Mental Health Management in a General Setting - Essay Example

MENTAL HEALTH MANAGEMENT IN A GENERAL SETTING PSYCHOSOCIAL HEALTH ASSESSMENT (PSHA) AND MENTAL HEALTH MANAGEMENT PLAN OF A DEPRESSED PATIENT 26th May, 2012 Introduction Patients with psychological and mental problems are difficult to deal with by healthcare professionals, and this is because there is lack of a single assessment and management plan for mental disorders. Mental health problems usually arise due to socio-economic and cultural disparities or changes which have been brought about by population pressures in the society. For instance Australia's population is highly increasing and it is approximated to reach 42 million by the year 2050. If not contained, the rapid population growth will further worsen an already compromise of social, public health and environmental implications resulting to mental health problems (Lyn et al., 1991). This development of psychological and mental problems generally have high preferences in the vulnerable and disadvantage populations in our society due to stress accumulation. The population pressure also results to both environmental degradation and a subsequent development of climate change; and this facilitates into the current growth of social and health issues in our society including a decline in living standards for many residents. Some of these environmental, social and health-related issues include: pressure on the limited fertile cultivation land in Australia; high volumes of industrial and domestic waste which has treatment difficulties; inadequate provision of essential services; accidents and traffic congestion; lack of affordable housing and slum development; stress and lowered mental health; increased chronic diseases such as obesity, high blood pressure and diabetes; and inadequate aged care nursing services (Howat and Stoneham, 2011). Psychosocial Health Assessment Psychosocial health assessment (PSHA), refers to the testing of target population or patients for social and psychological well-being and test presence of these disorders. Psychological assessment and testing in mental health patients usually enables healthcare professionals especially psychologists to have a better understanding of a person and their behaviour. This procedures is very essentials in the formulation of a management plan to enhance problem solving for many medical professionals. The healthcare professionals utilise this assessment in determining the core components of a person’s psychological or mental well-being, patient personality, intelligent quotient, or some other character components (Jackson and Kroenke, 1999). This can also facilitates the general identification of both weaknesses and strengths so as to assist them in addressing and solving their psychosocial dilemmas. There are several ways an healthcare professional can utilise these psychological tests, and it comprises a diversified research-backed tests and procedures of making specific assessments on aspects of a person’s psychological components. The patient assessment are used to identify different personal characteristics such as determination of IQ, personality problems, and other behaviours. Mental health problems experienced by a patient includes anxiety disorders, depressive disorders, substance use disorders and personality disorders, and they generally exists in different proportions in the society depending on socio-economic and cultural settings. All these disorders account for the majority of patient's mental illness in the health care facilities and community, and some of these disorders may become chronic and this may be complicated to solve. Psychological assessment for a depressed patient should be carried out through clinical interview, testing of intellectual function, personal and behavioural assessment. This can be complemented by specific areas of psychosocial assessment, such as aptitude or achievement in school, career or workplace counseling, management skills, as well as career planning. Clinical Interview The clinical interview is a major component of psychological assessment and this through intake, admission or diagnostic interview. The clinical interview should be done for 1-2 hours to give an opportunity for gathering important personal background and family data, and this information is essential for management plan formulation. In the interview the patient should be led to give healthcare professionals the required information related to living behaviour and personal history with the professional interviewer, through specific questions about various life experiences. This can be carried by computerized interviews, through a series of standardised clinical and personal questions on a computer software in the clinician’s office instead of face to face talk with the patient. Clinicians should obtain basic patient's demographic information, however it can involve structured diagnostic interview questions to help the healthcare professionals formulate an initial diagnostic impression for that specific patient. It has a prior importance since psychologists conducting the test, will formulate their own clinical impressions about the patient upon his exposure, through a direct interview with the patient. This can be followed by an assessment of intellectual functioning. Assessment of Intellectual Functioning (IQ) The intelligent quotient of a person is a theoretical construct of a measure of general intelligence, and this dictates the personal ethics and behaviour. This assessment is important for depressed patients despite not giving the exact levels of a person's actual intelligence, and only determinines important components of patient's intelligence. This is carried out through two major parameters of personal intellectual functions, and