Mental health is a healthcare aspect with the ultimate focus on the psychosocial stability, behaviour and the emotional status of an individual (Gilam, 2018). Thus, mental status examination encompasses the in-depth assessment of the individual’s cognitive, affective and behavioural components to determine the mental health problem. The mental health status assessment provides relevant information that is useful in halting the progression of the mental health problem to more severe mental health illness (Crouch, 2014). Various components of mental status examination are assessed to arrive at the diagnosis of the mental health problem and ultimately the process of recovery.
With due reference to the current psychological, behavioural and social state of Mr Chung, it is definite that he has a mental health problem. In line with the case study, the components of mental status examination to be evaluated are mood and thought content. Mood is the state of inner feeling that is sustained over an extended period while thought content encompasses the range of thoughts of the client. According to the diagnostic statistical manual (DSM-V), mood problems are classified under the bipolar and other related disorders.
With regards to the subjective and objective data obtained from the assessment of Mr Chung, it is evident that he is experiencing a disturbance in mood. The most notable observation of the mood instability in Mr Chung is the flat mood and tearfulness with a sad and restrictive affect. Moreover, he states that has been experiencing low mood and feeling of worthlessness. The visible expression of mood, affect, is consistent with the prevailing attitude as the client assumes a rounded shoulder posture and a transfixed stare on the floor. Mood instability typically manifests in significant impairment in general activity and social functioning of the individual (DSM -V). The disability is observed in Mr Chung’s decreased ability to interact and participate in the care of baby Charlotte as well as a feeling of being a failure at work.
On the other hand, the client’s thought content demonstrates impairment in the overall mental health wellbeing. On evaluation, a myriad of thought is running through Mr.Chung’s mind of which some are detrimental to his general welfare. He is anxious about his health with feelings of worthlessness and suicidal ideations. Also, he contemplates the lethal drugs to take away his life. Depressive and stress-related disorders result in alteration of the thought content as is in the case of Mr.Chung. According to the DSM-V, disturbed thought content poses a high risk for suicidal ideations as well as impaired social and operational functioning. In the expression of his thoughts, the client’s beliefs of hopelessness and that any treatment will offer no help are the observable thought content disturbances that complicate his already altered mental health well- being. The combination of social and workplace stressors are the cause of the disorganised thought content of the client, but the client views self as the genesis of his current problems. The client has been overwhelmed by hopelessness, and thus recovery should focus on restoring hope and sense of self -worth to promote positive living (Townsend, 2017).
The stressors in a person’s experiences are observed in the social functioning and the mental stability of the person (Moodley & Ocampo, 2014). The extent of the stressors determines the level of impairment relative to the vulnerability of the individual. The stress-vulnerability model stipulates that a triad of factors is responsible for the development of mental health illness (Fernando, 2014). These factors include stress, coping skills and the level of vulnerability. It is evident that Mr Chung has had challenging experiences in life that predispose him to the current mental instability. The main factors affecting the client are long working hours with associated heavy workload and anxiety over the deteriorating state of his health.
As a result of the client’s inability to cope successfully with the stress, impairment in overall mental and social functioning develops. For example, due to the long working hours and high workload, Chung was unable to participate fully in planning for his wedding. Moreover, after the baby’s birth, he only had one week off. This situation of absence from the family makes Chung feel inadequate in his roles since he cannot take care of the ailing wife. Consequently, he feels worthless and a let down to the family. Secondly, due to exhaustion at work, he committed a drug error and as a result, was subjected to investigation by the medical board. This posed an impediment to his professional development as he desires to undertake study for promotion.
Therefore, Chung feels that his ordeals are self-imposed thus aggravating his mental instability.
Another factor leading to Chung’s current mental status is the anxiety over his deteriorating health. The recent experience of palpitations, chest pains and breathlessness have diminished Chung’s perception of purpose in life. This is indicated by expression of fear that he might have a heart attack and die. Further, he contemplates on taking drug overdose for suicide. Citing that he is hopeless is a sign of ineffective coping skills.
Incorporation of the stress-vulnerability model in Chung’s experiences it is evident that he is more vulnerable to stressors with limited and ineffective stress coping mechanisms. The vulnerability is directly associated with genetic factors thus the inability to contain the stressors in ways such as taking medication as in the case of Mr Chung despite being a doctor. According to the model, if an individual fails to adapt to the stress the symptoms of the mental illness will worsen (Kinderman, 2014). As in the case of Chung, failure to cope successfully with the long working hours has weakened him rendering him unable to take necessary measure to curb his ailing health. Contrary to the practice as a doctor he opts to terminate his life instead of taking medication. This is a clear demonstration of impairment in coping resulting from the high level of vulnerability. Coping skills are protective factors that reduce vulnerability and stress ( Hungerford et al., 2018). They may include medication, social support and a supportive environment all of which Mr Chung lacks. Therefore, Chung feels inadequate and loses the sense of self -worth and considers death as the solution to his problems.
Recovery from mental illness is a journey of regaining hope and return of psychosocial functioning with ultimate realisation of a definite sense of self. The mental health recovery approach emphasises and supports the person’s potential to recover (Myers, 2015). According to the theory, hope, respect and empowerment are fundamental principles for the journey to recovery. The model also emphasises the value of developing new meaning and purpose in life after the stressors experienced in life.
The sole role of recovery-oriented mental health practice is to enable the delivery of mental health services satisfactorily to support recovery from mental health illness (Townsend, 2017). Therefore, the principles of hope, respect and empowerment are critical in the process of Mr Chung’s recovery. The following is a discussion of the interaction of the above principles to ensure holistic healing of the client.
