Mental Health Diagnosis - Essay Example

? MENTAL HEALTH CASE ANALYSIS: ASSESSMENT AND TREATMENT OF A CASE OF ACUTE SCHIZOPHRENIA Introduction This is a case study in mental health diagnosis, treatment and care. It involves a practical case which involves a patient going through a given set of circumstances that need to be examined and dealt with. The case analysis will begin by critically assessing the facts of the case below. This will involve the theoretical examination of factors and situations that relate to the case and the formulation of a practical plan to deal with the patient and provide appropriate treatment. Case Facts Toni is a 22 year old student who completed secondary school successfully and moved to a university in a suburban community. In the final year of the course, Toni began to complain to his course tutor that the course was becoming stressful. Her performance fell and she cut down on the hours she used to spend studying. At home, Toni became more reclusive and she began to miss lectures and spend long hours in isolation. She refused to leave her bedroom and began to express paranoid delusions about things that are non-existent. She began to complain about how terrible life was and began to argue for a life outside the normal. Toni became less concerned about what she ate and she seem to be going through serious anorexia. She took up strange practices and has said she is not interested in living in a modern setting anymore. She has began advocating for strange beliefs and teachings and in one of her conversations with a group of friends she expressed interest in the Afterlife and how she longed to get into that arena. Toni's mother recently saw that she had visited a suicide forum on her computer and she also saw a note which she suspected to be a suicide note. Framework of Treatment “Mental health is the adjustment of human beings to each other and the world around them with a maximum effectiveness and happiness” (Basavanthappa, 2007). Mental health is therefore about how to make people have a happy life and adjust to the individuals and people around them to attain the best mental and emotional lives. It relates to organising and individual to attain integration, autonomy, perception of reality, environmental reality as well as growth and development (Elder et al, 2012). There are several policies in the UK that supports mental health and a healthy emotional and mental life for all. The Human Rights Act of the UK which came to force in 1998 provides rights for all people. These rights cover the right to life and the right to important privileges in different elements of social life. Also, the Department of Social Security came up with the Opportunities for All in 1999. This programme guaranteed rights for all members of the society including people with disabilities like mental challenges. It sought to eliminate discrimination and encourage a better life for all these different people in society. According to the New Horizons Strategy of the UK government, the following pointers and indicators mark the wider framework of mental health in the UK and is to be worked at by the year 2020. The first point is to improve the mental health of everyone in Britain. This end is to be attained by eliminating discrimination, promoting early diagnosis and treatment as well as the provision of specific treatments for individual cases. The 2020 framework of the UK also focuses on stakeholders and supporting them to attain the best results in mental health. Also, the framework seeks to promote accessibility of mental healthcare (Department of Health, 2009). Although this policy is not in operation, it is being developed and targets are being pursued by the various stakeholders. In most cases, mental health cases are initiated by a third party who notices that the patient has issues (Cohen, 2011). This is because most patients with mental health problems fail to realise the severity of their problems whilst others totally deny it. There is a major debate between cognitive behavioural therapy and how it should be done. This conflict leads to numerous challenges and problems finding a universal formula and system to deal with problems that are related to mental health cases. With this policy framework put in place by the government, the case of Toni needs to be given urgent attention. She has exhibited behaviours that relate to isolationism, strange beliefs, dislike for mainstream lifestyles and other activities. Since her mother has identified the changes in her daughter, she can play the role of recommending therapy or psychological treatment to Toni. This must be done in a persuasive manner by consulting Toni and respecting her by telling her that she needs the input of a professional to maximise her potential. This should be the case rather than insisting or forcing her which could make her adversarial (Cohen, 2011). On the other hand, if it is apparent that Toni is likely to harm herself, then the mother will be permitted to use all means available to get her to get professional help. This could be done by forcing her to a psychiatric facility where she would