My name is (add your name) and I work as a registered nurse in the XXX helathcare facility. While working in the mental health ward I was assigned to take a mental health assessment of Mr. Johannes (approximately 45 year old) (MRN number XXXXX) living alone in Australia. He was admitted to the mental health ward by her mother as she noticed signs of depression and deteriorated health conditions
As stated by the patient in the mental health assessment, depression is the primary problem of the patient in current situation. There are secondary health issues, due to which physical health of the patient is also deteriorating such as increased body weight, unusual sleep pattern, hyper pressure, anxiety, agitation, lack of concentration and high drinking pattern that affects his physical health by decreasing his strength and immunity. His increased addiction for alcohol, negative thoughts about his self-worth and affected personal as well as professional life (Anderson et al. 2015).
While describing his symptoms, his body language and his statements about his health conditions should be stated. In the entire mental health assessment related conversation, patient did not make direct eye contact with me and was constantly moving his hands, eyes and face. He was not stable to his thoughts and statements and for several responses changed his response within fraction of seconds. For example while replying to the question about his personal life related problems affected his professional life, he changed his response from yes to no within seconds and stated that personal problems are concern for every individual and it does not affect someone’s professional life. Further as per the statement of the patient, he was on medication for hyper pressure and was suffering from anxiety and agitation. he was unable to sleep properly from last three months and was suffering from binge drinking and eating due to which his body weight increased (Dawson, King and Grantham 2013).
The client was currently living in his house where no one came to visit him except his mother as he did not wanted to disclose his health condition to others.
As per the mental health act for determination of severity of mental health of the patient, assessor should rate several points while conducting the mental health assessment with patient. These are level of consciousness, thought perception, attitude and insight, speech and activity of motor sense, and cognitive abilities. In this assessment with Mr. Johannes, he was having low mood, less self-confidence, negative thoughts, dull appearance and lack of consciousness and hence, his level of depression could be rated as moderate to severe as the episodes lasted for three months.
As stated by the patient in the mental health assessment, depression is the primary problem of the patient in current situation. There are secondary health issues, due to which physical health of the patient is also deteriorating such as increased body weight, unusual sleep pattern, hyper pressure, anxiety, agitation, lack of concentration and high drinking pattern that affects his physical health by decreasing his strength and immunity. His increased addiction for alcohol, negative thoughts about his self-worth and affected personal as well as professional life (Anderson et al. 2015).
While describing his symptoms, his body language and his statements about his health conditions should be stated. In the entire mental health assessment related conversation, patient did not make direct eye contact with me and was constantly moving his hands, eyes and face. He was not stable to his thoughts and statements and for several responses changed his response within fraction of seconds. For example while replying to the question about his personal life related problems affected his professional life, he changed his response from yes to no within seconds and stated that personal problems are concern for every individual and it does not affect someone’s professional life. Further as per the statement of the patient, he was on medication for hyper pressure and was suffering from anxiety and agitation. he was unable to sleep properly from last three months and was suffering from binge drinking and eating due to which his body weight increased (Dawson, King and Grantham 2013).
The client was currently living in his house where no one came to visit him except his mother as he did not wanted to disclose his health condition to others.
As per the mental health act for determination of severity of mental health of the patient, assessor should rate several points while conducting the mental health assessment with patient. These are level of consciousness, thought perception, attitude and insight, speech and activity of motor sense, and cognitive abilities. In this assessment with Mr. Johannes, he was having low mood, less self-confidence, negative thoughts, dull appearance and lack of consciousness and hence, his level of depression could be rated as moderate to severe as the episodes lasted for three months.
As stated by the patient, he was diagnosed with depression when he was admitted to the hospital. However he was given with medication for hyper pressure. Further, he also mentioned that due to his deteriorated physical and mental health condition, he was admitted to the hospital by his mother.
He did not had any past medical history and this depression episodes are the only health concern he is suffering from in the current situation. Currently he consumes medication for hyper pressure once every morning and did not mentioned any signs and episodes of allergies. His mother is his primary carer and without her no one comes to take a visit to his home as he has isolated himself from the entre society. Therefore, his house is his only accommodation where he performs all his activities of daily life alone. This was the health background which was collected from the mental health assessment of the patient (Bost et al. 2012).
In the current situation, the patient was suffering from the severe depression due to his grievous experiences of life. He stated that he never experienced depression before. However, due to his thought of being worthlessness, he gradually developed the symptoms of depression. He was exhibiting different clinical signs related to the depression. He stated that he had the abnormal sleep pattern. Previously he used to wake up at 6’o clock for work but due to negative thoughts, he had the unusual sleeping pattern. Besides, he stated that he had anxiety and he was feeling agitated at the same time. He had a lack of concentration in the last three months. After having the conversation, he reported that he usually had negative thoughts and he kept questioning his self-worth. He gained significant body weight due to the negative thoughts and alcohol consumption habit. He did not have any ideas of attempting suicide but the negative thought process of him may leads to the attempt of suicide. He was consuming the medicines of hypertension every morning on a daily basis. No diagnosis has been planned for him and he never went through any diagnosis process. However, he suggested that communication may help him to overcome the obstacles of life by releasing the negative thoughts. Medical experts also suggested that effective verbal communication with any individual would help him to overcome the depression he was experiencing for the more extended period (Eccleston et al. 2016). The thought processes of him affected his lifestyle since he was an alcoholic and eat unhealthy foods which influence his daily activities and health. He was willing to involve himself in the treatment plan so that he can get over the negative experience and ability to lead the quality life.
