Multi-agency Treatment, understanding and Care Plan: Heroin Addiction - Research Paper Example

Multi-agency Treatment, understanding and Care Plan: A Case of Heroin Addiction Introduction Drug abuse is not a crime. It is a sickness which can be cured. This is why we should not put the blame always on drug users. Instead they deserve our understanding and care. Such is the mission of a mental health nurse—to assist the drug user in his quest towards wellness and improvement, in the form of recovery programs and medical treatments so that these people can recover and become productive citizens of society. Being a mental health nurse is a challenging profession. The challenge starts with the fact that they often work with various members of society such as children, adults and the elderly who has mental problems. They help these people not only in giving medical treatment and recovery programs but they also help these people regain their lost lives by helping them go back to work and preparing them mentally for life’s opportunities. They also help in the procurement of jobs specifically designed from them and also follow-up maintenance therapy of these patients in their homes. They also aid in finding these people suitable homes in a hope to rehabilitate them, since a problematic household and work environment can create stress to these people and may enable them to get back to their vices or be depressed again. These efforts of the mental health nurse are best realized with the help of various disciplines which help in the recovery of the mental patient. We call this effort a collaborative work of multi-agencies in developing a treatment and care plan for these patients. In the case of mental patients, a collaborative effort is really needed between physicians, mental health workers, social workers, occupational therapists, work agencies, insurance companies and housing agencies to make the lives of these mental patients functional. This paper seeks to describe the case of a client of mine who came in to our institution with the aim of finding her lost life once again. Later on, I will discuss how she went about her process of recovery and what out institution did to help her in her quest for a normal life. After the case presentation, we shall discuss the importance and the role of multi-agencies in creating a treatment, understanding and care plan to help these unfortunate victims of drug abuse. Later on we shall also tackle the role of mental health nurses as members of this collaboration in relation to nursing practice and guidelines. Brief biography The Nursing and Midwifery Council seeks to protect the identities of patients by saying that the nurse must “…treat information about patients and clients as confidential and use it only for the purposes for which it was given.”(The NMC code of professional conduct: standards for conduct, performance and ethics, 2004). Thus in this paper we shall use anonymous names and places to guard the rights of our patients. Jane was a 17 year-old teenager who was brought in for treatment and rehabilitation in out institution for heroine abuse. She had escaped from home and was homeless on the streets. At first glance, we noticed she was having withdrawal signs. We first ran a physical and mental health check-up on her and did a panel of tests, including a drug test for opiates. We then contacted our house psychiatrist so that she could be given proper medical treatment. The next day, she received a comprehensive substance misuse assessment program where she agreed to complete certain work for a period of time. Jane was asked whether she wanted to be detoxified or be maintained on a certain amount of medication and she chose the latter. We, together with the doctors discussed our assessment of Jane and we contacted Jane’s mother who has agreed to support her all throughout therapy. We then contacted the community drug agency which was located near her place. We found out what types of services would be available for her once she was released from our care. Soon Jane was working with the substance abuse team, which consisted of the nursing staff and other professionals. We then contacted her social worker and together we mapped out her plan for accommodation and release. We then contacted resettlement services so that she would be given intensive support on her release, including helping her go back to school and providing for her support groups and clubs to divert her attention. On the day she was released, there was a meeting between the community prescribing service and our institution staff together with the community drug worker. All these collaborative efforts have proven that Jane was capable of living a drug-free life and it was effective in maintaining her as such, because ever since her release, follow-ups with her was good and she went back to school. Assessment First, we will focus on the work of our multidisciplinary team. Our team was composed of a psychiatrist, mental health nurses, pharmacists, social workers and drug workers. We met as we shared assessments of the case and formulated our treatment and care plan. These meetings were effective in assessment and treatment of a drug user like Jane because each of us was able to contribute our own ideas and knowledge based on our individual expertise. There was distribution of work and care in the meetings. We were able to sit down and plan carefully from the day Jane arrived at our institution up to the day she went home and scheduled follow up on the community drug agency. Jane was seen to be compliant with her follow-ups and soon returned to school without reverting back to drugs and this was a measure that our treatment plan for her was effective because it was organized, and well-though of with careful planning and implementation from the various professions. Our other patients were also successful and they seemed to be satisfied with our services. However the disadvantage was that we seemed to spent more time on data gathering rather on focusing more on the treatment of the patient. Some problems associated with this process were the amount of time which is wasted in individual patient assessment alone. Usually, the physician, who is a general practitioner, will soon refer the patient to the addiction