HNN301: Mental Health Promotion - World Health Organization - Assessment Answer

Mental Health Promotion Assignment

Case Scenario

Physical and emotional violence has a demonstrated impact on mental wellbeing (Matheson et al., 2015). It is important that nurses are cognisant of the impact of violence as many people under their care might be affected. This assessment task is an assignment requiring you to demonstrate your understanding of violence, its impact on mental health and wellbeing in Australia and what mental health promotion approaches can be used to address violence.

Assignment Task

In this assignment you are required to choose one of the following types of violence, from the World Health Organization (WHO; 2002) typology of violence:

• Family violence
• Community violence

Discuss this type of violence and its impact on mental health and wellbeing. Include in your discussion:

• Factors that lead to this type of violence;
• Incidence, those at risk, impact of this type of violence on the mental wellbeing of Australian individuals and/or families and/or communities;
• Use the literature to:

Explore mental health promotion approaches that can improve health outcomes in relation to this type of violence and;

How nurses can use this information to make a difference to those who have experienced violence.

Introduction

Family violence is a major issue that affects the mental health of an individual in different ways. Family violence can be defined as the systematic and intentional use of violence and physical abuse to create fear in the victim and to control the victim’s behavior. There are many different ways of abuse that are used in family violence that further impacts the physical, sexual damage, psychological impact, social isolation, helplessness and economic deprivation. The term family violence is interchangeably used with the term domestic violence. However, domestic violence is the violence done by the intimate partner, but family violence is a broader term, which encompasses the violence against women and children, by partner or by other family members.

It has also been noticed that Aboriginal and Torres Strait Islander people, generally use the term ‘family violence’ instead of domestic violence. This is the matrix that explains the aggressive, harmful and violent behavior, which is more reflected in the Aboriginal communities. The use of this term does not isolate the fact that Aboriginal women and children face the greatest impact of family violence. Family violence is mostly characterized as the gendered crime, where 95% of the victims are women and 90% of the perpetrators are men (Cussen, & Lyneham, 2012). This analysis provides a critical factor of gender and that for understanding the aetiology of the violence, it is important to understand various social and cultural factors that influence the proliferation. This paper will provide the overview of the family violence and its impact on mental health of an individual.

What is Family Violence

Family violence is defined as any sort of the sexual, physical, emotional or psychological abuse that occurs within the family and family relationships. The term family violence includes the violence against children, which is child abuse (by parent or any other family member), spousal violence (violence by intimate partner, also called as domestic violence) (Beck, & Raghavan, 2010), and violence against elders in the family. Family violence is a crime that straightly violets the human rights to freedom. Such violence can be committed against anyone, but according to the reported incidents, 95% family violence is done by men against women, children and other vulnerable members of the family. Family violence is endemic in the society and affects people regardless of their age, culture, sexual identity, socioeconomic status, ethnicity and religion.

While family violence and child abuse are generally considered as separate forms of violence, it is essential to consider the inter-relationship among both. Both the forms of violence often coexist, when the violence in family is directed towards women and children. This kind of violence could also be considered as a psychological child abuse, as it impacts the psychological condition and mental well-being of children. The psychological abuse towards children is directed even when they are not the primary victim and the main victim is their mother. Family violence can occur in different king of relationships, such as lesbian and gay relationships, violence against disable people in the family, and also old people. Violence done against elderly people in the family is called as elder abuse. However, term elder abuse can also be used when the violence is perpetrated by the professional care givers or healthcare professionals.

Factors Responsible for Family Violence

The main factor responsible for the family violence is that the abuser wants to gain control over the victim. The behavior of the abusers often originates from the sense of power and entitlement. The violence by men against women is mainly to display domination and want to control. The people, who are at highest risk of family violence, are the Aboriginal and Torres Strait Islander people. The factors against children, women and elders are affected by different factors. The factors responsible for child abuse under family violence are aggression, unemployment, crowded family environment, alcoholism and substance abuse. Child abuse could also be the result of the victim’s frustration and anger against violence. In general there is no single factor responsible for child abuse. The violence against women is mainly to display control by forcing fear. “The termfamily violenceis also preferred by Indigenous people, as reflected in Australian Government policy and in this context, refers to the extended social and kinship ties that Indigenous peoples have with one another” (Wallace, & Roberson, 2015, p. 8).

Some of the other factors responsible for family violence are precipitating causes, situational factors and underlying factors. Precipitating factors are those events that trigger a violent incident by the abuser, situational factors refers to the social environment of antagonism. Underlying factors include the historical circumstances of the Aboriginal and Torres Strait Islander people, which make their position vulnerable in the society and make them the victims of the violence. There are many other social and political factors responsible for such abuses in family. The ATSI people face the maximum family violence due to their political and historical status. These people often live in the remote and rural areas of Australia. They do not get proper access to food, healthcare facilities. Their low socio-economic status, do not allow them to achieve high level education and thus, they do not get stable and permanent employment opportunities. Due to lack of money and financial opportunities, this community has become vulnerable.

