The Throes of Acute Mania - Term Paper Example

Introduction One of my cases involved a 33-year-old woman who was diagnosed with bi-polar 1, and was in the throes of acute mania. The woman presented to the hospital three different times in five weeks. The first two times she was released, with a treatment plan, to a friend's house with no other intervention. The third time she was released to her friend's house, after the friend had indicated that she was no longer willing to look after the woman, with a mobile crisis team that consisted of two volunteers – one who picked the woman and took her to her daily after-care therapy sessions, and was also in charge of med compliance, and one who agreed to stay with the woman while the friend was at work. This proved to be the magic bullet, as the woman was not readmitted to the hospital, and gradually got better as her med compliance helped her overcome her acute mania symptoms and consistent outpatient therapy alleviated these symptoms as well. Description of the incident I was called to meet with a 33-year-old woman, who had a young son, in a psychiatric facility as a part of the crisis response team attending to this woman's case. The woman has bi-polar disorder and was in acute mania. She had crashed her car, then was taken away by police escort to the psychiatric facility because her estranged husband had called the police after her accident, having recognized the signs of acute mania in this woman. At the time she was admitted to the hospital she was incoherent and did not know where she was or why she was there. She had no recollection of the accident, and, if asked if she felt that she was a danger to herself or others, she had ranted that she wished that she were dead, and she was afraid that she had killed her son, even though the son was not in the car at the time of the accident. The woman had been hospitalized five times before for acute mania. I was assigned to her case as a part of the team that was in charge of helping her assimilate into the outside world from the hospital. The first time that she was in the hospital, everything went relatively smoothly upon discharge, although I had some concerns because the woman was not 100% even then. However, the woman had stabilized, with the help of the medication that she was provided in the hospital. The woman had a place to stay at a friend's house. I had a meeting with the friend to make sure that it was a healthy environment for this woman, and found the friend stable, intelligent and patient. The friend was willing to let this woman stay at her house until she stabilized completely and was able to find a job and a possible apartment of her own. The patient was also to attend outpatient services every day as a part of her discharge plan. The discharge plan also included med compliance, and detailed recommendations to the friend for caring for the woman. I helped the woman and her friend understand all the points of the plan, as well as provided contacts for services should there be any crises. However, one week later this woman was readmitted to the psychiatric facility. This time, she was readmitted because she threatened to kill herself and her son, which shows that my initial suspicions were correct - this woman was not 100% well when she was initially discharged from the hospital. This woman was discharged just three days later, even though she was incoherent and talking nonsense. I once again met with the friend, along with the woman's daughters to find out what had happened at the friend's house. The friend indicated that med compliance was difficult for the woman, in that the friend had to keep reminding the woman to take her meds. The friend worked full-time, so could not always be around, and stated that she was frustrated with the woman because the woman talked all the time, came into her bedroom unannounced every morning at five A.M., usually nude, and came into her bedroom while she was with her boyfriend. The boyfriend was getting frustrated with the woman as well, and was urging the friend to not let the woman stay at her house anymore. However, the friend knew that this woman did not have a place to go – neither of her daughters were willing to take her, or able to. One of the daughters lived with her boyfriend and her boyfriend's parents, and the other daughter lived in a section 8 housing that was very strict about the number of residents in any given home, and was afraid that if her mother lived with her that she would be kicked out. The estranged husband, having been through a similar scenario with this woman five times before was also refusing to take her. I was very reluctant to let this woman go, but I had no choice. The hospital was discharging the woman, and the friend stated to me that she was still going to take care of the woman, as the friend knew that she was the woman's only option. Once again, the woman was also required to attend outpatient counseling every day for four hours, and followed the treatment plan that was devised by her psychiatrist, psychologist and other members of her team. Once again, I made sure that the woman and the friend were aware of all aspects of the plan, that included med compliance and outpatient therapy. One week later, the woman was back again. Unfortunately, her mania had only gotten worse since the last discharge. She was back in the hospital due to a fistfight with her friend. The woman had also left the friend's house one day while the friend was at work, and left all the doors in the house open, and walked, in her socks without shoes, through the rain. When the friend came home from work, one of her cats was missing and did not return. As the friend also had two new puppies, the friend worried that the woman would cause the puppies to also get free and not return or worse. The woman had left the stove on one day and left the house as well. In short, the friend could no longer care for the woman. As she was the only one who was willing to care for the woman, this presented a problem. The woman was back in the hospital and still was uninsured for the purposes of this visit. I knew