Problems Associated with the Treatment and Care of Patients with Mental Disorders - Case Study Example

Problems Associated with the Treatment and Care of Charlie and Liam Name Student Number Institution Course Code Instructor Date Table of Contents Table of Contents 1 Introduction 2 Continuity of Care 2 Mental State Assessment 4 Suicide Risk Assessment and Management 5 Multidisciplinary Team Work 7 Family and Carers Roles in the Treatment and Care of Loved ones 8 Recommendations 9 Reference List 10 Introduction Mental cases call for critical measures and concerted efforts of all clinical staff involved in the treatment and care process to be careful and make relevant observations that will enhance the recovery process. This analysis involves two young men Charlie and Liam who sought mental health services from Logan Hospital, but a number of failures occurred in the treatment process and resulted to their deaths. By incorporating key concepts underpinning contemporary mental health services in Australia, this essay brings up the problems that arose in the treatment and care processes accorded to Charles and Liam giving a conclusive summary of the necessary changes to avert such occurrences in the future. Improvement of quality of health care delivery can be ensured through observation of mistakes made and problems encountered and subsequently coming up with policies and procedure to correct the prevailing situations. Continuity of Care Continuity of care among mental patients ensures effective management of treatment and making relevant observation on their recovery progress. The Commonwealth of Australia (2010) outlines that according to the National Standards for Mental health Services, state clients possess rights to access the best mental health care which culminates to the most effective possible recovery. Further, the health institutions are expected to ensure continuity of care through mental health integrated service network (Department of health and Aging 2010). From a critical point of view, it is evident that continuity of care commences once a mental case arises and has been met accordingly by professionals (Bachrack 1981), with components of client’s individualised care and treatment is connected with relevant agencies as per the needs of the case presented (Commonwealth of Australia (2010). The processes is initiated upon a client entering a service system within a health care setting which may be a hospital or a community set up. The continuity of care is ensured in the mental health service delivery in the event of services change or in the event of changing a case practitioner within a clinical setting (Victorian Mental health Service 2008). A good example involves a mental client leaving a in-patient psychiatric facility and is sent to a community mental health centre. The aspect of care continuity ensures the recovery process is incessantly pursued and maintained to achieve the best recovery results. Continuity of care involves elaborate but flexible procedures that ensure clients acquire various services related to the course of their needs in the recovery process. The main attributes in this context involves being familiar and the proximity of necessary service availability to ensure the client necessary need in respect to psychological and financial aspects. Further, continuity of care demonstrates interconnectivity of communication between patients or relatives and service providers termed as the information continuity (Drew, Adams and Walker 2010). On the same note, more principles on the continuity of approaches to care are supportive administration, cultural sensitivity as well as collaborative relationships. The aspect of approaches to continuity of care may vary in respect to the histories of the clients institution and demographics attributes coupled with current service needs. Nevertheless, all dimensions of the concepts ought to be realised in the care and treatment delivery of mental cases. Through the use of a multi-disciplinary team and following an integrated service model, assertive case management come into focus. Further, according to the Department of Health and Human Services (2008), a key component in the event a client is admitted to in-patient care is for maximum contact to be maintained by a case manager with the client. In respect to Liam and Charlie case study, the issue of continuity comes up with respect to Liam being seen by a medical officer in the ED (33), then a different psychiatrist on the ward followed by another one in the AOA. Then Liam saw Dr. Davies followed by another practitioner in the open ward. Charlie’s case management arrangements after discharge show fragmented, loose and vulnerable process; nevertheless, the Coroners indicate that he found the management by CYMHs as appropriate (116). Mental State Assessment Mental state assessment gives a clear identification of client and is the fundamental point of initiating a treatment and care process. The aspect of Mental State Examination (MSE) involves a specified structured tool that is used to measure and understand the client’s mental state at the time of interview to ascertain the case analysis. This is conducted through a systematic interview inquiring into the exact symptoms and signs coupled with a well structured record of observations made. This includes an assessment involving the patient’s cognitive, emotional and physical state and the parameters interpreted as per the mental clinical procedures to identify the patient’s mental state. According to Bland et al. (2009), the parameters assessed involves appearance and attitude, behaviour and mobility, traits in talking, thinking process and content, mood state, intelligence and cognitive level, perception