Task 1
Read the following case study and answer the questions that follow:
Case Study
Joanne is a 32 year-old, single parent of two children (currently aged 4 and 3). She was diagnosed with schizophrenia in her late teens and has been prescribed a range of antipsychotic drugs with poor effectiveness in controlling both her auditory hallucinations and suicidal thinking. Joanne has made several suicide attempts in the 10 years following her diagnosis and has had several admissions to her local mental health unit. Her two children were removed from her care by child protection services 3 years ago and were only returned to her full-time care a few months ago when Joanne’s mental health symptoms responded well to a new antipsychotic, Clozapine. However, Joanne is struggling with some of the side effects of Clozapine (weight gain, headaches, dizziness, blurred vision) and the requirement for regular blood tests (Clozapine causes reduction in white blood cell count).
Joanne has been a client of your community mental health support service for the last year. She is aware that she is very overweight, and her diet is poor. She finds it difficult to be motivated to do household chores and is self-conscious about going out of the house because of her weight. She has no contact with her family, has no friends or supports in the area and usually spends the day watching television. However, now she has the children back in her care, she would like to change her lifestyle, improve her physical health and develop strategies to manage the side effects of her medication and promote recovery.
1. What recovery goals might Joanne have?
2. What strategies can she use to support wellness?
3. Identify barriers to Joanne developing a wellness plan.
4. How would you work with Joanne to address the barriers?
Case Study, continued…
6 months later, Joanne is engaged with a local playgroup and mental health support group and has enrolled in a course at her local TAFE. The children appear to be settled and there are no concerns regarding their care. However, Joanne has come into the office saying someone in her support group has talked about an advanced directive and she would like to know more about this.
5. How would you explain the purpose of a crisis plan advanced directive to Joanne?
6. What might Joanne include in an advanced directive?
Case Study, continued…
Joanne tells you she is considering asking her prescribing doctor to change her antipsychotic medication. While she recognises its effectiveness of Clozapine in controlling her symptoms, she has not been able to lose weight, and she is really concerned about the health risks associated with Clozapine. She wants to include a statement in her advanced care plan that she no longer wishes to be treated with Clozapine if re-admitted to hospital. You are aware that previous antipsychotic medications have not been effective for Joanne and are concerned that if she becomes unwell again the children will again be removed from her care.
7. How will you respond to Joanne?
Case Study, continued…
Joanne decided to stop taking antipsychotic medication altogether 2 months ago and is starting to experience symptoms of her illness: she is hearing voices, is emotionally distressed, is finding it difficult to manage daily living task and is neglecting basic hygiene for both herself and the children. She has not been attending playgroup or the self-help support group.
8. What do you need to do?
Task 2
Read the case study below and answer the questions that follow:
Case Study
Anya has been referred to your community mental health support service following her discharge from Cumberland psychiatric hospital. She is a 40 year-old woman who experienced severe physical and sexual abuse as a child and several abusive relationships as an adult. She was diagnosed with borderline personality disorder when aged 20, following a 5 year history of self-harm, suicide attempts and drug abuse. Since then, she has also been diagnosed with depression and panic disorder and has had several admissions to psychiatric units.
She has 4 children, all of whom have been removed by Community Services on the basis of neglect and exposure to domestic violence. She has frequent episodes of binge drinking, is a heavy user of over the counter pain medication and cannabis. She dislikes taking prescribed medication for depression and anxiety because of the side effects.
Anya’s last admission was due to a severe episode of clinical depression, precipitated by physical abuse by her partner, cessation of contact visits with her children due to her arriving at visits intoxicated and a car accident which left her with limited mobility and drink driving charges. She has returned to live with her partner as she had nowhere else to go. She has no contact with her family and her friendships have previously been connected to her drug use. She says she wants to change her life, but doesn’t know where to start.
1. What are Anya’s needs and issues?
2. How might the abuse she has experienced as both a child and an adult impact on her mental health?
3. Anya’s situation is certainly very complex but, unfortunately, not uncommon. What would be the key elements of a realistic recovery plan from Anya’s perspective?
4. There are many risks and barriers impacting on Anya in successfully implementing a recovery plan. Identify and discuss at least three (3) risks/barriers that you believe are critical to Anya achieving her goals.
5. What support would you provide to Anya as part of recovery in the following areas;
a) Information and education
b) Addressing trauma issues
c) Providing resources
d) Monitoring client progress
6. What services would you need to liaise with/refer the client to as part of the recovery plan?
7. How you would evaluate your service delivery with your client?
Task 3
Review Anya’s case study in Task 2 and your responses to the questions, paying particular attention to Question 4, then answer the following:
1. Develop a risk management plan. You need to identify each risk, your strategy/ies for managing the risk and who is responsible for this. (250 words)
2. Write down the relevant legislation in your State/Territory you would need to consider.