unit and this causes delays in management. The addiction unit, in turn will spend more time in assessment and the nurse spends another hour on assessment on referral to specialist service. This is when the multi-agency meeting comes to an advantage because it eliminates the repetitive assessments involved. One useful assessment form is the Maudsley Addiction profile (Marsden et al, 1998) Another thing was the issue on confidentiality which was partly tackled at the beginning of this paper. However this can be explained because the clause on confidentially seems to say that data will be disclosed if there is benefit to the patient. Since we are all health professionals, there seemed to be no problem in questioning confidentiality. Disclosure of data was for the benefit of our client and it was for her recovery. This collaboration system also does not involve a hierarchy of leadership roles. All professionals were seen to be equal with each other. This seemed fair because it facilitated the massive exchange of ideas among various health professionals. Also we also found out that perhaps more funding is needed to facilitate our meetings. We hope that the institution will realize that. Funding is needed to finance the cost of travel among members so that the case is better discussed and the members will be more willing to assume their role as collaborators. A multidisciplinary system requires the joint participation of all professionals involved. This is composed of a physician who is competent enough to prescribe treatment for drug abusers, taking into mind the effects of drug use and overdose on a patient and its possible complications. This physician must be readily available when needed. The institution involved in the treatment of drug abuse must also exhibit good governance by providing the necessary medications, equipment and modalities in treating drug abusers. Another important component of the team is the patient himself. The patient should be willing to accept treatment, and examine his own inadequacies. The patient must be willing to change himself for the better, thus he must subject himself to treatment. He must be made aware of the importance of the rehabilitation program and must be fully involved by setting his own goals. He should also be the one to monitor the progress of his own treatment and should cooperate by telling the worker what he feels or what symptoms he is experiencing every now and then. The patient should also be the one to choose his own design of treatment depending on his availability and convenience. In our case, Jane was given the chance to choose her treatment—whether she wanted to be on medication or to stop the medication abruptly. The team also should include the carers or the parents of the patient. They should be supplied with education and training with regard s to the care of their patient and in monitoring progress. Finally, the mental health nurse is important because it is he who has the first line of care of the patient. She sees the patient directly, provides care and comfort for the patient, assists the patient in his needs and monitors progress. She also serves as a mediator for the collaboration of various systems so that her patient can recover well and be monitored even at home or while they are at the community. The care of mental patients is based on the Case program Approach (CPA), which comprises mental health policy in UK. This approach was based on the fact that mental patients are not confined to the hospitals forever but that they remain to be taken cared of once they are out of the hospital or in the community. The CPA is composed of four stages. Stage 1 is a thorough assessment of the needs of the mental patient. Stage 2 is care plan development in which there is a collaborative effort between the professionals dealing with drug abuse and the patient himself and his family. Step 3 is to identify a key worker which will act as the major deliverer of the care plan and Stage 4 is review of a patient’s progress and plan. (CPA, 1997) For drug users, a full multidisciplinary CPA is needed because drug addiction is a serious disease with serious complications and has several effects on the drug user. The drug user may not function well outside the hospital and may succumb to recurrent drug abuse and may even be a threat to society. These patients are volatile and unstable (CPA, 1997) These facts reason out why the above case clearly illustrates how a multidisciplinary approach is to be undertaken in cases of drug addiction. We know that drug addiction is a brain disease which makes the person dependent on a substance. This dependence affects the drug user not only physically but also mentally, socially and emotionally. Thus a multidisciplinary system is needed in a collaborative effort to treat the complications of drug abuse. Understanding and planning Drug abuse is currently a problem in UK. A recent national estimate for England suggested around 140,000 injectors of heroin or crack-cocaine (0.42% of those aged 15 to 64). (Hay, 2004) In 2008, the second 10 year drug strategy Drugs: protecting families and communities was launched; it followed on from the previous strategy which was launched in 1998 and updated in 2002. The strategy reflects the devolution of powers with in the UK and Scotland, Wales and Northern Ireland have thus adopted country specific strategies. The Scottish Government published a new drugs strategy in 2008 (Health protection Scotland, 2007) Because of the complexity of treatment of drug abuse, several attempts have been made in creating models of collaborative efforts of multi-agencies. (Ogundipe, 1997) These models often involves providing early treatment and making available treatments to drug users when they need them and providing a standard of care for them, helping them live a drug free life later on. A multidisciplinary approach in treating drug abuse is important because it involves everyone to participate, not only the medical practitioners but also other health professionals. This is found in the Guidelines on Clinical Management of Drug misuse and Dependence. These guidelines view shared care as "the joint participation of specialists and general practitioners (and other agencies as appropriate) in the planned