and sensory experiences, judgement and insight. The medical expert involved in the assessment is required to possess an ability to curiously and cautiously observe while at the same time ensure relations and rapport, coming up with queries in a respectful and effective manner as well as keenly listen to answers given by the client for expert analysis (Bland et al. 2009). In context, the following observations are evident from the coroner’s report: The mental state of Liam was addressed adequately at the hospital as indicated (7) with possible information about Charlie lacking (74). Indications shows Charlie was in need of mental health assessment (91, 98) but not all crucial information was forwarded to the other staff for continuity of care and treatment. This resulted to ineffective decisions being made by subsequent staff (97). Suicide Risk Assessment and Management Risk assessment involves the most credible stage in care delivery of mental clients to ensure no occurrence of danger or self-harm during treatment or in the future, as well as assess the probable impact. According to Bland et al. (2009), risk assessment is the major responsibility within mental health work involving a systematic, structured and thorough process of assessment. The accuracy of the assessment is underpinned in the quality of the therapeutic relationship, the judgement made by the psychiatrist or any other health practitioner, time for reassessment coupled with the degree of risks associated to others (Purtell and Dowling 2007). The presence of risk factors to mental cases is necessary to point out the occurrence of suicidal incidences. It is imperative to note that most cases or suicide are connected to known or unknown mental illnesses. Thus, the presence of mental illness risk factors indicates the need for suicidal risk assessment. The necessity for risk assessment allows the carers and health practitioners to take necessary measures to manage the patient and ensure no opportunity for suicide attempts. According to O’Connor et al. (2004, p. 253) the first twenty eight days after discharge of a patient from a psychiatric in-patient facility is crucial in respect to suicide risk and especially in the event the admission was done based on a suicide attempt, depression or suicide ideation. Risk assessment on suicide cannot be carried out in isolation from psychiatric assessment incorporating a comprehensive history, mental state examination as well as the changes observed in the risk status (O’Connor et al. 2004). In respect to Bland et al. (2009), risk evaluation as well as protective factors, coming to an understanding of the client’s experience; with an emphasis on the aspects of self-harm irrespective of the intention, whereby despair, hopelessness, shame, agitation, psychosis, anger, and guilt and previous attempts increase the risk becoming contextual areas that call for addressing the assessment process (Bland et al. 2009). Nevertheless, in respect to O’Connor et al. (2004) argument, assessment and management of suicide risk incorporate a level of uncertainty due to the lack of a perfect process to clearly identify suicide risk or even gauge the continuously changing life of a given person. Multidisciplinary Team Work Multidisciplinary team work is a central principle in the Australian National Mental Health Practice Standards involving the provision of mental health services by incorporating a multi-disciplinary workforce (Bland et al. 2009). The team works together to realise a holistic treatment approach and care for clients in an effective manner. Threats to effective interdisciplinary practice incorporate workforce emphasis on the given roles in the practice, rather than directly addressing the benefits of consumers and carers, as well as flexible approaches to treatment responses whereby practitioners follow a preconceived response. According to MacDonald et al. (2002), being rigid and pre-occupation with professional concerns brings about priority loss of given clients and carer needs. Multi-disciplinary teams are faced by stiff competition for authority and expertise from other disciplines that have competing practice paradigms (Stanbridge et al. 2013). The need for teamwork is inevitable in a multi-disciplinary team and ability of each discipline to define their area of competence. The approach upholds principles of respect, valuing other’s experience, perspective and making use of effective communication to enhance multi-disciplinary team work to the interest of clients, their families and carers (MacDonald et al. 2002). In order to successfully collaborate and work effective within teams and agencies, there is need for identification of aspirations, goals, needs and problems of clients. From the report, communication breakdown was evident within the multi-disciplinary team through lack of providing all crucial information and not disagreeing with decision from the seniors due to hierarchical culture like in the care of Liam involving Dr. Banduwardene and Dr. Davies (50, 133, 141, and 147). Family and Carers Roles in the Treatment and Care of Loved ones Family and carers have a great role in the effective realisation of quality recovery of mental patients. According to Jones (2010), carers and relatives play a crucial role to client care process and support pathways in the reduction and recovery of the prevailing condition. Looking at carers, having a better understanding of the client’s specific condition enhances care strategy and reduces stress levels, as well as enhances overall sense of wellbeing. According to the Queensland Government (2010), families’ corroboration with carers results to positive outcomes. Further, Mental Illness Fellowship (2010) emphasises that focus on