Alma is 68 years of age. She grew up in a small country town, is an only child and was born when her parents were in their 40s. Alma was diagnosed with schizophrenia when she was 19 and spent the following 15 years as an in-patient in a large psychiatric hospital in the city. While she was in hospital, all her teeth were extracted and she has worn dentures since she was in her early twenties. When she was discharged, she lived in a nearby boarding house for several years and received regular visits from a community psychiatric nurse who assisted with her medication.

The boarding house was overcrowded and in poor repair. During this time her only income was a disability pension from Centrelink. The boarding house provided basic accommodation, breakfast and an evening meal. Boarders had to leave the premises between 10.00 am and 5.00 pm. Most of the other boarders were people with mental illnesses, homeless men and younger people with disabilities.

Alma formed a relationship with Dave, one of the male boarders. During the day Alma and Dave spent most of their time in hotels and bars. He was a heavy drinker and sometimes became abusive and violent towards Alma. Alma became pregnant but miscarried at four months. While she was in hospital the boarding house was closed down and Dave left town. Alma was assisted by a social worker to find state housing accommodation and she moved into a one bedroom unit in a high rise block in an inner city area. Most of her neighbours are recent migrants and refugees from culturally and linguistically diverse backgrounds.

She is registered with a busy city medical practice and her medication is prescribed by one of their GPs. There is a high staff turnover and she is not always able to see the same GP. Alma is very overweight, has recently been diagnosed with type 2 diabetes and high blood pressure and is showing early signs of dementia. She smokes heavily and has frequent respiratory infections. She experiences occasional episodes when she hallucinates and hears voices. She now receives the age pension. Her schooling was interrupted because of her illness, and because of this she has limited literacy skills and has never held a job. She spends most of her time watching her favourite soap operas on TV. Although she has been living in her unit for many years, she does not know any of her neighbours and has no close friends. Her parents died many years ago.

1.Identify Alma’s significant health issues.

2. What social and environmental factors may have had negative effects on Alma’s health and wellbeing over her lifetime?

3. what services can you suggest to improve Alma’s overall health and wellbeing?