Mental State Examination Of Harry: Nursing Interventions For Mental Health

Overview of Harry’s Case

During the treatment of mental health patient, it is important to have a mental state examination in order to achieve a better quality care. While examining the mental health of the patient, some personal information is also gathered. Once the mental state examination is done, the main symptoms are found out for the nursing intervention. It helps to improve the treatment procedure. The following paper is showing the mental state examination of Harry, the mental patient of the case study. Analysing the main symptoms the nursing intervention will also be provided in the paper.

Mental Health Act Status: Examination Authority

Suicide

Static Factors

• Previous Attempt: No
• Previous Self-harm: No
• Exposure to suicide: No
• Stressful life events: No

Dynamic Factors

• Suicidal thoughts: No
• Plan: No
• Loss of hope: No
• Lack of social support: No

Comments: From the above assessment it is quite clear that Harry, who is an 18 year old high school student, is not suicide-prone and have never attempted or planned for that.

Violence/Aggression

Static Factors

• History of violence/aggressive behaviour: Yes
• History of domestic/family violence: No
• History of sexually inappropriate behaviour: No
• Criminal history: No
• History of substance use: No
• Major mentality/personality disorder: No

Dynamic factors

• Anger/impulsivity: Yes
• Current substance use: yes
• Non-compliant with treatment: Yes
• Violent ideation/attitudes: Yes
• Psychotic symptoms: Yes
• Carries weapons/access to firearms: No
• Exhibits bullying behaviour: No

Comments: From the screening, it is clear that Harry becomes angry and sometimes behaves violently without any particular reason. His psychotic symptoms included delusionary behaviour and he also believes his brother responsible for his illness. He is reluctant to take treatment. Her mother noticed substance abuse of paraphernalia recently.

Static factors

• History of trauma/abuse: No
• History of domestic/family violence: No
• History of financial vulnerability: No
• Cognitive impairment/disability: No
• Lack of family support: No

Dynamic Factors

• Impaired decision-making: Yes
• Sexually disinhibited: No
• Self-neglect: Yes
• At risk of victimization: No

Comments: This screening process depicts that Harry is not deprived of society and family, whereas, her mother was concerned about his health. But, the main risk is self-negligence. He was caught standing in the middle of a busy street which could endanger his life. His decision-making process is also impaired.

Absent without approval

Static Factors

• History of absconding: No
• History of breaching MHA: No

Dynamic Factors

• Treatment refusal: Yes
• Desire/intent to leave hospital: UK

Comments: Harry never received any mental health treatment and is not willing to receive treatment also. Due to this reason he refused hospital officials too.

Parental status and /or other carer responsibilities

• Does the person have responsibility for children aged 17 years or less? No
• Does the person have any contact with children through access visits or shared residence? Yes
• Does the person have other carer responsibilities? No

Protective Factors: Harry has no child and he is not having any responsibility over any minor. Although, he lives with his younger brother but their relationship is not so open as Harry is reserved and doubtful about his brother.

Overall assessment of risk and plans to mitigate risk

Overview/Impression

• Person’s level of risk appears to be highly changeable: Yes
• There are factors that contribute to uncertainty regarding screen: Yes
• A more comprehensive risk assessment is required: Yes

General appearance	· Silent · Submissive · Onset excitability (Sudden)
Behaviour	· Fluctuating · Changes from silent, melancholic to violent aggressive rapidly
Speech	· Mostly normal speech · Screaming and laughing when violent · Uncooperative behaviour
Mood and Affect	· Frequent fluctuation · Submissive to violent and vice versa
Thought process	· Delusionary behaviour · He believes he can become invisible for few minutes · Blames his younger brother for his illness
Thought content	· Psychotic and delusionary behaviour · He was caught by the police standing at the middle of a busy street and he was confident that he would not get harmed as he was invisible at that moment · Thoughts of paranoia makes him believe that his younger brother is responsible for his illness
Perception	· Distorted perception · The false account of impression makes him believe that he becomes invisible
Cognition	· Significant declination in cognition · His mother reported his academic and social interaction has been deteriorated · He also spends some sleepless nights
Judgment	· Contorted judgement · The risk factor is that, he stood at the middle of a busy street as he believes he was invisible which could harm his life.
Insight	· The assessment provided a faulty insight of the patient · His mother reported that his psychotic behaviour is affecting his socio-academic life · It is also affecting his sleep at night

