Knowledge for Mental Health Care Practice - Essay Example

Knowledge for Mental Health Care Practice Question 2 John In John’s situation, it is evident that he is suffering from a mental health disorder and substance abuse, which is causing him to behave in such peculiar manner. It is recommended that John pass through a comprehensive mental health and substance abuse assessment in order to come up with the best diagnosis for his condition. This assessment will help him to be able to receive the appropriate medical attention according to his condition. According to research, 5-9 percent of adolescents between the ages of 9-17 tend to have a serious emotional disturbance that that affects negatively on their normal functioning towards the community, in their school, and at home (Chambers, et al., 2003, p. 1049). It is estimated that this adolescents have a greater risk of developing drug and substance abuse as compared to adults. About 7.6 percent of adolescents, aged 12-17 meet the criteria of dependence on abuse of illegal drugs or alcohol (Burn, et al., 2004, p. 964). In terms of mental health problems, it is usually caused by abuse of drugs such as marijuana, and alcohol and it is the case in most situations that the mental problem tends to increase abuse of these substances. The above facts relate to johns situation in which case he started abuse of drugs such as marijuana at the age of ten. It is most likely that his drug abuse habits have been the root cause for his mental health problems. A comprehensive assessment of John’s situation will require the use of the basic screening and assessment approach of persons with co-occurring disorders given by the Substance Abuse and Mental Health Services Administration (Substance Abuse and Mental Health Services Administration, 2010). This will require a systematic assessment process that will be able to lead to an appropriate treatment plan for John. The first step towards assessing John’s co-occurring disorder is to engage with him and let him open up to share freely by creating a good rapport and comfortable environment. With this achieved john is able to share his situation and share important information that is required for the assessment process and diagnosis. Fortunately, the practice nurse attending to John has been able to achieve this state by making John feel free to share his story and problems. The second step involves identifying John’s family or any other collaterals who may be familiar with his history. This is because his condition may inhibit him from reporting accurate instances of his past or present. It is also important considering John’s explanation on how he started abusing alcohol at a tender age. Although John appears to give accurate accounts of his problems, it is recommendable to clarify with people who have known him over a long period (Gould, et al., 2005, p. 1637). The next step requires screening; this will help identify John’s co-occurring disorders. In John’s situation, the screening should identify his substance abuse and mental disorder. In terms of substance abuse, the screening should look into major safety risks such as intoxication or withdrawal. John should pass through further screening in his past and present, problems related to this disorders, and substances causing these disorders. In terms of mental health, the screening should determine safety risks such as violence, suicide thoughts, Hepatitis C, and HIV risk behaviours, screen for present and past mental symptoms and finally screen for cognitive and learning deficits (Goulden, 2004, p. 11). The screening process is supposed to determine the potential risk of harm and be able to take the appropriate precautionary measures (Glascoe, 1997, p. 522). After the screening step, the following step classifies John into a quadrant basing on the severity of his mental disorder. At this stage, it is also likely to determine his locus of responsibility in relation to his behaviours and judgement. The quadrants are as the following table indicates III Less severe mental disorder/ more severe substance abuse More severe mental disorder/ less severe substance disorder IV I Less severe mental disorder/ less severe substance disorder More severe mental disorder/ more severe substance disorder II John’s case falls under quadrant III following his narration to the nursing practitioner. His denial of a drinking problem and basing on the fact that he has abused the drugs over 10 years it means his substance abuse is more severe. Hearing of voices, losing interest in playing the guitar, isolation and missing classes shows that his situation is getting worse but less severe because he does not have suicidal thoughts and does not engage in risky behaviours. In step five, the assessment should determine John’s level of care. This will be with the use of the ASAM PPC-2R, which provides a six dimension criteria that appropriately place John in a level of care (Smith, et al., 1990, p. 265). After the assessment, five levels of risk are to be considered and these are potentiality of suicide, interference with efforts to control addiction, ability of self-care, social functioning, and course of illness. John’s situation of severe substance abuse, isolation, feeling of judgement from his peers, denial of substance abuse, loss of interest in school and music all indicate that he requires psychiatric