Mental status examination comprises of the general observations made by the medical professionals to evaluate a person’s mental health status. The components of MSE include appearance, mood and affect, behaviour, thought process and thought content (Norris, Clark, & Shipley, 2016). In this case study, it has been observed that Chung looks tearful and flat, his mood was miserable and his eye contact was poor. As stated by Norris et al., (2016) affect is an objective observation of an individual’s emotions by the health professionals, which includes the observation of facial expressions, body posture and body movements. Likewise, it was noticed that Chung was uncomfortably seated on his seat and he was wilting with rounded shoulders and was continuously staring at the floor for long intervals of time. During the discussion, Chung mentioned that his mood was very low since the last six weeks and he also felt anxious. Moreover, his sleep pattern as inferred from the case study is seen to be disturbed with initial symptoms of insomnia and his weight is affected due to poor appetite. Patel et al., (2015) stated that mood is a subjective report of individual emotions. Instability in mood is an indicative symptom which can be easily detected by the investigator during an interview. In addition, mood instability represents alterations in healthy body functions such as sleep disturbance and changes in normal appetite. Further, Chung stated that he was experiencing chest pain that might lead to a heart attack. He expressed that he felt worthless and was not able to cope with the work and family requirements. He states that nothing is going to help or improve his situation, so he wishes to die. Considering his signs and symptoms it can be concluded that his mood is depressed, and he is experiencing delusions about his health.
The diagnostic and statistical manual of Mental disorder (DSM) was established in 1952 by the American Psychiatric Association. It was created to help health care professionals to use as assessment criteria for diagnostic purpose (Regier, Kuhl, &Kupfer,2013). According to American Psychiatric Association (2013), a person who expresses 5 or more symptoms that relate to the diagnostic criteria of a mental health disease is at a high risk of developing that disease. Some of the signs that are presented by Chung in this case study closely belongs to the diagnostic criteria of anxiety disorder, whereas most signs and indications which are presented in the case study are closely linked to the major depressive disorder. For instance, the presence of same symptoms for more than two weeks which includes diminishing interest in daily activities like eating, disturbance in sleeping pattern, suicidal thoughts and presence of physical symptoms of loss of weight in the absence of any medical condition. Additionally, one of the major symptoms that a person can feel on being depressed is harbouring feelings of worthlessness and guilt consciousness. According to the case study, Chung presented most of the symptoms which comes under the criteria of major depressive disorder like delusions, suicidal ideation, insomnia, anorexia, weight loss, poor speech, helpless feelings and thought of guilt and worthlessness and hence, it can be stated that Chung is most likely to develop acute depression.
A stress vulnerability model is an imperative tool for recognizing and managing relapses of mental illness. Stress vulnerability model closely works with three main factors which are responsible for the development of mental disorder. These factors include, biological factors, personal attributes and environment (Moller, 2017). According to this model, stress may activate a vulnerability, transmuting the potential of predilection into the certainty of pathophysiology. In this model two aspects are involved, one is vulnerability which means the inbuilt susceptibility to develop a kind of mental health disorder, and the second aspect is stress which is related to the challenges that individuals face during their lifespan (Colodro-Conde et at 2017)
In this case study, there are certain vulnerability factors which are closely responsible for Chung’s stress. First is the cultural shock, as per the case study, Chung moved to Australia from China though his family is still based at China. On special occasions, he was unable to see his family and his marriage was also planned by Harriett’s parents, so Chung was not really involved in the celebration because it was not according to the Chinese culture. This closely reflects that he is disconnected from his culture which makes him upset. In the words of Shekunov (2016) culture bereavement and cultural shock are vulnerability factors during the migration process, because people lose their social structure and support, which is a big reason for grief reaction. Moreover, this stress sometimes can result in functional impairment or distress. Thus, in this case study, culture shock is one of the major factors of Chung’s poor health. According to Bustamante et al., (2018) migration is sometimes considered as a process which is the same as mourning. In this process an individual gets separated from his family, language, his culture and social background, which is linked with different stresses. Therefore, Chung’s separation from his culture makes him miserable.
Further, the second factor which is closely associated with Chung’s poor health is his poor coping ability being a father for the first time. Chung and his wife had a baby 3 weeks ago. When the baby was born Harriett had to face a lot of complications and due to the busy work schedule of the client, Harriet’s family stayed with them to look after the baby. Chung found it hard to spend time with the baby because he realised that his wife’s family is overprotecting the baby. Thus, these circumstances have a major role to play in Chung’s health status. In the view of Doss, & Rhoades, (2017), birth of a baby is denoted as a transition to parenthood, which includes both aspects of joy and stress for new parents. Doss et al., (2017) found that new parents can present with sudden, small to medium deteriorations in the normal relationship functioning as compared to the pre-birth trajectories. Consequently, being a new father Chung found himself in a situation where he had plenty of responsibilities. In addition to this, new fathers experience declines in their ability to fulfil the demands of their family and work. Moreover, fathers can feel reluctant and incapable to express their support needs and the main reason behind this is prioritising their responsibilities to adjust within the new situations. (Darwin et al., 2017). Hence, Chung is reported to feel overwhelmed by the new family environment.
