the most significant factors in the treatment of a patient with an anxiety disorder is to
maintain calmness while talking to the client, and remain with them, while they are in a highly
anxious state. Anxiety can lead to serious threats to self and thus, it is essential to bring them out
of that situation. Also, a client will calm down and feel secure, if the person handling them is
calm and collected. Talking to them softly, and addressing the concerns they might have,
regarding the apprehension, can help them open up to suggestions and treatments. A nurse can
recognize the three facts by gaining the trust of the patient – ABC – Alarms, Beliefs based upon
previous incidents which has resulted in the present condition and Coping mechanisms, which
can be identified as effective, or not over a period of time (Bystritsky, 2013) These facts, then
can be applied in the treatment process, to help patients deal with their disorder.

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Similarly, anxiety, as Nathan and Gorman (2015) believe, can be treated with the use of CBT-
cognitive behavioural therapy. Putting the client's perspective into place, recognizing the patterns
of anxious behaviour and incorporating methods to transform those thoughts into positive
outputs can help a patient in overcoming the fears and anxiety.
A highly anxious patient might pose a threat to not only himself, but others around. Similarly,
their anxiety might escalate, in such instances. Also, a client will calm down and feel secure, if
the person handling them is calm and collected.Hence, applying the CBT can be a challenging
process, unless the nurse can talk to them softly, and write downthe situations which causes
apprehension and uncertainty. CBT has been applied to patients with extreme depression
symptoms and suicidal tendencies, and have been found to be beneficial in both cases.Applying
CBT involves teaching the patients about the coping mechanism and helping them to change
their outlook to a positive one. A person, afraid of the dark, or getting anxious in a crowded
room can either get out of the room, or learn to block out the crowd with defence mechanism.
Although, since each patient is unique, and each situation differently, as Kaczkurkin and his co-
authors (2015) concludes, itis essential to determine which component can be used in what
situation, to make it effective.

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