be under constant watch and care. The NHS New Horizons Strategy indicates that Toni can have access to all the relevant facilities in the UK medical system and through the strategy she qualifies to get special attention because she is a young adult who falls into the category of patients who are to be given improved access to mental health services (Department of Health, 2011). Symptoms From the facts of the case, the main issues that Toni seem to be exhibiting are: Suicidal Emotions, Thoughts and Acts: The fact that she has been seen visiting suicide forums and speaking about the Afterlife indicates that Toni has a strong desire and tendency to take away her life. This means that she is in danger of self harm and her mental state could potentially deteriorate further. Isolation & Withdrawal: The fact that she spends a lot of time in her room and misses out on lectures and has no interest in seeing her old friends indicate that Toni is showing some withdrawal symptoms. This marks a major change in her mental state. Phobias: Toni seems to have some fears about life and about the modern society. It seems she does not want to get back with her life and does not want to continue in the modern society of today. Due to this, she wants to withdraw and create her own world and this could further worsen her isolation and if it becomes acute, she could breakdown and become a psychotic individual and this could lead to other complications like hallucinations and similar cases. Eating Disorders: Toni is eating less and is now a victim of anorexia. She has a loss of appetite and this shows that she is in a mental condition that is serious and can ruin her physical health as most mental problems causes. Possible Approaches to Diagnosis There are several angles from which Toni's mental condition today can be examined. This include the various angles like myths, change in circumstances and spiritual transitions that is linked to mental cases. Myths & Delusions: This angle might suggest that Toni has been reading or getting in contact with unrealistic elements in the media and books that is having an influence on her life. It is possible that she has come to contact with someone who has made her to believe in a worldview that is steeped in mythical happenings and ideas that do not really exist. This might be an issue that can only be examined through the balance of the two ideas. Transition in Life: From another perspective, it could be said that Toni is going from one phase in life to anther phase. This suggests that she has come in contact with a different view of life and is now streamlining her life to attain it. There are notable examples of people who experienced conversions that changed their lives. Examples include people like Martin Luther who fell from a horse and started Protestantism in the Middle Ages and Bill Gates who took a major U-turn to quit his education at the prestigious Harvard University to do computer programming which made him the world's richest man. This could be one of the phases that Toni is going through at the moment. Spiritual Matters: Another angle from which a mental condition like this would be examined in mysticism ridden societies like the Middle Ages Europe or some societies in the developing world to day is to diagnose it as a spiritual situation. In this case, it would be argued that Toni is possessed and needs to go through some kind of rituals and circumstances like torture or prayer sessions to recover. This view has no factual basis it is steeped strongly in mysticism and faith. In this case, some patients and their associates might recommend working with a faith healer. This would involve going through a series of rituals that blends spirituality and physical counselling and coaching to attain the end of healing the patient (Gonzalez, 2009). Change in Circumstances: It could also be that Toni has experienced a major situation that has changed her life significantly. For a young person like Toni, it is possible that she is going through an emotional phase whereby she is made to go through some harsh circumstances in her normal life that is causing her to resort to some kind of escapism. For instance, she might be going through the end of a relationship that she invested so many emotions in that is not working out. Such a situation can cause many young people like Toni to exhibit strange character traits and trend that could be detrimental to her mental health and send a bleak signal to those around her. Substance Abuse: Another possibility is that Toni has now gotten herself into the consumption of some unusual substances like drugs or alcohol which is making her to see things that do not really exists. This leads to hallucinations and other anti-social behaviours and it could be that her parents have observed the situation from a limited perspective. Although these approaches and angles are various angles through which the changes in Toni's behaviour can be explained, they are not ends in themselves. Modern mental healthcare has evolved from various approaches that are connected in these approaches of viewing mental health cases (Cohen, 