. Mental health assessment
Principles of mental health assessment
‘…assessment is “the systematic and ongoing evaluation of information about a consumer in order to ascertain his/her diagnosis, needs and desire outcomes of care. Assessment forms the basis for the development and review of an individualised care plan in collaboration with the consumer, his/her family, carers and significant others.’ (Meadows et al., 2007, pg 281).
Perhaps the most important section of the textbook on assessment is from page 285 onwards. “Mindfulness in Assessment’ has sub-sections on ‘keeping an open mind’, ‘the crime of Procrustes (forcing a ‘fit’), ‘to assess is to intervene’, ‘interview skills’, and ‘personal style’. The lesson is to…
“…make the best use of all information that comes our way through the task of assessment. However, we should be constantly checking ourselves that we are not jumping to hasty conclusions based on our accustomed habits of interpreting clinical presentations, or rigidly hanging on to positions we may have taken on an issue, even in the face of accumulating evidence to the contrary.” (Meadows et al., 2007, p. 285).
Mental Status Exams (MSEs)
The main reason we use a Mental Status Examination (MSE) is as a tool to help the clinician gather objective data that can be used to help determine the cause of the symptoms (aetiology), diagnosis, prognosis, treatment, and to assess risk of harm or violence. The MSE is usually standardized in the agency where it is used (Kneisl & Trigoboff, 2009, p. 217).
Categories within the MSE usually include:
• General behaviour, appearance and attitude
• Characteristics of speech
• Emotional state
• Content of thought
• Orientation
• Memory
• General intellectual level
• Abstract thinking
• Insight evaluation
• Summary
(Kneisl & Trigoboff, 2009, pp. 217-220).
* Please note that practical Assessment Skills are covered in the unit HLTH421, and assessment is relevant to all units HLTH421-424.
Please refer to your textbook (Mental Health in Australia, Meadows et al., 2012) for this topic area.
• 2. Case managementPage
2. Case management
Principles of case management
Despite varying definitions and associated case management models, case management as a concept is very simple. It essentially involves the delivery of safe and effective care to the consumer. It usually involves a case management plan, an assigned ‘case manager’, and associated access to services relevant to the planned treatment. In a lot of cases the case manager works as a facilitator who oversees and co-ordinates the treatment, who works with the consumer and with the team of professionals associated with the treatment plan and the Area Health Service that serves the area where the consumer resides.
Case management:
‘…represents a set of organising principles for ways of thinking about care; includes a variety of different ways of distributing authority within teams; carries embedded within it certain ethical and moral value systems; contains preferences for where care is delivered; and gives some guidance to the clinician in the presence of the client as to what are more or less desirable activities to undertake’
(Meadows et al., 2007, p. 359).
Follow this link to read the definition of case management from the Case Management Society of America.
As you read through it, notice how similar or different it is to case management definitions within an Australian context.
http://www.cmsa.org/Individual/MemberToolkit/StandardsofPractice/tabid/69/Default.aspx
In your textbook, the authors consider case management and pose the question ‘What ingredients of case management are important? (Fossey, in Meadows et al., 2007 p. 360):
Ten essential ingredients for effective case management
• The case manager should deliver most of the care themselves
• They should work with the community to enable the consumer to build/maintain their lives apart from mental health services
• Care should be community-based, not clinic-based
• Team support and service planning are essential
• The case manager should have primary responsibility for the consumer’s services
• Case managers should be professionals (this is not always the case overseas) and supervisors should be experienced and credentialed.
• Case loads should be realistic
• Lower intensity transitions should be well planned and executed
• Consumers should have 24/7 access to care, if not from the actual case manager, then via an out-of-hours crisis team
Please refer to your textbook (Mental Health in Australia, Meadows et al., 2012) for this topic area.
Read
Meadows et al. (2012):
Read: Case Management chapter. Various models are discussed, and as in the assessment section of the book, spiritual dimensions are listed as important considerations that are frequently overlooked in models, and in practice.
Reflection
Think about where you work. What have you noticed about the type of case management style used in this organisation? What model of case management best fits this style? Is that model based on ‘best practice’ for this type of service? What model (if any) might work better?