hospitalization. Probably this is the conclusion that will result after an ASAM PPC-2R assessment (Smith, et al., 1990, p. 264). The next step to take in assessing John is to compile all the results in the above assessment and give a diagnosis. The key thing to note is that a diagnosis should look into on John’s past as mental symptoms are best diagnosed depending on the client’s history. John’s history with substance abuse from a tender age to his disturbing history of hearing voices in his mind can be a good basis for diagnosis. An additional assessment to be carried out in john’s situation is to identify any forms of strengths and talent. It is recommendable for any assessment to put attention to a patient’s supports, strengths, skills, and talents. This one area can provide a positive approach in the direction of treatment. In John’s situation, he mentioned his skill in playing the guitar and having composed a variety of songs that he was yet to release. This will be a great basis of treatment, as it will help him to overcome the low moods and give him something to focus on. This will be good especially in fighting the addiction problem; also will help him control the voices in his head. Question 3 Belinda According to the various symptoms observed from Belinda, she is most likely to be diagnosed with Borderline Personality disorder. Borderline Personality Disorder (BPD) is a mental health condition in which the person has long-term patterns of unstable or turbulent emotions (Logan & King, 2002, p. 300). The cause of this condition is unknown though genetic, family, and social issues play roles. The risk factors of this condition include abandonment in childhood or adolescence, disrupted family life, poor communication in the family, sexual, physical, or emotional abuse. In the extract, her father, whom is serving a prison sentence, as a child, sexually abused Belinda. She displays poor communication with her mother who challenges her promiscuous behaviour, binge drinking, and substance abuse, which lead them to intense arguments and sometimes physically aggressive fights between them. Persons with this condition are often uncertain about their identity, and they view things in terms of extremes (Lyman, et al., 2007, p. 48). They also have very sudden shifty feelings that lead to intense and unstable relationships. Belinda actually demonstrates this symptom due to her shifty feelings of wanting love, to form very intense short-term relationships with men, which break down early into the relationship. Other clear symptoms are the repeated crises and acts of self-injury, such as wrist cutting and overdosing, which is very evident in Belinda’s history of deliberate self-harm which include self-inflicted cuts to her arms, thighs and torso. She has also taken repeated overdoses of medication. People with BPD also demonstrate intense fear of being abandoned, which Belinda shows when she tells the Home treatment team that her mother always wants to get rid of her and begs them to persuade the mother not to do so. People with BPD also display the feeling of emptiness, boredom, and inappropriate anger, which Belinda displays as those feelings result in her having frequent uncontrolled bursts of anger. They also show symptoms of impulsiveness, this being substance abuse or sexual relationship, that were evident in Belinda’s promiscuous behaviour, binge drinking and substance abuse. Patients with this condition also cannot tolerate being alone, which is evident when Belinda told the team that her mother suggested that she should get a flat of her own, viewing this very cruel and that she cannot make it on her own. Through establishing the similarity of Belinda’s symptoms with this condition, signs and tests may be carried out to find out the severity based on the symptoms. These signs and tests should provide satisfactory results to come up with a conclusion on the severity of Belinda’s BPD. Belinda should undergo treatment of psychotherapy. Psychotherapy is the type of therapy used to treat emotional problems and mental health conditions (Goldman & Morrissey, 1997, p. 341). Most people with BPD are treated by Community Mental Health Teams (CMHTs) (Teicher, 2000, p. 60). A CMHT can be made up of social workers, psychiatrists, psychotherapists, or community mental health nurses. In accordance to the severity of Belinda’s symptoms, she should undergo a treatment process known as Care Programme Approach (CPA). This treatment is rolled out in four stages namely: assessment of the health and social needs, care plan created to meet those assessed needs, appointment of a care coordinator and reviews. In these reviews, the treatment is regularly reviewed and any necessary changes to the care plan can be agreed (U.S. Department of Health and Human Services, 2010). The psychotherapy recommendations are as follows: treatment should last at least 12-18 months, dialectical behaviour therapy for people who really struggle with self-harming behaviours, metallization-based therapy, which is a mixture of group and individual reflection, therapeutic communities and structured group therapy programmes. The first therapy Belinda would undergo is Dialectical Behaviour Therapy (DBT). The goal of DBT introduces two main concepts. The first is validation, which is accepting that the person’s emotions are real, valid, and acceptable. Second