they includes both the intelligence tests and neuropsychological assessment. Intelligence assessment is a shallow test and it is frequently administered unlike the neuropsychological assessment which is a more extensive form of assessment and take a prolonged period of patient exposure (Hahn et al., 1996). The test focuses on both the intelligence testing, as well as determination of all the cognitive strengths and deficits of the affected person. The patient should be exposed to the commonly administered IQ test such as the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV). This is a procedure that takes up to ninety minutes patient exposure especially for adults, and its divided into four major scales or full scales IQ, and further subdivisions of a number of mandatory and supplementally or optional subtests. The mandatory subtests can give a personal measure of full scale IQ levels, but the supplemental subtests provide additional and important information about a patient’s cognitive abilities. Since the scales of the test is based on personal answers on questions of information and vocabulary, some of the subtests demands physical manipulation of objects to determine personal levels of creativity. For instance the Wechsler is tapping into the diversified components of a person’s brain and thinking process, and this or this explains why it is necessary to carry a face to face IQ assessment as online IQ tests can not be equivalent to real IQ tests given by a psychologist. Personal Assessment Personal assessment has been designed to assist healthcare professionals to obtain a better understanding patient's personality. Personality is a wide and complex combination of factors which have developed over the entire life period, and its different components which includes; genetic, environmental and social components and this test consider a composite of all these influences. The patient should be subjected to two procedures, that is objective tests which is a basically true or false measure of personality dysfunction or projective tests which is based on using of pictures to understand the personal experiences. This test gives personality traits including hypomania, social introversion, paranoia, masculinity/femininity, and psychopathology (Koekkoek et al., 2006). Done by a correlation between an individual’s responses to different questions scattered randomly throughout the test that have positive or negative relationship with a particular personality trait. Usually the questions always do not have an obvious relationship with the trait to which they are correlated without being faked, but enables patients to understand themselves. Online tests at the clinician's office can also determine personality disorders especially when a simple assessment of psychological or mental health well-being is required. Projective tests involves several procedures, but the patient should be tested with a series of cards with pictures depicting particular life situations while few are blank. The assessment is done by allowing him to pick cards at random and asking the patient to formulate a story for what they see in each card issued. The test determine personal experiences and this can be obtained from the type of dilemmas and recurring themes that this patient associates the pictures portrayed in the cards issued (Hinshelwood, 1999). This reflects his personal life encounters, and since the picture themshelves do not have anything in particular of a true story, then anything said by this patient is an unconscious reflection of an actual picture of his real life experiences and inner turmoil. Behavioural Assessment The patient has to undergo a behavioural assessment process to helps health professionals to identify actual behaviours of this patient, as this is an important tool of understanding of the personal behaviour and its aetiology. This assessment can be done at home to identify current behaviour patterns, at school, at work, or in an hospital or inpatient enviroment (Griffiths et al., 2000). The clinician Targets both negative and positive behaviours observed, and also on their respective reinforcements. This gives the therapist has a good idea of intervention needed by this specific patient in order to enhance patient achievement of a new and healthier behaviour. Self or online assessment is possible by tracking their moods over a period of one to four weeks using mood journals oruse of inventory form questions respectively. Mental Health Management Plan After a complete psychosocial assessment by psychiatric clinician, a summary of the patient results is formulated based on the mental status and psychological assessment. This data is important in the analysis and determination of priorities, identify problems associated with depression and therefore helps in establishment of management and care plan. Depression can be associated with a variety of risk outcomes which includes; poor taking of roles and responsibilities, suicide, anxiety, nutritional imbalance, hopelessness, ineffective coping, chronic low self-esteem, disturbed sleeping patterns, impaired social interactions and self-care deficit (Videbeck ,2004). By determining the level of associated risk problem, it is easy for psychiatrist clinician to decide on either to hospitalise the patient or allow different levels of outpatient admissions. The most characteristic risk of depressed patients is presentation of suicidal ideas and this usually directs them to perform harmful thoughts or decisions. This therefore requires a surerity of personal safety, and this should be given the first priority as this patient have to be urgently hospitalized. In the hospital environment there is close monitoring of this particular patient and this follows a management of other identified