2009). Due to this, mental health uses some of these techniques as invaluable tools for the diagnosis and treatment of cases. However, the main difference of mental health is that it integrates elements of science and other theoretical frameworks to diagnose and treat cases. The formal framework that can be used for diagnosing and treating Toni's case is examined below. Diagnoses from a Mental Health Perspective In the formal mental health environment, practitioners are regulated by laws and professional ethics that require them to use various conventional, acceptable and scientific methods that seek the best interest of the patient (Bailey, 2000). In this case, if Toni is made to go to see a professional, the professional will owe a duty of care to her and would have to follow all the relevant ethics in diagnosing her situation from a scientific perspective. The scientific method of dealing with the case is to be done by assessing the feelings, emotion, behaviour and thought of Toni and identify the problems and formulate a treatment plan for her (Merrell, 2003). From the symptoms of Toni's case, there is evidence that her case history contains traces of acute schizophrenia. Schizophrenia Most writers describe schizophrenia as a psychiatric condition. Schizophrenia is described as “psychotic symptoms such as delusions and hallucinations” (Mueser and Jeste, 2011 p3). In this case, the patient has audible thoughts, hears commenting voices, feels controlled by some external forces and has a thought withdrawal (Mueser and Jeste, 2011). This is a much more serious form of mental problem whereby the patient loses control of the environment and begins to perceive and feel things that do not actually happen. The UK's epidemiology of schizophrenia suggests that there are 0.4 to 1.4% of people in the UK who suffer from schizophrenia in their lifetime (Bhugra, 2011). The NICE guidelines for schizophrenia states that divides the treatment of the issue into primary and secondary approaches. The variations include changes in the treatment and management of the various cases and situations. Toni's case is not conclusively schizophrenic. She is basically withdrawn from her friends and normal school life. She has started speaking about things that are not realistic and she seems to want a lifestyle outside her normal. Her isolation has caused concern for her parents and she is suddenly interested in things that suggests she is hallucinating. However, there is a possibility that she is experiencing some degree of schizophrenia or her condition could generate into that. This is because she seems to be pursuing some kind of actions that are moving her towards the believing in the afterlife and suicide. She is seeking more meaning about these two things and she is doing this alone. There is a good chance that she could develop an alter-ego or get some kind of justifications outside the normal environment that could be likened to delusions and hallucinations. Treatment Plan Mental healthcare programmes involve elements of psychological, psychiatric and sociological training and streamlining to assist the patient (Lester and Glasby, 2010). This means that there is the need for different approaches and systems to be used to deal with the situation. In doing this, there is the need for Toni's fundamental human rights to be respected and she must not be made to feel degraded or deranged as a member of the society (Glasby, 2012). This means that she should be assessed and her legal capacity to grant authorisations should be ascertained. If her condition is severe, then some kind of a guardian like her mother should stand in and give authorisations for actions. However, her consent must be sought at all times. A simple model for the treatment of a person like Toni would begin by setting up the treatment goals as defined by Keady et al (2003). This would involve the identification of what needs to be completed through the treatment. After that, there should be the development of specific steps for the attainment of each goal in this treatment. These treatments ought to be discussed with Toni or a person who stands in for her. After that, a timeframe must be set up by the health professional in charge of the treatment and management of the situation. Treatment should be recorded in the treatment planner. Toni would have to endorse the plan and also contribute to the attainment of the plans. After these plans are laid bare, the medical profesisonl in charge should always monitor the case and come up with solutions where there is the need for variations. Richard's Seven pointers require several things from a practitioner.The practitioner must provide thorough psychological evaluation by the use of scientific methods and systems. These methods and results should be documented and issues related to them should be outlined in such a document. From there, the professional would come up with the patient's goals, therapy objectives, targets, schedules and timeframes. Afterwards, there should be a reference to the plan in every situation. The plan should be used to guide the patient and also evaluate and