is dialectics, which relies on the importance to be open to ideas and opinions that contradict those of the person. Another type of therapy in the treatment is Metallization-based therapy (MBT) (Wilens, et al., 1997, p. 942). MBT is based on the concept that people with BPD have poor mentalism capacity. Mentalisation is the ability to think about thinking. It recognizes that other people have their own thoughts, emotions, beliefs, wishes, needs, and interpretation of other people’s mental states may not be necessarily accurate (Dubowitz, et al., 1992, p. 604). The goal of MBT is to improve the person’s ability to recognize their own and other’s mental states, and learn to let go of thoughts about oneself, others, and examining them to see if they are valid. This therapy should last around eighteen months and lastly, the use of Therapeutic communities (TC) in the treatment. TCs are designed to help people with long-standing emotional problems and a history of self-harming by teaching them the skills needed to interact socially with others. Question 4 Myra Taking care for a patient suffering from Alzheimer dementia is not an easy task and it can have a great impact on one’s daily life (Kelleher, et al., 2000, p. 1320). Patients suffering from Alzheimer tend to lose their abilities in unpredictable manner; therefore, a caregiver needs to have patience and resilience. It is also important to be physically and emotionally fit. In this case, study, Myra’s situation seems to be deteriorating on a slow but crucial state. Taking care of patients suffering from Alzheimer poses many challenges, as most people refer to it as a grief experience. One gets to watch memories disappear and great skills varnishing with time. It is for this reason that a caregiver to a patient diagnosed with Alzheimer like Myra to have proper skills and be ready to provide the best services and company for such a patient. Care giving can be a very consuming practice as it makes one witness their loved ones diminishes over the years causing depression, grief and anger, which is a common phenomenon. However, one needs to note that concern and patience in learning about the disease over time can reduce frustration, enable one to have certain expectations and be prepared for the daily challenges they are bound to face. It is therefore very important to have someone with the right skills to take care of such a patient. Some of the skills can be patience, calmness as sometimes it can get tough and tiring, friendliness and positivity. Myra’s husband died 10 years ago and she lives separately from her two children and eight grandchildren. In short, she lives isolated and this situation has notably contributed to her physical as well as mental health issues. The utmost principle of patient centred care is getting to know the patient personally. Here, the carer must comprehend the personal as well as the family background of the patient. Previously, Myra had worked as veterinarian and had possessed a range of pets. In addition, she had been very interested on outdoor pursuits and a member of a rambling club. The case scenario also indicates that Myra had a very active social life. She used to content herself with word puzzles and crosswords in order keep her mind sharp. In short, she was a very active and busy scheduled person in her day-to-day life. Such a person cannot easily adapt to conditions like low concentration, confused thinking, and poor mobility. Hence, the carer must give strong support to Myra to instil confidence in her and hence to assist her to cope with her current physical/mental health problems. In addition, the carer must respect the preferences of Myra and try to consider her as a partner in setting goals. Myra seems extremely distressed when she is more aware of her deteriorating cognition and the situation in turn would worsen her mental status. Therefore, it is advisable for the carer to assist Myra to solve word puzzles and crosswords. This practice can increase the confidence level of Myra. Likewise, the carer may assist Myra to walk some distance every day. Undoubtedly, such activities would greatly influence Myra and she can regain her positive attitude toward the life. It is reported that Myra is periodically incontinent. Since this issue may weaken Myra mentally, the carer must try to enlighten Myra that this problem is common among many of the older adults. The major thing to be noticed is that the carer should not be irritated while dealing with Myra’s incontinency problems. Recently, Myra was found wandering a fair distance from her house in the early morning. It can be considered as an indication of her wish to go outside her home. The case study reflects that Myra rarely get chances to leave her residential home. Therefore, the carer must be willing to take Myra to some outside places where she is interested to go. It is also identified that Myra seldom has visits from her family. At this age, Myra surely wishes the presence of her children, grandchildren, and other relatives. In this context, the carer must convince Myra’s family members that their presence would reduce her feeling of loneliness. While working with Myra, the carer must try to give different choices to the patient, as this practice would provide Myra with a feeling of freedom (Burgoyne, 1977, p. 40). Recently, Myra cried out and asked for her mother in a