Supportive Mental Health System - Case Study Example

Introduction Numerous individuals who have been diagnosed and classified as ‘mentally ill’ disallow such label and may claim that they do not have an illness to recover from. It is certain that the experiences of a considerable number of individuals classified as mentally ill have usually been quite detrimental. Hearing the life experiences of countless individuals in recovery, one is commonly astonished that they have endured and survived at all. This involves the narratives of individuals from ethnic and black minority groups. Numerous individuals have not merely able to endure their difficult conditions but also able to endure their ‘mental illness’ and the effects or outcomes of a generally less than accommodating or supportive mental health system wherein their stories were ignored for the reason that they were believed to be distressed in their thinking, feeling and views of the world. Multitudes of people survived as an outcome of their experiences, proving that difficulties can normally be surmounted and provide a foundation for growth and development. The objective of this paper is to provide a critical reflective study of actual social work practice with people with schizophrenia. I will reflect on my current social work assignment with a female in her 70s with schizophrenia while on placement with an Adult Community Mental Health Team. In order to protect the identity of the person and maintain confidentiality of sensitive issues I have changed names and altered some details. This paper will reflect on issues and dilemmas emphasised by the client’s admission to a psychiatric unit (i.e. restrain by nurses); the strategies I used in working and communicating with the service user; the process of risk assessment and collaborative working; issues of gender and discrimination; and, review of models of mental health, namely, biological, social, and psychological. Case Background Mrs. Thomson’s general practitioner (GP) had contacted the psychiatrist at the local psychiatric unit; the psychiatrist is a registered medical officer (RMO) or a doctor with specialist knowledge of working with people with a mental disorder under Section 22 of the Mental Health Care and Treatment (Scotland) Act 2003. The RMO then contacted the Adult Mental Health Team due to Mrs. Thomson’s diagnosed mental illness. It was reported, specifically, that Mrs. Thomson is experiencing delusional belief that she was a messenger from God. The daughter of Mrs. Thomson had arrived to visit her mother and was bothered that she had been buying expensive clothes and furniture which was a complete change from her normal financial prudence. The RMO consulted the Mental Health Officer to assess Mrs. Thomson for short term detention as stated under Section 44 of the Mental Health 2003 Act. A social worker is likely to be involved in the early stages of assessment and treatment of a person’s mental disorder (Campbell, 1999). Mrs. Thomson attempted to leave the ward as a response to the messages from God. At this point, the RMO assigned to the case, in accordance to section 22, is a doctor with the training and experience in providing positive outcomes for patients with mental illness. The doctor was prompted to appeal for a short term detention as stated under section 44 of the Act due to Mrs. Thomson’s mood grandiosity and third person auditory hallucinations. She stubbornly believes that she was on a special mission for God and that taking the prescribed medication would interfere with her ability to fulfil the mission. Mrs. Thomson was diagnosed as a person suffering from schizophrenia due to her experiences of pronounced sensory changes. Auditory changes, such as Mrs. Thomson’s hallucinations and her lack of concentration could be related to over stimulation of thought experienced by schizophrenia. According to DSM APA’s classification it is characterised by at least six months of continuous symptoms, as shown by Mrs. Thomson’s condition. Because of Mrs. Thomson’s attempt to leave the ward a nurse was also present, in accordance to MHO Section 61 (2), due to the risk of Mrs. Thomson’s abandonment of the ward. Mrs. Thomson presented herself as a very friendly lady, but in closer examination it can be noticed that she has difficulties in concentrating. The mental health organisation (MHO) and I continued to advise Mrs. Thomson of her rights as well as the powers and duties of the MHO. Nonetheless, there are issues and dilemmas concerning diagnosis of mental health problems. Psychiatrists have persisted on developing and improving classifications of mental disorder syndromes. A vast amount of data have been made public reporting physiological and structural changes in the mental state of patients with severe mental illness, such as schizophrenia, but up to now no distinguishing pathologies have been discovered. Nevertheless, under Section 328 (1) Mental Health Care and Treatment (Scotland) Act 2003 a