that the hospital would try to discharge her again, despite the fact that this was the third visit in just over a month and that the woman was progressively worse every time she came in. Again, after only three days the woman was being discharged from the hospital. Since the friend was no longer able to care for her, her daughter was extremely distraught. The woman's only options were to either be released, with nowhere to go or go to a state mental institution. Group homes in the area were full, with waiting lists. The daughter, understandably, did not agree with either of those options. Intervention I intervened by pushing for the patient to have a mobile crisis team. This is a difficult service to procure, as there are a great multitude of patients who need the service of a mobile crisis team. A mobile crisis team serves as an alternative to emergency department psychiatric care, and the team provide psychiatric services such as assessment and crisis stabilization in the patients' homes. (Currier, 2010, p. 37). There are barriers to access to these teams, however, and the main barrier is the lack of funding for the teams and the overwhelming need for them. These resources are scarce, in other words. Also, the services are typically used for suicidal patients who are discharged from the hospital. The woman was not suicidal, per se, but she was definitely suffering from an acute manic period from which she was not able to extricate herself, despite the other hospital visits. Moreover, there was evidence that there were issues with med compliance, as well as the fact that the woman was not attending her after-care outpatient counseling as she should. The friend, while well-meaning, did not have the proper background or resources to take care of this woman. Moreover, the friend worked during the day, so was not able to get the woman to her after-care sessions and was unable to deal with med compliance, as she did not know how to “force” the woman to take her meds. To this end, there were two individuals who were assigned to the case. One individual was assigned the task of driving to the friend's house, picking up the woman and taking her every day to her after care therapy sessions, and was also assigned the task of med compliance. The other individual assigned was a person who would stay with the woman during the day while the friend worked, who was, in effect, for lack of a better word, a “babysitter.” This individual was an important component, however, as the friend had concerns about leaving the woman alone in her house because of fear that her animals would be hurt or that the woman would do something to destroy the home. With these two people who agreed to help the friend care for the woman, the woman felt comfortable enough to keep the woman living in her home. The two people who were assigned these tasks were both volunteers, which was the only way that this could be accomplished, as there is a lack of funding for these teams. My theoretical framework is that mobile crisis teams' purpose is to prevent patients from returning the emergency room for further mental health services after being discharge from the hospital. The theory is that patients return to the emergency room after being discharged because they are having issues with med compliance and with compliance with after-care services. According to this theory, “increased attendance at the first outpatient mental health appointment would initiate an ongoing treatment course, with subsequent differential improvements in psychiatric symptoms and functioning for patient successfully linked to care.” (Currier et al. 2009, p. 36). The goal was to get the woman attending her after care outpatient services on a regular basis, and 100% med compliance. In reflection, I realize that this was the most proper response I could have made at that juncture. The woman's only option was to be committed to the state mental institution, but this would not have been beneficial to this woman, as the state mental institution is not a place that most people would want to be. Underfunded, dirty, and crowded, the state mental institution is really the place of last resort. The only other option was not an option, and that would be to release the woman from the hospital, but she would have had nowhere to go. Group homes were out of the question, because, as stated before, they were full and had waiting lists. Outcome My intended outcome was that the patient would comply with meds and outpatient therapy, and that she would not reappear at the emergency room for further treatment, and this is what happened. I had weekly follow up meetings with the woman and her friend, along with other family members, and these meetings were fruitful and the woman gradually got better. For several months, she stayed in a hypo-manic state, but was not at a crisis point anymore and the friend could handle her. I felt proud that I was able to affect change through my role in getting the mobile response team together for this woman. The team only had to intervene for one week, after which the woman stabilized enough that they no longer were needed. However, they were on call and would come back to the home at the first sign of acute mania in the woman. Points of learning I learned that, unfortunately, patients do not get the care that they need. This woman is just one example of somebody who is discharged from a mental health facility long before she is ready. She was lucky, in that she had a person who was willing to care for her. Many patients do not have that. I also learned that mobile response teams can be extremely beneficial to patients in the same situation as this woman, even if the participants only job is to effectively “babysit.” Further, I learned that med compliance and compliance with after-care are key to a patient's recovery. Source Used Currier, Glenn, Susan Fisher, and Eric Caine. “Mobile Crisis Team Intervention to Enhance Linkage of Discharged Suicidal Emergency Department Patients to Outpatient Psychiatric Services: A Randomized Controlled Trial.” Academy of Emergency Medicine, 17.1 (January 2010): 36-43. Read More