Mental Health Practice - Coursework Example

?Mental Health Practice: Case Studies Question 2 Referring to John’s symptoms described in the case scenario, it appears that John has developed paranoid schizophrenia. Paranoid Schizophrenia is a type of schizophrenia and a chronic mental disorder in which the patient suffers from a psychotic mental state. Precisely, an individual with paranoid schizophrenia develops delusions (false beliefs) that somebody is following or trying to harm them or their family members; and those people also feel auditory hallucinations (Mayo Clinic). For instance, John is hearing voices that are much distressing and harder to ignore. In addition, he feels like some people are pursuing him and hence he is not safe outside his room. The case study also points out that John has a past history of suicidal thoughts, which is another major symptom of paranoid schizophrenia. It is also identified that John likes to live isolated because he thinks that other people would not understand his actual condition and may treat him like a mad person. Paranoid schizophrenia is considered to be a brain disorder where genetics and environment are likely to be the major contributory causes. John relies on alcohol and substances in an attempt to recover from the difficulties of this mental disorder. John’s low mood and his inability to attend lectures can be recognised as the complications of this disorder. As compared to other subtypes, paranoid schizophrenia is a less complicated mental condition because it causes fewer problems with memory, concentration, and dulled emotions. Although paranoid schizophrenia is a chronic mental condition that may gradually lead to complications like suicidal thoughts, proper treatment and support would increase victims’ chances of leading a happy and normal life. Here, a comprehensive mental health and substance use assessment is needed for exploring more about his disorder. Clinical formulation is a key part of a comprehensive mental health assessment. It is a “clinical summary of the assessment using a bio-psycho-social approach” that tries to answer the questions like ‘why this person?’, ‘why this problem?’, and ‘why this time?’ (cited in ‘What is a mental health assessment’). A comprehensive mental health assessment comprises of clinical assessment as well as information gathering in a number of areas. Such an assessment will begin with presenting problems. In this stage, the practitioner assesses the history of presenting problems with particular attention to elements like onset, duration, course, and severity. The second phase is the assessment of current family/social status of the patient (here John). Here, his education life will also be evaluated. Since paranoid schizophrenia is greatly related with genetics and environment, John’s relevant cultural issues including personal and family concerns have to be identified. It is very necessary to give focus to previous assessments and interventions if any, because that would assist the practitioner to obtain more valuable information about John’s mental illness. In addition, it is better to examine John’s and his family’s psychiatric history. In order to obtain a clear view about John’s current mental status, it is vital to pay specific attention to his disorder development history. In the next phase, the practitioner has to identify the current medications taken by John (if any). Since substance/alcohol abuse is a complication of paranoid schizophrenia, substance use assessment must be a part of this mental health assessment. Under the substance use assessment, the practitioner has to examine the kinds of substances used by John, their dose and complications, and their ultimate impact on him. In addition, particular focus must be given to withdrawal complications of different substances used by John. Finally, the mental health assessment includes a detailed study of various personal/family/social elements led to the current condition. For a comprehensive mental health assessment, mental status examination is a crucial component (‘What is a mental health assessment’). The care team for paranoid schizophrenia must include various professionals like case worker, general practitioner, pharmacist, psychiatrist, psychotherapist, social workers, and family members because this particular mental illness can affect different areas of the patient’s life. In addition, the care team must frequently check the mental status of the patient throughout his life as paranoid schizophrenia is a chronic disease. There may be some stages where the patient may feel that he is fine and needs no more medical help. However, some stressful life situations or other shocking events may recall the symptoms of paranoid schizophrenia. Therefore, the care team must conduct a detailed investigation into John’s personal affairs and family background so as to reduce his exposure to stressful and distracting life events. Question 3 Considering the details provided in the case study, Belinda is likely to be diagnosed with depression. Depression can be simply defined as “a state of low mood and aversion to activity that can have a negative effect on a person’s thoughts, behaviour, feelings, world view, and physical well-being” (PHCSI, n.d.). Clinical practitioners indicate that depressed people