Exploring Mental Health, Poverty, and Cultural Safety in Nursing

This essay explores the intricate relationship between mental health, poverty, and cultural safety within the Australian healthcare system. It highlights the prevalence of mental health issues in Australia, particularly among vulnerable populations such as women, young adults, and indigenous people. The essay emphasizes poverty as a significant social determinant of mental health, exacerbating the risk and consequences of mental illness. It further discusses discrimination faced by individuals with mental illness within healthcare settings and underscores the importance of cultural safety and person-centered care in nursing practice, referencing the NMBA code of conduct and ICN code of ethics. The essay concludes by advocating for accessible, culturally appropriate healthcare services and addressing inequalities to improve mental health outcomes for all Australians.

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Table of Contents
Introduction:................................................................................................................................................1
Poverty........................................................................................................................................................3
Discrimination.............................................................................................................................................4
Code of conduct for nurses [NMBA 2018)..............................................................................................5
Standard for practice of nurses (NMBA 2016)........................................................................................6
The Code of Ethics (ICN 2012)...............................................................................................................6
Australia’s health system.............................................................................................................................7
Conclusion...................................................................................................................................................8
References...................................................................................................................................................9
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Introduction:
Mental health includes psychological, social and emotional wellbeing. It affects how people
think, act and feel. It also helps to determine how people relate to others, make choices and
handle stress. In Australia, mental health issue is widely spread and has impact at social,
economic and personal levels. Every year one in every five people in Australia will suffer from a
mental disorder. It is the third main cause of disability burden in the country, estimating 27% of
total years lost because of disability (Mental health: a state of well-being, 2014). In 2015, over 4
million people were estimated to have mental health issue and nine billion dollars was spent on
it. Women, young adult, indigenous people, immigrants, people living in rural areas, low socio-
economic people, people with chronic disorders etc. are more vulnerable to mental health issues.
Depression, substance use disorder and anxiety are most common prevalent mental illness.
Mental disorders are more prevalent among 18-24 years old adult and its prevalence decreases
with age. Women are more vulnerable to mental illness than men. Similarly, indigenous people
are more likely to suffer from mental disorders than non-indigenous people (Mental health
services in Australia, 2018). Approximately 26% people between 18-24 years had suffered from
some kind of mental illness while only 5.9% population over 65 years had experienced it.
According to 2007 data of National Survey of mental health and wellbeing, about 45% of people
in the age between 16-85 years will experience mental illness in their life time at some time.
Similarly, mental illness is more prevalent in unemployed people i.e., 34% unemployed women
and 26% in unemployed men.
In 2013-2014 according to survey of Australian adolescents and children mental health and
wellbeing, almost 1 in 7 children i.e. 13.9% aged between 4-17 years had mental illness in the
previous 12 months. The rate of mental issue in males living in urban areas was slightly higher
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and in remote or rural areas it was higher in females. People from refugee background and
CALD communities (Culturally and Linguistically diverse) have experienced trauma, torture and
loss in past while moving to Australia
Poverty
Mental health of a person is shaped by several economic, physical and social factor. Social
determinants of health can be defined as the condition in which people are born, live, grow up
and work and accessibility and quality to health care (Allen, Balfour, & Marmot, 2014). There
are several social determinants of mental health that includes, social exclusion and
discrimination, poor education, adverse early life experiences, poverty, income inequality, poor
housing etc.
Poverty is one of the major risk factors of mental illness. It enhances the risk of mental illness
and can be a consequences and casual factor of mental illness. Mental illness can disrupt people
training, education, entry and progression within life. It even hampers social, personal and
professional life that leads to isolation and decreased work productivity even unemployment. So,
the consequence of mental health can be poverty (Social Determinants of Mental Health, 2014).
Higher rates of mental health disorders are associated with socio-economic disadvantage and
poverty. Social characteristics like disability, gender, ethnicity, race, family status affects the
presentation and rates of mental health issues and access to the services and support. People
living in poverty often experience food insecurity, lives in unstable housing, violence and trauma
in distressed neighborhood, struggle to pay bills, unemployment, social exclusion,
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discrimination, limited or no access to public health care facilities and education etc. increases
the level of stress affecting the behavior and mental health of these people.
Impact of poverty is much more alarming in case of children. Exposure to trauma and persistent
stress trigger harmful stress hormones in them that affect their genes and brain development.