monitor results. In cases where there are digressions, there should be an adjustment in the plan and the practitioner must re-strategise where necessary (Zwotinski, 2012) 1. Actual Treatment Using the model above, the treatment of Toni can be conducted by following a guided procedure for defining the goals of the programme and the efforts to be put in the programme to attain a given end Psychological Evaluation With all the symptoms gathered by Toni's mother, a professional will have to listen to the case history from Toni herself and more information should be collated form all other sources. The health professional is likely to make the following conclusions from the evaluation: 1. Toni's case involves a mild form of schizophrenia and could degenerate into a serious form. 2. Toni's has difficulties in social integration. In order to deal with this, there would be the need of the following: 1. Psychological therapy for schizophrenia 2. Psychiatric treatment for possible schizophrenia 3. Counselling for social re-integration Authorisation from Toni These things should be put before Toni and she must understand that she is not a crazy person. However, she must be made to know that her mental health is important and in order to have a more meaningful life, either as a member of the society she lives in or as a person who would take up a different role in the religious and spiritual realms, she needs to be fine mentally and emotionally. This way, Toni must be made to understand that he treatment is non-adversarial but rather in her best interest and her cooperation is essential. With this background, Toni must be made to understand the nature of the treatments and after that, she must be made to sign all relevant documents. In a case where Toni's situation is extremely bad and she is incapable, the professional must consult and in most cases, a guardian like her mother can give the authorisation. Failure to do this might lead to serious legal and professional consequences for the mental health professional and also for the medical facility. Goals The goals will be as follows: 1. Prevent the intensification of the cases of schizophrenia 2. Re-integrate Toni into the mainstream society Objectives The health professional must come up with clear objectives: 1. Apply psychological therapeutic conditions to find out about Toni and come up with direct solutions that will ease the stress on her. 2. Understand Toni's condition in a non-judgemental manner and come up with solutions on how to deal with her mental position. 3. Identify the social blocks to her integration into society and try to help her to overcome them and get a meaningful relationship with other people. Strategy The main strategy is to get Toni to book a psychological therapeutic programme that is appropriate for her. In serious matters, she must be made to consult the psychiatrist and also take up social counselling. The primary healthcare professional in charge of the case must collate information from all the three experts [if she is not the only one handling the case] and come up with treatment plans and schedules for Toni. Toni must have regular monitoring and check up sessions where her conditions would be assessed. Also, there should be sessions with her mother to get an independent assessment of the treatment. References Bailey, D. (2000) At the Core of Mental Health: Learning Issues for Practitioners and Mental Health Trainers London: Pavilion Basavanthappa, B. T. (2007) Psychiatric Mental Health Nursing London: Jappee Brothers Bhugra, D. (2011) Schizophrenia London: British Psychological Society. Cohen, D. (2011) Practical Considerations in Mental Health Treatment London: SAGE Publications. Department of Health (2009) “New Horizons: a shared vision for mental health. Flourishing People, Connected Communities” [Online] Available at http://www.dh.gov.uk/en/Healthcare/Mentalhealth/NewHorizons/index.htm Accessed: November 29th, 2012. Department of Health (2011) “No Health without Mental Health; a cross Government mental health outcomes strategy for people of all ages.” [Online] Available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_124006.pdf Accessed: November 29th, 2012. Elder, R., Evans, K. and Nizette, D. (2012) Psychiatric & Mental Health Nursing Sydney: Elsevier Australia Glasby, J. (2012) Understanding Health and Social Care 2nd Edition London: Policy Press. Gonzalez, S. (2009) The History of Mental Health: Theories, Diagnosis and Cures Hoboken, NJ: John Wiley and Sons. Keady, J., Clarke, C. C. and Adams, T. (2003) Community Mental Health Nursing and Dementia Care Berkshire: McGraw Hill Education. Lester, H. and Glasby, J. (2010) Mental Health Policy and Practice 2nd Edition London: Palgrave Macmillan Merrell, K. W. (2003) Behavioural Social Emotions London: Routledge. Mueser, K. T. and Jeste, D. V. (2011) Clinical Handbook of Schizophrenia London: Guilford Press. Roach, S. S. (2000) Introduction to Gerontological Nursing Amsterdam: Wolters Kluwer Health Zwotinski, R. (2012) “Richard's Seven Products of the Mental Health Treatment Plan” Journal of Mental Health Science 12 (6) pp469 – 471 Read More