Recommended reading
Contemporary Psychiatric Mental Health Nursing – Kneisl and Trigoboff, 2013.
Read the chapter titled dealing with ‘Counselling the Individual’. Planning and implementation is also discussed by these authors as well and case management. Remember that this book is written for nurses; however, the broader information is applicable to this unit.
N.B. In 2009 version of text, ‘Counselling the Individual’ is Chapter 29 (pgs 773-7
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• 3. Treatment planningPage
3. Treatment planning
Principles of treatment planning
There is quite an overlap between this topic area and the topic of case management. Case management and treatment planning are, and should be, interconnected. You cannot effectively case manage (and hope for good health outcomes) without a plan. Similarly, when you are assessing a consumer, thoughts and ideas on the nature of the treatment plan should be becoming obvious.
A consumer is assessed, they may be in need of case management, and a comprehensive plan is drawn up to help them achieve and/or maintain health gains.
Treatment plans need to take into account (and address) the mental illness itself, and its impact on the various domains of the person’s life, i.e. the broader effects of a mental illness. Issues that may need attention to include basic human needs, occupational issues (this can include activities of daily living – ADLs), social interventions, and any necessary interventions/education with support families and/or carers (Meadows et al., 2012).
National standards dictate that the progress of consumers should be reviewed regularly, and consumer outcomes should be regularly monitored. Progress will be enhanced by the consumer’s adherence to the treatment plan, and this in turn is an important determinant of progress and better health outcomes (Meadows et al., 2012).
The importance of ‘peripheral’ issues in treatment planning and consumer monitoring
“Intervention for persons with a mental disorder should begin with attention to meeting their basic human needs. Maintaining continuity of care and effective delivery of any kind of intervention package will depend on the person having some level of support to ensure the meeting of basic human needs, such as food, safe shelter and basic physical health care”(Meadows et al., 2007, p. 365).
“Issues of poverty, irregular and inadequate income, lack of safe and affordable housing options, and discrimination in these areas substantially increase the stress of living with psychiatric disability, acting as barriers to full and successful participation in community life”
(Carling, as cited in Meadows et.al., 2007, p. 365).
These quotes highlight the need to be holistic in considering treatment. Practical assistance can often be the ‘last straw’ issue for a person living with mental illness:
“…not meeting these issues can often undermine a person’s mental health and well-being, and ability to participate in or adhere to other interventions” (Meadows et al., 2007, p. 365).
These types of broader issues need to be taken into account when planning treatment.
Please refer to your textbook (Mental Health in Australia, Meadows et al., 2012) for this topic area.
•
• Reflection & discussion for this moduleForum
Share your thoughts and comments here.
3. Mental disorders, brain chemistry and pharmacology Why are brain chemistry and physiology important in the study of mental illness? We examine some basic concepts of brain chemistry with respect to mental disorders, prescribing of medications, and consumers’ use of licit and illicit drugs. In this topic students will:
• develop a solid understanding of the psychobiological approach to the study of mental illness and will learn to examine the interplay between mental illness and the use of prescription and illicit drug use;
• critically evaluate available public health policy as it applies to the mental health sector;
• gain an understanding of an established theoretical body of the holistic determinants of mental ill health in Australia;
• apply an understanding of the concepts behind brain chemistry as it relates to human behaviour and to mental illness.
• 1. Mental disorders in AustraliaPage
1. Mental disorders in Australia
The National Mental Health Strategy is discussed earlier in this unit. Within the strategy is the mental health policy (see below):
Read details at: http://www.health.gov.au/internet/main/publishing.nsf/Content/mental-pubs-n-pol08
This policy takes into account some of the holistic determinants of mental disorders in Australia. Its scope is broad enough to incorporate federal, state and local government areas and it aims to make a difference across Australia, regardless of locale. It is also broad enough to incorporate the need to consider vulnerable populations in regard to mental disorders.
“Across many areas of government, effort is being directed to achieve greater social inclusion for all of the community – but especially for those groups most at risk of social exclusion, such as those who experience homelessness, Aboriginal and Torres Strait Islander peoples and disadvantaged children. The goal of social inclusion recognises that good mental health is fundamental to the well-being of individuals, families and communities. Conversely, mental health problems and mental illness can cause high levels of disability and reduced quality of life for those who experience them, impact on their families and friends, and can have significant societal and economic consequences.”
