Mental Health Psychosocial Intervention - Essay Example

?Mental MENTAL HEALTH PSYCHOSOCIAL INTERVENTION April 11, Psychosocial Intervention Introduction In working with a patient, who you know is a frequent flier (a patient who has had numerous admittances to the hospital for same problem). You will need to review his past medical records and the interventions that worked and did not work in previous admissions. You will need to check the patients’ old lab reports that were done, check the medications that the patient was on during the past times he was in the hospital and then the previous reasoning that the patient was admitted to the unit. The patient has suffered with recurrent depression, but has been in recovery for alcoholism. The patient stated that he also hears voices that he can control as long as he does not drink and stays on his medications. Patient had stated that he had bouts of depression and has had suicidal ideations. The patient knows that he needs to be compliant with his medications and has been known not to take his medicine. In thinking about new therapies for this patient you as the nurse, doctor or as a therapist should think to include more psychosocial interventions to make him feel comfortable, so that he will want to continue to take his medications and not want to drink that he knows causes his various problems. The caregivers should think about Social training groups, relaxation skills, and various activities that will improve coping skills. When the patient first arrives at the hospital for the coming admission you could ask him if he remembers doing any of this before to see about his level of consciousness. Working with any patients like Gary the caregivers should try to figure what Coping Mechanisms should be used and not used. You will have to identify the problem and set up a goal that will help the patient learn how to deal with his problem or problems. You know that the patient has recurring depression, is an alcoholic, and he says that he hears voices and can at time become violent due to these voices. The caregivers can think of ideas that can give the patient social support and strength so that he will not rely on the voices he hears. You can check into the resources that did not work and find out why he did not use them and then you can try to find new resources that may work. Case Study Gary a 51-year old male with previous admissions, but has decided to discharge himself from the hospital AMA (Against Medical Advice). The patient has a history of Depression due to financial stress and due to this stress he drinks alcohol so much that he suffers from alcoholism. The patient admits to have suicidal ideations and has even taken an overdose of his medications. This is the reason that is being admitted this time. Due to this overdose due to feeling stress of his financial problems and then he drinks and aggressive issues arise and the patient gets into fights when the patient hears the ‘voices’ in his head telling him to hurt other people. The patient does admit that he can control the ‘voices’ when he is compliant with his medications, but when the patient is intoxicated his mental status decreases and could become violent. The patient does not always seek help in the community due to his past behaviors. Discussion of Psychosocial Interventions A review of psychosocial interventions begins with Erikson and for this patient, Gary, he needs to work on trust versus mistrust. The patient must want and feel trust with the caregivers while in the hospital and then he must feel comfortable in his community when he is discharged from the hospital. The patient must also work on autonomy versus shame and doubt. The patient can do this by wanting to learn about the how and why that his medications must be taken regularly and that he can learn to do this on his own and that he does not have to worry about his financial problems, because he will be given ideas that will help him in the community. The patient feels alone and this brings on depression and then the drinking and all the other problems and if the patient could learn to seek help and learn more skills to fit in with the community the patient will be working on generativity versus stagnation. The patient seems stuck and wants to make the easy out, so patient decides to take an overdose of his medications. The patient also needs to work on industry versus inferiority. The patient shows this from having the financial stress and trying to find a better job or having work issues and he may be feeling inferior, since maybe he feels that he can do better but does not know how to improve in these areas. In a discussion that you will have with the patient you could find out that he believes that his problems all start with his financial problems. This is a case that environmental theory can be used. The patient is an alcoholic which he may think the community is the reason for this problem. The patient is also on psychotropic medications. He may think this for alcohol is a depressant and many drugs depress the Central Nervous System (CNS) when they are being used in the wrong way or abused. This could be the reason that the patient feels that he does not fit in with the community. The patient also fits with this idea for he is a negative thinker due to his history and financial distress. “According to Norman Vincent Peale, the author of ‘The Power of Positive Thinking’ and Aaron Beck, a noted psychiatrist, have both stated that a person’s mood can be influenced by the way she or he thinks. If a person is negative about self, the world, and the future negative moments occur at the expense of positive experience.” (Shives, 1992, p. 357) This part works for Gary for he having financial problems and he may have had bad memories of the hospital when he went AMA and discharged himself and now he feels guilty and tried to commit suicide by taking an overdose of his medications. “Though the voices that the patient hears, but says that he can control them when on his medications but not when he drinks may be his way of reinterpreting negative or distorted thoughts and actions more realistically and positively” (Shives, 1992, p.357) even if it doesn’t always work. This is why we must try to get Gary to be stay compliant with his medications. Since, Gary the patient, has admitted that he hears voices he could have some criteria for a delusional disorder. These voices tell him to hurt people. This is the reason why the patient should be admitted for he is a danger to others and himself. The patient can receive therapy such as Psychotherapy, Milieu therapy and Chemotherapy. Psychotherapy is used in this way. Communication groups so that Gary can learn ways to improve his relationships with family, friends and workers. Milieu therapy could be used so he can have a chance to learn and use his new skills and practice them in a structured setting before going into the community environment. Chemotherapy is used to find the appropriate anti-psychotic drugs to be used (Shives, 1998) to go along with the medications that Gary is already on at admission. Psychosocial Interventions The psychosocial interventions that could be used are as follows: 1. Establish a trusting relationship. 2. Alleviate anxiety. 3. Maintain biologic integrity. 