Shelter Program Individual Assessment - Essay Example

? Individual Assessment Introduction At first glance, AG does not look like an ordinary homeless person, although his clothes are relatively old and on close look they are worn out, he seems to keep them clean which is unique considering his condition. However after I had talked to him and observed him in consequent visits, I realized the first day was one of the good days and he could sometimes walk around in filthy clothes without seeming to be bothered in the least. I met him working at the Bergen County Health, Housing and Human Service Center for the Christ Community Development Corp, which is a shelter program that incorporates the provision of food shelter and counseling for individuals wanting to make changes in their lives. In the program we also ran the NEXT STEP program Shelter program, under these social services assistance is provided for individuals as well as a variety of other services such as legal, HIV screening, counseling and arranging for vouchers to help them get into government housing programs and access food stamps. Background Primarily, my job as an intern involves keeping records and placement the individuals who come to the shelter so while I did not spend a lot of time in formal one on one session, I had access to most of his medical records personal history since these were in my domain. Aged 33, he was a Hispanic man who had been discharged from the army3 years ago, subsequent mental problems had made it impossible for him to get a civilian job especially after he was diagnosed with PTSD. He was suffering from several other problems both mental and physical but the former were more dominant and evident. After his war experience, he had problems sleeping, constant hallucination and sleep walking; he became extremely aggressive and was arrested twice for assault. He developed a drinking habit and although he is receiving a disability insurance- army veteran pension, he is jobless and spends all his money to purchase liquor. Five months before he came to the center he had attempted suicide by swallowing several sleeping pills and washing them down with a whole bottle of vodka, fortunately called 911 and was rescued by paramedics. His life before he joined the army could also hold clues to his mental problems since it was very unstable, he used to live with his mother but their relationship was very strained since she had a history of emotional problems. His father has never taken an interest in his life and although he has two brothers, they are not close and in fact he has not seen to either of them since he returned forms the military. They shun him because they think he is crazy and would not want him close to their families, like their mother they had advised him not to join the military but since he did they felt it was justifiable to ignore him as he was paying the price of his high headedness. Overall he had no family support structure and he felt bitter since he felt neglected and unloved, he had been married briefly in his twenties but she left him because of his constantly beating her, he had no children. Coping Mechanism Owing to the frustration he felt he developed several habits, which worked as coping mechanism so he could escape the reality of his life, for one, he already drank heavily but after his discharged he became a real alcoholic and neglected everything else. When he eventually gave up on trying to fit in with his family and spent most of his time and money on cheap liquor, he is now addicted and cannot remember a time when he was not sober of trying to get a drink except during his stay in hospital. In the army he had taken up smoking and although he had tried to stop, he had eventually given up on stopping, he told me that smoking gives his some element of peace and wellbeing, he also admitted to sometime smoking marijuana although he claimed he was not addicted. Another coping mechanism he uses is denial, he denies being estranged with his mother and claims that he lives with her although social workers had established the contrary; he however insists that they are still in good terms and keeps talking about how she loves him. He blamed the government for his alcohol woes and claims he was exposed to toxin which he can only repress by drinking, and claims that is a conspiracy between the government and the alcohol manufactures to get ex vets addicted and blame it on the stress of war. Risk Factor His main risk factor that is both a cause and result of his mental instability is his self-destructive nature which is especially evident when he is drinking; this mostly seen in his attempt to suicide which shows he is becoming increasingly frustrated with life and losing his sense of self-worth. Furthermore, he often exceeds his limit and drinks himself to a coma. In the past two months says he has woken up in an emergency room and once in a police cell as he was passed out by the roadside. He is homeless and although sometimes he sleeps in some of the shelters provided by churches in the city, he mostly just passes out on park benches and when the weather allows culverts. This exposure to the elements makes his vulnerable to ill health and he has been diagnosed with pneumonia although he refused to be treated claiming he was “fine”. Strength Despite the fact that he has been diagnosed with mental instability he is a very bright individual and talking to him when he is lucid, I realized that he was quite pragmatic about his condition, this is further evidenced by the fact that he came to the center voluntarily. His symptoms are not always present and when he is feeling normal, he attempts to get help as he is di when he showed up at the center. However, these periods are short and few and even when he is willing to get help, he often falls back to his life of alcoholism and neglect. Another strength that is manifested in him is in the fact that he optimistic and believes one day he will be able to deal with his situation and go back to a normal life, most importantly get accepted by his family. This is what motivated his to come to the center since he hopes that he may become the man he once was before everything in his life suddenly seemed to fall apart. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) One of the analytical techniques used to evaluate patients such as AG is the DSM-IV through which the therapist tries to address the whole individual, it stems from the assumption that successful intervention in psychiatric or emotional disorder requires that they consider a variety of perspectives (Zimmerman and Chelminski, 2005). Axis 1 comprises what is considered to be the primary disorder or rather what drives the patient to the hospital in the first place. In AG’s case, he came because of a flare up of self-destructive symptoms, primarily this were his suicidal tendencies which had driven him to attempt to kill himself earlier. Axis 2 refers to the underlying personality disorder that could be resulting in the problem that has caused to seek medical attention (Hasin et al., 2006). According to historical data, AG’s symptoms could have flared up as result of a variety of reasons; for one, it could be a result of his untreated PTSD, the condition had made him violent in the past and he frequently experience periods of blind rage and he would strike out against anyone or anything (Welch et al, 2013). Gradually his rage started to be redirected to himself and his pent up feeling of frustration and low self-esteem begun to drive him to think of ending his life. His alcoholism, marijuana and smoking problems could be classified under this Axis since they, in addition to increasing his psychological and social problems, they, contributes to his depression. AG had been injured in the war in an explosion that had caused a minor concussion; However, it was treated successfully while he was still in service. The third Axis contains any physical medical or neurological problems that may be relevant to the patients’ current or retrospective psychological issues (Kendler et al, 2011). Nevertheless, it is possible, although it could not be proven without intensive medical examination and tests which are not possible in the present condition, his pneumonia despite posing a challenge to his overall health does not appear to have any effect on the mental predisposition. His major stressor is his estrangement with his mother and consequent homelessness The major causes of psychological stress are coded in the Axis 4, for AG, there are several factors that could be categorized in this axis. These include his recent separation from his mother which he is apparently dealing with as is evidenced by his constant denial of, his discharge from the army for among other reasons mental illness could also be a major psychological stressor. During the interview, he would switch on without warning from logical and coherent to paranoid incoherent ramblings. Finally there is the Axis 5 which encapsulates the individual’s level of function during the time of assessment; it is normally coded at between zero to a 100 (Taheri and Perry, 2012), even normal person will not score 100, would classify him at between 21to 30 since he manifests symptoms of hallucinations paranoia and self-destructive behavior. AGs functionally is difficult to rate since at one point he is lucid and seems to function normally but without warning he gets into a depressive mood he becomes an entirely different person almost as if he is schizophrenic. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) The patient is delusional and based on his explanations he sometimes has hallucinations Based on a DSM 5 diagnosis I would suggest that he can be categorized under the Schizophrenia Spectrum and Other Psychotic Disorders all which have the some of the psychotic symptom that are evident in AG such as hallucinations and delusions (Keefe, 2008). However I cannot give a specific diagnosis s owing to the fact that I did not spend enough time with him to narrow down his symptoms. I arrived at this conclusion by listening to some of his illogical claims that he made in parts of the interview when he overtly displayed mental disability. AG claims that the government is out to destroy him and other veterans and him with drugs and he thus refuses to take treatment for his alcoholism and even pneumonia since he believes medication will only make him worse. AG spends almost all his pension money on purchasing alcohol; According to what he told me and what was in his records, he was willing to do anything to get drinking money and when he exhausted his own he would beg and sometimes steal. One of the reasons he had fallen out with his mother is because he was taking items from the house and pawning them to feed his habit and she when she discovered him she threw him out. A DSM analysis would classify this under substance related and addictive disorders, I believe this diagnosis to be correct since he admitted to heavy drinking and during the interviews he had a smell of gin around him although he told me he had only take enough to “get him going” . He says when doesn’t have a drink he feels dizzy and nauseous and can’t talk without a stammer, he experiences what he describes as a maddening thirst that he believes he can do anything to sate. Although he has denied it, I suspect he is also a regular consumer of marijuana and he is on the way to being addicted if not there already. This is because some of the withdrawal symptoms he was describing were sounded like they could be a result of a deficiency of both alcohol and marijuana. Memories of his time in the war haunt him and sometimes he dreams about bombs mangled bodies and gets very paranoid AG’s experiences in the war keep recurring in his mind sometimes even when he is not asleep and he feel as if someone is looking for him trying to kill him, keeping himself safe from this “people” has become an obsession and he often keeps changing locations in the endeavor to secure himself. In the DSM 5 analysis, I would categorize him under Trauma- and Stressor-Related Disorders, which are a new category in the analysis framework (Kilpatrick, 2013). I am confident that is a concrete diagnosis since it is in line with his medical records, which show that after he returned from the army he was very paranoid, and it affected his social engagement. Moreover, caused serious adjustment problems as he was frequently getting into fights, which he all claimed, were in self-defense although he was always the one who attacked