mental illness, personality disorder or learning disability however caused or manifested and cognate expressions shall be construed. Previous findings have been challenged by current findings and there are quite a lot of competing assumptions or theories. The process of diagnosis in psychiatry is mainly focused on the classification of syndromes whose exact character is inadequately understood. There are other dilemmas related with the application of psychiatric diagnoses. Although current operationalised diagnostic handbooks may enable psychiatrists to issue trustworthy diagnoses, the prognostic capability of those diagnoses is imperfect. Patients classified as ‘schizophrenic’ can experience a range of symptoms, none of which are consistent. There is a broad array of outcomes with regard to permanent mental health. Treatment is essentially decided by the symptoms and behaviour of individual patients rather than being particular to a specified diagnosis. Understanding an individual from the psychological and social point of views is normally at least as significant as diagnosis in interpreting the person’s symptoms and behaviours. Diagnosis can be extremely unstable eventually. Patients originally diagnosed as stricken by paranoid thoughts and hallucinations caused by the toxic effects of substance abuse usually persist to be diagnosed as having schizophrenia over time. Ultimately and possibly most essential, patients are stigmatised by several diagnoses and can experience evident social and psychological harm as an outcome of being labelled as ‘mentally ill’. These are actual issues and dilemmas of psychiatric diagnosis. Working with the Service User: Risk Assessment and Collaborative Working As a principle of the 2003 Act with regard to active participation I attempted to engage with Mrs. Thomson and involve her in the assessment process. A person-centred approach to my current mission as a social worker allows me not only to develop the focus of assessment on Mrs. Thomson’s problems but also to ensure open participation hence promoting recovery. Under the Social Work Scotland Act 1968 LOA authority has a duty to assess the needs of people; furthermore, the Carer Recognition Act gives the same level of authority to assess the needs of carers as qualified social workers. I, personally, bring to the assessment process a profession value base with skills and knowledge of assessment models and a continued professional development scheme which I reflect upon to present a general idea of communication with Mrs. Thomson. The initial assessment visit with Mrs. Thomson was challenging due to the anxiety I felt brought about by the unpredictable nature of the initial assessment. Mrs. Thomson has noticeable disturbing thoughts which were distressing her and interfering with her ability to concentrate. Her hearing impairment further confounded the assessment process of ensuring information on possible alternatives to Mrs. Thomson’s detention as well as her protections and rights to legal representations under Section of the 2003 Act. I, then, developed a style of engagement with Mrs. Thomson. In order to ensure communication I wrote down open-ended questions. Even though I did not want to collude with her delusional beliefs I also attempted to build a trusting relationship. Moreover, I did not attempt to establish reality so as to avoid provoking anxiety. The Scottish Social Services Council (SSSC) code of practice stipulates that independent assessments should make sure that inequality and oppression are revealed and challenged. The Mental Health Officer’s role is to provide an independent assessment of Mrs. Thomson to allow her right to be protected. This involved discussion with the RMO of the current situation as Mrs. Thomson was attempting to leave the ward and was restrained by nurses. Employing the holding power of nurses was a powerful restriction using physical restrain which initially, on reflection, is a disturbing experience for the client and for specialist nurses who have powers under the Act to detain a person for two hours or more. This incident was highly influential on my role as a social worker to work with people in an empowering way. Client empowerment is one of the most important components of social work practice. Traditionally individuals with serious mental illness, such as schizophrenia, have been deficient of empowerment. One of the most effective means of empowering the ‘mentally ill is through involvement in the assessment and treatment planning procedure. I think that the realisation of empowerment through assessment and treatment planning is founded on both organisational and psychological factors. Specifically, for empowerment to come about, individuals with serious mental disorder need a nominal degree of psychiatric stability and level of decision-making skills, in addition to an organisational culture that encourages mutual decision making and supplies the resources needed for empowerment. Read More