problems (Steinmetz and Tabenkin, 2001). This may includes treatment of depression problems of psychomotor agitation or retardation, insomnia or hypersomnia, and poor appetite or excessive appetite which are frequently associated with these patient. A combination of some these psychotherapeutic elements such as cognitive-behavioural therapy, interpersonal therapy, psychodynamic psychotherapy, and other psychotherapies is usually the best non-pharmacological approach. Generally the patient was initially exposed to cognitive behavioural therapy, and he should be given eighteen treatments to eliminate depression associated behaviours. Most of patient with depression have distorted view of themselves and the society at larger and it si appropriate for this patient to have these feelings counteracted by administartion of cognitive-behaviour therapy. It is an effective therapy for all ages because a lot of side effects are encountered in the medical interventions. This therapy should be continued for atleast 6 months until the depressive behaviours subsides, and abolition of any reccurences or relapses (Kunsook, 2006). Psychodynamic psychotherapy should follow as it can help in changing maladaptive patterns of behavior, identify feelings, ensure coping with ongoing and past conflicts, improve self-esteem and insight, self understanding, increase ego strength as well as interact more effectively with others. Its found that interpersonal therapy is useful in treatment of acute depression in adolescents with and this decreases the rate of relapse. Therefore it is very important to expose the patient to interpersonal therapy to eliminate the patient's depression disorders. A treatment procedure for this patient with depression was carried out and it followed a continous step by step plan with a sequence of interventions from safety management, symptom management, medical treatment, psycho-education, and psychotherapy in that order (Jacobs, 2005). The purpose of this treatment plan was to organize the interventions to meet required objectives for my patient and improving his understanding about depression, importance of medication adherence, interpersonal and social interaction, as well as self-esteem, and provide him with skills to develop a constructive coping mechanism. The treatment was aimed for the depressed patient to acquire and maintain a stable recovery from his mental illness and change to a productive life in the mainstream of society (Videbeck, 2004). The patient admitted in the hospital reduce his risks due to mood disorders, and this keeps him safe from harming himself or other people, engaging in socially right and appropriate behaviour, maintaining adequate nutrition by providing a well balanced diet, getting enough sleep, and personal care, adhering to required medical regimen, as well as following up on discharge plan (Cornwell, 2003). Chemotherapy offers a relieve for the symptoms and this therefore calls for a psychotherapic intervention which includes cognitive-behavioural and interpersonal therapies. This can be complemented to achieve an effective management for patients with either acute or mild depression, as well as aiding in prevention of its recurrence, especially in children and adolescents. This combination therapy has been associated with a fast and sustainable response, as well as significantly increased rates of recovery from clinical depressive symptoms; improved quality of life; and a better treatment compliance, especially when treatment is needed for longer durations than 3 months. A full treatment and recovery of depressed patients is possible by use of antidepressant chemotherapy and clinicians have preferred selective serotonin reuptake inhibitors (SSRIs), which are the most frequently prescribed class of medication (Roose & Sackeim, 2004). Thus pharmacologically the patient was treated using a treatment and intervention by use of major antidepressants especially of the group SSRIs. The patient should be subjected to an administration of fluoxetine, and this drug has an improved levels of safety and effectiveness as compared to older tricyclic antidepressants in management of both depression as well as anxiety, obsessive/compulsive disorder, or eating disorder (Harvard Medical School, 2005). However the side effects of sexual dysfunction and suicidal feelings should be expected and therefore properly managed through specific procedures, especially in young children and adolescents. Conclusion Mental health and psychological patients requires an effective procedure for their identification and subsequent development of a working management plan. There is no a single method which can be effecient is assessing both psychological and social well-being of patients. The mental health management plan covers a sequence of interventions which includes safety management, symptom management, medical treatment, psycho-education, and psychotherapy in that order (Videbeck, 2004). The overall treatment and management of depression is by either use of pharmacological antidepressants or administration of non-pharmacological means. References Cornwell Benjamin (2003), Clinical Assessment and Management of Depression Griffiths, J., Ravindran, A.V., Merali, Z., & Anisman, H. (2000). Dysthymia: A review of pharmacological and behavioral factors. Molecular Psychiatry, 5(3) 242-261 Hahn SR, Kroenke K, Spitzer RL, Brody D, Williams JB, Linzer M, deGruy FV. (1996), The difficult patient: prevalence, psychopathology, and functional impairment. J Gen Intern Med.;11(1):1–8. doi: 10.1007/BF02603477. [PubMed] Havard Medical School (2005), What Are the Real Risks of Antidepressants? Harvard Mental Health Letter, 21(11), 1-4 Hinshelwood RD. (1999), The difficult patient. 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