Recovery model supports and emphasizes on a holistic view of mental illness rather than emphasising on physical symptoms. The main aim of the recovery model is to help individuals who are suffering from distress and mental illnesses to look beyond mere existence and reality (Jacob, 2015). As mentioned by Waldemar, Arnfred, Petersen, &Korsbek, (2015), the recovery model or recovery-oriented practice is based on the principle and ethics of individual’s orientation and individual participation instead of focusing on stabilisation and relief of symptoms. Furthermore, the overall purpose of recovery model is to help individuals in gaining an acceptable and meaningful life. This can be provided by caring relationships, and it has been reported to attain their goals and promote hope which is a key aspect in the recovery of mental illness (Waldemar et al., 2015)
Recovery-oriented practice starts with respect and appreciation of a person. Due to stigma and improper education about mental health people are at a high risk of developing suicidal tendencies in some countries (Ziedonis, Larkin, & Appasani, 2016). In this case study, it has been observed that Chung’s communication is very poor as he is not contented. In order to enable Chung to achieve trust, it is very important for the health professional and the family to show respect by being courteous and honest in all the interactions by using the recovery-based communication. Further, community can help Chung in improving his health by using non- stigmatising language will enable him to maintain confidence. It is critical to support him to take part in recreational and occupational activities which are central for him to improve his health status (Ziedonis, Larkin, &Appasani, 2016).
Empowerment is a positive aspect of mental health recovery, which closely works on partnership, personal control and it helps to promote self-determination and boosts empowerment (Picton et al 2018). Moreover, as stated by Picton et al (2018), there are certain barriers which make it hard to achieve empowerment attributes like social isolation, discrimination and stigma. In this case study, to help Chung to experience autonomy, it is very important for the family to encourage him to participate in baby care, this will help Chung to feel connected with the family. In addition, participation in community-oriented program will enable him to boost his self-esteem. Empowerment is very important to encourage Chung to participate in the discussion and provide him with all important information and support that he needs to manage for his stable mental health (Jacob, 2015).
The feeling of regaining authority through sufficient support is very important to preserve the hope of recovery in individuals who are in hopeless situations due to their mental state (Samuelsen, Moljord, & Eriksen, 2016). In this case study, it has been observed that Chung is suffering from social ideation. It seems his life is not in his control and he feels trapped. Listening positively to his story and displaying a caring and genuine attitude can make a huge difference in his life. Reassurance by the midwife and family support is central to enable Chung to develop confidence. Moreover, counsellor and employment assistance services can also be arranged with Chung’s consent (Vatne, &Nåden, 2018). Consequently, these steps are very important to preserve hope in Chung life to protect him from any kind of suicidal ideation.
References:
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub
Bustamante, L. H., Cerqueira, R. O., Leclerc, E., &Brietzke, E. (2018). Stress, trauma, and posttraumatic stress disorder in migrants: a comprehensive review. RevistaBrasileira de Psiquiatria, 40(2), 220-225.
Colodro-Conde, L., Couvy-Duchesne, B., Zhu, G., Coventry, W. L., Byrne, E. M., Gordon, S., … & Eaves, L. J. (2017). A direct test of the diathesis–stress model for depression. Molecular psychiatry.
Darwin, Z., Galdas, P., Hinchliff, S., Littlewood, E., McMillan, D., McGowan, L., &Gilbody, S. (2017). Fathers’ views and experiences of their own mental health during pregnancy and the first postnatal year: a qualitative interview study of men participating in the UK Born and Bred in Yorkshire (BaBY) cohort. BMC pregnancy and childbirth, 17(1), 45.
Doss, B. D., & Rhoades, G. K. (2017). The transition to parenthood: Impact on couples’ romantic relationships. Current Opinion in Psychology, 13, 25-28.
Jacob, K. S. (2015). Recovery model of mental illness: A complementary approach to psychiatric care. Indian journal of psychological medicine, 37(2), 117.
Möller, H. J. (2017). New aspects of the vulnerability stress model in general, its relevance in schizophrenic psychoses and the place of antipsychotics.
Norris, D. R., Clark, M. S., &Shipley, S. (2016). The Mental Status Examination. American family physician, 94(8).
Patel, R., Lloyd, T., Jackson, R., Ball, M., Shetty, H., Broadbent, M., … & Taylor, M. (2015). Mood instability is a common feature of mental health disorders and is associated with poor clinical outcomes. BMJ open, 5(5), e007504.
Picton, C., Patterson, C., Moxham, L., Taylor, E. K., Perlman, D., Brighton, R., & Heffernan, T. (2018). Empowerment: The experience of Recovery Camp for people living with a mental illness. Collegian, 25(1), 113-118.
Regier, D. A., Kuhl, E. A., &Kupfer, D. J. (2013). The DSM?5: Classification and criteria changes. World Psychiatry, 12(2), 92-98.
Samuelsen, S. S., Moljord, I. E. O., & Eriksen, L. (2016). Re?establishing and preserving hope of recovery through user participation in patients with a severe mental disorder: the self?referral?to?inpatient?treatment project. Nursing open, 3(4), 222-226.
Shekunov, J. (2016). Immigration and risk of psychiatric disorders: A review of existing literature. American Journal of Psychiatry Residents’ Journal, 11(02), 3-5.
Vatne, M., &Nåden, D. (2018). Experiences that inspire hope: Perspectives of suicidal patients. Nursing ethics, 25(4), 444-457.
Waldemar, A. K., Arnfred, S. M., Petersen, L., &Korsbek, L. (2015). Recovery-oriented practice in mental health inpatient settings: A literature review. Psychiatric Services, 67(6), 596-602.
Yao, C., Thorn, K., Duan, Z., & Taskin, N. (2015). Workplace stress in a foreign environment: Chinese migrants in New Zealand. Equality, Diversity and Inclusion: An International Journal, 34(7), 608-621.
Ziedonis, D., Larkin, C., &Appasani, R. (2016). Dignity in mental health practice & research: Time to unite on innovation, outreach & education. The Indian journal of medical research, 144(4), 491.
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