Mental Health Through the Lifecourse - Case Study Example

Mental Health Through the Lifecourse Student’s Name Institution Affiliation МЕNTАL НЕАLTH THRОUGH THЕ LIFЕСОURSЕ Introduction The paper is centered on providing a social work assessment of an assigned case. The assessment will be focused on three major areas, which are risk assessment, a mental state examination, and a needs assessment of the individual in the case. Proposition of possible intervention will also be a feature of the assignment in relation to the identified case. In this way, the paper will also include a rationale for the parameters of every assessment in order to establish a comprehensive case study. The film on which the assessment is based on gives a presentation of assessment of risk in relation to further suicide attempts by the subject who has previously taken an overdose of painkillers. The film explores the various issues that the nurse has to consider in trying to establish a plan to help the patient stay safe. The three areas that this paper focuses on are all geared towards assessment and management of suicide risk in mental health. The significance of such an evaluation underlies the fact that mental social work deals with not only the individual but also includes aspects such the community, family, and groups. Many social factors come into play when dealing with issues such as the one presented in the case. In this way, it is important to evaluate all the factors associated with mental health in order to determine the best way of helping the affected individual. Risk Assessment A risk assessment refers to a systematic method that is used in the evaluation of the potential risks that may be significant in a given situation (Karls & O’Keefe, 2008). Peter, the young man in this video attempted suicide by taking an overdose of painkillers in his room alone where he was discovered by his family. The family called an ambulance and rushed him to hospital. My assessment of the man in the video will be based on the ten parts of risk assessment that I have learned from the course. Ideation: Mild Plan: Mild Method/ Lethality: Moderate Emotional State: Moderate Support/ connectedness/ protective factors: Moderate Previous attempts: mild Reason to live/ hope: moderate Collateral history: moderate Substance use disorder: moderate Suggested action: mild I assess a moderate risk Ideation: Mild The patient admits to having periodic thoughts of wanting to die but the thoughts are not frequent and do not last for long. He admits to thinking about the need to end the negative feelings he has but those feelings are not intense. There has been no previous record of suicide attempt or attempts to harm himself in any way though he admits that he has thought about suicide once before but did not actually go through with it or make any conscious efforts to act on the thought. This attempt by taking an overdose is more of a cry for help as he seems to want to draw attention to the pain he is feeling inside. However, it is also important to note that the idea of killing himself is something that had taken root in his mind but after actually trying, he seems to have taken note of the implications of such an action. Plan: Mild The client does not have an immediate plan to commit suicide but seems to have some thoughts about dying. The threats of committing suicide are indirect but very. He seems to think that maybe death would be a solution to his frustrations but also does not have an actual desire or plan in motion of carrying out these threats. He is also adamant in stating that he does not want to die but that he thinks if he died it would be better. The overdose was an impulsive action that happened after he had been drinking alone in his room feeling lonely, frightened, and confused. He reports feeling anxious after taking the pills. Method/ Lethality: Moderate The lethality of the method employed by the client can be said to be moderate. The taking of the pills in his room seems to have been having a likelihood of rescue or intervention. Taking the pills and then leaving the packs on the bedside is an action that would have most likely driven a family member to discover the action and take some rescuing steps such as when the mother discovered the packs and called an ambulance. According to Green & McDermott (2010), this can be categorized as a passive action in the sense that he was alone, avoided his family members and went to drink alone in his room but he did not bolt the door. He also did not make the conscious effort of hiding the medicine packs after taking them, which indicate that he would have unconsciously wanted to be found and helped. He also took the pills when the family members were in the house indicating he desired the presence of people who might intervene. Emotional State: Moderate It is evident that the client in this case has a pattern of fluctuating mood swings. He also shows feelings of anger towards his family for not trying to understand him. He especially shows anger towards his father who he says does not care about him and is always on his case. He feels abandoned, dejected and misunderstood most of the time. He also shows some indications and symptoms of psychosis, which are evident in his explanation of messages being sent to him and thoughts of people being out to get him. It is therefore suffice to say that the client has moderately intense emotional distress that manifest through feelings and actions. Support/ connectedness/ protective factors: Moderate The patient in this case seems ambivalent about getting assistance. He is not adamantly refusing help but also seems reluctant in actively seeking it. He has moderate levels of conflict with the family and seems to think he has been left out and neglected. He does not seem to be very connected to his family since he likes to stay in his room alone majority of the time. The family does not seem to be able to offer adequate support or consistent support but they are there sometimes. He mentions that he feels better when he sits next to his mother even though they do not communicate, he also mentions previously talking to his sister on the phone though currently he does not seem to know what to say. There is some level of disconnect in the family. Previous attempts: mild The client has had no previous suicide attempts. Reason to live/ hope: moderate The patient in this case shows some pessimism in regards to future plans. He does not think positively about his situation and has negative feelings about how the future might