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-pol08-toc~mental-pubs-n-pol08-1~mental-pubs-n-pol08-1-3
The scope of mental disorders in Australia
“In a 12-month period, one in five Australians will experience a mental health problem or mental illness. Reducing this will not only have benefits for individuals, but will benefit the whole community through increased well-being and productivity.”
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-pol08-toc~mental-pubs-n-pol08-1~mental-pubs-n-pol08-1-3
• 2. Brain pharmacologyPage
2. Brain pharmacology
Brain chemistry and pharmacology
Unless your profession is nursing, or your undergraduate degree is in biology, you probably do not know much about the intricacies of brain chemistry and of pharmacology. To be an effective counsellor, you do not need an exhaustive knowledge of the biochemistry of the human brain.
I have given you details below on chapters that cover psychopharmacology and psychobiology in depth (the chapters are in the recommended reading, not in your textbook). When you are in need of further information about a particular drug, or drug interactions, you can access a MIMS (at the UNE library, at your workplace, or online).
You don’t need this in-depth knowledge to pass this subject, however. It is beyond the scope of this subject. You do need to understand the concepts behind brain chemistry as it relates to behaviour and to mental illness. The important thing is that you have a working knowledge of how important brain physiology is on:
• mental disorders,
• medications, and
• licit and illicit drugs that consumers may use.
A very good, simple summary of medication can be found in the book
Treatment Protocol Project (2004), Management of Mental Disorders (4th ed.), Sydney, World Health Organization Collaborating Centre for Evidence in Mental Health Policy. It can be found in UNE’s Dixon Library as follows:
Call number 616.891/M266/2004
Author Treatment Protocol Project.
Title Management of mental disorders / Treatment Protocol Project.
Edition 4th Australian ed.
Publication Darlinghurst, N.S.W. : World Health Organization Collaborating Centre for Mental Health and Substance Abuse, 2000.
Physical Details 2 v. : 26 cm.
Pages 109-111 gives a breakdown of drugs, adherence and relapse:
Management of Mental Disorders, pp. 109-111
Chapter 2.1: Medication
2.1.1 Information about medication
When are drugs used?
The aim of drug treatment is to produce an overall reduction of illness. Given that most drugs may produce unpleasant side effects, it is important that the medication produces a great enough improvement of symptoms and functioning to warrant the unpleasant side effects that may occur. The prescribing doctor needs to consider both the long-term and the short-term advantages and disadvantages of using medication, as well as the available alternative treatments and adjunctive treatments (eg psychotherapy). If it is felt that medication will provide an overall beneficial effect, it is usually recommended.
Which drugs are used?
The choice of a particular psychotropic drug (ie a drug that has an effect on the mind) will depend on the individual’s diagnosis. Once a diagnosis or provisional diagnosis has been established, appropriate medication is recommended by the prescribing doctor following consideration of such factors as the individual’s medication history (eg previous response to various psychotropic drugs, potential side effects, adherence1 to medication), and family history of drug response. Each of the major classes of psychotropic drugs is discussed later in this chapter.
What is the optimal dose?
For most drugs the optimal dose is the one that provides maximum therapeutic benefits and minimal side effects. Initial doses, based on clinical guidelines, may need to be adjusted to reach an optimal dose for a given individual. If side effects become a problem, the dosage may be reduced, or other medications that alleviate specific side effects may be added. Alternatively, a different class of drug may be tried.
What is a maintenance dose?
Once symptoms have been alleviated, there is usually a continuation period of months to years. If the illness is likely to be chronic or frequently recurring, a longer-term maintenance dose may be required. The dose will vary from one individual to the next, depending on the balance between symptom control and medication side effects. Additionally, this dose may vary according to psychosocial factors. For example, with schizophrenic illnesses, during times of stress the individual, the case manager, the doctor, and family members may discuss the benefits of increasing the maintenance dose slightly in an attempt to avoid a potential relapse.
The Phases of Treatment
Acute Phase aims to:
• stabilise acute symptoms
• relieve symptoms
• restore previous function.