Impact of Family Violence over Mental Well-Being of Individuals

The impact of violence is very grave and harsh on the victims. It destroys their mental health and well-being. The people at the highest risk of mental illness due to violence are Aboriginal people. Family violence is a major problem in Australia, and Australian government considers it as a problem of national importance. Since last 25 years family violence is consider as a major public health issue (Behind Closed Doors: The Impact of Domestic Violence on Children, 2009). Earlier family violence was considered as a personal issue and believed to be the personal affair of a family where State should not interfere. However, this issue is now widely considered and acknowledged as the social issue, which remained hidden due to lack of appropriate data.

Family violence negatively impacts the health and development of children, individuals and families. Young children and adolescents are highly impacted by family violence. The impact could lead to physical injury, psychological abuse and even emotional distress (Behind Closed Doors: The Impact of Domestic Violence on Children, 2009). Children, who grow up in the family environment of violence and abuse often grow up as the victims or abusers. Such children can create another generation of victims and abusers and thus, the cycle may go on like this. Children suffer from emotional abuse as they are neglected and become the silent victims of the abuse. Family Violence is considered as the multi-dimensional problem that results into varied social and health related outcomes (Garcia-Moreno & Watts, 2011, p. 2). This problem is perceived as a major issue in the Indigenous communities. The incidences of family violence are higher in the Indigenous communities then in non-Indigenous communities in Australia.

The cultural dispossession and other social, economic, psychological problems of the ATSI people increases the level of violence in their community. Children, who are exposed to family violence, are denied with their right to stable environment and safety. Most of the children facing such issues at home grow up with same destructive behavior. Children being victims of Family violence often complaint about chronic physical pains, problem in sleeping (nightmares, bed wetting and insomnia), feels fear, depression and anxiety, underdeveloped motor skills, hampered ability to speak and learn and usually do not grow as normal children. Adolescents facing family violence often display destructive behavior, vandalism, poor decision-making skills, and high level of stress, gang involvement and drug or alcohol abuse, increase in depression and suicidal thoughts (Richards, 2011, p.

1). Women facing family violence may suffer from different mental and emotional problems that impact their mental well-being. The women may feel helpless and hopeless, insecurity, reduced self-esteem, sleeping disorders, poor coping skills, anxiety, depression and social isolation (Trevillion et al, 2012, p. 55). The chance of miscarriages also increases in the pregnant women facing family abuse (Mitchell, 2011, p. 42). The adults facing violence within family may face mental disorders, sleeping problems and suicidal thoughts due to anxiety and depression. The mental well-being of the individuals in Australia is getting highly affected by the instances of family violence. The individuals facing such issues have underdeveloped coping skills, financial problems, low level of education, and unstable working status (Harrison et al, 2012, p. 8). The mental health issues related to victims of family violence are anxiety, depression, post-traumatic stress disorder, and dissociation (Mitchell, 2011, p. 42).

Mental Health Approaches to Improve Mental Health Outcomes of Violence Victims

Physical and sexual violence are the major reasons behind mental health morbidity among the people, who have faced family violence and those who have witnessed such violence. Traumatic stress is the topic, which has gained high attention; however, the findings are still underdeveloped. The people who have been affected by some kind of family violence in their life require cost effective interventions and approaches to cope up with their mental issues. These victims also require proper guidance that can help them to come out of their mental, physical and emotional distress (Phillips & Vandenbroek, 2014, p. 4

2). There are many opportunities for the mental health professionals and healthcare settings, which can be worked out under jurisdiction and organize a mental healthcare approach. The main focus of the mental health approaches must be to identify the reason behind the violence and manage the mental and physical health injures in victims. The approach should also target the people affected by violence regardless of their age, gender and ethnicity (McDowall, 2010, p. 17).

However, it is noticed that mental health disorders are not necessarily the sufficient cause of the violence, but different studies support the view the often more victims suffer from mental illness than perpetrators. In the families with violence children are often affected. They become the direct or indirect victims (Richards, 2011, p. 1). The risk towards the adult victim works as a direct predicator for a child to become a victim of violence too. The first approach towards improving the mental health of the victims is by Assessing Past Harm and Future Danger. It is very important to understand the level of harm that victims have gone through. The evidence based risk indicators must be identified through condition of the victim. The adult victims can be asked through interviews about the level of risk in future. According to the Department of Child Protection (2014, p. 1) professional judgment about the level of risk must be identified, in order to save the victims from future harm and providing them safe environment.

