Coroners Reporting on the Mental Care Continuity and Assessment - Case Study Example

CRITICAL REVIEW OF CORONERS REPORT By Location Critical review of Coroners Report Continuity of care Continuity of care usually comes in relation to the quality of care provided over time. Basically, many people perceive continuity of care as the state of having a continuous caring relationship with a specific health care professional. Two mental health care providers, continuity of care can be perceived as the provision of services that are seamless through coordination, integration, and free sharing of information through the providers that are involved in the mental health care provision process (Wierdsma, Mulder, de Vries &Sytema 2009, p. 54). In the case of Liam John Wright, continuity would have been greatly enhanced if in any case there was a specific healthcare professional that was monitoring his condition right from the first day when it was noticed that he was having some symptoms of mental problems (Bland, Renouf &Tullgren 2009, p. 111). However, it is seen that he is left in the hand of a number of professionals. There is also evidence that there was no proper sharing of information among the professionals who were involved in the provision of care to Liam John Wright. For instance, it can be seen that there was no adequate sharing of information relating to the problem that Liam had between Dr. Denham and Dr. Paul. There was also inadequate sharing of information between Dr. Banduwardene and Dr. Davies, who were responsible for taking care of Liam when he was transferred to the AOA. In the case of Charlie, it can also be observed that there was allot of changing of professionals that were held with the responsibility of taking care of Charlie while he want undergoing treatment at ITO. The assessment of Charlie’s condition was taken by Dr. Mir. Later he was left under the care of Susan Bourke as case manager. Susan Bourke was later replaced by Jennifer Neill (Lock 2009, p. 67). Jennifer Neill was more experienced and had been Miss Bourke’s supervisor. The change of hands of the case manager is believed to have likely interfered with the success of the procedures (MacDonald, Herrman,Hinds, Crowe & McDonald 2002, p. 92). Throughout the process of care provision Charlie was taken care of by both Ms. Bourke and Ms. Neill. However, the sharing of information in this case was not an identified problem because records show that Ms. Bourke and Ms. Neill worked very closely for the purpose of the success of this process. Given that Ms. Neill was Ms. Bourke’s supervisor, she must have been aware of the care procedures and activities that Ms. Bourke was involved especially in the case of Charles Michael Powell. Mental state assessment Mental state assessment is an important part of mental health care that is always defined as the structured assessing of a mental patient’s cognitive and behavioral functioning. It is always defined as the structured process through which a patient’s state of mind can be evaluated. Mental state assessment should be the first thing that is done in the case of an out-patient and psychiatric hospital setting. There are some things that must always be taken into consideration during mental state assessment. These things include: speech, behaviour, appearance, mood, obsession, phobia, abnormal experiences and beliefs, insight, and cognition (Lloyd & King 2003, p. 167). In Liam’s one of the abnormal experiences that he had gone through is the instance when he was the experience of losing a friend, a driving license a car, and having a broken arm. The broken arm meant that he would not be able to work as a carpenter for a certain period of time. As a result, it is recorded that Liam was very upset by the situation that did not allow him to work as a carpenter. The mental state assessment is usually undertaken through evaluating five areas of a patient’s mental statues. The areas evaluated are registration, orientation, attention, calculation, and recall. The areas of functioning that are evaluated include appearance, behavior and movement, mood, affect, speech, thoughts content, cognition, thoughts process, insight, and judgment. Liam’s situation is made even worse when his younger brother reveals to his friend that Liam had been having a relationship with his girlfriend leading to a sudden end to the relationship. As a result, Liam developed suicidal thought. He mostly thought of bringing an end to his life with occasional thoughts of ending his brother’s life too. As from that day he seemed to have developed an obsession of ending his own life. During the assessment it was discovered that Liam had been having the suicidal obsession for about a month. When Charlie was assessed it was discovered that he had suffered an acute psychotic episode thought to be induced by substance abuse. The assessment led to the realization that Charlie had abused a number of drugs ever since he was 12. He was also observed to have had inappropriate behaviour one of them being the incident when he smashed the house with a metal pole. During the first assessment it was also observed that Charlie was having some sort of response to visual and auditory hallucinations. Another awkward behaviour that was reported about Charlie was banging a wall with his head. Charlie also complained about being followed by people and that he had seen people on TV who could read exactly what he was thinking about. During the period when Charlie was detained it was also observed that there were some changes in his mood. However, throughout the process it was observed that there was a number positive improvement with Charlie paying more attention to his medications and not the drugs