Continuation Phase aims to:
• maintain stabilisation
• prevent return of acute symptoms
• continue treatment for the duration of the episode.
Maintenance Phase aims to:
• prevent relapse.
Drug education
As with any form of treatment, the individual is required to give ’informed consent’. Informed consent means that the individual is informed about what is involved in the treatment, including its possible side effects, as well as the risks of not using the-treatment, and that they agree to participate in the treatment. Some individuals may be required to take medications against their will as directed by a community treatment order or equivalent (as per mental health legislation), however, the same principle applies of ensuring the individual is thoroughly informed about the treatment. By providing information to the individual, he or she is more likely to appreciate the merits of the treatment and may be more likely to adhere to the programme.
It is the prescribing doctor’s responsibility to gain informed consent and to provide the individual with education about his orher prescribed medication. However, other clinicians can play an important role by providing ongoing education. It is important for the individual to receive information about:
• the drug name and brand name of each prescribed medication
• why the medication is needed
• the effectiveness of the medication
• when and how to take the medication
• any special warnings or restrictions that may apply (eg interactions with other drugs)
• the likely duration of treatment
• the length of time it takes for improvement to occur
• possible side effects
• the importance of adherence and consequences of missing doses
• the importance of determining the optimal dose
• whether or not the medication is addictive
• the need for blood tests or other tests
• alternatives to medication
• monitoring early warning signs of relapse.
Education is ideally accomplished through both discussion and written materials. It will also be important in many situations to ensure that carets receive adequate education about the drug treatment programme.
The NIMH provides information about a range of common psychotropic medications. These can be printed off from their websitehttp://www.nimh.nih.gov/health/publications/mental-health-medications/index.shtml
Encouraging adherence to medication
Drug treatments will only be effective if individuals take the drugs regularly as prescribed. The less regularly the drugs are used, the less effective the medication will be. There are numerous reasons why individuals may not adhere to treatment, including forgetting to take it or experiencing significant side effects. They may have particular fears about the medication,
or there may be problems in the clinician-patient relationship.
In many cases when individuals cease taking their medication and do not relapse immediately, they may believe their medication was not really necessary. However, many medications, particularly the antipsychotics, are very fat soluble and take a long time to be totally cleared from the body. Hence, the individual is still receiving benefits from the medication for some time after stopping treatment. Once the medication is finally cleared from the body, relapse may occur. It is important for individuals to understand such effects so that their decisions about adherence to treatment are based on accurate information.
Adherence to treatment (whether the treatment involves medication or psychological therapies) and suggestions for improving adherence are covered in more detail in Chapter 1.
Monitoring of physical and mental status
Individuals who are taking medication need to be monitored regularly. The aim of this monitoring is to determine whether the drug is having the desired effect, and to assess the presence and extent of any side effects or adverse drug reactions. This monitoring will guide futures,decisions about treatment. The Mental State Examination (see Chapter 1: Core Management Skills) will be helpful for assessing changes in mental symptoms such as mood and thought content.
Failure to respond to treatment
A number of factors can contribute to a suboptimal response to treatment. An approach to apparent treatment failure involves reviewing the diagnosis and checking that any underlying physical causes have been excluded or appropriately treated. Ensure the dosage and duration of treatment has been adequate, and that treatment adherence has been reliable. Addressing alcohol or substance abuse, and relevant psychosocial or personality factors is important. Referral to a psychiatrist may be indicated.
Discontinuation of treatment
It is now recognized that a withdrawal syndrome can occur on ceasing many psychotroplc agents and is not an indication of physical dependence. For the antipsychotics, TCAs, SSRIs and venlafaxine, a flu-like syndrome has been described. More importantly, withdrawal fits can occur with the abrupt discontinuation of long-term, high dose benzodiazepines, or antiepileptics used as mood-stabilisers. Rapid cessation of lithium has been linked with a relapse of mania in bipolar patients. It is important to warn patients of the likelihood of discontinuation symptoms. A slow reduction of medication dose prior to cessation can minimise this.
Early warning signs of relapse
For many recurring illnesses (such as schizophrenia and affective disorders) individuals may be able to recognise certain behavioural or affective symptoms that frequently occur just prior to relapse. These symptoms are called early warning signs of relapse (for further information see Chapter 3: Affective Disorders or Chapter 5: Schizophrenic Disorders).