Inequalities between different social class in the incidence of mental illness, chronic illness and
life expectancy is very obvious. People living in poverty or low social class even struggles to
have healthy and nutritious food, lack respect from others, face inequalities and discrimination,
and often are victims of violence, substance abuse, neglect which are the risk factors of mental
illness in them.
Mental health also has negative impact on physical health of individual which further adds stress
and burden to people who already are in disadvantaged compromised situation
Discrimination
The mental health stigma existing in the health are system and among the health care provider is
considered as one of the major barrier in accessing health care treatment and recovery. This
stigma is also the reason behind the poor quality of physical care with people having mental
illness. This further impacts the health care providers for their help seeking behavior which
negatively affects their working environment (Knaak & Szeto, 2017).
The people with mental illness are commonly found feeling dismissed, devalued and
dehumanized from the hands of various health care providers with whom they come in contact to
(Pellegrini, 2014). They are not included while taking any decision regarding their health,
receive subtle or overt threats of coercive treatment, not receiving correct information about their
own condition or treatment options, being made to wait for longer duration while seeking help,
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being treated in demeaning or paternalistic manner, big rude or told that they would never get
well and being spoken to or about using technical jargons or stigmatizing language. It has also
been observed that patient with certain disorders like personality disorders are rejected by health
care staff and are often felt to be manipulative, difficult and gets very little attention. Another
issue is lack of awareness and unconscious biases which can minimize the stigma related
behavior (Byrne, 2010). The health care providers also hold pessimistic views about the reality
and likelihood of recovery which acts as a factor and barrier for the mental health patient seeking
help. The health care providers act with a mentality that mental health issues are incurable which
directly affects their approach towards the person suffering from mental illness.
Code of conduct for nurses [NMBA 2018)
The NMBA i.e. Nursing and Midwifery Bod of Australia has issued new code of conduct for
midwives and nurses (New codes of conduct for nurses and midwives published, 2017). These
are important for al the nurses and midwives as they provide and support safe practices a as part
of their roles and responsibilities.
According to this, there are seven basic principle for nurses that includes: 1. nurses should
adhere and respect to occupational obligations under the National Law and obeyed by relevant
law. 2 nurses should provide person centered, safe and evidence-based practice for patients and
should promote cared delivery and shared decision making between the individual, friend, family
and health professionals. 3. They should engage with people respectfully and culturally safe way,
should have honest professional and foster open relationships, follow their obligations about
confidentiality and privacy. 4. They should express honesty, integrity, compassion and respect.
They commit to supervising, accessing and teaching students and other nurses to develop
efficient and effective workforce. 6. They recognize the important role to notify quality policy
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development and healthcare, and research ethically, support and respect decision making of other
people who participates in the research. 7. They promote good health for individual, their family,
community and themselves and addresses the inequality in health care service.
Standard for practice of nurses (NMBA 2016)
It is an evidence based and person centered with curative, supportive, palliative, preventive,
formative and restorative elements. According to it registered nurses recognizes the significance
of culture and history to health (Registered nurse standards for practice, 2016). It involves seven
standards that are: 1. analyses and think critically nursing practice. 2. Engages in professional
and therapeutic relationships. 3 they should maintain the capacity for practice. 4. Conducts
assessments comprehensively. 5. Plan for nursing practice. 7. Provide appropriate, responsive
and safe quality nursing practice.
The Code of Ethics (ICN 2012)
It has 4 principle elements that define the standards of ethical conduct which are: the primary
role and responsibility of nurse is to provide care to people who requires nursing care. They
carry personal accountability and responsible for nursing practice and maintain competence by
continuous learning (The ICN Code of Ethics for Nurses, 2012). They assume their major role in
implementing and determining acceptable standards of clinical nursing management, research,
practice and education. And lastly, they sustain a respectful and collaborative relationship with
coworkers in their fields and others as well.
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All the above documents never promote discrimination of any nature i.e. based on caste, creed,
color, religion, race, ethnicity, etc. Its moral responsibility and duty of all heath care
professionals to provide without any biasness. Any kind of discrimination whether workplace,
hospitals, offices, schools or colleges is strictly forbidden under the law.
Australia’s health system
The principle for Australia’s Health System are stewardship, affordable access of health care for
patients, recognition that bot private and public health care system support health care,
supporting evidence-based mental health service, improvement of health status of aboriginal
people, transparency of decision making, accountability for structural reformation in 2020-2021
providing better facilities and commitment to provide high value clinical care, world class health
system and high value clinical care. Health care services is provided by several health
professionals and organizations that includes nurses, medical practitioners, hospitals,
pharmacies, non-government and government agencies. They provide wide range of facilities
and services from preventive to public health services in communities, emergency health
services, primary healthcare, hospital-based treatment, palliative care and rehabilitation.