and substances that he used to abuse. It did not take long before Mr. Powell forwarded concerns about his state, claiming that it had turned out to be gradual regressing. Suicide risk assessment and management In the provision of mental health care suicide risk assessment and management is always one of the most important things. Mental health professionals have a very important role to play in prevention of suicide. Suicidal symptoms, behaviours, and risks are likely to be noticed among people having mental disorders (Large, Ryan &Nielssen 2011, p. 510). People with mental disorders should be screened and assessed for any signs of being suicidal. Any patient who talks about wanting to commit suicide should always be taken seriously (Queensland Health 2001, p. 167). For instance, in Liam’s case he had mentioned to the police officers and the doctors that he had considered committing suicide and even confirmed that he would do it then. The first step of assessing suicide risk is looking for warning signs of suicide such as threatening to kill one. The care giver should then consider factors that increase suicide risks. These factors include: previous suicide attempts, drug and substance abuse, history of psychiatric diagnosis, impulsive poor self-control, recent losses, hopelessness, and family history of suicide. It is important for the care giver to ask questions so that they can get this information from the patients. As a result of the evaluation there must always be immediate medical and psychiatric intervention. The risks involved with suicide include ending one’s own life and the lives of others, causing harm to self and others, and involvement in unhealthy activities such as drug and alcohol abuse. There should also be some kind of working together between the healthcare provision professionals and the affected patients’ family members. Since the family members are the one who closely interact with the patients they will be in a better position to notice suicidal tendencies in the patients (Mulder 2011, p. 606). For example, Liam’s parents were able to notice suicidal tendencies in Liam and reported the same to the mental health care provision professionals at Logan Hospital. People who happen to have shown suicidal tendencies should be reassessed regularly. As for the case of Charlie he had declined to accept to having any suicidal thoughts. Even the time when he appeared to be doing well he would see an Alcohol, Tobacco and other Drug Services (ATODS) counsellor and he would still deny having had any suicidal thoughts. The alarming thing is that eventually he ended up committing suicide (Hunt, et. al 2010, p. 101). If the ere would have been continuous assessment there is a very high possibility that the doctors at Logan Hospital would have been able to detect the suicidal tendencies before Charlie committed suicide. When a mental health care professional is dealing with a patient with suicidal tendencies they should make sure that the case notes include information such as: family members’ concerns; relevant suicide risk assessments; previous treatments received; and the benefits and risk assessment of major clinical decisions (O’Connor,Warby, Raphael &Vassallo2004, p. 354). In Liam’s case there was a clear indication of concerns raised by the members of his family with regard to his suicidal tendencies in the case notes. There were also previous psychiatric history and previous treatment that had been given to them. Not much is recorded in the case of Charlie apart from the fact that he had continuously denied having suicidal thoughts. Multi-disciplinary teamwork There are a number of health care provision professionals that are always involved in the process of providing care to people with mental problems. The teamwork involving the people that are entrusted in offering care to people is very important because it basically determines the outcome of the whole process (Queensland Government 2008, p. 117). Not everyone can do everything. A multi-disciplinary team in mental care should include psychiatrists, community mental health nurses, clinical nurse specialists, psychologists, occupational therapists, social workers, and medical secretaries. Sometimes other disciplines such as drama therapists, counselors, art therapists, care workers, and advocacy workers, can also be involved in the process. In the case of Liam it is clearly evident that there was involvement of professional from multiple disciplines. There was Dr. Renee Denham, who was a registrar in psychiatry who undertook the first assessment and recorded any relevant information that she came across in the process. There was also the involvement of the police who had been called upon when Liam had attempted to commit suicide. There was also the treatment team that was headed by the Dr.Chinna Sammy, who was a psychiatrist and Senior Medical Officer. A registered nurse by the name Teece was also involved in the process (Lock 2009, p. 99). She assessed Liam for the risk of being involved in self-harm. The principal house keeper of Logan Hospital by the name Dr. Paul was responsible for the management ad allocation of rooms at the hospital. When Liam was transferred to the AOA he was put under the care of Dr. Bandesh Banduwardene and Dr. Davies. The thing is that the working together of all the involved parties is always very important if in any case the process is to be a success. The working together with these professionals usually beginning with the sharing of important information about the patients that they are attending to (MacDonald, Herrman,Hinds, Crowe & McDonald 2002, p. 127). Charlie was also attended by professionals from multiple disciplines. He was assessed by a psychiatric