his victims accusing him of following or spying on him. Assessment tools As an intern I had little contact with the patients beyond the initial interview where I collected information about him, therefore the only assessment tool I employed was the clinical interview. This is usually the tool that is applied when the patient first arrives at the hospital or center as their personal information and medical history is gathered through an interview/s with the one of the psychiatric assessors. It was during these interviews which I conducted that I was able to gather his personal information and interact with him on a one on one basis and make observations based on my impressions of his physical or mental conditions. The scope of the information I received was however limited since he did has not always coherent and sometimes he would ramble of about conspiracy theories about the governments evil plots against veterans and refuse to answer question and keep repeating that; he always tried to be good but they won’t let him. He never said who “they” who were; furthermore although sometimes he acted normal and gave consistent information he would at times seem to loose direction and talk in circumlocution without making any sense and even refusing to acknowledge my presence. I believe I could have made a more incisive analysis of AG if I had the time to apply other tools that to do not overly depend on the patients verbal output, one of such tools could be a behavioral assessment. This requires that the therapist studies the patient in their natural environment and make independent and objective observation about their behavior, in AGs case if I had time I would have liked to study him in his interactions with other veterans and people in the shelter. This would have given me more conclusive information on his personality since in social space; people easily manifest their true characteristics Interventions The post traumatic disorder can be treated through cognitive behavior therapy that is focused on the trauma and gradually bring the events the patient is repressing (Morrison, 2009), in this case memories of his active service to the open. Despite his preexisting mental problems, before any progress can be made, it is crucial that the PTSD is addressed since it is in my opinion largely responsible for his overt dysfunctional behavior such as violence and alcoholism. It is likely that AG is suffering from schizophrenia which is evidenced by the fact that he sometimes acts like a normal person and talks logically but without explanation can turn violent and even suicidal (Edwards et al., 2013). For people living with such a condition, psychotherapy is often recommended; one of the therapies I would recommend if the diagnosis was proved to be correct would be cognitive behavioral therapy. This way specific symptom that are affecting him could be addressed such as low self-esteem and social functioning, this is done without focusing on the past causes of the problems and focusing on the current issues and trying to remedy them independently. For the alcoholism and denial that allows him to justify it, I would recommend psychotherapy; the patient can be made to gradually confront the drinking problem and try to convince him to agree to undergo detoxification. However this should be integrated with drugs such as Chlordiazepoxide, multibtamins and Disulfiram which will help the patient keep from relapsing by helping combat the withdrawal symptoms or making them sick after ingesting alcohol (Mental Health Weekly Digest, 2007). Through psychotherapy, the patient will also be made to focus on the actual alcoholism and not the emotional problems that they think are responsible for it, antidepressants could also be used to combat, the alcoholism, and schizophrenia and to some extent the PTSD (Jonsoton, 2012). However the success rate of any or all of the above therapies would be significantly improved if AG had a support system since part of the reason his condition has worsened so drastically is lack of family support. If possible, family intervention could be arranged so that his mother and brother can be part of the therapy and show him that they really want for him to get better, that way he would have motivation to work in getting his life back on track. Conclusion In conclusion, it is evident that AG’s problems are likely deeper than I can be able to asses in the two session I have talked to him both because; it conventionally takes longer and owing to his periods of inconsistence and incoherence. From the limited encounters, I can nonetheless confidently claim that his mental problem may run deeper than his conscious experience especially when one considers his painful personal and family life. Whether or not diagnosis made herein or the therapy recommended is correct can only be determined by a full scale assessment using several different tools and a critical observation of the patient. However if for purposes of the discussion it was to be assumed the diagnosis was correct, them cognitive behavior therapy used alongside with psychotherapy for alcohol abuse would substantially contribute the betterment of the patients health. I however hold that the patient would have more to gain from family support than any medication could offer since from a psychoanalytical perspective, it is likely that his self-destructiveness and instability is an indirect reaction to his being shunned by his family and lacking social support. References Mental Health Weekly Digest (2007). Alcoholism; medication shows promise as a treatment for alcohol dependence. Mental Health Weekly Digest,25. Retrieved from http://www.newsrx.com/newsletters/Mental-Health-Weekly-Digest/2007-11-12/30111220074MN.html Edwards, C, Gillespie N,. Aggen, S, Kendler K,S. 2013. 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The DSM-5 controversies: How should psychologists respond?Canadian Psychology, 54(3), 166-175. Kilpatrick, D. G. (2013). The DSM-5 got PTSD right: Comment on friedman (2013). Journal of Traumatic Stress, 26(5), 563-566. Kendler, K. S., Aggen, S. H., Knudsen, G. P., Roysamb, E., Neale, M. C., & Reichborn-Kjennerud, T. (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. The American Journal of Psychiatry, 168(1), 29-39. Read More