Patient Case Management
History and diagnosis
There are certain vulnerabilities that expose certain populations to health problems notable mental problems. Epperly& Kevin(2000) describe vulnerability as a state in which an individual, a population or a group of populations are exposed to increased probability of harm. This susceptibility to harm arises from the relationship or the lack of it of individuals with certain resources available as well as the life challenges they face. Vulnerability also results from problems encountered in development, social status and in adequacy of supports. Although culture and other social as well as economic factors are significant factors that influence a person’s access to appropriate mental health care, there are some other factors that also matter. These include but are not limited to age, race, ethnicity, nationality, physical, mental or language ability, gender and gender identity, sexual orientation, religion and spirituality, education and marital status.
In this particular case the vulnerable population encountered is people who are gender and sexually diverse. McKinley Health Center (2008) defines these populations as including but not limited to people who consider they to be gay, lesbian, bi-sexual or transgender. This means that they do not exclusively consider that sexuality should be experienced in heterosexual pairings. The gender and sexually diverse populations in Alberta is [particularly considered in his case. Statistics Canada (2004) revealed in a 2001 census that 1.2% of Alberta residents consider themselves to be in this category.
Mental health client hails from this background and believes himself to be both gay. He is physically attracted to people of the same sex. The client is in his late twenties and presents as anxious and fidgety with a general rugged and untidy appearance. The client also seems tired and sleep deprived.
Diagnosis of the client was done using the DSM-IV –TR as a diagnostic framework. Under axis 1 of the framework the patient was diagnosed with severe delirium. The patient seemed to be experiencing a lot of confusion. He had many lapses in attention during conversation and seemed to generally have many memory gaps. The client seemed to experience a lot of problems in concentrating and his attention kept wandering. His incoherent speech revealed disorganized thinking. Similarly under axis 1 of the diagnostic framework, the patient was diagnosed with a substance abuse disorder. The patient confessed to the health care giver that he had an addiction to alcohol. He was also observed to constantly ask for a drink of alcohol. After a while without the alcohol the client was observed to exhibit tremors especially in his limbs. He also complained of severe headaches.
Under axis 2 of the diagnostic framework, the patient was diagnosed as having a mild anti-social disorder. He kept to himself and did not seem to have any social skills. Axis 4 of the DSM helped to diagnose the patient as having had a sexual –abuse related disorder. A talk about his history with therapist revealed that the patient had been physically and sexually abused in his childhood.
The patient comes from a family which has experienced divorce. He therefore has had to grow up with his mother and an abusive step father. He currently lives with his ‘life partner’ a man, under a homosexual union. The client has been unable to hold down a steady job or develop a meaningful career. As such he has been doing menial jobs, which he changes every two months. His dependence on alcohol seems to have affected every sphere of his life, including his social life and his employment ability. He has been involved in crime in a bid to satisfy his addiction. He has stolen money from an employer. For this crime he has been arrested and heavily fined. The patient‘s life seems generally in disarray and he is in dire need of intervention by healthcare givers. The client is however well educated and has a university degree.
Treatment plan
Given the complexity of the client’s case. It is necessary to ensure that treatment is approached from a multi-dimensional perspective making sure that all areas old the client’s health are considered and that factors that have been contributory to his current situation are adequately addressed.
Issues of culture that may be encountered have to be properly addressed and care taken to ensure that sensitivity to certain cultural aspects is observed (Fernando , 2003).It is important that the healthcare givers learn about the person’s culture and their concept of mental illness. This will greatly guide the healthcare givers on how to approach treatment and how to communicate the need for the same to the patient. A person’s culture plays an important role in how they perceive and understand mental ill health which in turn affects how they respond top treatment given. This view will also determine the extent to which they choose to involve their family and friends for support. Being from Canada, which is quite western in terms of culture, it is expected that the client understands mental health in a broad context, as part of general well being. Being fully educated, it is also expected that his literacy levels play a contributory role in his understanding of mental health as a physiological and psychological issue as opposed to spiritual issue like other cultures might suggest. However, it is important that the healthcare givers try and understand the client’s personal perspective concerning mental ill health .Since the client identifies himself with the gay community it is important to find out how mental ill health is viewed within this community and to respect heir views on the same. This will be especially important when dealing with matters concerning sexual abuse in his childhood. It is very important that healthcare givers appreciate the client’s view of his own condition and appreciate the potential effects of this on the progression of the treatment ( Fernando, 2003).