the individual state of client, maturation, optimal functioning and independence are approaches that enhance and help families to ensure their roles in mental illnesses care take precedent. Stress-vulnerability-coping model clearly shows that in the event of vulnerability due to mental illness, there exist factors that enhances the eventuality of mental illness symptoms emerging, that is risk factors, as well as there exist factors making it less likely for symptoms to be evident (Evans et al. 2012; Mcauliffe, et al. 2009). These are termed as risk and protective factors respectively and both may incorporate aspects of the individual’s biology, individual attributes or environmental aspects with the likelihood, understanding, as well as recognition of symptoms that occur in an individual that is vulnerable (Mental Illness Fellowship 2010). Carers ought to be respected, listened to and supported in their work: further, they ought to be flexible, vigilant and focussed towards ensuring effective and strategic care to mental patients (Queensland Government 2010). In context, Liam and Charlie’s case indicates supportive families involved in their welfare, as well as were well knowledgeable and well acquainted with the symptoms (30, 72 and 90). The aspect of carers come in with Logan’s hospital failure to sufficiently respond to concerns raised by Charlie’s parents (70), further, not all information was passed on to dr. Leivesley and dr. Paul (116) (Queensland Courts 2009). Recommendations From analysis, the following recommendations can be deduced: Continuity of care through changing of staff arrangements (145). Empowerment of case managers to refer patients directly to the MHU without the need for an admission from the ED (146). There ought to be an efficient process of passing crucial information up the chain to the necessary decision making organs and tools. Policies should be introduced in regard to admission process in the ED or via case managers disseminated to the relevant practitioners. There is need for increased training on team work and team communicating skills for multi disciplinary practices. There is need for more funding in respect to mental health clinicians. Practitioners working in mental health settings ought to embrace the attribute of being responsible to make sure handing over of information is accurate, concise and effective to ensure continuity of care (Queensland Courts 2009) (133). Reference List Bachrah, L., 1981. Continuity of Care for Chronic Mental Patients: A Conceptual Analysis. American Journal of psychiatry. Vol. 138, no. 11, pp. 1449-1456. Bland, R., Renouf, N. and Tullgren, A., 2009. Social Work practice in Mental Health. Crows Nest: Allen and Unwin. Commonwealth of Australia 2010. National Standards for Mental Health Services 2010. Accessed July 7, 2015 from . Department of Health and Aging 2010. Mental Health Statement of Rights and Responsibilities 1991. Canberra: Australian Government publishing Services. Department of Health and Human Services, 2008. Resource Manual Assertive case Management: A Proactive Approach. Accessed on July 6, 2015 from . Drew, N., adams, Y. and Walker, R., 2010. Issues in Mental Health Assessment with Indigenous Australians. In N. Purdie, P. Dudgeon and R. Walker (Eds.). Working Together Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles. Canberra: Australian Government, Department of Health and Aging. Evans, S., Huxley, P., Baker, C., White, J., Madge, S., Onyett, S. and Gould, N., 2012. The Social Care Components of Multidisciplinary Mental Health Services. Research and Policy. Vol.17, no. 2, pp. 23-29. MEDLINE, EBSCOhost. Jones, K., 2010. Family Carer Education in Mental Health, Paper Presented at the Empowerment in Mental : Working Together Towards Leadership Conference,27-28 October 2010. Accessed July 5, 2015 from . Lloyd, C. and King, R., 2003. Consumer and Carer Participation in Mental Health Services. Australasian Psychiatry. Vol. 11, no. 2, pp. 180-184. MacDonald, E., Herrman, H., Hinds, P., Crowe, J. and McDonald, P., 2002. Beyond Interdisciplinary Boundaries: Views of Consumers, Carers and Non-Government Organizations on Teamwork. Australasian Psychiatry. Vol. 10, no. 2, pp. 125-129. Mcauliffe, D., Andriske, L., Moller, E., O’Brien, M., Breslin, P. and Hickey, P., 2009. ‘Who Cares?’ An Exploratory Study of Carer Needs in Adult Mental Health. Australian e-Journal for the advancement of Mental Health (AeJAMH). Vol. 8, Iss. 1, pp. 1-12. Mental Illness Fellowship, 2010. Recognizing Possible Triggers of Mental Illness Onset or Relapse: The Stress-Vulnerability-Coping Model of Mental Illness. Accessed July 7, 2015 from . O’Corner, N., Warby, M., Raphael, B. and Vassallo, T., 2004. Changeability, Confidence, Common Sense and Corroboration: Comprehensive Suicide Risk Assessment. Australian Psychiatry. Vol. 12, no. 4, pp. 352-360. Purtell, C. and dowling, R., 2007. A Selection of Models of Case Management in Mental Health. In G. Meadows, B. Singh and M. Grigg (Eds.). Mental Health in Australia Collaborative Community Practice. South Melbourne: Oxford University Press. Queensland Courts 2009. Inquest into the Deaths of Liam John Wright and Charles Michael Powell’. Brisbane: Office of the State Coroner. . Queensland Government 2010. Consumer Carer and Family Participation Framework. Brisbane: Queensland Government. Stanbridge, R., Burbach, F.R., Rapsey, E., Leftwich, S. and McIver, C., 2013. Improving Partnerships with Families and Carers in In-Patient Mental Health Services for Older People: A Staff Training Programme and Family Liason Service. Journal of Family Therapy. Vol. 35, Iss. 2, pp. 176-197. Victorian Mental Health Service 2008. A Guide to Mental Health Terminology. Accessed July 7, 2015 . Read More