change. However, he seems to want things to change but does not seem to strongly believe they will. He shows some level of hopelessness and is vague when detailing plans for his future actions. This is evident in the manner he keeps asking with doubt how the nurse thinks he can be helped. However, he also shows that he has not totally lost hope for the future and that there is a possibility for change and assistance. Collateral history: moderate His accounts of the events are not very precise and he only seems to remember some of what happened. He does not seem to able to coherently give an explanation of events and only communicates vaguely which gives doubt on the credibility of his elaboration. He is not very open to the nurse talking to his parents or family but he seems to welcome the possibility. His narration of the events preceding the overdose are however accurate as he correct the nurse on details he had mentioned before which are consistent. Substance use disorder: moderate There is some risk associated with intoxication since he admits to drinking quite frequently and alone in his room. He states that he likes drinking because it “knocks him out” and makes him feel a little less frightened or lonely. The frequency of his drinking may indicate a risk of dependence but it is not a very high risk. Suggested action: moderate Mental health personnel should take moderate action through a personal mental health assessment and a follow up within 24 hours. This is because of the drinking combined with the decision to overdose on painkillers. It is important to evaluate the patient in order to ensure that they are not at immediate risk of attempting suicide. This is also important in order to get him the care and medical attention he may need before the problem escalates and poses serious problems and danger. Mental State Exam The mental status exam is an evaluation of the patient based on observations of their verbal and overt behaviour in addition to subjective experiences. The mental status examination will cover the areas listed below. Date, time, and setting of (or reason for) interview Attitude towards the examiner Appearance Behavior/ motor activity Mood/ affect Speech/ language Thought process Thought content Perception Intelligence/ cognition Judgment/ insight. Attitude towards the examiner The patient was cooperative and even forthcoming with information in some aspects. He also seemed to be open to communication and did not shut down. However, in minimal instances he seemed to require a bit of further prodding to explain himself. His attitude projected someone willing to accept help from the examiner. Appearance The patient is a young male adult of Caucasian descent. He is of average build and appears to be in good physical health even strong and able bodied. His black hair is combed away from the face towards the back of his head. His appears neat and is dressed in simple clothes; a t-shirt and trousers. Throughout the interview he appears reflective and a bit disturbed like someone who is trying to come to terms with some difficulties inside his head. Behavior/ motor activity During the entire length of the interview, Peter kept fidgeting in his chair, squinting his eyes as though in deep thought and touching his head. He seemed to have a good realization of what was going on and his body movement reflected some aspect of mild discomfort. His behavior depicted a mild level of anxiety and tension. Mood/ affect The patient’s affect was normal and in line with the content of the discussion (Jordan & Franklin, 2003). He remained pensive and exhibited sadness and even despair at the issues being discussed in relation to his suicide attempt. His mood remained sad and desperate as he outlined the various issues related to his feeling depressed and tired of it all. At some point he exhibited panic when an intervention with the family was mentioned. Speech/ language His speech was leveled as he used soft and spaced sentences with halting spaces in between communication. He seemed unable to put to words the exact nature of his feelings. At times it was difficult to understand what he was saying as he would mumble in a low tone. His vocabulary was good and easy to understand and his responses were coherent most of the time. Thought process The patient’s thought process can be said to have some varying levels of clarity and logic. He would jump from one issue to another and did not seem to have a clear thought process to explain the various factors the examiner wanted to know. For instance, he began by saying he was tired of some messages that kept coming through with threats to harm him. Later he focused on his sister leaving home and jumped to his father’s hostility. The vague nature of Peter’s thinking is consistent with a mild loosening of associations. He also seemed to show some inhibition of thought process which was evident in his slow thought and conceptualization, a difficulty to explain himself and dwelling on thoughts internally characterized by his deep thought appearance. Thought content Through answers given by the patient, it is evident that he has had suicidal thoughts one more previous occasion but did not translate the thought into action. He also seems to have some form of delusions regarding his safety. This is seen when at the beginning of the interview he notes that someone or some people are out to get him and he has not done anything. They keep sending messages yet he cannot elaborate on the type of messages or show any indication of their presence. Perception The patient seems to exhibit aspects of perceptual disturbances (Grinnell & Unrau, 2010). The messages that keep coming and threatening to harm him appear to be hallucination. Intelligence/ cognition The patient seems of passable intelligence since he is able to communicate in an understandable manner. He is also consistent most of the time in the line of examination and even seems to recognize his feelings and impact of his actions at some point. Judgment/ insight The patient seems to suffer from poor judgment based on his actions and the way he lives his life. His personal life is not organized, he drinks alone in his room most of the time, forgets to shower and does not seem to have structure in the manner he lives his life. Needs Assessment Need-for-service assessment evaluates the patients need for mental health service in line with the previous assessment that is the mental health examination and the risk assessment. Dealing with stress: The patient seems unable to deal