Individuals who wish to remain drug free or on minimal doses of medication because of unpleasant side effects may be able to learn to monitor these symptoms. If early warning signs occur, the individual promptly resumes medication at a predetermined level as discussed with his or her doctor and seeks immediate medical advice. This treatment is called targeted drug maintenance and is usually reserved for those individuals who have remained stable and symptom-free for a considerable period of time. Using this treatment regime, relapse may potentially be prevented or the severity of the episode reduced. Often, however, it is not possible to prevent a relapse from worsening, even if early signs are recognised and treated.
View this information in PDF format.
Stigma and brain chemistry
Why is stigma important in a discussion about brain chemistry and pharmacology?
We have discussed stigma at length in this unit. In this topic area, stigma is once again important.
“Understanding the working hypotheses of psychobiology is important for removing the guilt and stigma associated with psychiatric disorders.”
(Kneisl & Trigoboff , 2009, p. 83).
Often when you are part of a treating team, you will have to commit to psychoeducation of the consumer, the carer or the consumer’s family.
“A major barrier that inhibits clients and families from seeking care is stigma. Stigma results from lack of knowledge, misunderstanding how a severe mental disorder comes about, and not a small contribution from media sources that sensationalize events and demonize those who are ill.”
(Kneisl & Trigoboff , 2009, p. 83).
You will need a working knowledge of brain chemistry to help you understand the processes at play, so that you can use this conceptualisation to raise the issue with those in your care.
Medication non-compliance is also an area where you will need some knowledge of brain systems and psychopharmacology. A consumer, their carer or their family will often not want to take the medication prescribed, and if you are case managing them, this becomes one of your challenges. You will have to have enough knowledge to relay how the drug works (broadly) and why it has an effect on the mental issue at hand.
“Teaching clients and families about the biological aspects of the disorder increasestheir understanding of the illness and its treatment, and can increase the client’smotivation to continue to seek appropriate treatment.”
(Kneisl & Trigoboff 2009, p. 83).
Multidisciplinary teamwork
A chance to enhance skill building and information sharing
Chances are, you will be a part of a multidisciplinary team (see Module 1). Part of effective case management and counselling is the ability to work in a team. Use the opportunity to ask colleagues and team member’s questions about medications, questions about drug interactions, and questions about best practice. This can be integrative, it can solidify a team, it will education you about pharmacology, and it will lead to better health outcomes for the consumer.
Holistic psychiatric mental health practice
The importance of looking further than just the biological when considering mental disorders
While it is important to remember the importance of brain chemistry, it is just part of the whole. We have to consider body, mind, brain and behaviour. Integrating psychobiological principles enhances the goal of holistic psychiatric mental health practice (Kneisl & Trigoboff 2012).
There are no specific sections in the textbook on brain chemistry and pharmacology. These readings from the Kneisl & Trigoboff text are recommended to extend your knowledge of these areas.
Read
Kneisl & Trigoboff (2012), Contemporary Psychiatric Mental Health Nursing:
• Psychobiology, Behaviour and Mental Disorders
• The Science of Psychopharmacology
N.B. in 2009 version of text:
• Psychobiology, Behaviour and Mental Disorders (Chapter 6)(also in e-reserve)
• The Science of Psychopharmacology (Chapter 7)
•
• Reflection & discussion for this moduleForum
4. Evidence-based practice in mental health
This module examines principles of best practice in delivery of mental health care. In this topic you will:
• learn about the principles of evidence based best practice and develop the confidence to apply established theories in order to deliver effective mental health care;
• compare and contrast the concepts of rehabilitation and recovery and discuss the key distinctions;
• critically analyse the current literature on relapse prevention and make available to consumers the appropriate evidence based literature in order to support the clients’ ongoing wellbeing.
• 1. Principles of best practicePage
1. Principles of best practice
What is best practice?
“Best practice is defined as a comprehensive, integrated, and cooperative approach to the continuous improvement in all areas of an organisation’s operations.”
(Meadows et al 2009, p. 264)
When we want to use data to help us decide on services/approaches/models, we have to be sensitive to the various ways in which data can be misleading. Evidence-based practice can help with that.
