NSB204 Mental Health And Illness

Task Description

This assignment aims to help you to begin to use your professional and clinical judgement and to think like nurses working in a mental health settings and/or in relation to the mental health needs of people regardless of the setting.

Choose one of the four case scenarios below, of a person who is experiencing difficulties related to a mental health disorder.

1. Case scenario one: Mary- Depression

2. Case scenario two: Cormac- Schizophrenia

3. Case scenario three: Jayan- Risk of suicide

4. Case scenario four: Arnold – Mania

Related to the person in your selected case scenario your assignment will demonstrate your understanding of the following

• Mental Status Examination (MSE)

• A clinical formulation including biopsychosocial history and your own MSE observations leading to the clinical formulation

• A nursing handover

• Recognising and responding to the mental health needs of the identified person by identifying best practice nursing interventions

• How to engage a person in a therapeutic relationship

• The application of cultural safety

• The application of the Australian mental health recovery model

You will need to justify your assignment points with reference to relevant literature. Students who plan to do well in this assignment, will read and use the unit text and readings as well as additional relevant evidence-based practice. resources.

Case Scenario One: Mary- Depression

Mary is a 41-year-old woman who lives with her husband Jim and three children (James, aged 17, Elyssa, aged 14 and Matthew, aged 10 years). Mary holds a responsible position in a large accounting firm and loves the work she does. Jim is a partner in a legal firm and is very supportive of Mary. They have been married for 20 years. They have a large, comfortable home in Clayfield and the children all attend private schools. Mary describes moments of despair where she is tearful and has little or no energy to move from her bed. She believes she is a burden to her family. At these times, she lacks motivation to complete simple activities such as eating and dressing. In the past, Mary has always looked smart and ensured she showered on a daily basis yet over the last month, Mary’s family have noticed that she sits in her dressing gown for long periods of time and her personal hygiene has deteriorated. She is currently on sick leave from work.

Mary’s husband Jim reports that Mary often talks of feeling worthless and hopeless and has made comments in the past that she cannot see how she will manage to get through another day. These thoughts appear to be occurring more frequently. Jim also reports that Mary is having difficulty sleeping and he often finds her awake staring at the window in the early hours of the morning. On assessment, Mary appears clean and tidy. She is dressed in fashionable jeans and t-shirt with sandals. Her short, dark hair is brushed but is lank and greasy looking. She wears no makeup and sits quietly with her hands clasped in her lap, her eyes downcast and her speech slow and monosyllabic. Attempts at engaging her are met with brief responses although she is orientated to time, place, and person. Mary mentions that she belongs to her local church and usually attends weekly as well as volunteering time to special events held in her community. Mary admits that over the past month she has not been to church and has not responded to phone calls from her friends. She says she gets little pleasure from her usual church activities and feels too tired to go to services.

Mary says she is physically well. She was diagnosed with depression three years ago and was hospitalized for five weeks but has been well since then. She was treated with Citalopram (an antidepressant) but decided to stop taking it a year ago because she felt she no longer needed it. Mary does not drink alcohol, use illicit drugs, or take any prescribed medication. She regularly sees her GP for health checks.

The family is very concerned about Mary’s health because she has had a previous admission to hospital for depression and her mother suffered depression for 35 years before taking her own life nine months ago. However, they are reluctant to have her admitted to hospital against her wishes as she says there is nothing wrong with her and she does not want to trouble anyone. She is adamant that she needs to be at home to look after the children and cook meals for her husband.

Case Scenario Two: Cormac- Schizophrenia

Cormac is a 24-year-old single man. Cormac’s childhood was unremarkable, but he has never had a strong network of friends. He was an average student and graduated from high school along with his classmates. He commenced studies in electronics but soon dropped out as he tended to not finish work, could not get on with the other students and he did not trust the feedback his tutors gave him about assessments. When he was 20, he had his first admission to a psychiatric hospital, precipitated by a relationship breakdown. He was diagnosed with schizophrenia, hospitalised for three weeks and stabilised on Olanzapine. Today, four years later, he has been brought to the hospital by the police, accompanied by his parents with whom he lives, after becoming threatening towards his mother