delivery of care for patients with drug misuse problems informed by an enhanced information exchange beyond routine discharge and referral letter...." (NTA, 2007) This document is very important to health care professionals involved in treating drug abuse because it highlights the importance of the role that every healthy professionals plays. It further adds, “General practitioners, nurses and pharmacists have been encouraged through NHS plans in Britain to develop areas of special clinical interest and many clinicians have done so, leading services within primary, secondary and custodial care settings.” (NTA, 2007) Recently, these health care professionals are given more opportunities in training for the care of these patients. Even though there are many local models involved in multidisciplinary systems in drug abuse treatment and care, still they are one in purpose. First, these systems ensure that they deliver their plan efficiently so as to provide for the multiple needs of these drug users. The Models of Care for Treatment of Adult Drug Misusers: Update 2006 (NTA, 2006) is a very useful guide of as to how these drug treatments are organized in each locality as to need. The Integrated Care for Drug Users in Scotland highlights several principles to upgrade the way treatment is being delivered in localities. (Scottish Executive Effective Interventions Unit, 2002). In Wales, the Substance Misuse Treatment Framework for Wales is responsible for carrying out the above mentioned purposes. (Welsh Assembly Government). Since the economy is ever changing and the legislations being changed every now and then, drug pushers are constantly creating changes to peddle their products to unfortunate drug users. Thus, multidisciplinary systems need to be aware of this fact so that they can formulate their own plans in providing care for the drug user. If I were to create a more efficient multidisciplinary care system, I would suggest a standardized assessment schedule which is to be used by all members of the team. This will enable prompt delivery of services and can deliver the skills of each professional involved. This provides faster access to care and can increase patient satisfaction (Gask et al, 1997). The team should also meet with the local agencies that are responsible for providing support and assistance to drug users. They may be useful as support groups who will determine the quality of life of drug users in the future. Also, it is a must that not only is a general practitioner in a mental health facility is made available at all times but also psychiatrists who have received further training. This minimizes the waste of time encountered on data gathering and assessment of the patient. The 2007 Drug misuse and dependence UK guidelines on clinical management is considered as a bible for substance abuse in UK. Its key points include “..specific training, supervision and competency needed to work with drug misusers, team-working across primary and secondary care, national guidance, local policies and protocols, audit and review, involvement of patients in their own care, the role of families, NICE guidelines, risk management, medicine prescription for treatment of drug misuse, and adequate steps for children of drug misuse parents” (NTA, 2007). The guidelines further add that patients should be involved in their own care. A good initial assessment should be done for the continuing care of the patient. This runs counter to the fact previously discussed before that this process is time consuming. Yet these guidelines tell us that a thorough assessment is a must. Also, the guidelines are in favor of an individual care and treatment plan, which should be reviewed regularly. It has also emphasized the importance of workers having a good therapeutic alliance and support systems. This will facilitate cooperation in a group and minimizes conflicts. The guidelines also emphasize that the common social problems being encountered by the patient are housing, employment and financial difficulties. Thus an ideal multidisciplinary team in drug abuse rehabilitation would consist of inclusion of employment, housing and back-to-school programs. It is the role of the mental health nurse to facilitate such collaboration. Self help groups and support groups are also encouraged. (NTA, 2007) In terms of physical well being, the guidelines also emphasized the need for vaccinations against blood borne infections. Drug users should be screened and concomitant illnesses treated to avoid spread to other people who are needle shares if the drug user mistakenly goes back again to his vices. Co morbid illnesses should also be considered as well as special cases like pregnancy, old age, and young drug users. The team members should discuss the risks of the patients should that illnesses can be cured and health needs further addressed. (NTA, 2007) Conclusion In conclusion, the case of Jane served as an eye opener for us regarding the true status of multi-agency care systems in the treatment care and planning of drug abuse rehabilitation. This paper first showed the importance of carrying out the task of evaluating our systems so that we as health professionals may be made aware of what is lacking in our program sand we could find ways of being of service to more patients in need. In tackling the case of Jane, we have discovered how organized multi-agency treatment and care is yet it is sometimes marred by some inconsistencies. Perhaps more investigations are needed to find out whether these systems are effective or not. This paper personally recommends the uses of a multidisciplinary approach in mental health situations such as drug abuse and any other psychological problems. A psychiatric patient is a patient with a complex case. In addition to his physical illness, he is also with mental and psychological instabilities. It is essential that in cases like this wherein the consequences are viewed to be dangerous or the patient can pose s a threat to our society and when he is at risk of going back again to drug abuse, a multidisciplinary approach can be employed. This is in lieu with the Guidelines on Substance abuse as we have previously tackled. There is no such thing a perfect society. 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