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Barriers to Mental Health Care

This case presents the issues of Peter, a man living with his wife, Gail on the edges of a regional
town. Read the scenario then respond in your assignment to the following questions.
Peter is a 35-year-old man who lives with his wife and two children, aged 10 and 7 years, on a
small property just outside a large regional town. Peter grew up on a farm three hours’
drive north but is now well established in the regional town. He works as a middle level
manager in a construction business. He consults a local general practitioner, Dr
Mercedes, for a first visit because he has been experiencing insomnia and loss of energy.
Peter adds that one of his workmates has recently been diagnosed with leukaemia. Dr
Mercedes has only ten minutes allocated to see Peter and performs a quick physical
examination and takes some blood. She asks Peter to return in one week. At the second
visit to Dr Mercedes, Peter is told that no physical problem was found on his blood tests.
The doctor is at pains to rule out the possibility of leukaemia. Peter appears relieved. The
doctor prescribes a short acting benzodiazepine, temazepam for his sleep. She asks Peter
to return in a month if things have not improved.
A fortnight later, Peter goes to see his old family GP, Dr Bill Holden, who practises in a town
close to his parents� farm, where Peter is staying for a visit. Peter explains that he has
felt much worse in the last fortnight. His sleep pattern has deteriorated considerably and
although he gets off to sleep fairly easily, he wakes every night staring at the clock at
2am and then can’t get back to sleep for hours. The mornings are his worst time but as the
day goes on things gradually improve. In the evenings Peter has felt tense as the time to
go to bed comes closer and he knows his night will again be difficult. On questioning
from Dr Holden, Peter says, �life has always had its ups and downs�, but that he has
never felt like this before. He says he has lost his taste for food and has lost 5kg in
weight. His wife had told him that he seemed to have lost interest in all his normal
hobbies and appeared to get no pleasure from anything. After further questions from Dr
Holden, Peter went on to say that his sex drive had dropped away totally. Bill Holden
also checks whether Peter has any significant suicidal thoughts and is relieved to find that
Peter has no active suicidal plans at present.

Peter went on to explain that lately his wife had tried to cheer him up. He was unable to react to
her efforts and constantly felt down. Subsequently Peter’s wife, Gail complained that he
always rejected her and was spending more and more time at work. Peter had told her
that he was under considerable pressure at work, as his company was trying to secure
more building contracts despite difficult economic times. Things had got really difficult
between them and last Friday night she had accused Peter of having an affair. He
admitted to her that he has sought support from his secretary at work, but denied that a
relationship has developed. Gail was very upset and asked him to leave.

The next morning Peter packed his things and drove home to the family farm to stay with his
parents. He decided he needed help and that is why he had come to see Dr Holden, whom
he had known all his life. After listening to Peter for twenty minutes, Dr Holden tells him
he believes Peter is suffering from major depression and that a combined approach of


tablets and talking therapy is indicated. Dr Holden tries particularly hard to educate Peter
about “depression as an illness” since there is a particular stigma about mental illness in
his local community. He informs Peter about the good chance of a recovery from this
episode with appropriate treatment.
Suggested structure for assignment is;
Introduction: state briefly what you intend to do in the assignment (150 words).
Body: Briefly describe the nature of Peter’s problem. Reference any material you have used (200
In a regional area such as the one where Peter lives, what are the barriers to mental health care?
Give an account of the local scene for someone with a mental health problem. You may
pick the area you are currently working, or research an existing area and use this (200
What do you think are his most pressing concerns? Provide a list of both Peter’s and Gail’s
concerns. Also suggest the strengths Peter may already bring to help overcome his
problem. Give brief explanations of each concern and identify any interventions that may
help him. Ensure you identify the level of evidence of the interventions and provide
examples from the literature of research that has demonstrated this evidence (800 words).
Examine the different disciplines that may be able to help Peter and Gail and give examples of
the way in which these disciplines could work together (300 words).
Conclusion: Tie all of your findings together and give a concise summary of what you have
found (350