His parents say that over the past weeks Cormac has become increasingly withdrawn, agitated and irritable and he refuses to go to work where he is a salesman in a store that sells audio-visual equipment. They also say that he ceased his medication at least six weeks ago. This has been the source of considerable conflict between him and his parents and when they told him he should stay on medication he became hostile and shouted “it makes me terrible” and “there is nothing wrong with me”. His parents also say he has been smoking marijuana several times a day. The nurse notices that he has a beard, his long, blonde hair is greasy and matted, and he has a washcloth on his head; his clothes are crushed and stained; he is very thin and he avoids eye contact. When interviewed by the nurse Cormac is cooperative. His replies are brief; often not relevant to the question asked and usually given in a monotonous tone. He is unable to remain seated for long and often gets up and goes to the window to look out. He shows little emotion when relating his story, but sometimes laughs for no apparent reason. He says he has stopped taking his medication because he felt tired all the time, had a dry mouth, and had trouble passing urine. While being interviewed it is noted that Cormac’s lips occasionally move silently as if he is talking to someone and that he turns his head as if to hear someone speaking. When asked whether he can hear someone, he admits that he can hear “strangers talking about me.” He says the “voices are real, they’re not in my mind.” He is oriented to time, place and person and his memory for recent events seems intact. Cormac states that the voices say he is “no good” and that his boss has been taping all his conversations with customers to catch him making mistakes. Cormac spends hours scrutinising videos which he believes contain information about him. He has also been behaving strangely with customers, telling them not to buy certain brands of equipment because they contain recordings of the conversations, he is had with the national spy agency. He believes that he can send and receive messages from God through the radio and television

Case Scenario Three: Jayan- Risk Of Suicide

Jayan is a 27-year-old Aboriginal man who has been brought into an inpatient psychiatric unit in a rural area by the community nurse because he is at risk of suicide. Jayan grew up with his mother and his three younger sisters in Barcaldine. Their father died prematurely of leukemia when Jayan was just four years old. Jayan did not like school where he was bullied and subject to racist taunts. His siblings, cousins and himself often found themselves in playground fights that started when someone insulted one of them or their family. Somehow it always seemed to be the Aboriginal kids that were dragged up to the Principal’s office, in trouble for starting the fights. At home, his Mum always did her best to make sure the kids were housed and well fed, and he loved playing football and being with his family and mates. He was talent-scouted as a young teenager to join a city football club but as the eldest and only male at home it was not a good time to move away from home

Today Jayan works as a station hand which he enjoys as he loves horses, cattle and being out in the bush. The community nurse states she was asked to see Jayan by his mother who reported that Jayan was “not looking after himself properly and drinking too much.” She also described him as being “very moody” since his girlfriend Tess left to study in Brisbane about two months ago. The community nurse believes Jayan is depressed. Jayan looks much younger than his stated age; he has long, shaggy, dark hair which reaches to his shoulders. He wears a cowboy hat and is dressed in dusty jeans, a grubby long-sleeved shirt and worn out riding boots. He has the word LOVE spelled out in tattoos on each of the fingers of his left hand. The fingers on his right hand have tattoos that spell TESS. He is very thin. He says he has no appetite. Jayan is initially very reluctant to speak to the nurse and says, “What’s the point anyhow?” When asked who he talks to most easily, he becomes teary and tells the nurse about his girlfriend Tess leaving to study in Brisbane two months ago and his fears that she will not love him anymore.

He speaks quietly, answers mostly in monosyllables and presents as flat and depressed. He admits to feeling sad and to “always thinking about Tess”. He says “What she wants to go down there for? Who she with”? He also tells the nurse about his cousin, Michael, who committed suicide by hanging about a year ago. Jayan says, “Michael found a way out.”

When the nurse tells him about his mother’s concern, he says “Well she won’t have to worry about me for much longer.” When asked what he means by this statement tears fill his eyes and he say, “I feel terrible now Tess in Brisbane… just hopeless.” When asked whether he has had any thoughts of wanting to kill himself he replies, “I’ve thought about it a lot. I know how to do it too”