Marys Mental Health - Research Paper Example

? Mary’s Case Study of Mary’s Case Study Introduction As a community health worker, there are several patients that have to be evaluated and attended to. These patients usually have different conditions and different issues that they are struggling with. The patient’s issues are usually influenced by various factors such as age and socio cultural background among other factors. While some patients present themselves voluntarily to the community mental health workers, there are those who have to be persuaded or forced to see the community mental health worker. Such is the case of Mary who came in at the urging of a friend. From her evaluation, it was determined that she has a problem with dependence on drugs. A DSM-IV-TR 5 Axis diagnosis of Mary will be used to categorize Mary’s physical as well as psychological state and overall functioning. To arrive at the classification, factors such as her dependence on drug use, her problems with sexual functioning, her inability to function in social situations without the use of drugs, and problems adjusting to different situations will be considered. Her physical health will also be considered in the categorization. This is because Mary has multiple issues that are relevant to the diagnosis and treatment of her mental condition. DSM-IV-TR 5 Axis diagnosis Mary’s mental health is influenced by the fact that she has substance dependence problems or substance related disorders. She admits that she is unable to work without having taken alcohol which she says calms her nerves. She is also dependent on heroine, and when she cannot get heroine she depends on other drugs such as Valium, Xanax or Klonopin until she can get access to heroine. She has also previously tried cocaine but according to her, it did not give her the same result that heroine does. She also reports that she has previously used marijuana. Her behavior also shows some characteristics of anxiety disorder which usually involve intense worry or apprehension and anxiety. This usually causes a person to act in a way that the person believes protects him from suffering from anxiety which in Mary’s case is take alcohol or drugs to ‘calm down.’ Her intense worry is seen to result from the fact that she suspects that she is pregnant and is worried about the impact that her lifestyle will have on her child as her boyfriend wants her to keep the child, she is however unsure as to her fitness as a mother (Brooks 2006). Her problems are further compounded by the fact that she suffers from sexual disorders. Despite living with her boyfriend, Mary observes that they rarely have sex and when they do, no precautions are taken. This is despite the fact that Mary works as a prostitute although she has indicated that she ensures that she uses condoms with the rest of her sexual partners. For most of her life, Mary has had serious problems. Her parents were both dependant on alcohol. Her father was an alcoholic and her mother is a recovering alcoholic. While she has been taking drugs for the five years that she has been with her boyfriend, her dependence on drugs can be seen to go as far back as 12 years when she confesses to have experimented with marijuana. This is a clear indication that Mary has some adjustment issues as she has not coped with her parent’s dependence on alcohol and has instead become dependent on drug use to get through the day. Her adjustment disorders have persisted for most of her life, and she has thus been dependant on drugs for a long time. In the analysis of Mary’s mental condition, it is evident that she suffers from conditions that are usually referred to as the ‘V codes’ which often include a variety of relational problems. These are problems that may require clinical attention but that are not psychological disorders. Such problems can include neglect and abuse. As a child, Mary was neglected by her parents because of their dependence on alcohol. Their alcoholism made it impossible for them to pay attention to her as a child. Mary seems to have continued the cycle of neglect and relational problems through her choice of spouse. Her boyfriend neglects her and his duties. He does not work and depends on the money that Mary makes as a prostitute. While he does not physically abuse her, he is unwilling to take precautions during their sexual encounters which have exposed Mary to an unplanned pregnancy that she is unprepared for. As such, she may have a child that she cannot adequately provide for. This means that Mary can be diagnosed on Axis 1 (Brooks, 2006). There was a lack of a long term history of the patient’s personality traits at the initial encounter. This means that the Axis II classification had to be deferred until such information was available. On Axis III, Mary has presented some physical symptoms. These swollen and tender breasts as well as missed periods. This is an indication that Mary is pregnant. Mary’s classification on Axis IV is done on the basis of the social and environmental problems that have contributed to her mental condition. As a child, she experienced problems with her primary support group mainly as a result of the alcoholism from her parents, and later the fact that her father abandoned her, her mother, as well as her siblings when they were still young. As an adult, she also suffers from problems with her primary support group characterized by the tension that exists between her and her boyfriend. Her anxiety and fear of pregnancy comes from her fear of neglecting her child, as a result of the neglect that she experienced herself. Her classification on Axis IV is also as a result of the occupational problems that she has experienced. She is unable to find a decent job and therefore works as a prostitute which is a difficult work situation. Her work situation is made worse by the fact that she may be pregnant which will make it difficult for her to work. This will worsen her economic situation which may make it very difficult to take care of her boyfriend as well as the child that she may be having. Mary also has problems accessing adequate health care as she does not have health insurance. These are the various Axis IV stressors that Mary experiences. For Mary, the Axis IV stressors are negative life events (American Psychiatric Society, 2000). Mary’s assessment on Axis V is used to document the overall judgment of her social, occupational, and psychological functioning. This judgment is based on Mary’s mental condition at the point of encounter (when she came in at the urging of her friend). Mary’s