Mental Health: Case Study in Rural Australia

Mental health encompasses psychological stability and absence of psychiatric
abnormalities. It also involves emotional well-being and ability to control one’s behavior. Other
concepts constituting mental health include self-dependence, autonomy, and intellectual
competence. Mental illnesses include critical clinical conditions such as Alzheimer’s syndrome,
dementia, psychopathy, obsessive disorders among others. There are also other conditions that


occur more frequently such as anxiety, depression, addiction, mood swings, grief, stress and
others. When such conditions present with a certain threshold of severity, clinical intervention is
necessary. Psychiatric and psychological interventions are particularly helpful in avoiding
outcomes such as suicide and tendencies to harm one-self. This paper refers to the case of Peter
who visits two doctors and is diagnosed with depression. The paper describes the condition of
Peter, looks into societal perception of mental conditions, points out the patient’s major
concerns, and offers interventional recommendations to help the patient manage depression.

Peter’s Problem

Peter’s clinical complication is depression. Smith, Saisan, and Segal explained that
symptoms of depression include hopelessness, loss of interest in one’s daily encounters, sleep
abnormalities, irritability, fatigue, and inability to concentrate among others (2010). Peter
experiences most of these problems, and in addition to that, he has fears of having acquired
leukemia. Blood tests revealed that Peter was not suffering from leukemia, and his fears were
probably motivated by a sensation of hopelessness often associated with depression. Again, Peter
presents with occurrences such as loss of appetite and unintended weight loss. Both experiences
are symptoms of depression as research findings show (University of Michigan, 2014). Peter is
also unable to have fun and interact lively with his family. The condition has worsened with time
and patient inability to sleep has aggravated even after treatment with temazepam. Peter also
pointed out that life has both good and bad courses. His assertion was motivated by sadness and
despair which often occur during depression. Actually, depression is a real disease, and it is best
explained from the feelings of patients (University of Michigan, 2014). Possible causes of
depression in Peter’s case include fear of having leukemia, work-related emotional stress, and


being too self-critical. The condition is worsened by accusations of infidelity placed by Gail
against him and his subsequent dismissal from home.

Barriers to Mental Health Care

Peter’s local setup presents significant barriers to his access to mental health care. First,
the community expresses unwelcome perceptions about mental diseases. It stigmatizes patients
of mental disorders making them feel uncomfortable when seeking psychiatric and psychological
care. So as to avoid social consequences, patients may not readily accept that they have mental
illnesses. This may interfere with their tendency to seek care and also cooperate in management
of these conditions. In Peter’s case, Dr. Holden takes caution when informing his patient about
depression as an illness of the brain. The strategy worked effectively in avoiding
misunderstandings with his client. Additionally, mental diseases such as depression involve
diagnostic questions that patient may not readily answer in the locality. These include one’s
interest in activities such as sex as seen in the case of Peter. Other local determinants of care
accessibility include adequacy of medical and psychiatric personnel to handle patient concerns
effectively. In some situations, patients would require in-depth evaluation that would cost health
institutions considerably large amount of time. In cases where hospitals would not have adequate
personnel, institutions would limit the length of patient appointments so as to attend as many
clients as possible. On the same point, small towns may not sustain medical specialists such as
psychiatrists, and patients would have limited access to specialized mental health care (The
Royal Australian and New Zealand College of Psychiatry, 2015). In Peter’s case, Dr. Mercedes
only had ten minutes to diagnose and evaluate the clinical condition of her client.

