SOCIAL DETERMINANTS OF HEALTH
SOCIAL SUPPORTS / NETWORKS
WHAT QUESTIONS SHOULD YOU ASK SAM RELATING TO THIS SDH?
- Have you been in touch with your friends from your high school?
- How do you keep in touch with others outside of your family?
- What is your relationship like with your mother and brother?
- Have you spoken with them about how you feel after your father passed away?
WHAT ARE SOME WARNING SIGNS THAT INDICATE SAM IS AT RISK OF SUICIDE?
- Expressing suicidal ideation, wish to die
- Feelings of hopelessness, rage, anger, seeking revenge, acting reckless, anxiety, agitation, abnormal sleep
- Expressing no reason for living, no sense of purpose of life
WHAT ARE SOME QUESTIONS THE CHN SHOULD CONSIDER RELATED TO SAM'S FAMILY DYNAMICS?
- Has the family become more distant as a result of the passing of the father?
- Has the passing of the father brought the family closer together?
- Is there more pressure on each family member to compensate more as a result of one less family member?
HOW CAN SAM'S COMMUNITY CREATE A POSITIVE ENVIRONMENT FOR HIM?
- Large Indigenous community who is heavily cultured
- Youth groups that Sam can join
- Indigenous based community centres that teach individuals about their culture
As the CHN, what forms of substance abuse would you watch out for with Sam, who may engage in as a result of his suicidal ideations?
- Alcohol
- Cannabis
- Cigarettes
GENDER
HOW DOES THIS SDH APPLY TO SAM'S SCENARIO?
- WOMEN HAVE MORE SOCIAL SUPPORT THAN MEN
- MEN ARE LESS LIKELY TO SEEK FORMAL HELP FROM HEALTH CARE PROFESSIONALS
- STEREOTYPICALLY, MEN ARE SOCIALLY EXPECTED TO REMAIN STOIC
HOW DO YOU INTERPRET WHAT STAGE OF GRIEF SAM IS GOING THROUGH ACCORDING TO KUBLER-ROSS GRIEF CYCLE, AND WHY?
DEPRESSION
- Abandoning his responsibilities (ex. school, post secondary education).
- Could be overwhelmed due to his father's death and him now having to adjust his role within his family.
WHAT KIND OF QUESTIONS CAN THE CHN ASK TO ASSESS SAM'S AND HIS FATHER'S RELATIONSHIP?
- How would you describe the relationship you had with your father?
- How are you processing your fathers death?
- Did you frequently spend quality time with your father?
WHAT ASPECTS OF THE PHYSICAL ENVIRONMENT CAN IMPACT SAM'S MENTAL HEALTH?
- Lack of green space
- Closures of schools, sports leagues, etc
- Underdeveloped infrastructure
What are some potential treatments, interventions and medications that should be considered when looking at this scenario?
Family Support and Education In terms of the suicide, having an open discussion with a loved one (Sam talking with his family members
Psychotherapy
Medications; Antidepressants, antipsychotics, anti-anxiety
CULTURE
HOW DOES THIS APPLY TO SAM'S SCENARIO?
- SAM IS OF A MINORITY BACKGROUND.
- INDIGENOUS POPULATIONS WHO LIVE IN REMOTE AREAS MAY EXPERIENCE LACK OF RESOURCES, MENTAL HEALTH SUPPORT, EDUCATION ABOUT COVID & MENTAL HEALTH.
- UNDERLYING CAUSES THAT CAN CONTRIBUTE TO MENTAL HEALTH ISSUES: RACISM, INTERGENERATIONAL TRAUMA, COLONIALISM, RESIDENTIAL SCHOOLS.
WHAT QUESTIONS WOULD YOU ASK SAM, WHO IS HAVING SUICIDAL IDEATION?
1. Do you think about your own death or about dying?
2. Have you ever thought of harming yourself or trying to take your own life?
3. Do you have a plan?
4. Can you tell me how you feel about your own life?
5. What are some of the aspects of your life that make it worth living?
HOW CAN HAVING A STRONG FAMILY BOND IMPACT HOW SAM PROGRESSES THROUGH HIS COVID DIAGNOSIS?
- Having a support system who is there to fulfill daily tasks while you are recovering (grocery shopping, walking the dog, etc)
- Promotes a more positive and optimistic environment for the person to recover
* Strong family bonds are important now more than ever as a result of Sam's father passing away *
WHAT ARE SOME RISK FACTORS THAT CAN CONTRIBUTE TO AN INCREASED RISK OF COVID TRANSMISSION WITHIN SAM'S COMMUNITY?