particular situation. It indicates that she needs proper love and care that she lost at the death of her husband ten years ago. Hence, Myra should get more love and care from the caregiver to meet the idea of evidence based care. One should also be ready to take necessary interventions in helping Myra such as scheduling mini-work outs during the day. This can help in releasing endorphins helping one to stay in a positive state of mind and happy. Should also take time to engage with the patient in a game such as puzzles, jigsaw, or board games. Considering Myra’s history, she is bound to respond well to this intervention, as she is fond of such activities and probably needs someone that can go through it with her and bring the joy back. As a caregiver, it is necessary to avoid boredom and intervention to apply in such a situation is make effort to teach something new (Frey, 2003). This could be engaging in a story telling session with Myra and letting her put together the little bit if memory she has of her past and probably learn something new. The next crucial part is that because Myra’s situation keeps on deteriorating in a continuous manner it would be best to ask for help from a specialist, as this would also help the caregiver from having negative attitude when things are not working to expectations or sudden changes happen in the patient such as Myra. References A.D.A.M Medical Encyclopaedia, 2012. PubMed Health. [Online] Available at: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001931/ Burgoyne, R. W., 1977. The structured interview: An aid to compiling a clear and concise database. International Journal of Mental Health, I(37), pp. 37-48. Burn, B. J. et al., 2004. Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child andAcademy of Child and Adolescent Psychiatry, VIII(43), pp. 960-970. Chambers, R. A., Taylor, J. R. & Potenza, M. N., 2003. ‘Developmental neuro-circuitry of motivation in adolescence: A critical period of addiction vulnerability’. American Journal of psychiatry, IX(160), pp. 1041-1052. Dubowitz, H. et al., 1992. The physical health of children in kinship care. American Journal of Diseases of Children, III(146), pp. 603-610. Frey, R. J., 2003. Genetic factors and mental disorders. [Online] Available at: http://www.encyclopedia.com/doc/1G2-3405700172.html [Accessed 8 March 2013]. Glascoe, F., 1997. Parents’ concerns about children’s development: Prescreening technique or screening test?. Journal of Pediatrics, IV(99), pp. 522-528. Goldman, H. H. & Morrissey, J. P., 1997. A conceptual framework for evaluating the intersystem impacts of managed behavioral health care: Report on a roundtable discussion, Cambridge: Goldman, H. H., & Morrissey, J. P., A conceptual framework for evaluating the intersystem impacts of managed Human Services Research Institute 1997. Goulden, K. J., 2004. Teaching developmental-behavioral screening/surveillance to healthcare professionals, Elk Grove Village, IL: American Academy of Pediatrics. [Online] Available at: http://www.aap.org/sections/dbpeds/pdf/ [Accessed 11 March 2013]. Gould, M. S. et al., 2005. Evaluating iatrogenic risk of youth suicide screening programs: A randomized controlled trial. Journal of the American Medical Association, V(293), pp. 1635-1643. Kelleher, K. J. et al., 2000. Increasing identification of psychosocial problems: 1979–1996. Pediatrics, 50(105), pp. 1313-1321. Logan, D. E. & King, C. A., 2002. Parental identification of depression and mental health service use among depressed adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, V(41), pp. 296-304. Lyman, D. R., Njoroge, W. & Willis, D., 2007. Early childhood psychosocial screening in culturally diverse populations: A survey of clinical experience with the Ages and Stages Questionnaire: Social Emotional (ASQ:SE). ZERO TO THREE Bulletin, V(27), pp. 46-55. NHS Choices, 2011. NHS Choices. [Online] Available at: http://www.nhs.uk/Conditions/Psychotherapy/Pages/Introduction.aspx NHS Choices, 2012. NHS Choices. [Online] Available at: http://www.nhs.uk/Conditions/Borderline-personality-disorder/Pages/Treatment.aspx Smith, M. S., Mitchell, J., McCauley, E. A. & Calderon, R., 1990. Screening for anxiety and depression in an adolescent clinic. Pediatrics, II(85), pp. 262-266. Substance Abuse and Mental Health Services Administration, 2010. New study indicates that early intervention for young children with mental health challenges Supports healthy development and improves family life. [Online] Available at: http://www.samhsa.gov/newsroom/advisories/1005065224.aspx [Accessed 12 March 2013]. Taylor, J. R., Chambers, R. A. & Potenza, M. N., 2003. Developmental neurocircuitry of motivation in adolescence: A critical period of addiction vulnerability. American Journal of Psychiatry, IV(160), p. 1041–1052. Teicher, M. D., 2000. Wounds that time will not heal the neurobiology of child abuse. Cerebrum: The Dana Forum on Brain Science, IV(2), pp. 50-67. U.S. Department of Health and Human Services, 2010. Administration for Children and Families; Administration on Children, Youth, and Families, New York: Children’s Bureau. Wilens, T. E., Biederman, J., Abrantes, A. M. & Spencer, T. J., 1997. Clinical characteristics of psychiatrically referred adolescent outpatients with substance use disorder. Journal of the American Academy of Child and Adolescent Psychiatry, VII(36), pp. 941-947. Read More