Introduction
The prevalence of mental illness among adults has been significantly increasing globally, with depressive disorders being the most common (Cavney and Friedman, 2018). According to the World Health Organization (WHO), depression is a major cause of other mental illnesses, and its prevalence is higher in women than in men. Sadness and grief, while normal human emotions, are underlying causes of depression (Lockett, Waghorn, and Kydd, 2018). Depressive disorders, also known as mood disorders, are characterized by symptoms such as loss of appetite, low motivation, lack of interest, and weight loss. When these symptoms persist, they constitute major depressive disorder (Zimmermann et al., 2016). Untreated depression can lead to serious health issues and endanger patients’ lives (Morgaine, 2017).

Barriers to effective mental health care are well-documented and include patients’ acceptance of their condition, accessibility to mental health services, socioeconomic conditions, cultural barriers, and stigmas associated with mental illness. This essay examines the case study of Jill, a patient suffering from major depressive disorder, to identify barriers to her treatment, strategies to overcome these barriers, and the legal and ethical considerations involved. A conclusion will summarize the findings.

Case Study

Jill, a 35-year-old European woman, has been married to Shane for 12 years and has three children aged 10, 7, and 4. The family immigrated to New Zealand from the UK nine months ago. Jill, formerly an early childhood educator, has not worked since their move. Two months ago, Jill’s grandmother passed away, but financial constraints prevented Jill from attending the funeral. Over the past month, Shane has grown increasingly concerned as Jill has neglected her hygiene and household responsibilities, stopped attending her children’s activities, and spends most of her time in bed. Jill has expressed feelings of worthlessness and has recently told Shane that the family would be better off without her. After taking 20 paracetamol tablets, Jill was admitted for observation.

Jill reports difficulty sleeping, constant exhaustion, an inability to concentrate on watching TV or reading, and weight loss over the past few weeks.

Several barriers to Jill’s mental health treatment are identified:

A. Patient’s Resistance

Resistance to accepting mental health issues is a significant barrier. Factors contributing to Jill’s depression include migration, separation from friends and family, job loss, financial challenges, cultural adjustment issues, and grief. Individuals with mental health issues often struggle to recognize their condition, fearing loss of self-esteem, stigma, rejection, and privacy concerns (Cavney and Friedman, 2018; Morgaine, 2017).

B. Limited Knowledge of New Zealand Healthcare System

Jill and her family lack adequate knowledge of New Zealand’s healthcare system. New Zealand recommends private insurance for immigrants, and those living in the country for less than two years are not eligible for free healthcare services (Lockett, Waghorn, and Kydd, 2018).

C. Cultural Differences

Cultural differences can hinder mental health treatment. Jill may feel isolated and unfamiliar with health-seeking patterns in New Zealand, despite being from a European background (Lockett, Waghorn, and Kydd, 2018).

D. Financial Constraints

Financial constraints are a significant barrier. The high costs of mental health services, medication, and travel in New Zealand can impede Jill’s effective treatment (Brooker et al., 2016; Lockett, Waghorn, and Kydd, 2018).

E. Language Barriers

While the English language used in New Zealand is not entirely different from Jill’s native English, regional variations and nuances may pose challenges.

F. Strict Immigration Policies

Changes in immigration policies and limited access to welfare and health services in New Zealand can adversely affect immigrants’ mental health (Morgaine, 2017).

G. Stigma Associated with Mental Illness

Social stigma can prevent individuals and families from seeking mental health care, hindering appropriate assessment and treatment (Cummins et al., 2015).

2. Nursing Strategies to Address These Barriers

Nursing strategies can help patients and their families overcome these barriers:

A. Self-Education

Nurses must educate themselves about immigrants’ backgrounds, cultures, and other factors to enhance cultural competence (Morgaine, 2017).

B. Assist Patients and Families in Accessing Mental Health Services

Nurses can guide patients and families in accessing community resources and navigating the New Zealand healthcare system (Cummins et al., 2015).

C. Build Trust in the Healthcare System

Nurses can build trust by ensuring privacy and confidentiality, offering flexible appointments, and providing preventive services. Educating families about the benefits of treatment and managing suicidal behavior is crucial (Morgaine, 2017).

D. Communicate Information and Resources

An impressionable team approach and guidance on referrals and community organizations are essential (Dakin, 2016).

E. Address Suicidal Intent

Nurses must identify suicidal intent in patients and educate families on coping strategies (Cummins et al., 2015; Dakin, 2016).

3. Potential Impacts on Jill’s Family

Jill’s mental illness can be traumatic for her family, affecting her children and husband emotionally. Her lack of participation in family activities may lead to negative emotions and stress (Power et al., 2016; Aldersey and Whitley, 2015). Holistic care for the entire family is crucial for effective treatment (Shrestha-Ranjit et al., 2017; Richard, 2018).

4. Legal and Ethical Issues

New Zealand’s healthcare system complies with international human rights treaties and provides a non-discriminatory legal framework for patient rights. Nurses must follow the code of ethics, including informed consent and confidentiality (Bas-Sarmiento et al., 2017; Soosay and Kydd, 2016). Legal considerations also include navigating complex immigration laws and ensuring access to public funds and financial support (Shrestha-Ranjit et al., 2017).

Conclusion

Depression, a major cause of other mental illnesses, presents numerous barriers to effective treatment, including acceptance, accessibility, socioeconomic conditions, cultural differences, and stigma. Nursing strategies such as self-education, helping families access services, building trust, and addressing suicidal intent are crucial. Considering the health of all family members in treatment planning is essential for effective care. Holistic care and legal and ethical considerations are paramount in addressing the complexities of mental health treatment for immigrants like Jill.

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