In such a situation, when patients are experiencing depression, few therapies can help the patient to overcome the situation. A systemic review and empirical studies of depression suggested that cognitive behavioural therapy is the best therapy for coping up with severe depression. Depression usually makes people helpless about their self and subsequently affects the daily routine and lifestyle of the patient. Effective communication with a patient in the 30 to 60 session of cognitive therapy may help the patient to boost the self-esteem and gain the self-worth. In a majority of the cases, patients have low self-esteem due to the series of adverse events they are experiencing. Communication with empathy and compassion would help him to gain the self-worth and confidence in coping up with negative experiences.Moreover, he would have a sense of security, and he would be able to talk about his area of concern to the caregiver. Moreover, the exercise daily will boost the endorphins which would give the long-term benefit to cope up with depression (Eccleston et al. 2016). Since he had unhealthy eating habits and alcohol consumption, eating healthy would help him to get over his problem. Incorporation of fruits, more vitamins and vegetables is the crucial part of food diet to live the standard life. Since he had the abnormal sleeping pattern, getting enough sleep and fixed sleeping time would help him to enhance the quality of life (Anderson et al. 2015). Engaging himself with motivational therapies, motivational speech about leading life would help him to overcoming the phase of negative experiences (Pennant et al. 2015). Taking responsibility for his own, encouraging him to live a quality life would help him to ease the negative thoughts. Three months of communication therapy along with other change of habits would help him to manage depression completely.
The patient was a middle aged Caucasian male. He is suffering from severe depression. While talking to the emotional advisor the patient appeared to be quite disturbed and depressed. He did not want to express much about himself unless asked about. He was constantly fidgeting which showed that he was not entirely comfortable with the conversation. It was seen that he kept on twitching his mouth to the right side of his face every time he started to talk. He seldom looked up to the doctor and answered his questions, throughout the conversation (Brownlie et al., 2014). He was wearing very simple clothes, such as a grey t-shirt, track-pants and had a watch on his left hand. He did not have any distinguishing marks or tattoos that were visibly exposed.
All through the conversation, the patient stayed in the same posture. He sat on a chair with his head bowed down. He rarely put his head up and looked to the doctor while answering his queries. It appeared that the patient had an issue with his hands and that he had a shuffling gait problem, even though he was sitting the entire time. From the way he was speaking it was evident that he had apraxia of speech which is motor disability that makes the individual unable to converse in a usual manner. The patient was following the question word-by-word to answer them and he was clearly having difficulty connecting the questions to his own experiences and was taking a bit more time to answer them. His facial expression showed that he was in pain and deeply troubled. He did not laugh or spoke in a friendly manner, he was completely indifferent even though the doctor was trying to make him comfortable all the while. While talking about his family or even his own issues he seemed to be quite embarrassed (Brink, 2014). He was constantly placing his hand on his head while talking and kept on fidgeting with his fingers the entire time. He was grimacing occasionally. Even though he did not show any signs of tremors, his appearance seemed to be quite disorganised.
While talking to the RN the patient seemed to be extremely hesitant. He had a trouble with his speech. He was stuttering all the time he was asked a question. It seemed that the patient had an issue of echolalia which is a psychiatric disorder where the individual repeats the words of others while speaking. Every time the RN asked him a question, the patient followed and repeated his words to answer him (Rayner et al., 2014). The conversation was almost forced. Since the patient did not talk unless he was asked a question. It was the RN who kept the conversation ongoing and maintained the flow. The client expressed that he was lacking concentration and motivation at work. The patient admitted that he was having negative thoughts and even developed suicidal tendency recently. Although it did not seem that he was having any kind of thought blockage, but then it could not be clearly distinguished since he was so hesitant to talk about all the things that were troubling him.
While assessing his mental state from the entire conversation it was found that the patient was very depressed and lost all motivations in life. He did not seem to care much about anything in his life anymore and nothing seemed to influence him at work either (Paniagua & Yamada, 2013). He felt agitated the whole time. The patient even became abusive to people while he drives to supermarket and this has worsened in last 3 months. People have been reacting to his behaviour as well, although no one has physically hurt him till then. It was indicated that he was having dissociation and suicidal thoughts as he said that he felt like “not worth living sometimes”. He had issues with drinking. Occasionally he got drunk, although he confessed that his drinking issue did not affect his work and he was not concerned about it.
