1. List rapport strategies observed during that interview

Start with introduction and talk about family, start with strengths, not worries, few direct questions, little direct eye contact, plain English and simple sentences.

2. How do you distinguish between culturally appropriate shyness and social withdrawal secondary to depression and/or psychosis?

Shyness lifts during the interview as rapport strengthens, the degree of shyness fits with your expectation for that person given what you already know of their background, and there are additional features on history and mental state examination of depression and/or psychosis.  Family says they are not like that all the time. 

3. List the key feature of your management plan from here.

Continue detailed history, detailed risk assessment, physical examination, collateral information, biological investigations, pharmacological interventions, drug and alcohol treatment options, engage with family services and /or court.

4. How can you adapt your plan to ensure it best meets the needs of an Indigenous client?

Link with Aboriginal mental health worker, liaison officer or interpreter, talk with family, give plain clear English descriptions of the link between stress and mental illness and potential treatments and interventions you can offer for the sadness, the psychosis and the social stressors.

Explore family strategies for mediation with wife, engage Indigenous services e.g. A&OD, or local Aboriginal medical service, focus on strength e.g. include ‘more hunting’ and ‘more music’ in the plan, problem solve, find the priority area for change identified by the client and work on that (avoid being overwhelmed by social stressors or working on a less important priority).

In this case the most important starting point may be sorting through the process for regaining access to the children.  The motivation in that process may lead to commitment to treatment for alcohol misuse, the actual symptoms of depression and /or psychosis may not be the client’s priority for treatment.