Question:
Write an essay about the impact of mental health issues.
The essay concerns with the case study of John that highlights the impact of mental health issues. John is identified with first episode psychosis. The essay deals with this subject due to increasing incidences of drug induced psychosis in Australia. There is a bout of literature available on impact of living in a culture of substance abuse. Aboriginals and Torres Strait Islanders are highly represented in category of adolescent addiction and psychosis. It is necessary to understand the factors responsible for drug dependency and induce of psychosis.
The essay aims to highlight the significance of thorough biopsychosocial assessment in the field of mental health treatment. In the context of this case study, the paper aims to analyze and discuss the biopsychosocial factors that contributed to John’s mental health issue. A thorough literature review will be performed to identify appropriate nursing care management for john and relevant interventions.
Psychotic disorders at young age can derail an individual’s vocational, social and academic development (Murray et al., 2013). It initiates a trajectory of accumulating disability. According to Roncero et al., (2013) amphetamines and marijuana leads to permanent depression. These substances are responsible for self-talking behavior, hostile nature, hallucinations, cognitive distortion etc. It is evident from the study by Degenhardt & Hall, (2012), who believes that excess dependency on alcohol and drugs induces psychosis and these results are supported by West Australian Department of Health.
Family members of such individuals face unique challenges such as irrational behaviors, hyperactivity, unwanted conflicts, and aggression and communication difficulties (Waldock et al., 2015). The same is evident in the case of John. The primary concern of John’s parents was his behavioral changes, poor performance in academics, self talking, aggression and violence.
According to Wunderink et al., (2015), the development of psychosis is due to psychological and social stressors. This is conceptualized by the “stress–vulnerability model”. Therefore there is a need of a thorough biopsychosocial assessment of John. It includes assessing John’s mental state, biological, psychological and social factors adding to the vulnerabilities and stress (Moe et al., 2013). In case of John, the Biopsychosocial model will help to understand the addiction better.
According to the case study, John’s biological father had schizophrenia. It is evident that John’s psychological issues had biological origin. His father was also abusive to his mother and him. According to Haddad et al., (2014), psychosis is induced by complex inter play of biological, psychological and social factors. There can never be a specific reason that explains the cause of psychosis. Biological factors refer to the genetic origin behind development of psychological issues such as aggression, self-talking, hyperactivity, hallucinating and others. Study by Medhus et al., (2013) reveals that Schizophrenia contains a genetic component and is confirmed by conducting research on twin babies. Children of parent with history of psychological issues eventually tend to develop similar behaviors due to biological changes (Medhus et al., 2013).
The Psychological factors concerns with thoughts, feelings and behaviors. Recently, John has been observed to show aggressive behavior, hampered communication, or performance in education, attention deficit. He is highly addicted to alcohol, smoking and marijuana since the age of 15 years. Children are very sensitive during their early life. At the age of eight he experienced violence and abuse in his house. It greatly influenced his mind, which was manifested in his adolescence. As a child he travelled and changed schools therefore, he could never make close friends. John stopped participating in school activities and in making friends. He enjoyed being lonely. However, in the past he was a fun loving and joyful boy and excelled in his academics. Murray et al., (2013) highlighted the distinct relation between drug dependency and mental health issues such as depression, hallucination, personality and anxiety disorders. This relation is deduced based on psychoanalysis and social learning theories.
According to the neuropsychiatric study by Wunderink et al., (2015), an individual repeats a particular action if he/she receives a powerful reward. Such experiences urge them repeat the actions. The addictive behavior is understood based on several aspects such as the environmental factors, the rituals, thoughts and feelings of John involved. He realized no negative consequences as he attempted to smoke or use drugs initially, which reinforced his power to satisfy his urge.
John’s addiction was mainly due to his friends. He was growing up in a culture of addiction. Eventually he was addicted to alcohol, marijuana and smoking. Medhus et al., (2013) explained that social factors represent family influences, friends and other relationships. It is evident from the case study of John that his environment has great impact on his mental condition. The social factors for drug addiction were identified, were based on social system theories, family system theory, cultural and anthropological theories may be used to examine the social factors involved in addiction (Degenhardt & Hall, 2012). Degenhardt et al., (2012) analysed that developing an addiction is an interpersonal process and is determined by relationship with other members in the society. The fact can be justified by the reports of L’Abate, (2014) which reveals that ever since smoking in public places was declared illegal in Singapore and was subjected to taxation there was decline in smoking activity among people. Conclusively, availability adds to vulnerability.
Therefore, it can be concluded drug induced psychosis in John was a cumulative effect of various factors. John needs a multi-disciplinary approach to understand the addiction related problems to address the identified issues.
In the initial stage of counseling, John will require confrontation of his addiction. Nurses can motivate him to accept the adverse consequences of drug dependency. It will prevent his denial about presence of psychotic symptoms due to addiction. John can avail contingency management therapy. In this system, patients receive prizes in form of food, movie tickets, where in turn the client will have to adhere to therapeutic process. Such funds may attract clients to resist craving (L’Abate, 2014). In the initial stage John will have to undergo Motivational Engagement Theraphy (MET), where clients receive motivational sessions for period of one month to accumulate courage to quit addiction. John may require this session for longer period as he has multiple addictions – smoking, alcohol abuse, amphetamines and marijuana dependency. The counselor motivates and inspires them through successful stories or videos to instill positivity in them (Lea et al., 2015).