rating was 51-60, which presents itself in moderate difficulties or moderate symptoms in her functioning (both social and occupational functioning). A summary of Mary’s diagnosis therefore appears as follows: Axis I: Drug and substance dependence as well as social anxiety and relational problems. Axis II: diagnosis will be deferred for later as there is no information about her personality traits (long term) Axis III: suspicion of pregnancy. Axis IV: problems with primary support groups, both as a child and as an adult. Axis V: Global assessment of Functioning -51-60 (American Psychiatric Society 2000). Case Formulation From the formal diagnosis, it is important to develop a case formulation which is important in coming up with a treatment plan. The case formulation will consider Mary’s development and the different factors and influences that may have affected her mental condition. Case formulation is done over the course of interactions between the mental health worker and the client. The case formulation for Mary is as follows: Mary is a 24 year old African American with a heavy dependence on different kinds of drugs. She is currently pregnant and despite her pregnancy, she continues to use drugs and alcohol. The onset of her drug use seems to have been brought about by her parents’ behavior as they were dependent on alcohol. She dropped out of school and as such, she is unable to get a decent job and has to work as a prostitute. Her boyfriend also contributes to her drug dependence as he is a drug user himself, and that he depends on her for upkeep. This means that her diagnosis is as a function of the set of life experiences as well as an inherited predisposition for alcoholism and drug use. Mary’s cultural background is an important factor that will be considered in the formulation of the treatment plan for Mary. As an African American, Mary identifies with her culture (the African American culture). This means that some of the symptoms that she experiences are more relevant because of her cultural background, and from the fact that she is a young female. Such symptoms include the social anxiety that she experiences as well as her dependence on the different types of drugs (Loring & Powell, 1998). Treatment Planning and Implementation After the careful examinations and diagnosis, it is important to come up with a treatment plan that will ensure that the most appropriate treatment is designed for Mary. In coming up with a treatment plan, there are several factors that have to be considered. These includes the best treatment option, the goals of the treatment, the best kind of treatment, the financial feasibility of the treatment and well as the client’s needs and how best to meet these needs. For Mary’s case, it is important to come up with short term as well as long term objectives of the treatment. For Mary, the short term goals of the treatment will be to get her to stop her dependence on drugs. The long term goals will be to ensure that she can deal with her dysfunctional relationship as well as get a reliable source of income. The long term goals also include getting a way for Mary to come up with a strategy that will ensure that she does not relapse into drug use. It is important that most immediate needs are met. This will mean that Mary has to undergo a pregnancy test to confirm that she is indeed pregnant. Short term needs will also include getting Mary to stop her dependence on drug and alcohol use. This will involve getting her to change her mind set about the whole issue of her dependence on drugs and alcohol as she has expressed doubts as to whether she is capable of stopping her dependence on drugs. In treating Mary, it is determined that Mary does not pose a risk to herself as she does not have any suicidal tendencies and she has not been arrested or been in trouble with the law. Her problems do not require intense medical attention but require a combination of psychotherapeutic interventions. Her lack of medical insurance is also a factor to consider in treating Mary. This means that there is no need for Mary to be hospitalized during the course of her treatment. For Mary, the outpatient treatment is the best option of treatment. As she cannot afford the services of a private practitioner, Mary will be advised to seek treatment on agencies that are available in different localities and that are funded by the public funds. The Community Mental Health Centre will be important in helping her cope with her dependence on drugs. The centre is also important as it will provide her with a support group of people who may be suffering from similar issues (Loring & Powell, 1998). Mary will be offered individual psychotherapy where one on one session will be held. These sessions will be an hour long, held at regular intervals where Mary will discuss her issues and attempt to come up with solutions to her problems. This will help Mary get to the root of her problems, and deal with issues from her past which have made her dependent on the different kinds of drugs. The one on one interaction will also help her analyze her relationship with her boyfriend, and find a way forward in regards to the child that she may be expecting. With the help of the individual therapy sessions, Mary will be encouraged to explore different options that are available to her in regards to the child that she is expecting. The options that she will be encouraged to explore will include giving the child up for adoption as well as having an abortion. This is important as carrying the baby to term may put her life and that of the unborn child in danger. Group therapy will also be recommended for Mary. It is expected that group therapy will provide her with a safe environment where she can share her problems with people with the same problems, receive feedback from those present. Group therapy will help her build on her social skills and her interpersonal skills. This is because Mary is seen to be lacking in social skills which has led to her dependence on alcohol. In Mary’s case, group therapy is important as it will provide her with the support system that she has been lacking from childhood. This support system will help her overcome the obstacles that she may find on her way to recovery. The community mental health worker may have to make several referrals in Mary’s case. She has to be referred to a general practitioner or doctor who will evaluate her physical health and condition. She doctor will help in determining whether Mary is pregnant and the health implications of her pregnancy. Mary may also be referred to a psychologist or a psychiatrist depending on the extent of her mental health conditions. The referrals are meant to ensure that her mental health is well taken care of, and to ensure that the treatment plans that are devised will be for the overall benefit of the patient (Mary). Ethical and Legal Issues and Implications One of the ethical issues that are faced in Mary’s case is the consent to treatment issue. Mary can be considered as an adult who has what is referred to as ‘decisional capacity.’ This means that Mary has the right to accept or decline any treatment option that may be availed to her. She also has a right to refuse any form of treatment for her condition. Another ethical issue in Mary’s case is confidentiality. This is an important consideration as patients with substance use problems are known to be deterred from seeking treatment as they may have a concern about the lack of confidentiality by the clinicians or mental health care provider. The Drug Abuse Prevention, Treatment, and Rehabilitation Act (21 U.S.C. 1175) however provides for the client’s confidentiality to be protected (Parsons, 2001). There are limits to the confidentiality that the patient has. The NASW Code of Ethics (1996) makes the recommendation that the client is informed of the limitations that the confidentiality that exists between her and the caregiver. The client should be informed of these limitations before he discloses any information to the caregiver. The mental health provider is often faced with a concern as to whether he should disclose any information about the patient to any relevant third parties without breaking the confidence that the patient has in him. This concern is especially relevant when referrals are being made. One has to consider how relinquishing the patient’s confidentiality may affect the treatment plan and the outcome of the treatment. The effect may be negative or positive (Loewenberg, Dolgoff, & Harrington, 2000). Another ethical consideration in Mary’s case is the informed consent for treatment. Informer consent mandates that the health professional in dealing with a patient must obtain from the client informed consent before any treatment plan is put into effect. To get informed consent from the patient, the health practitioner has to disclose to the patient all aspect of the care and treatment that will be given to the patient. This includes a disclosure of the risks, discomforts, as well as the benefits of the health care plan that is being pursued. The informed consent also requires the health practitioner to disclose any alternatives for treatment that may be available to the patient. The informed consent also requires the practitioner to disclose to the patient how much the confidentiality will be maintained. The patient or client must also be informed of the consequences that he will face should he withdraw from the treatment program before the recommended time. The issue of informed consent must therefore be explored before the treatment plan can be explored. Transference and Counter Transference Issues In the context of therapy, transference is the situation in which the client redirects his feelings from a significant person to the therapist. Transference often presents itself as an attraction towards the therapist. It (transference) can also present itself in the form of rage, anger, mistrust or dependence on the therapist. In Mary’s case, there is a concern that transference of the feelings that she has from her past encounters and present relationship may complicate the treatment plan. Her father abandoned the family when she was still young and Mary harbors feelings of anger and resentment about the abandonment. The fact that she did not receive the necessary care as a child, and having watched her parents struggle with alcoholism makes it hard for Mary to trust those around her. Her relationship with her boyfriend as well as the relationships that she has with her clients has also made her resentful and mistrustful. There is therefore a genuine concern that she may transfer these feelings to those meant to cater for her mental health. This may hinder the treatment plan and make it harder to achieve the treatment goals (Fiscalini, 1994). Counter transference is the redirection of feelings that a therapist has towards a client. This is usually seen in the emotional involvement or entanglement that the therapist sometimes develops to the client. The issues that Mary has may stir emotions in the mental health practitioner that is charged with the responsibility of providing care to Mary. It is important that the practitioner has a clear understanding of whatever issues that he may have. This will help the therapist to carefully identify and examine the feelings that the client has, whether these feelings are conscious or unconscious. It is said that there is an acceptable level of transference and counter transference in the interactions, and that this acceptable level is important in ensuring that the patient receives the best possible care. It is however important that the therapist acknowledges the impact or influence that transference and counter transference has on the relationship between him and the client. Conclusion The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) is effective in that it enables the different mental conditions and psychological disorders to be classified in a multidimensional way. The classification is often reliable and enables one to use the provided relevant information to come up with an effective treatment plan. In Mary’s case, the treatment plan will include immediate management of the conditions that she has presented, as well as short term and long term goals to ensure that she can overcome her drug addiction, dysfunctional relationship and improve her general quality of life. References American Psychiatric Society (2000), Diagnostic and Statistical Manual of Mental Disorders (4th ed. Text Revision) Brooks, B. (2006) DSM-IV-TR for clinicians: Accurate Diagnosis and Treatment Planning. Fiscalini, J. (1994). The Interpersonally Unique and the Uniquely Interpersonal. Contemporary Psychoanalysis, 30:114-134. Loewenberg, F. M.; Dolgoff, R. & Harrington, D. (2000). Ethical Decisions for Social Work Practice, 6th Edition. Itasca, IL: F. E. Peacock Loring, M. & Powell, B. (1998) Gender, race and DSM-III: A study of objectivity of psychiatric diagnostic behavior. Journal of Health and Social Behavior. 29, 1-22. Parsons, R. D. (2001). The ethics of professional practice. Boston, MA: Allyn & Bacon. Read More