may feel anxious, worried, hopeless, worthless, guilty, and hurt. The case context clearly indicates that Belinda shows several symptoms of depression. Evidences suggest that most of the depressed people have suicidal tendency (PubMed Health). Currently, Belinda is under the observation of the Home Treatment Team because she threatened her mother trying to throw herself in front of a bus. This indicates that Belinda has also a suicidal thought. The case study also reflects the fact that Belinda has a long history of deliberate self-harm, including self-inflicted cuts to her arms and thighs. While closely evaluating the past history and family background of Belinda, it seems that some worse life events have resulted in her current mental problems. She was sexually abused in her childhood by her father. This incident had dreadfully affected her mind. As a result of this sexual assault and the consequent prison sentence of Belinda’s father, her mother also developed depression. Obviously, Belinda has been suffering severe mental problems since that childhood event. Hence, she consider self-harm as a way of coping with her life problems. She thinks that such practices might help her express her feelings that she cannot put into words, and may reduce emotional pain. Clinical practitioners say that self-harm may help depressed people feel better for a while. For people like Belinda with major depressive disorder, self-inflicted cut is the only way they know to manage feelings like guilt, hopeless, sadness, self-loathing, and rage (‘Cutting and self harm’). Belinda has also taken repeated overdoses of medication. Through taking overdoses of medication, Belinda tries to release her emotional pain and to relax her distracted mind. Depressed people never think about the after-effects of overdose medication, but they try to obtain temporary relief from their pain caused by mental distractions. The case study also indicates that Belinda had developed behaviours like sexual promiscuity, substance abuse, and binge drinking. Such bad behaviours often led to very heated arguments and sometimes physically aggressive fights between Belinda and her mother. It is obvious that Belinda has not obtained proper love and care from her parents and this life situation made her prone to those bad behaviours. In order to regain love and care, she used to form intense short-term relationships with men. Such relationships ended in faster break-up and she often makes dramatic gestures following the relationship break-up. Undoubtedly, such events worsened her mental condition. Evidences suggest that mentally depressed people would do whatever makes them relaxed. Intense anger is another major symptom of depression. From the case context, it is clear that Belinda has ‘frequent uncontrolled outbursts of anger, following which she often says she feels empty and bored’ (case). Referring to the views of Hollandsworth (1990, p. 124), they are the direct symptoms of depression. In this situation, her mother’s decision to find a flat of her own may worsen her depressed mind. Although Belinda frequently argues and fights with her mother, she fears that she cannot manage without her mother’s help. Belinda complains the Home Treatment Team that her mother always needs to get rid of her. Therefore, it is clear that Belinda lacks proper care. Evidently, Belinda has developed multiple mental health issues, specifically mental depression. The root causes of her current mental depression and related problems can be ascribed to her tragic family background. As per the developmental theories of Erikson and Freud, a child’s relationship with its parents plays a significant role in molding its personality traits. The theorists also argue that school environment has also a great influence on a person’s character determination. Hence, in order to address the mental condition of Belinda, the therapist has to establish a good therapeutic relationship with Belinda. For this, the clinical practitioner has to attain the trust of Belinda. The clinician must be very supportive so that the patient is less likely to feel hopeless and boredom. The clinician’s services have to be available to Belinda in times of crisis because loneliness intensifies the depression. The clinician must educate Belinda about her illness and treatment goals (Boyd 2008, p.362). This will also help to obtain proper and timely responses from the patient. In addition, it is advisable for the clinician to give proper encouragement and feedbacks to Belinda concerning the progress of the treatment. At each stage during the course of treatment, the clinician must set clearly stated goals and monitor their achievement. In sum, the clinician must provide Belinda with proper care that she lost in her childhood. Question 4 Person centred planning or care can be simply referred to “a process for continual listening and learning, focussing on what is important to someone now and in the future, and acting upon this in alliance with their family and friends” (HSA). In the United Kingdom, the government policy ‘Putting People First’ specifically states the significance of person centred planning (ibid). According to some recent researches, person centred care can be described as evidence based practice (Sanderson et al). As scholars point out, person