Based on the literature review, Cognitive Behavioral Therapy (CBT) is a powerful approach to minimize the symptoms of first episode psychosis. This psychosocial intervention is found to reduce hallucination (Galante et al., 2015). Therefore, it will benefit John. It includes sessions of verbal questioning, to modulate the belief system of the Patient. It is followed by experimental reality testing performed in community or psychiatric wards. Using this approach for John is justified as the studies of Carter, (2015) revealed that CBT influenced patients positively. Treatment process of John must include family intervention. Care and affection from close and dear ones help overcome insecurities and adhere to medication process (Carter, 2015).
John requires person centered therapy. Developed in 1961 by Rogers, it showed significant influence after implementing in psychiatric nursing (Videbeck, 2013). It incorporates in its service the concept of person-to-person care, unconditional acceptance, warmth and non-judgementalism. It includes techniques such as summarizing, paraphrasing and reflecting. (Smith & Grant, 2016) believes that the feeling of acceptance have a positive influence on the patients. John needs community-based therapy. This approach is based on Maxwell Jones’s eminent work in the area of Psychosis (Moe et al., 2013). It includes treating patients in informal community atmosphere. This approach will address John’s psychological issues as he will be undergo social learning, information sharing and decision-making and at the same time patients respect and dignity is maintained. Bramness et al., (2012) contends that these therapies positively influence patients with drug-induced psychosis. The approach incorporates positive elements in its services to patients such as love, empathy, friendship, partnership, acceptance and other supportive factors.
There is no specific outline for treatment of First episode psychosis. Therefore, nurses in mental health practice must apply the above strategies while balancing them as per the changing condition of John. The psychotherapeutic interventions are successful when the nurses in care is registered and qualified with high level of psychotherapeutic training and teaching (Galante et al., 2015). However, John is receiving intervention at early stage where his condition has not turned chronic or schizophrenic. Therefore, he has high chance of being recovered. According to Haddad et al., (2014), mental health nurse must be skilled in handling tense situation caused by distress patient and should be able to give them reassurance. They must behave assessing the strength and weakness of such patients. They must be aware of behavioral and personal life issues of patients (Videbeck, 2013).
Recently, mental disorders such as schizophrenia among adolescents have generated widespread international momentum. In response to this, the “US National Institute of Mental Health” has introduced the funding initiative, which promotes the development of better services for patients experiencing first episode psychosis (Moe et al., 2013). Evidence based therapies are included in the intervention process for functional and clinical recovery (Medhus et al., 2013). It offers a real hope inspite of the several complexities in the patient. Based on a thorough literature review it can be concluded that early intervention services for mental health issues faced by John may improve his symptoms and the adaptive functioning may be restored. The treatment for psychosis was successful due to continued effort of “Society of Addiction Medicine”, “Association of Medical Education and Research on Substance Abuse” and other (Bressington & White, 2015).
Intervention is planned in a way that the patient is completely detached from addiction with no sign of relapse. However, John being only 18 years old and keeping in mind his high level of multiple addiction there is a high chance of relapse. Therefore, twelve-step therapy would be best suitable for him. It includes AA and NA and other repetitive stages to overcome relapse (Niemi-Pynttäri et al., 2013).
Meeting ethical standards is mandatory to provide psychosocial interventions, which safely matches with the client’s interests. Mental health professional are required to comply with the codes of conduct such as: the “NSW Psychologists Registration Board Code of Professional Conduct”, and “Australian Psychosocial Association Code of Conduct and Society Code of Ethics”. It is essential to maintain the confidentiality of all clients records and counseling sessions to provide service users with the constructive environment and encourage disclosure from them. These records and reports should neither be exploited for any commercial purpose nor disclosed to any third party without any written consent from the client and follow the guidelines in “NSW Health Privacy Manual” (Larimer, 2013). Medical information must be provided to the clients adequately. Recently, in California, patients have taken legal actions for providing incorrect information regarding relapse. It may happen with John as well. Similarly, every stage of intervention may include risks and benefits, which should be clearly stated to the clients (Lea et al., 2015).
Mental disorders like schizophrenia are fatal and serious in nature and mainly emerge during adolescence and early adulthood. The consequences of addiction (smoking, alcohol abuse, marijuana ad amphtamines) is highly disruptive in nature. There is an increasing attention towards treatment of young individuals experiencing psychosis. Currently, there are several intervention programs available for meeting the needs of young people and their families. Early intervention not only involves bringing forth the best practice based on the symptoms recognized in the early stage, rather it also includes special care in identifying the biological, psychological and social challenges that exaggerated a particular mental health issue. Nurses play a great role in treatment of patients with psychosis. The thorough literature review has enhanced my knowledge related to substance abuse and Schizophrenia. There are parents who are not aware of consequences of neglecting early psychological symptoms and hence care is delayed exaggerating the vulnerability. Anne’s initiative helped John to receive early intervention while he was experiencing first episode of psychosis.
References
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Carter, R. (2015). Delivering cognitive behaviour therapy in a secure setting: Richard Carter describes the development of a link nurse role aimed at increasing patient access to interventions, and outlines its core functions.Mental Health Practice, 19(3), 23-26.
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