- Overcrowding in the community (high schools, apartment buildings, grocery stores, shelters)
- Businesses not complying with regulatory by-laws
- Lack of health literacy among the community
As a CHN, you believe that Sam is at risk of developing an eating disorder due to the stress he may be experiencing from the loss of his sense of smell and taste. What are some strategies to combat the potential development of one?
- Encourage healthy eating
- Discuss media messages.
- Promote a healthy body image
- Foster self-esteem
- Share the dangers of dieting and emotional eating.
EDUCATION
WHAT QUESTIONS SHOULD YOU ASK SAM RELATING TO THIS SDH?
- “What influenced your decision to drop out of high school?”
- "You mentioned before that you were looking forward to culinary school, what made you change your mind?”
HOW DO YOU BUILD A THERAPEUTIC RAPPORT WITH SAM?
- Meet the person in a comfortable and private environment (this will make the person feel safe and open to discussion)
- Listen empathetically and use a calm tone of voice
- Take the time to consider Sam’s story (this makes sure they are being treated as a human being and not as a problem)
- Highlight their strengths, validating their feelings
WHAT SHOULD THE CHN CONSIDER WHEN ASSESSING THE IMPACT OF THE FATHERS DEATH ON SAM?
- Does he feel like his family blames him for spreading the illness to the other family members?
- Financial issues and his mother having to provide for both him and his brother
- Feeling like he shouldn’t be going to school because his family can’t afford it now because it is only his mother’s income
HOW CAN THE NURSE ASSESS THE CULTURE SURROUNDING MENTAL HEALTH WITHIN SAM'S COMMUNITY?
- What resources are already implemented to address mental health in the community?
- What is the attitude of the community towards mental health (specifically age group)?
- What is the rate of suicide among Indigenous adolescents within the community?
As a CHN, you suspect Sam may be experiencing survivor’s guilt (when a person believes they did something wrong by surviving a tragic event). How do you deal with this topic or how do you bring it up with him?
- Ensure Sam is able to accept and allow these feelings
- Encourage Sam to connect with others
- Have Sam share feelings with family and friends. Or, if loved ones do not understand these feelings, look for a relevant support group.
- Both face-to-face support groups and online communities allow survivors to connect with others, express themselves, and ask questions.
- Practicing self-care to take mind off of things
FINANCIAL AND SOCIAL STATUS
HOW DOES THIS SDH RELATE TO SAM'S SCENARIO?
- DEATH OF FATHER COULD AFFECT FINANCIAL SITUATION
- Adolescent boys exposed to persistent poverty are more vulnerable to poor academic achievement and an increase in behaviour problem
- HIGHER RATES OF POVERTY IN INDIGENOUS COMMUNITIES
- FINANCIAL AND SOCIAL STATUS CAN AFFECT SAMS HEALTH (might think he needs to get another job, could be an added stress which may put him at risk of developing depression and anxiety and further increase his suicidal ideations).
HOW DO YOU ASSESS SAM'S COPING SKILLS?
- Ask whether he participates in smoking and drinking, or avoids interacting with friends and family (negative coping skills)
- Ask whether he has cultural or spiritual connections, if he seeks help from friends and family, if he regularly exercises (positive coping skills)
WHAT STRATEGIES CAN THE CHN RECOMMEND THAT WILL HELP SAM AND HIS FAMILY COPE WITH THE DEATH OF THE FATHER?
- Counselling
- Acknowledge their pain
- Draw comfort from faith (ex. Indigenous rituals and ceremonies)
- Joining a support group with other families who experienced the death of a loved one as a result of COVID
Are there limitations that rural communities have in regard to accessing mental health services? Why or why not?
- Limited resources
- Mental health diagnoses are conducted by primary health care providers (due to COVID, they may not consider mental health a priority)
- Not a lot of services catered to youth
- Culturally sensitive care may not be provided in the main hospital of the community
As the CHN, how can you help Sam cope with the loss of his sense of smell and taste?
- Acknowledge Sam's feelings about the loss.
- Consult with an ear, nose, and throat specialist for guidance.
- Maintain hope for recovery. (60-80% chance of recovering senses within a year)
- Cultivate a sense of gratitude: "You have survived a potentially lethal disease."
- For additional help, see a counselor or join a support group.