4. Establish clear, consistent, and open communication. (Shives, 1998) These interventions will help Gary, the patient, feel comfortable and safe. If Gary is to stay in the hospital he will learn the appropriate coping strategies, so maybe he will be able to learn control when times would get rough for him. The staff will also have to work with his Alcoholism and teach him other coping strategies besides drinking. Coping Mechanisms to be taught This patient is able to learn various coping strategies through therapy groups where communication and social skills will be utilized. The patient will participate in individual and group activities during his stay in the hospital. Issue of Alcoholism When the staff is working with the patient with his problem of alcoholism they can increase the factual knowledge about alcoholism. They should also foster interdependence on people, rather than dependence on alcohol. The caregivers should encourage the person to participate in self-determination by identifying personal strengths. They can encourage the patient to reestablish broken relationships. The patient must through encouragement to accept his own humanity. They should allow the person to grieve over the loss of alcohol. The staff should foster change in or modification of the person’s life-style that contributed to drinking and they should encourage the development of alternative approaches to coping with stressors. (Shives, 1998) Issue of Suicide Interventions that can help with this issue the caregiver can accept the patient for who he is. The caregiver should avoid judgmental statements about self-destructive behavior. They should convey a caring attitude. We should encourage verbalization of feelings. We should also provide opportunity for the patient to succeed in simple minor tasks so that the patient will receive positive feedback and self of self-worth. The patient will demonstrate a feeling of acceptance. The patient will identify present stressors or issues related to suicidal ideation and attempt to harm self. Identify one or two positive aspects of self. They must also have to verbalize the absence of suicidal ideation. The patient will communicate feelings of self-worth and acknowledge need for continuing therapy once mood stabilizes to enhance self-esteem. (Shives, 1998) Issue of Depression The patient, Gary, who has had recurrent episodes of depression can be identified in these ways. “Persons who are depressed may be difficult to communicate with or approach. Isolation, withdrawal, ambivalence, hostility, guilt, or impaired thought processes are but a few symptoms that can interfere with the development of the therapeutic relationship. The caregiver must be able to show acceptance, honesty, empathy and patience. (Shives, 1998) Issue of ‘Voices’ This issue could be treated by the caregivers giving the patient more time to have more appropriate interactions through individual and group activities that improve social skills. The groups that may work for the patient could be Relationship groups where the emphasis is on being in relationships where one’s needs as well as other’s needs are met. He could also participate in job support groups where maybe he could find out ways to decrease in financial stresses. He would have a chance to share his feelings on why he has work problems. Maybe this would help decrease the voices in his head by giving him a chance to listen to other ideas on how to solve his problems. (Gladding,2003) The patient could also benefit from Social Skills training is a modality that improves personal and social functioning and reduces hospital recidivism in participants. This is a highly structured and interactive modality. The patient could also participate in Independent Living Skills training group that is for patients to learn about management of personal funds, and in Gary’s issues this would help him with his financial stresses. This type of group can also help him to feel a part of the community. (Sammons, 2003) The patient could also be a participant in Disorder Management Training. This type of training is a modality that is different from related social and living skills approaches, but reflects a growing recognition on more specialized skills so that he can handle his alcoholism, his ‘voices’, his suicide attempts, depressive issues and his anger issues. He can learn about what to look for each of these problems and he can learn about the relationship of what he feels and the actions that he does and how his actions affect his life and others. He will learn about the pharmacological ways to help him and to use relaxation and stress management activities. He will learn to use assertive skills to help deal with other people around him. This modality will also give him lessons in dealing with his medications and learning about how to stay compliant with his medication regimes. (Sammons, 2003) Other resources for care of patient These guidelines also list the many psychosocial approaches of known effectiveness but do not describe them or give them much further information. 1. The Expert Consensus Guideline Series Treatment in Schizophrenia 1999 (McEvoy, Scheifler, & Frances. 2. Journal of Consulting and Clinical Psychology , Kendall 1998 They also tell that all treatment must be tailored made to a specific patient. You will have to make changes and integrate other theories to be effective for these patients. There is a progression of pharmacological and psychosocial treatment they start with the nonspecific items of their problems to the more specific issues. It has also been said that you must include psychosocial activities in any treatment along with drug therapy. Conclusion When caring for a patient like Gary you must look at the whole person. You must look at the physical needs and the emotional needs that include the need to belong. These issues are the ones dealing with his alcoholism and anger issues. Once that is covered you can move into the psychosocial problems of what caused his financial problems that was caused by his anger and violent tendancies that lead to his suicidal ideations. Through attending the various interventions (therapy groups) that were mentioned earlier the patient should show improvement. References Gladding, Samuel T. (2003) Group Work A Counseling Specialty. Chapter 12 Groups for Adults. 4th edition, Merrill Prentice Hall. Ivey, Allen E., Ivey, Mary Bradford, & Simlek-Morgan, Lynn. (1997) Counseling and Psychotherapy, Chapter 4 Developmental Counseling and Therapy; 4th edition Allyn and Bacon. Sammons, Morgan T. & Schmidt, Norman B. (2003) Combined Treatments for Mental Disorders A Guide to Psychological and Pharmacological Interventions. Chapter 7 Combined Treatments of Rehabilitation of Schizophrenia by William D. Spaulding, Dale E. Johnson & Robert D. Coursey published by American Psychological Association Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing. Chapter 7 Therapeutic Interventions 4th edition Lippincott Philadelphia New York Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing. Chapter 13 Theories of Personality Development 4th edition Lippincott Philadelphia New York Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing. Chapter 19 Depression and Mania 4th edition Lippincott Philadelphia New York Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing, Chapter 21 Delusional or Paranoid Behavior 4th edition Lippincott Philadelphia New York Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing, Chapter 22 Schizophrenia and other Psychotic Disorders, 4th edition Lippincott Philadelphia New York Shives, Louise Rebraca. (1998) Basic Concepts of Psychiatric-Mental Health Nursing, Chapter 26 Alcoholism 4th edition Lippincott Philadelphia New York Read More