Peter’s and Gail’s Concerns


Peter’s concerns included his current and future health, safety of the job environment,
economic gains for his company, as well the well-being of his family. On the other hand, Gail’s
concerns are about health and social condition of her husband. Gail worries about Peter’s loss of
interest in different aspects including interactions with his family, eating, engagement in sex, as
well as his long stays at work. However, Gail does not expect Peter to suffer from a mental
condition, and so, she does not relate Peter’s condition to disease. Instead, she worries that
Peter’s behavior is associated with an affair with his secretary.
On his side, Peter worries about a possibility of experiencing severe health complications
in the future. The instance of one of his workmate being diagnosed with leukemia makes him
worried about his possibility of suffering from the same condition. The patient is probably
dissatisfied with his current job and he feels a need to take early measure of avoiding leukemia.
It is for this reason he suggested that Dr. Mercedes examine him for cancer. However, peter’s
condition does not improve even after being proved not to have leukemia. Most likely, the
middle-level manager still feels predisposed to the disease and he fears continuing with the job.
Peter has a considerably young family and the thought of acquiring cancer could be causing
severe mental disturbance to him. So as to overcome these worries, Peter should purpose to
resolve the ambiguity regarding his working place and predisposition to disease. Wahrenberg
explained that when people have misunderstandings about issues that cause them to worry and
become anxious and depressed, they should seek direct answers to such concerns for them to
overcome them (2014). Therefore Peter would need seeking assurance from health agencies and
his company that he would not be placed at the risk of diseases by the working environment.
Peter is also concerned about his currently deteriorating health status. The patient
expected that his health status would have improved after his first visit to Dr. Mercedes. His


expectations were unmet, and instead of having improvements, Peter experienced worse sleep
disturbances. When patients fail to improve after taking medications, they have high tendencies
to question their diagnoses and they may end up experiencing increasing worries. If their doubts
are high, they may not feel improvements. Research indicates that patients can heal from placebo
effects on the basis that patient beliefs play significantly in determining treatment outcomes
(Miller, Colloca, & Kaptchuk, 2009, p. 518). Likewise, it is possible for patients not to recover
from illnesses if they continue to belief that they are sick. Since depression is a disease of the
mind, Peter’s thoughts of not healing would have counted remarkably in causing his health
deterioration. So as to settle the above concerns, Peter would require psychological boost.
Psychotherapy would be necessary in boosting his mentality and overcome the impact of
negative feelings. There are various professionals who could administer psychological therapy to
Peter. They include health care specialists such as psychologists and nurses, as well as social
professionals such as spiritual leaders and counselors. Research shows that morale boost
facilitates patient healing and recovery from diseases (Miller, Colloca, & Kaptchuk, 2009, p.
518). However, there are certain standards that psychotherapy should meet for it to work for the
case of Peter. First, the therapist needs having updated information concerning depression and its
management. This would see to optimal effectiveness of recommendations offered by the
therapist. Again, the patient must feel free to interact with his therapist. It is recommendable that
Peter uses a therapist whom he likes. Additionally, psychotherapy should be time-limited, and it
should be reconsidered if the patient does not improve within the first six sessions (Clinical, 2015). Again, the intervention should entail interpersonal, behavioral, and
cognitive types of therapy. Cognitive therapy would particularly improve patients’ perception of
self and their future, and it also helps them to overcome behavioral challenges such as inability


to sleep (Hofmann, Asnaani, Vonk, Sawyer, & Fang, 2012, p. 427). Therefore, it would be
effective for the case of Peter considering his situation and concerns. Other approaches that
could work effectively in managing depression include engagement in exercises. The
intervention would boost both his physical and mental health. However, Peter would still need
motivation to engage in exercises as adherence to the practice could be hindered by his current
condition. Peter experiences fatigue, loses interest in most activities, and has considerably high
chances of poor self-esteem. Research shows that the above experiences often compromise the
effectiveness of exercise as a measure to manage depression (Blumenthal, Smith, & Hoffman,
2012, p. 18). Peter may also consider approaches such as using appetizers to boost his poor
appetite. He may also consider taking a short leave from his job so as to regain his health.
Generally, Peter expresses strengths that would facilitate implementation of various
management strategies. For instance, he is willing to seek medical help to handle his condition.
Therefore, he is likely to cooperate with his health care providers and adhere to
recommendations. Additionally, Peter has a family that would be a source of support for his
recovery. It is most likely that his wife would offer necessary physical and psychological support
if she understands the health situation of her husband. Lastly, Peter is employed and it is most
likely that he has an insurance cover that would cater for his treatment and therapy.
Relevant Disciplines and their Coordination in Managing Peter and Gail’s Situation
Depression is a significantly complex disease owing to its association with other
conditions such as aging, physical ill health, grief, dementia and so on. Different health care
disciplines should share knowledge and guide one another in its management. Relevant
disciplines in the case of Peter and Gail include a psychologist, psychiatrist, nurse, therapist,