SYMPTOM	INTERVENTION
Delusion	· Providing some anti-psychotic drugs (Liu, Tang, Hung, Tsai & Lin, 2018). · Supporting the patient to participate in societal programs to overcome the social isolation and to be engaged in community also (Wade et al., 2018).
Aggression	· Not laughing at his thought process rather being empathetic and supportive to build a friendly relationship as well as involving patient in self-care management process (Heckemann et al., 2015). · Psychotherapy and behavioural modification can be helpful in this regard (Price, Baker, Bee & Lovell, 2015).
Suspected drug abuse	· Informing the patient about the negative outcomes of drugs with some evidence based examples (Brady, McCauley & Back, 2015). · Engaging the patient in some motivational activities as per his hobby (Mertens, Ward, Bresick, Broder & Weisner, 2014).

The above case study describes the condition of an 18 year old high school student Harry, who has been suffering from some mental disorder due to drug abuse. From the assessment of his mental status it is found that the main risk factor is associated with the self-ignorance behaviour. He was caught by the police while standing at the middle of a busy street and when caught he stated that during that time he was invisible to others and there was no chance of getting hit by any moving car. Such psychotic as well as delusionary behaviour can cause serious life threatening incidents in future. He also carries doubtful and paranoia for his younger brother which is a matter of concern for his mother. However, from the assessment of his mental condition, three main factors have been identified and they are delusion, aggression, and suspected drug abuse. According to his vital symptoms, nursing interventions has also been set. In order to deal with the delusionary behaviour of the patient, anti-psychotic drugs can be provided. Apart from that, to bring the patient into the main stream of the society, it is important to encourage him in participating societal programs. It will help him to recover social isolation. Laughing at his thought process can make the patient angry so, while talking to him it is essential to stay calm and be a good listener to build a trustworthy relationship with an empathetic and supportive behaviour (Unhjem, Vatne, & Hem, 2018). Providing psychotherapy and behavioural modification is also preferred as nursing intervention (Abrams, Goulding, Waern & Sjöström, 2018). Harry has also been suspected for drug abuse by his mother and in order to deal with this issue, informing the negative consequences of drug abuse is necessary and engaging the patient in motivational activities can also be very much helpful nursing intervention. However, more screening and further treatment plan is recommended for Harry to integrate self-care technique.

Conclusion

The above paper provides a thorough mental state examination of Harry and it also provided appropriate nursing intervention strategies to overcome the vital and harmful symptoms. Further treatment can help him to live a better life.

References

Brady, K. T., McCauley, J. L., & Back, S. E. (2015). Prescription opioid misuse, abuse, and treatment in the United States: an update. American Journal of Psychiatry, 173(1), 18-26.

Mertens, J. R., Ward, C. L., Bresick, G. F., Broder, T., & Weisner, C. M. (2014). Effectiveness of nurse-practitioner-delivered brief motivational intervention for young adult alcohol and drug use in primary care in South Africa: a randomized clinical trial. Alcohol and Alcoholism, 49(4), 430-438.   

Heckemann, B., Zeller, A., Hahn, S., Dassen, T., Schols, J. M. G. A., & Halfens, R. J. G. (2015). The effect of aggression management training programmes for nursing staff and students working in an acute hospital setting. A narrative review of current literature. Nurse education today, 35(1), 212-219.  

Price, O., Baker, J., Bee, P., & Lovell, K. (2015). Learning and performance outcomes of mental health staff training in de-escalation techniques for the management of violence and aggression. The British Journal of Psychiatry, 206(6), 447-455.

Abrams, D., Goulding, A., Waern, M., & Sjöström, N. (2018). T246. Decreasing Aggressive Behavior In Patients With Cognitive Impairments By Training Psychiatric Staff In Interactive Skills. Schizophrenia Bulletin, 44(suppl_1), S212-S213.

Liu, Y. C., Tang, C. C., Hung, T. T., Tsai, P. C., & Lin, M. F. (2018). The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta?Analysis of Randomized Controlled Trials Informs Evidence?Based Practice. Worldviews on Evidence?Based Nursing, 15(2), 130-139.

Wade, D., Als, N., Bell, V., Brewin, C., D’Antoni, D., Harrison, D. A., … & Mythen, M. (2018). Providing psychological support to people in intensive care: development and feasibility study of a nurse-led intervention to prevent acute stress and long-term morbidity. BMJ open, 8(7), e021083.

Unhjem, J. V., Vatne, S., & Hem, M. H. (2018). Transforming nurse–patient relationships—A qualitative study of nurse self?disclosure in mental health care. Journal of clinical nursing, 27(5-6), e798-e807.