Australian health care system support culture safety and person center care as people in Australia
are culturally diverse (Australia’s health system, 2016). There are people of different culture,
race, ethnicity all over Australia and they need culture appropriate care. It has several laws and
legislation s that support cultural safety and person-centered care in nursing which should be
provided to patients.
There are several health services providers in Australia that includes: Health promotion and
disease prevention, Primary care and community services, Secondary and tertiary services, Long-
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term and continuing care services. The two models of health care delivery in Australia that
provides services for people with mental illness are health promotion and prevention and
secondary and tertiary service (Health Service Delivery Profile, 2012)s. Health promotion and
prevention model provides prevention, early intervention and promotion services through several
national action plan. It provides services like communicable disease surveillance, screening,
immunization, family planning, tobacco, alcohol and obesity health promotion. Secondary and
tertiary services provide services for the outpatient and inpatients. It also provides ambulance
service that includes acute culture, transport and emergency service. It provides mental health
services that are delivered through general practitioner, psychologists, psychiatrists, community
based mental health services, psychiatric units within hospitals, psychiatric hospital and
residential care services.
Conclusion
From the above paper it is evident that people with mental illness faces difficultly in each stage
of their life. The issue is not only limited to any area but is prevalent every part of the world.
Women, people with low socio-economic status, disabled people, indigenous people and young
adult are more vulnerable to mental illness than others.
People with mental illness are mostly discriminated and treated unequally by health care worker.
Strict action should be taken against the health worker who discriminated and treat them
unequally. People training, awareness program and guidance should be provided to health
worker before they come in contact with such patients. Need based and culturally appropriate
care should be provided. People living in poverty and with mental disorders would benefit from
accessible health care services within vulnerable community. So, health care facilities should be
easily accessible in these areas and holistic health care should be provided to make health care
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system more effective. Health care in Australia should focus on to decrease the risk factors and
social determinants of health to prevent mental issues and other health related issues.
References
Allen, J., Balfour, R., & Marmot, M. (2014). Social determinants of mental health. PubMed, 26(4), 392-
407.
Australia’s health system. (2016). Retrieved from Australian Institute of Health and welfare:
https://www.aihw.gov.au/getmedia/f2ae1191-bbf2-47b6-a9d4-1b2ca65553a1/ah16-2-1-how-
does-australias-health-system-work.pdf.aspx
Byrne, P. (2010). Challenging healthcare discrimination: Commentary on … Discrimination Against
People with Mental Illness. Advances in Psychiatric Treatment, 16(1), 60-62.
Health Service Delivery Profile. (2012). Retrieved from WHO and Australian Institute of Health and
Welfare: http://www.wpro.who.int/health_services/service_delivery_profile_australia.pdf
Knaak, S., & Szeto, A. (2017). Mental illness-related stigma in healthcare. PMC, 30(2), 111–116.
Mental health services in Australia. (2018, May 3). Retrieved from AIHW:
https://www.aihw.gov.au/reports/mental-health-services/mental-health-services-in-australia/
report-contents/summary/prevalence-and-policies
Mental health: a state of well-being. (2014, August). Retrieved from World Health Organization:
http://www.who.int/features/factfiles/mental_health/en/
New codes of conduct for nurses and midwives published. (2017, September 28). Retrieved from Nursing
and Midwifery: http://www.nursingmidwiferyboard.gov.au/News/2017-09-28-new-codes-of-
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conduct.aspx
Pellegrini, C. (2014). Mental illness stigma in health care settings a barrier to care. NCBI, 186(1). Retrived
from http://doi.org/10.1503/cmaj.109-4668.
Registered nurse standards for practice. (2016, June 1). Retrieved from Nursing and Midwifery Board of
Australia: http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?
record=WD16%2F19524&dbid=AP&chksum=R5Pkrn8yVpb9bJvtpTRe8w%3D%3D
Social Determinants of Mental Health. (2014). Retrieved from World Health Oranization:
http://apps.who.int/iris/bitstream/handle/10665/112828/9789241506809_eng.pdf;jsessionid=5
37F85B00AF87E029D232BF391A13DF9?sequence=1
The ICN Code of Ethics for Nurses. (2012). Retrieved from International Council of Nurses: www.icn.ch
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