with environmental stressors both practical and emotional. Friendships and social relationships: The patient has limited scope of social relationships, as he does not indicate the presence of any outside friendships beyond his family. He is dissatisfied, lonely, with no tangible emotional investment from the social front. There is no indication of the presence of intimate relationship or religious and spiritual connection. Family Relationship: Patient’s quality of relationships with the family is degenerative and a major source of unhappiness. He is dissatisfied with the relationships he has with his father, feels alienated from the sister, ignored by the brother. He lacks emotional support and has a tense relationship with the father. He however seems to be sufficiently provided for materially. Work, Leisure, Education: Patient has a limited scope of personal interests. Lacks motivation to take part in leisure activities, seems to have no hobbies or any active life beyond staying in his room and drinking. Housing: Patient lives at home with his family and has his own room. Physical health: He appears healthy, has no history of health issues and seems to have good access to healthcare. He however seems to have a risk of substance abuse based on his pattern of drinking alone in his room frequently. Daily living skills: Patient seems to have low level of coping skills in dealing with day to day living. He has no structure, forgets the most basic things like personal hygiene, and tends to be a loner though he craves connection. Possible Intervention Intervention for the patient will be based on reducing the impact of mental health issues presenting in the case. The patient can be categorized as at-risk of mental health problem or illness and as someone experiencing a mental health problem seeing that he has attempted suicide by taking an overdose. Intervention for the patient should focus on the needs for care identified in the previous section. According to Appleby et al. (2007), these needs go beyond the scope of clinical treatment since the nature of these needs are complex. In this way, the patient’s access to clinical care should also be complemented or supported by an access to other factors that include community support services, family support, social, and education support. In Peter’s case, family support in addition to clinical care is the most imperative intervention that would help the patient stay safe from harming himself. Support from family would also help deal with the patient’s biggest stressor contributing to his mental illness. He cites the family as being the primary cause of his self-harming attempt. In this manner, support should be provided through loving actions, attempts to establish a connection, constant assurance and monitoring his actions. McNeece & Thyer (2004) advocate for community support as beneficial in the form of social inclusion and in this case, would help the patient deal with his isolation. The patient needs to establish relationships outside the family and build a social life in the community which would provide him with an avenue for socializing and expressing himself in addition to dealing with the isolation and loneliness he feels. The provision of these services should be in partnered with clinical care for the most appropriate outcomes in relation to the patient’s mental health (Slade & Burgess, 2009). Intervention needs to be conducted in clear and precise approach that is suited to the life of the patient, their life stage and the specific or particular situations should be taken into consideration (Walters, 2008). In this way, intervention needs to focus on the social and environmental factors that have an impact on the mental health of the patient and their well-being. In this way, Ruch (2005) notes that the patient’s intervention needs to involve a wide scope of factors including health, family, among other factors and as such, appropriate measures should be taken in ensuring that the suitable services are made accessible to the patient. In structuring possible intervention for the patient, it is important to take into consideration the fact that mental health issues and problems are a major risk factor in relation to self-harm and suicide (Trevithick, 2003). In addition to this, clinical indicators also factor in such as previous history of self-harm. In this case, the patient attempted suicide by ingesting an overdose of paracetamol and accepts having previous thoughts of self-harm. These aspects are indicative of mental health issues and should be taken into account when structuring an intervention for the patient. The factors categorized as risk factors for suicide are complex and have an integrated relationship with each other (AKISKAL & AKISKAL, 2009). Intervention should thus be focused on addressing the various issues that are risk factors for suicide and self-harm including social, family, and community issues or even stressful events in life that may make an individual such as the patient gravitate towards self-harm. Conclusion The social work assessment and the possible interventions of the patient in the case is based on three assessments which are geared towards evaluating the patient and providing probable interventions as per the interview conducted on the patient. The three assessments include a risk assessment, mental state examination and a needs assessment. These assessments are in line with the fundamental features of the topic, which include the person in environment, evidence-based practice, relationships and use of the professional self. The various aspects covered in assessing the patient are rooted in the person in environment approach, which highlights the importance of understanding people and their behaviors through the context of the environment in which they live (Smith et al. 2010). The evaluation of the interview through the person-in environment context enables sufficient framework for the assessment of the patient’s problem based on the various aspects of life that are related. Evidence based practice as used in the assessments adopts a combination of well-researched interventions and clinical experience while the relationship and use of professional self, provided a better way of coming up with the interventions as well as more accurate assessment of the patient. References Akiskal, H. & Akiskal, K. (2009). Mental Health Examination: The art and science of the clinical interview. Appleby, G. A., Colon, E., & Hamilton, J. (2007). 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