nutritionist, and family members. Each member of the team would play a role that matches their
specialization for efficiency. For instance, a psychologist may head the team and communicate
the needs of the patient to the rest of the team. The psychiatric would carry out the role of
prescribing medications, while the nurse would constantly monitor the patient. A physical
therapist would help Peter engage in exercises, while the nutritionist would help the patient
recover his appetite. Family members would work together with the team in supporting their
patient by offering a peaceful environment and helping him physically and emotionally.
Novotney reported that depression management works best with the integration of multiple
strategies such as exercise, stress management, and pharmacological interventions (2010, p. 40).
There are numerous benefits associated with a multidisciplinary approach to disease
management. Novotney reported that the approach is cost-effective and it is cheaper than the
traditional forms of care that involved minimal integration (2010, p. 40). Such a strategy would
also save time for the patient as he would receive holistic type of care at the same time. Again,
the move is associated with a high degree of efficiency. Professionals would first share their
knowledge, discuss options, settle their differences, and offer recommendations that are verified
from multiple perspectives. The strategy would also promote patient satisfaction in that Peter
would not have to strain to have his needs addressed. Instead, professionals would work closely
with one another, identify patient needs, and make necessary arrangements and hence act on
behalf of their client. An inert-disciplinary approach would also enhance interactions between
the patient and care providers as professionals would gain a deep understanding of their



Mental health is a broad term describing people’s psychological status as well as their
lack of psychiatric disorders. Diseases of the mind are varied with some being critical and
complex while others are barely severe. Conditions such as depression, addiction, anxiety, loss
of moods, and stress may be mistaken for insignificant clinical conditions, but in most cases,
they impact undesirably on people’s health and life quality. A critical evaluation of Peter’s
experiences suggests that the middle level manager is depressed. He has been experiencing fears
of having leukemia but diagnostic test revealed that he did not have the condition. Even after
receiving the good news and receiving treatment to depression, Peter did not improve, and
instead, his condition worsened. His depression is severe to an extent that it affects the outcomes
of its treatment. His failure to respond positively to treatment was influenced by his depressed
status and a conviction that he was facing a severe threat to health. It is important to note that
some localities pose significant barriers to accessibility of mental health care to patients. For the
case of Peter, the society stigmatizes mental health patients. Such situations make it hard for
patients to comfortably seek treatment for mental diseases. Other factors affecting accessibility
of mental health services expressed by specific local regions include inability to sustain
psychiatric specialists. In most cases, diseases make patients and their families to worry. At the
same time, diseases such as depression could result from worrying. Major worries that Peter held
included the fear that he could be at the risk of getting leukemia. The middle-level manager was
probably concerned about the safety of his job environment considering the recent occurrence of
his workmate being diagnosed with leukemia. Psychotherapy, exercises, medication, and an
approach to address his causes of depression such as seeking assurance about the safety of his
working environment were recommendable approaches toward depression management for
Peter. A multidisciplinary team would be crucial in implementing such strategies. It would


involve clinical professionals as well as non-clinical staff. Gail and the rest of Peter’s family
would also be important as they would offer physical and emotional support to Peter and
promote his recovery from depression.


Blumenthal, J. A., Smith, P. J., & Hoffman, B. M. (2012). Is exercise a viable treatment for
depression? ACSM’s Health & Fitness Journal, 16(4), 14–21.


Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of
cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and
Research, 36(5), 427–440.
Miller, F. G., Colloca, L., & Kaptchuk, T. J. (2009). The placebo effect: illness and interpersonal
healing. Perspectives in Biology and Medicine, 52(4), 518.
Novotney, A. (2010). Integrated care is nothing new for these psychologists. American
Psychological Association, 41(1), 40.
Smith, M, Saisan, N., & Segal, J. (2015). Depression symptoms and warning signs.
The Royal Australian and New Zealand College of Psychiatry. (2015). Delivering mental health
care in rural areas.
University of Michigan. (2014). Depression.
Wahrenberg, M. (2014, July 8). Worry and anxiety in depression. Psychology Today.

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