You are asked to see Rose, an elderly Aboriginal woman, by a social worker from the renal unit at the local hospital.  Rose is sixty years of age and comes from a rural community.  She suffers from chronic renal failure and requires haemodialysis three days per week.  Rose has had to leave her community to live in a flat in town to receive the treatment.  Rose also suffers from non-insulin dependant diabetes mellitus that also requires regular medication.

Rose only speaks limited English and otherwise speaks “Aboriginal English”, a combination of English and her native language.  She was recently referred to the psychiatrist associated with the renal unit because the staff were concerned that she was “not coping”.  The social worker informs you that Rose saw the psychiatrist with her granddaughter, however the psychiatrist asked the granddaughter to leave the consultation and interviewed Rose on her own.  After the consultation, the psychiatrist reported to the social worker that he did not feel there was a problem and Rose’s “not coping” was, in his opinion probably a reaction to the dialysis.