According to the Department of Child Protection (2014), supporting the safety of the adult victim in the family can directly support the safety of the child. Adult and child victims should always encourage responding to the abuser, this also reduces the risk for both adult and child. According to the Family and Domestic Violence Policy (2012), in order to keep the adult victim and child safe, it is important to held the perpetrator for the accountability of their actions and actively seize their violent behavior. The Department of Child Protection is also responsible for managing the safety of the adult victim, child and other family members, who have faced family violence (Douglas, & Walsh, 2010, p. 488). The department is also responsible for taking the appropriate actions, if the child and adult victim’s safety and protectiveness are found to be low.

The National Plan to Reduce Violence Against Women and Their Children (‘National Plan’), supported by the Council of Australian Government, works towards reducing the violence experienced by women and their children. They also work towards enhancing the economic and social participation of the victims (National Plan, 2011, p. 9). This national plan states that “there is requirement of a coordinated framework’ in the response to preventing and reducing violence, which recognises the role of business; additionally, it explicitly requires the Commonwealth to develop ‘workplace measures to support women experiencing and escaping from family violence” (National Plan, 2011, p. 10).

According to the policy of ‘Closing the Gap’, the mental well-being of children can be improved by early education and holistic care (Sims, 2011, p. 11). For the early childhood education by the use of Indigenous specific programs that can support the early childhood education, playgroup and other school transition programs can be very beneficial in development and learning of Indigenous children (Bowes, & Grace, 2014, p. 9). Providing better educational facilities to children from low socio-economic background can help in making them better citizens (Bowes & Grace 2014). The involvement of community is also important to protect children from violence and to help them grow and develop. Family violence is a major issue in the vulnerable families. The socio-economic status of the families is highly associated with violent acts, depression and anxiety. The substance use in the men with low socio-economic status increases the risk of violence (Murray & Powell, 2009, p. 9)). Family history of mental health problems is also a great risk. When all these issues are addressed with proper approaches then something better could be done to improve the mental and physical health of the violence victims.

Role of Nurses in Promoting Mental Health In Violence Victims

The role of nurses is very important in promoting physical, emotional and mental health in patients. The quality nursing care can help patient to overcome their trauma and stress and also improve patient outcomes. There are many different ways through which nurses can help violence victims to improve their mental health, such as support, sympathy and understanding can help nurses to improve health of patients (Orchiston & Smith, 2012, p. 22). Family violence is a major public health problem in Australia. Family violence could be physical as well as psychological that affects the mental well-being of a person in various ways. Nurses are required to provide supportive and caring environment to the violence victims, as caring is the most significant want to reduce stress level.

Identifying the Victim: The first nursing intervention is that nurse must be able identify and respond to the victim. A nurse must be able to identify the victims and help them to recover from their problem. There are many situations, where victims are not able to report the interpersonal violence to the criminal justice agencies (McDowall, 2010, p. 16). This often happens when victims have the fear of family, friends and abuser, which stops them from revealing the abuse. However, family violence can lead to physical injuries and many emotional and social problems by which victim can come into contact with primary healthcare service, mental healthcare services or emergency department. Such setting provides the opportunity to the nurses to identify the violence victims and provide them necessary support (Reducing violence through victim identification, care and support programmes, 2009, p.4).

Documenting abuse Through Screening Tools: There are wide range of screening tools, which have been developed in the mental healthcare setting and emergency department that could be used to identify the victims of intimate partner violence, elder abuse or child abuse (e.g. OVAT, PVS, WAST, WEB) (Cussen, & Lyneham, 2012, p. 8). Scrrening tools generally consist of questions about the family and relationship status of the victim. These tools work effectively in identification. The abuse should be documented by the nurses for further treatment and counseling.

Mandatory Reporting: The country like Australia has the law of mandatory reporting of child maltreatment. Nurses are required to document the information about the abuse and report I to the professionals. This is essential to facilitate appropriate enquires and interventions (Cussen, & Lyneham, 2012, p. 8).

Psychological Interventions: Psychological interventions for the violence victims are very important. The nurses must be aware of such interventions in order to reduce vulnerability and increase the safety of the victim. This must be effectively done in the case of women, children and elders (Cussen, & Lyneham, 2012, p. 9).

Cultural Competence: Nurses are skilled and experienced in working in culturally competent working environment. They can identify the cultural factors that are responsible for the mental health issues of the victims.

Conclusion

Family violence is a major social health issue in Australia. Most of the victims of family violence are women, children, elders and disable. There are various, social, political and environmental factors associated with incidents of family violence. Such violence impact the mental well-being of individuals. Women, children and other family members, who are direct victims of family violence, suffer from depression, anxiety and hopelessness. The people at the highest risk of family violence in Australia are Aboriginal and Torres Strait Islanders. These people require attention of government and healthcare facilities, so that they can be saved from violence and risk of future violence. Nurses can play a significant role in identifying the victims and encouraging them to come out of their trauma.