Treatment of the patient also needs to take into consideration the psychosocial factors relevant to the client so as to determine their potential effect on the client’s general treatment process and his response to the treatment .in this case, psychosocial factors basically refers to how psychological factors as well as sociological factors influence the patient treatment. These are important considerations to make for the healthcare providers especially when making decisions concerning pharmaceutical as well as therapeutic interventions. This is because presence of certain psychosocial factors may not interplay well with certain therapeutic interventions or make it hard to implement certain pharmaceutical prescriptions properly (Wolf, 1998).
. In this particular case, since the client has a substance abuse disorder, this is likely indicative of psychosocial contributor factors. Physical and sexual abuse in his childhood is another psychosocial factor that is likely to affect the clients’ reception and response to treatment. As such this should be considered in the decision concerning what kind of treatments and interventions are best for the client. Medication in this case should be accompanied by different kinds of therapy. For his alcoholic dependence for example, it is advised that group therapy might be helpful. Groups such as Alcoholics Anonymous are known to be quite helpful. Counseling is recommended as a front line treatment for this patient. Counseling and talk therapy is recommended (Adams, 2009).
A combination of both psychotherapy and behavioral therapy and group therapy are recommended for the client so as to get down to the root of his problems, deal with them and undertake a behaviour modification treatment. This provides a complete and wholesome intervention. Finally, therapy or counseling may be administered by social workers, nurses, licensed counselors and therapists, psychologists, or psychiatrists. For the delirium disorder, psychoactive medication may be prescribed and supplemented by therapy and support. Rehabilitative treatment may need to be considered for the client as concerns his alcohol dependence and he may therefore have to be contained in the hospital or in a rehabilitation center so as to avoid exposure to the same conditions that encouraged the dependence.
Family and friends who may be able to provide support for the patient should be involved in the process of treatment administration to provide support and encouragement(Adams, 2009).. They also need to be advised to not expose him to conditions that would be detrimental to treatment offered .alternative treatment are also encouraged so as to aid normal treatment. These may include creative processes such as art and sport that help the client to explore his talents. This may help the client to express the client to express emotions and may also provide insight as to client’s prognosis as he continues to get more involved in them. It is also important that a medical history of the patient’s family be considered so as to put into consideration any inherited traits that may be of importance in treatment.
If the condition of the client is seen to need further expertise especially when dealing with pharmacology and psychotherapy, it is incumbent upon the physician to provide a referral. Therefore in this case, if any of the client’s issues are seen to need further expertise then it is advised that a referral be made immediately and all necessary clients’ information be provided to the new health care giver.
Care plan for Patient
Once the patient is approaching the time of discharging, considerations have to be made for the kind of care that the patient will receive after being discharged. It is therefore necessary to develop a health acre plan for him. This will make it possible to explain the kind of support to be provided to him by the different health care experts .The plan gives details about the kind of health acre to be given to the client and at what point these services are to be given. It will also advise on actions to be taken incase the patient faces a crisis related to his condition or treatment provided.
The care that will be needed for the mentally ill patient might involve different support systems and organizations. These may include professionals such as therapists, psychologists, psychiatrists and other healthcare providers. There needs to be a consistent effort on the part of these professionals to complement each other for the sake of the patient’s well being. The health care plan outlines ways in which this can be possible. The role of each health care giver is clearly outlined in the health care plan.
In this particular case, the mental health care needs of the patient are assessed. Different health care needs are identified to deal with the patient’s psychiatrist disorders of delirium and substance abuse. A health care plan is drawn to deal with the delirium. Appropriate medicate is suggested and prescriptions given. Therapy needed to mange the patient’s alcoholism is prescribed and the appropriate health care professional needed to handle the same recommended. Background information concerning the client that relates to these problems are also provided.
Psychotherapy for the sexual and physical abuse that happened in the patient’s childhood should be dealt with by a professional who can exhaustively deal with the issue. The same should be outlined in the healthcare plan as well as a suggested professional for the same. A brief background of the situation should be outlined in the health care plan so as to make sure that whichever professional handles the patient will be able to fully understand the patient’s history as is relevant to the case. The ideal outcomes for this therapy will be outlined. Since the patient will require different kinds of therapy, including group therapy and individual personal psychotherapy sessions, this will have to be detailed in the health care plan.