“In order for us to maximise the use of scientific information, it is necessary for us to have a useful set of rules. For some guidance as to how scientific investigation may be translated into assistance in clinical decision making, we will look to the domain of practice known as evidence-based practice (EBP).”
(Meadows et al 2009, pg 137)
In general, when we talk about scientific enquiry and ‘evidence’, we are essentially discussing statistical significance and randomised control trials, double blind studies and so on. In the real world, when dealing with mental disorders, and case management, it is not always possible to only rely on data from randomised studies. Advice and direction are needed in the meantime. Therefore, the clinician may bear in mind the levels of evidence upon which particular clinical decisions are based, and a ‘hierarchy of evidence’ can be considered to support decisions (Meadows et al 2009). Meadows et al (2009) give details on a ‘five levels of evidence’ approach, which can help with weighing up evidence.
A classification systems known as the GRADE system, which stands for ‘Grading of Recommendations, Assessment, Development and Evaluation’ (Guyatt et al 2006, as cited in Meadows et al 2009) takes more features of the literature into account than the ‘five levels of evidence’ system does. Importance of the outcome, size of the treatment effect, methodological quality, risks, burden, costs and personal and social value are incorporated.
Here is a link to an article on the GRADE approach to evaluating data, written by Dr. Gordon Guyatt (one of the developers of the system):
http://www.bmj.com/cgi/content/full/336/7650/924
“The posture of evidence based medicine is that the clinician uses the best available evidence to guide the decision. Additionally, the evidence based approach may involve sharing with the consumer the kind of evidence that is being used to guide the decision, and this is especially important in situations where recommendations from guideline literature should be seen as weak rather than strong”
(Meadows et al 2009, pg 137).
* This topic (best practice/evidence-based practice) is largely covered in HSMH423 and HSMH424, with a strong emphasis on evidence-based practice.
Please refer to your textbook (Mental Health in Australia, Meadows et al, 2012) for this topic area.
Read
Meadows, Singh & Grigg text (2012):
• Chapter titled Evaluation and the Concept of Quality – has a subsection ‘Quality in Practice – Processes’.
• Evidence – based practice (refer to text’s index for page numbers) – an overview of evidence based practice, including the origins of the approach. This section includes the ‘Five Levels of Evidence’ and leads on to a section on ‘Evidence and formation of Mental health Policy’.
Recommended:
Kneisl & Trigoboff (2012), Contemporary Psychiatric Mental Health Nursing:
• Section titled ‘Why is Evidence Based Practice Important?’ Subsections include Best Practices Based on Evidence, and Critical Thinking and Evidence Based practice. There is a ‘self-awareness’ exercise to do which prompts you to assess how ready you are to engage in best practice.
N.B. In 2009 version of text – Chapter 4 (p. 48)
2. Illness management, recovery and rehabilitation
* The two sections of this module are covered in detail in the unit HSMH424 Promotion, Prevention & Intervention in Mental Health.
This image shows the link for the National Standards for the Mental Health Workforce, from the Department of Health. This section deals with Relapse Prevention. Follow the link below to read the information. You will see that evidence base is an important consideration when making decisions related to assessment, treatment, relapse prevention and support:
View details at:
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-n-workstds-toc~mental-pubs-n-workstds-gui~mental-pubs-n-workstds-gui-7
Rehabilitation and recovery
Please be aware that rehabilitation and recovery are not the same.
The key distinction to make is between recovering and recovery:
“The recovery process is the foundation upon which rehabilitation builds, whereas what workers do is facilitate recovery”
(Anthony 1993, as cited in Meadows et al 2009, pg 48).
The general goal of rehabilitation is to help people with mental illness to regain their rightful place in the community (SANE 1999 as cited in Meadows et al 2009 pg 47). Core functions of rehabilitation include empowerment, opportunities for learning skills (or re-learning skills), and connecting with the community (SANE 1999 as cited in Meadows et al 2009 pg 48).