The patient has got the perception that the medications for depression does not work for him. Therefore in spite of the fact that the doctor had prescribed medications for his condition, he did not take such medications.
The patient did not have any hallucinations or any such visual disturbances. The patient also did not undergo any unusual experiences.
However most of the time the patient remains distracted. There is often lack of concentration. Even while watching television, he just flickers through the channels and does not pay much attention to the content of the show that is going on.
The patient fails to realise the significance of his symptoms and his current situation. This is mostly because no one around him points this out to him. At work no one notices the differences in his behaviour. While he gets drunk occasionally, about twice a week, Mr. Johannes is not concerned about it. He feels it is quite alright getting drunk after work, as it is not affecting his work and he has got no complaints regarding such matter form his boss.
Therefore there is lack of proper judgement of his present condition. However he does go to work properly and is able to manage his own finances. He does lack motivation to work like before, but continues to work on the activities that are required on a daily basis.
The therapeutic relationship that has been established is not yet a very strong one. The patient lacks the openness while communication with the counsellor. He is also hesitant about sharing his intimate details. He is not able to make direct eye contact while communication which proves that the therapeutic relationship is not strongly established (Cameron et al. 2013).
Risk Issues (if identified):
The risk issues that were identified included his negative thoughts which at one point might and up into suicidal thoughts since the patient was suffering from episodes of major depression (Arevalo?Rodriguez et al. 2015). The patent also had thoughts of worthlessness, lacking any motivation in life. The patient Mr. Johannes has been agitated and abusive towards the other people while driving or while sopping in the supermarket. Therefore this increases the risk of getting hurt or being hurt by other people. However now up till now there have not been such incidences.
References
Anderson, J., Malone, L., Shanahan, K. and Manning, J., 2015. Nursing bedside clinical handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-6), pp.662-671.
Anderson, N., Heywood-Everett, S., Siddiqi, N., Wright, J., Meredith, J. and McMillan, D., 2015. Faith-adapted psychological therapies for depression and anxiety: Systematic review and meta-analysis. Journal of Affective Disorders, 176, pp.183-196.
Arevalo?Rodriguez, I., Smailagic, N., i Figuls, M. R., Ciapponi, A., Sanchez?Perez, E., Giannakou, A., … & Cullum, S. (2015). Mini?Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database of Systematic Reviews, (3).
Bost, N., Crilly, J., Patterson, E. and Chaboyer, W., 2012. Clinical handover of patients arriving by ambulance to a hospital emergency department: a qualitative study. International Emergency Nursing, 20(3), pp.133-141.
Brink, T. (2014). Clinical gerontology: A guide to assessment and intervention. Routledge.
Brownlie, K., Schneider, C., Culliford, R., Fox, C., Boukouvalas, A., Willan, C., & Maidment, I. D. (2014). Medication reconciliation by a pharmacy technician in a mental health assessment unit. International journal of clinical pharmacy, 36(2), 303-309.
Cameron, J., Worrall-Carter, L., Page, K., Stewart, S., & Ski, C. F. (2013). Screening for mild cognitive impairment in patients with heart failure: Montreal Cognitive Assessment versus Mini Mental State Exam. European Journal of Cardiovascular Nursing, 12(3), 252-260.
Cumming, T.B., Churilov, L., Lindén, T. and Bernhardt, J., 2013. Montreal Cognitive Assessment and Mini–Mental State Examination are both valid cognitive tools in stroke. Acta Neurologica Scandinavica, 128(2), pp.122-129.
Dawson, S., King, L. and Grantham, H., 2013. Improving the hospital clinical handover between paramedics and emergency department staff in the deteriorating patient. Emergency Medicine Australasia, 25(5), pp.393-405.
Eccleston, C., Palermo, T.M., de C Williams, A.C., Lewandowski, A., Morley, S., Fisher, E. and Law, E., 2016. Psychological therapies for the management of chronic and recurrent pain in children and adolescents. The Cochrane Library, p.CD003968.
Paniagua, F. A., & Yamada, A. M. (Eds.). (2013). Handbook of multicultural mental health: Assessment and treatment of diverse populations. Academic Press.
Pennant, M.E., Loucas, C.E., Whittington, C., Creswell, C., Fonagy, P., Fuggle, P., Kelvin, R., Naqvi, S., Stockton, S., Kendall, T. and Group, E.A., 2015. Computerised therapies for anxiety and depression in children and young people: a systematic review and meta-analysis. Behaviour research and therapy, 67, pp.1-18.
Rayner, L., Matcham, F., Hutton, J., Stringer, C., Dobson, J., Steer, S., & Hotopf, M. (2014). Embedding integrated mental health assessment and management in general hospital settings: feasibility, acceptability and the prevalence of common mental disorder. General hospital psychiatry, 36(3), 318-324.
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