Domain 6 - Social and environmental stressors (Contextual Domain)

Overview

This domain considers the extent and severity of a range of factors in the person’s environment that might contribute to the onset or continuation of the mental health issue.

Significant environmental stressors and adversity can lead to increased symptom severity and compromise the capacity of the person to participate in or benefit from the recommended resources and services. Furthermore, understanding the complexities the person is experiencing (or has experienced) may alter the type of service offered or indicate that additional service referrals are required (e.g., a referral to a social support service).

Assessment on this domain should consider the degree to which any or all of the following factors are relevant to the person’s current circumstances and the referral decision:

  • Significant losses (e.g., job loss, relationship breakdown, loss of friends or social connections, death of a loved one).

  • Significant change and transitions (e.g., a change in living environment, relationship breakdown/divorce, death of loved one, a romantic breakup, transitions relating to gender or sexual identity).

  • Trauma (e.g., emotional, physical, psychological, or sexual abuse, exploitation, witnessing or being a victim of violence, family and domestic violence, intimate partner violence, natural disaster, exposure to suicide in family/community, loss, conflict).

  • Victimisation (e.g., human rights abuses, discrimination, racial abuse, financial abuse, victim of crime, refugee, or asylum-seeking experiences).

  • Family or household stress (e.g., household drug or alcohol abuse, a family member with an illness or disability, carer stress or stress associated with a caregiver role, access to children/grandchildren).

  • Performance-related pressure (e.g., unrealistic role expectations and caregiving responsibilities).

  • Socioeconomic disadvantage (e.g., poverty, unemployment, unstable or insecure housing).

  • Legal issues (e.g., involvement in the criminal justice system or family court, enforced separation from family).

  • Loneliness or isolation.

  • Self-care (e.g., difficulties with mobility, toileting, nutrition, or personal hygiene).

PRACTICE POINT - Historical adverse events

Evidence points to the contribution made by historical adverse events to longer-term mental health development. Assessment on this domain should consider the person’s history but only record higher ratings where earlier experiences impact the current situation and require additional specific resources or services.

Scoring

0 = No problem in this domain

1 = Mildly stressful environment

  1. The person is experiencing (or has experienced) one or more stressors that are currently having or are likely to have a minor impact on their mental health.

2 = Moderately stressful environment

  1. The person is experiencing (or has experienced) one or more stressors that are currently having or are likely to have a moderate impact on their mental health.

3 = Highly stressful environment

  1. The person is experiencing (or has experienced) one or more stressors that are currently having or are likely to have a significant impact on their mental health.

4 = Extremely stressful environment

  1. The person is experiencing (or has experienced) one or more stressors that are extreme, enduring, or recurring and are currently having, or are likely to have, a severe impact on their mental health.