doctor by the name Dr. Mir. He was counseled about his drug use and was seen by an Alcohol, Tobacco and other Drug Services (ATODS) counsellor. His case was also attended to by two case managers: Susan Bourke and Jeniffer Neill and a senior clinical nurse by the name Carol Kohleis who evaluated Charlie after he was caught trying to escape from the facility. RNs were also involved in the provision of care to Charlie and the other patients in the facility, especially when they were in the rooms. It would only take teamwork for all these professionals to work together for the common good of their patients (Renouf& Meadows 2012, p. 117). Family and carers role in the treatment and care of loved ones Family and careers usually play a very important role in the treatment of individuals with mental problems. Mental illnesses in a family usually lead to tension, troubled emotions and some cases. However, it would take active involvement of family and carers for there to be any success in the treatment and management of mental illnesses (Nembhard & Edmondson 2006, p. 951). Before even the patients are taken to mental hospital it is always the responsibility of their family members and those around them to notice the symptoms and help them in seeking medical attention. In most cases, people with mental problem will always live in denial. As the treatment process commences there are some historical issues that the care givers can only get from the family members (Queensland Health 2005, p. 212). After being discharged the family members are also supposed to make sure that they help the patients in attaining full recovery (World Health Organisation 2007, p. 42). In Liam’s case it was Mr. and Mrs. Wright, who was the first to inform the police of the fact that Liam had the intention of committing suicide. When Liam was taken for assessment they also made sure that they provided all the important information. They constantly raised their concerns over the increase in suicidal tendencies of their son. When Liam was spotted at the railways having suicidal thoughts it was his girlfriend who made a call with the intention of giving the information to his parents before anything could go wrong. Even when Liam was discharged his parents did not stop supporting him and raising concern over his suicidal tendencies. In Charlie’s case, it was his family who had given him support in fighting his drug addiction. It is even recorded that his parents had been able to keep him away from committing suicide for such a long period. When he is admitted at the hospital, during his assessment his parents made sure that they gave all the available information on the history of his problem. With such knowledge mental health care professionals can be able to easily diagnose the problem that a patient is having (Human Rights and Equal Opportunity Commission (HREOC) 1993, 23). Even when Charlie is released, his parents continue to support him and working together with the health care provider so that he would eventually attain full recovery. Bibliography Bland, R, Renouf, N &Tullgren 2009, Social work practice in mental health: an introduction, Allen &Unwin, Crows Nest. Human Rights and Equal Opportunity Commission (HREOC) 1993, Human rights and mental illness: report of the national inquiry into the human rights of people with a mental illness, vol. 1, Australian Government Publishing Service, Canberra. Hunt, IM, Windfuhr, K, Swinson, N, Shaw, J, Appleby, L &Kapur, N 2010, ‘Suicide amongst psychiatric in-patients who abscond from the ward: a national clinical survey, BMC Psychiatry, vol. 10, no. 14, pp. 1-6. Large, M, Ryan, C &Nielssen, O 2011, ‘The validity and utility of risk assessment for inpatient suicide’, Australasian Psychiatry, vol. 19, no. 6, pp. 507-512. Lloyd, C & King, R 2003, ‘Consumer and carer participation in mental health services’, Australasian Psychiatry, vol. 11, no. 2, pp. 180-184. Lock, J 2009, Inquest into the deaths of Liam John Wright and Charles Michael Powell, Office of the State Coroner, Brisbane. MacDonald, E, Herrman, H, Hinds, P, Crowe, J & 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. Mulder, R 2011, ‘Problems with suicide risk assessment’, Australian and New Zealand Journal of Psychiatry, vol. 45, pp. 605-607. Nembhard, IM & Edmondson, AC 2006, ‘Making it safe: the effects of leader inclusiveness and professional status on psychological safety and improvement efforts in health care teams’, Journal of Organizational Behaviour, vol. 27, pp. 941-966. O’Connor, N, Warby, M, Raphael, B &Vassallo, T 2004, ‘Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment’, Australasian Psychiatry, vol. 12, no. 4, pp. 352-360. Queensland Government 2008, Queensland plan for mental health 2007-2017, Queensland Government, Brisbane. Queensland Health 2001, Brief guide to the Mental Health Act 2000, www.health.qld.gov.au/mha2000/ Queensland Health 2005, Report of the Queensland review of fatal mental health sentinel events: achieving balance: a review of systemic issues within Queensland mental health services 2002-2003, Queensland Government. Renouf, N & Meadows, G 2012, ‘Working collaboratively in teams’, in G Meadows, J Farhall, E Fossey, M Grigg, F McDermott & B Singh (eds), Mental health in Australia: collaborative community practice, 3rd edn, Oxford University Press, South Melbourne. Wierdsma, A, Mulder, C, de Vries, S &Sytema, S 2009, ‘Reconstructing continuity of care in mental health services: a multilevel conceptual framework’, Journal of Health Services Research & Policy, vol. 14, no. 1, pp. 52-57. World Health Organisation 2007, Communication during patient hand-overs, www.who.int/entity/patientsafety/solutions/patientsafety/PS-Solution3.pdf Read More