This essay will look in turn at the potential mental and physical health issues affecting Daisy, Ethel and Eric. It will aim to identify these issues, explore the biological, social, and psychological needs of the individuals and community, and discuss the delivery of collaborative care with reference to the role of protective legislation where appropriate.
Beginning with Daisy, there are several issues to be examined. Firstly, possible problems relating to stress and anxiety. Daisy has recently been through several major life events, so one thing that could be occurring is adjustment disorder, or adjustment related anxiety or depression. The ICD 10 describes adjustment disorders as “States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event”, (WHO, 2010). It then goes on to say that the stressor may have affected the persons social network, or represented a major developmental transition. Daisy would fall into both of these categories, having recently moved homes, which would have decreased the size of her social network, and having to give up her job. A 2011 study suggests that negative life events can be associated with the onset of anxiety disorder, and lists size of social network and becoming unemployed as possible variants, (Spinhoven et al, 2011). Appendix (i) shows a list of potential stressors which could lead to anxiety, in which those potentially affecting Daisy have been highlighted, (Bourne, E.J. 2000). Despite each individual event not being sufficient to cause major concern, added together it suggests that Daisy’s situation could present cause for concern. A useful tool for looking at this kind of cumulative stress is the stress vulnerability model, conceived by Zubin and Spring, (1977). It suggests that people become mentally ill when the stress they face becomes more than they can deal with, and also that different peoples ability to deal with stress, their vulnerability, varies, so what can be manageable for one person may be enough to cause depression in another. Symptoms of adjustment disorders can be anxiety and depressive mood, and can be manifested as a brief or prolonged depressive reaction (WHO, 2010). The ICD 10 lists disrupted sleep and loss of appetite among the symptoms of a depressive episode, which is consistent with symptoms presented by Daisy. Daisy is also suffering from asthma, some research suggests stress and anxiety can exacerbate symptoms, although stress on it’s own cannot be solely responsible for the onset of asthma, (Chen and Miller, 2007).
When looking into potential solutions and collaborative care, it is important to not simply assume that the most obvious answer is the correct or only diagnosis. In this case, the physical symptoms we are presented with are loss of appetite, disturbed sleep and asthmatic episodes. The scenario states that Daisy’s previous episodes occurred around school exams. While this is worth noting, it should also be taken into account that at 46 Daisy will have experienced other stressful life events, where asthma has not apparently been an issue. Therefore, other factors should also be considered. We know that Daisy has recently moved to a new house in a more rural location, and known causes of asthma include mould and damp, which may be present in her new house, and allergens such as pollen or dust-mites which could both be more prominent in her new environment, (NHS, 2012). It would therefore be prudent for her GP to refer her to see the asthma clinic, which is available from most GP surgeries, (NHS, 2012).
Her GP would be the first point of contact with services if Daisy were to explore the possibility of treatment for depression and anxiety. According to NICE guidelines, (2013), Daisy should be asked if she has been feeling down, depressed or hopeless, and if she has having...