The mental health outcomes and assessment a tool (MHOAT) is an initiative created to better eh quality and efficiency of clinical information that is provided and circulated among health acre professional. It aims to make clinical information protocols uniform across the different professions so as to make clinical information easy to understand between one professional and another. Introducing uniform clinical information collection protocols. The systems makes the recording of clinical information as well as the documentation involved uniform so as to make retrieval of information as well as the understanding of it easier at any point of health acre or whenever it is needed. It also helps to keep an accurate record of outcomes of treatment at different stages and for different professionals or systems of support for the patient. The system has made the way health care givers and customers work standard and hence more efficient. The fact that information is made standard also improves communication between one physician and another as well as helping the patient to know what health care they are supposed to receive. Information obtained by the use of MHOAT may be assessed to provide future improvements in service. The consumer or patient will be given an opportunity to complete a self –report measure. This will basically consist of information concerning their health and how they feel. This information is necessary because it is collected in a standard way. In this regard any healthcare professional is able to interpret the data in a uniform way and in a way that other health acre professionals can benefit from. In this case, the consumer will be given a Kessler-10 from to complete because he is an adult. Filling of the form is optional and will not affect treatment received. However it is recommended that the consumer fills it in. information provided in the form will be treated confidentially and will be come part of the patient’s medical information.
The emphasis of the MHOAT is on patient needs other beyond anything else. Therefore here is form of partnership between the clinician and the consumer to make sure that adverse conditions are reversed. Discussions will therefore be open between the clinician and he consumer about what the best ways are for his recovery. It is important that the insights of the consumer are included in the treatment.
The patient needs to kept on twenty four hours watch to make sure ha he does not relapse in to alcohol abuse. Due to the extensive nature of his alcohol dependence, he may need to be medically weaned off the alcohol dependence by the use of drugs (Wolf , 1998). The patient will also need a lot of support from close friends and family as well as the health care personnel and health care givers in general. This is because his condition is very fragile and is likely to take a great emotional toll on the patient. The treatment period should therefore be complemented y a lot of support. In this regard, health care givers should liaise wit the family and friends of the consumer to make sure that they know how to treat the patient so as to make possible a quick recovery. Suicidal ideation should also be closely monitored in the consumer as he may experience the same during the process of recovery. The consumer should also be closely watched for attempts to harm themselves.
Justification of health care plan recommendations
In justifying g the patient’s need for counseling and various forms of therapy it is worth noting that counseling and therapy is one of the most effective treatments to mental illnesses. (Feltham &Horton, 2006). As a matter of fact many individuals have experienced relief from almost half of all their symptoms simply through counseling. The effect of counseling on the emotions is profound. Therapy provides a form of cathartic release for the consumer especially if the therapy involves the open sharing of feelings. It is possible for the consumer to feel hear and to have his feelings given a voice. In this particular this justification is used for recommending that he go through various forms of therapy. Therapy is also able to provide a way through which a consumer can access feelings that he may not yet have explored. He is then able to deal with them as they surface and this is able to provide a form of release for him
The recommendation of group therapy for to deal with the consumers substance abuse problem is justified by the fact that group therapy has been used over the last few decades to deal with substance abuse successfully. Groups such as the Alcoholics Anonymous for instance have helped many people world wide. This is because they are able to provide a support mechanism to the consumer of people who are going through similar struggles, it then provides a way in which participants may derive strength from each other ( Cooper, 2008).
However it is recommended that if the consumer’s alcohol dependence has gone past manageable levels then he should be medically weaned off the alcohol so as to prevent shock to the system. ( Adams, 2009).
References
Adams, A.J. ( 2009), Undrunk: A skeptics Guide to AA.Minnessotta:Hazelden.
Cooper, M. (2008). Essential Research Findings in Counseling and Psychotherapy: The facts are
Friendly.London:Sage.
Epperly, T.D., and Kevin E. M. (2000)”Health Issues in Men: Part II. Common Psychosocial
Disorders.” American Family Physician.62: 117-24.
Feltham, C. Horton, I. (2006) . The Sage Handbook of Counseling and
Psychotherapy:London:Sage.
Fernando, S. ( 2003) Cultural Diversity, Mental Health and Psychiatry: The strugl eaginst
Racism.NY:Brunner Routledghe.
Inouye, S. (2007).Delirium and other mental status problems in the older patient. Pa: Saunders
Elsevier; 2007:chap 26.
Wolf, L. F. (1998).Mental Health Services and Vulnerable Populations.Carlifornia: Diane
Publishing.