Firstly, respect for mental health recovery entails courtesy and honesty in social interactions as well as upholding the client’s dignity in spite of the mental health instability. Moreover, respect calls for the care provider to be sensitive to the client’s culture, values and belief to provide culturally sensitive care to promote smooth recovery (Bahren, 2017). The client under study feels that the wife’s family shadows his Chinese culture. Therefore, is imperative to assess other areas where Chung’s culture can be expressed positively in the family to improve his self- concept and self- perception.
Secondly, empowerment as a principle for real recovery requires a robust support system. The support network is instrumental in providing a suitable environment for positive living and recovery. Empowering Mr Chung makes him autonomous thus reducing the effects of psychosocial stressors. This builds confidence and a definite sense of self. For example, allowing him time to be with the baby will provide an opportunity to participate in the care of the new baby. This would be self –fulfilling thus reducing the psychological trauma of being a let down to the family. Also, empowerment makes the client understand that they are responsible for recovery. It is therefore essential for the family to devise ways of ensuring social inclusivity in the running of family matters to engender a sense of belonging to Mr Chung. By so doing, the client will develop a sense of purpose in life and consider self as a valued member of the family.
On the other hand, hope as a driving force towards recovery involves nurturing a sense of optimism in life and strengthening an individual to persevere through life’s setbacks (Myers, 2015). Since Chung has lost hope and the value of life, the recovery process will focus on restoring his sense of worth to divert his suicidal thoughts. He should be guided through introspection to realise his achievements and strengths to instil hope in his future and ability to lead a meaningful life. The client also needs to understand that life crises are typical and that an appropriate approach to them is the remedy.
An urgent risk area in mental health and psychiatry involves any condition that requires immediate intervention (Gilam,2018). Such a situation includes suicidal ideations and attempted suicide, depression, violence and extreme changes in behavior. From the case study, Chung requires prompt intervention to promote recovery from depression as well as controlling the feelings of worthlessness that trigger the suicidal thoughts. Chung’s self- report of contemplating suicide and loss of hope on the effect of drug therapy to his health status is thus an urgent risk area that needs exploration to restore his mental health wellbeing.
To address the risk of suicide associated with Chung’s psychological instability, the treatment modality to promote his well -being is medication. The treatment aims at stabilizing the client before considering rehabilitation (Myers, 2015). The drugs are efficacious in lessening the life-threatening symptoms from acute mental illness. To ensure a quick remission of symptoms, parenteral drugs would be administered. Moreover, a psychotherapy session would be necessary to make the client understand that drugs will play a role in his recovery. Psychotherapy nurtures hope and trust between the care provider and the client, and thus the patient is motivated to work towards recovery.
Mental health concerns are emotional and behavioral problems experienced by an individual. The emotional problems are expressed through mood changes especially sadness or disturbing anxiety while behavioral problems are evidenced by concerns of anger, violence, and inattention (Kinderman, 2014). From the case study, the client has portrayed both emotional and behavioral concerns. For example, Chung has a flat mood and is tearful with a sad and restrictive affect. Persistent disturbance in mood has resulted to inattention as well as social problems which all add up to causing instability in mental health. The pressure at work and feelings of being secluded in care of the baby exacerbate the problem.
The health concern of the client will successfully be addressed through family therapy. This is a form of psychotherapy that helps the family members resolve existing conflicts through effective communication ( Myers, 2014). In the case of Chung, the conflict arises from his feelings of inadequacy in taking care of the ailing wife and the baby. To achieve a satisfactory resolution, the family needs to allocate enough time for Chung to be with the baby while he is at home. Further, the family needs to provide emotional support to Chung as he continues with the other treatment amid the pressure at his place of work.
Health care providers have a role of upholding competent professionalism in the care of psychiatric patients (Fernando, 2018). The patient rights and confidentiality are legal issues about the care of clients which the nurses should be aware of because they affect the nursing practice today. The patient right to treatment or refusal of treatment and maintaining the confidentiality of the patient information are key in care of Chung. The ethical principle of beneficence ensures that the interventions undertaken to the client are beneficial while informed consent ensures that the client assents to the plan of care ( Gilam, 2018). The professional issues key to the care of Chung is the provision of competent care and accountability for the decisions made.
References
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Bahrer, S., & Carod, F. J. (2017). Global mental health: Prevention and promotion. Cham, Switzerland: Springer.
Crouch, R. (2014). Occupational therapy in psychiatry and mental health. Chichester, West Sussex: Wiley Blackwell.
Fernando, S. (2014). Mental health worldwide: Culture, globalisation and development. Basingstoke: Palgrave Macmillan.
Gillam, T. (2018). Creativity, Wellbeing and Mental Health Practice. Cham: Springer International Publishing: Palgrave Pivot.
Hungerford, C., Hodgson, D., Bostwick, R., Clancy, R., Murphy, G., De, J. G., & Ngune, I. (2018). Mental health care. Milton QLD: John Wiley & Sons.
Kinderman, P. (2014). A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing. New York: Palgrave Macmillan.
Moodley, R., & Ocampo, M. (2014). Critical psychiatry and mental health: Exploring the work of Suman Fernando in clinical practice. Hove, East Sussex: Routledge.
Myers, N. L. (2015). Recovery’s edge: An ethnography of mental health care and moral agency. Nashville: Vanderbilt University Press.
Townsend, M. C., & Morgan, K. I. (2017). Essentials of psychiatric mental health nursing: Concepts of care in evidence-based practice. Philadelphia, PA: F.A. Davis Company.
Vanheule, S. (n.d). Diagnosis and DSM.
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