centred care is a philosophical approach developed to enhance service delivery and service quality. Another objective of this approach is to make certain that service systems are capable of meeting the needs of older people and their carers. This system provides individual older people and their carers with an opportunity to take part in decision making regarding the care (Jones & Bourgeois 2010, p.7). When the carer gets to know the patient well, he/she can focus on the specific needs of the patient and hence provide better care. Finally, person centred care is a better way to influence the patient to develop a positive attitude toward the treatment. From the case, it is clear that Myra is an 83 years old woman suffering from geriatric health problems. Myra’s husband died 10 years ago and she lives separately from her two children and eight grandchildren. In short, she lives isolated and this situation has notably contributed to her physical as well as mental health issues. The utmost principle of patient centred care is getting to know the patient personally. Here, the carer must comprehend the personal as well as the family background of the patient. Previously, Myra had worked as veterinarian and had possessed a range of pets. In addition, she had been very interested on outdoor pursuits and a member of a rambling club. The case scenario also indicates that Myra had a very active social life. She used to content herself with word puzzles and crosswords in order keep her mind sharp. In short, she was a very active and busy scheduled person in her day to day life. Such a person cannot easily adapt to conditions like low concentration, confused thinking, and poor mobility. Hence, the carer must give strong support to Myra to instil confidence in her and hence to assist her to cope with her current physical/mental health problems. In addition, the carer must respect the preferences of Myra and try to consider her as a partner in setting goals. Myra seems extremely distressed when she is more aware of her deteriorating cognition and the situation in turn would worsen her mental status. Therefore, it is advisable for the carer to assist Myra to solve word puzzles and crosswords. This practice can increase the confidence level of Myra. Likewise, the carer may assist Myra to walk some distance everyday. Undoubtedly, such activities would greatly influence Myra and she can regain her positive attitude toward the life. It is reported that Myra is periodically incontinent. Since this issue may weaken Myra mentally, the carer must try to enlighten Myra that this problem is common among many of the older adults. The major thing to be noticed is that the carer should not be irritated while dealing with Myra’s incontinency problems. Recently, Myra was found wandering a fair distance from her house in the early morning. It can be considered as an indication of her wish to go outside her home. The case study reflects that Myra rarely get chances to leave her residential home. Therefore, the carer must be willing to take Myra to some outside places where she is interested to go. It is also identified that Myra seldom has visits from her family. At this age, Myra surely wishes the presence of her children, grandchildren, and other relatives. In this context, the carer must convince Myra’s family members that their presence would reduce her feeling of loneliness. While working with Myra, the carer must try to give different choices to the patient as this practice would provide Myra with a feeling of freedom. Recently, Myra cried out and asked for her mother in a particular situation. It indicates that she needs proper love and care that she lost at the death of her husband ten years ago. Hence, Myra should get more love and care from the caregiver so as to meet the idea of evidence based care. References Boyd, M. A. (Ed.). (2008) Psychiatric Nursing: Contemporary Practice. Lippincott Williams & Wilkins. Cutting and self harm. Helpguide.org. available at http://www.helpguide.org/mental/self_injury.htm [accessed 2 Feb 2013]. Hollandsworth, J. G. (1990) The Physiology of Psychological Disorders: Schizophrenia, Depression, Anxiety and Substance Abuse. Springer. US. HSA. Person centered planning. [online] available at http://www.helensandersonassociates.co.uk/reading-room/how/person-centred-planning.aspx [accessed 2 Feb 2013]. Jones, T. L & Bourgeois, S. (2010) The Clinical Placement: An Essential Guide for Nursing Students. Elsevier Australia. Mayo Clinic staff. Paranoid schizophrenia. [online] available at http://www.mayoclinic.com/health/paranoid-schizophrenia/DS00862 [accessed 2 Feb 2013]. PHCSI. Ways to get out of depression. [online] available at http://www.phcsicare.com/blog/tag/relieving-depressed-mood/ [accessed 2 Feb 2013]. PubMed Health. A.D.A.M. Medical Encyclopedia. [online] available at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001941/ [accessed 2 Feb 2013]. Sanderson, H et al. (n.d.) The Emergence of Person Centred Planning as Evidence Based Practice. [online] available at http://www.helensandersonassociates.co.uk/media/25609/research_person_centred_planning.pdf [accessed 2 Feb 2013]. What is a mental health assessment. Queensland Mind. [online] available at http://www.health.qld.gov.au/mentalhealth/docs/assessment.pdf [accessed 2 Feb 2013]. Read More