“…the principal purpose of psychosocial rehabilitation programs is to enable people with mental health issues to live fulfilling lives, which will necessitate accomplishing real community integration and restoring the full citizenship of people with mental illness and in turn means discrimination and social exclusion must be addressed. The community development approach to rehabilitation offers a community practice framework for finding potentially effective ways to address major social barriers to real integration in community life”
(Meadows et al 2009, pg 49).
Evidence-based practice and case management
In your textbook, page 359, best practice and evidence based care are discussed. The functionality of case management has been a topic of research for quite a while. An interesting finding (from the literature) presented here is that of comparing levels of contact within case management. The basic elements of case management were adhered to, including monitoring, review, and assertive response to default. But when intensive contact and standard contact were examined, no major differences were found in the outcomes.
“Merely increasing the time spent with someone in case management does not appear, in and of itself, to make any substantial difference” (Meadows et al 2009, Pg 360). It seems the quality of contact is most important, and this is a decision we can make because of an evidence base.
Further reading
Recommended
Treatment Protocol Project (2004), Management of Mental Disorders (4th ed) Volume One, World Health Organization Collaborating Centre for Evidence in Mental Health Policy.Sydney:
• This book is a handbook for clinicians who are treating consumers in the community. This volume (volume 1) deals with Core Management skills, medication, affective disorders, and anxiety and somatoform disorders. It relies on the principles of best practice.
Recommended:
Kneisl & Trigoboff (2012), Contemporary Psychiatric Mental Health Nursing:
The Critical Thinking exercise based on evidence based practice. It deals with a case study of an adolescent who has overdosed on medication. It incorporates ‘multiple intervention strategies based on research’. The vignette poses prompt questions for students to consider in relation to the case study, and how they would ‘follow-up’ with this consumer.
Length: 2000 words
Weight: 40%
Learning outcomes:
This assessment task covers learning outcomes 1, 2, 3 and 5:
• Appreciate the necessary theoretical, legal and ethical frameworks for mental health practice;
• Understand the need to support the rights of people with mental health issues and their carers to access and participate in their care and recovery;
• Promote positive images and challenge discriminatory stereotypes of people with mental health issues; and
• Describe best practice in terms of evidence-based interventions for mental health promotion, prevention, early intervention, illness management and recovery.
.
Case study: Bronwyn
For this assignment you need to view this video (7:22
he rationale for choosing this vignette as a base for your case study assessment item is because we can see the effects of Bronwyn’s mental health issues (from 15 years old) over a span of time. This means that you can then benefit from a retrospective case study.
Case study background
The interview with Bronwyn shows Bronwyn being very honest about her life, her trials, and her experiences living with depression. Bronwyn goes into detail about her experiences when she was 15 (before her diagnosis of depression, in her 30s, around 35 or 36), which was ‘an incident’, an overdose in an attempt at suicide. She tells of the trip to the emergency department, and her transfer to the Adult Psychiatric Unit. She also weaves this experience throughout her interview, and it becomes clear what an impact this incident had on her life.
Task
Imagine that Bronwyn (at 15) is about to be released from the Adult Psychiatric Unit into the Area Health Service where you work as a counsellor. You are part of a multidisciplinary team, but it is you who will be Bronwyn’s case manager.
1. Bronwyn will have been assessed and diagnosed in the psych unit. Describe and evaluate this process, and state what the underlying principles of assessment and diagnosis are. (400 words, 5 marks)
2. As Bronwyn’s case manager, discuss the theoretical, legal and ethical frameworks that will guide you in your dealings with Bronwyn. As part of this, outline the types of legal and ethical issues you will need to take into account in the planning for her care and recovery. (400 words, 5 marks)
3. What other issues will you have to take into account for Bronwyn’s reintegration back into her life outside the psychiatric unit?(400 words, 5 marks)
4. What rights will Bronwyn (as a 15 year old) have in regard to her treatment? What issues need to be taken into account in this regard? (400 words, 5 marks)
5. It was obvious from the video that Bronwyn felt disempowered when younger. What strategies could you employ to help deal with this? (400 words, 10 marks)
Presentation and Communication. This mark will take into account how your ideas are expressed (clearly , succinctly, logically, objectively), spelling and grammar, referencing, how effectively you have cited relevant scholarly literature, and whether you have critically analyzed the content in respect to the task. (10 marks)
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