Human Development in Evidence-Based Psychotherapy Case Study

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Introduction

Though human health is critical in societal growth, human development has been facing insistent challenges for a long time. For instance, HDR (2015) accentuates that unending poverty, inequalities, climate change, and challenges resulting from the lack of environmental sustainability significantly hamper human development. Eventually, employees fail to give their best in their workplaces, thus leaving their potentials unutilized. Many youths, women, and persons living with mental disorders are disadvantaged, consequently turning out to be an eminent setback in human development. If all human potential is fully tapped and earnestly utilized using efficient approaches and procedures, human life would be bettered and eventually heighten the fight against human development challenges. WHOQOL-BREF, McGill Quality of Life Questionnaire-Expanded, Mental Status Examinations, and Clinical Interviews effectively assess the mental health status. Judiciary, government, medical and religious institutions play a significant role in assisting people living with mental disorders.

The working environment plays a significant role in the improvement of human life. For instance, workers in risky workplaces are susceptible to being abused, losing their lives, losing identity and autonomy (HDR, 2015). Though technological advancement has brought about various achievements in society, it has attracted an equal measure of disadvantages such as reduction of workers, short-term contracts, thus adversely affecting the mental development of human beings. According to WHO (2013), mental health is a crucial part of the healthy development of a human being. Health encompasses the mental, social and physical status of a human being and does not necessarily focus on the absence of diseases. Mental health is highly affected by different socioeconomic aspects that need concentration for improvement, prevention, treatment, and healing. It is worth noting that human development cannot isolate the mental well-being of human beings since the former plays a significant role and needs adequate attention.

Consequently, the aspects and parameters entailing the patient’s mental status in San Antonio, TX, are considered. Different evaluations to determine the risk and severity the patient has on mental disorders are carried out. Telemedical services were done using Zoom and psychiatric services provided by Doxy healthcare. The whole exercise calls for direct, indirect, and observable approaches that amount to more effective mental health development and recommendation to the client.

Summary of Experience

The patient participated in the assessment voluntarily. The evaluation of the patient entailed the use of WHOQOL-BREF, which involved the subjective examination based on the cultural, environmental, and social perspectives. The WHOQOL-BREF was applicable since it gives an exhaustive review of a patient’s quality of life. However, the approach can occasionally be tedious owing to its practicability due to its length. The tool was effective since it could help provide comprehensive results based on the patient’s domain levels. The questions remained in the order they appeared in the original WHOQOL-BREF. Instructions and headers were to remain unaltered too. The WHOQOL-BREF yearns to help medical practitioners to make the right judgments on the aspects of the disease.

The Wesley was requested to fill in a McGill Quality of Life Questionnaire-Expanded (MQOL-Expanded), which had eight items that were significant in giving more information about the patient for better assessment. The response of the patient was anchored on an 11-point scale that ranged from 0 to 10. The MQOL-Expanded was admissible since it could also give a holistic identification of the quality of life of a patient who has a mental disorder. The assessment also evaluated primary life domains (feelings such as the burden, healthcare, cognition, and environment) and their relationship with the commonly considered ones (spiritual or existential, social, psychological, and physical).

The patient was also subjected to a mental status exam by Doxy healthcare. During the assessment, focused questions and observations were used to establish the health status of the patient. Though the results could have occurred in the context of a mental status examination, the whole process was such that it painted a clear picture of the patient based on appearance, cognition, thinking, and emotions. Indeed, information from a mental status exam can be combined with that of family and individual historical background help in the establishment of timely assistance to be accorded to the patient.

Name: Scott Wesley
Gender: Male
Age: 34 Years
Marital Status: Divorcee

Ethnicity: African American
Occupation: Accountant
Educational Level: College
Diagnosis: Phobia Related Disorders, Panic Disorders, and Post Traumatic Disorders.

Assessments
WHOQOL-BREF
McGill Quality of Life Questionnaire-Expanded
Mental Status Examination
Clinical Interview
WHOQOL-BREF (Formal)
Physical Health: 13.16% (Severe)
Psychological Health: 17.33% (Severe)
Social Relations: 16.23% (Severe)
Environmental: 33.75% (Severe)
McGill Quality of Life Questionnaire-Expanded (Formal)
Physical health: (My physical symptoms were) 13.15% (Severe)
Psychological Health: 10.32% (Severe)
Existential Health: 38.23% (Severe)
Social Health: 3.14% (Severe)
Environment Health: 40.26% (Severe)
Cognition Health: 14.24% (Severe)
Health Care: 13.35% (Severe)
Burden: 94.24% (Severe)
Mental Status Exam (Informal)
General Observations

Appearance: The patient was well dressed according to the current weather conditions. He had put on polished shoes and had tacked in his shirt. However, he had uncombed hair.
Speech: His speech was articulate, unequivocal, and in line with the interview context.
Behavior: He was calm during the assessment
Cooperativeness: He was very cooperative throughout the assessment. He was not rude and always asked for more clarification if he did not understand something in the evaluation.

Thinking

Thought Process: The patient was not much focused as he consistently reported that his life was meaningless.
Thought Content: The patient reported that he had found life meaningless and, on several occasions, contemplated committing suicide. He narrated how he always attempted to take away his life by taking poison whenever he was depressed.
Perceptions: The client reported having hallucinations based on visual and auditory aspects.

Emotion

Mood: During the assessment, the patient reported cases of being easily startled, tensed, and having anger outbursts. He said he was quickly irritated by colleagues at work and his friends.
Affect: The patient was sad, anxious, and easily angered.

Cognition

Attention: Once in a while, the patient could lose concentration, and his mind would go blank.
Memory: The patient always had flashbacks that relived traumas once in a while during the assessment. The recall ability was interrupted often, and he could use unrelated words during the evaluation.
Insight: The patient was much aware of the illness, though he felt that he did not believe that his life would be better. He was pessimistic and thought that he was not well prepared to face the future.
Judgment: During the assessment, it was established that the patient had good judgment.

Clinical Interview
Wesley reported that he started having hallucinations while at the age of 19 while living with his parents at home in San Antonio, TX. His parents were of African American race and lived peacefully. The patient was the only child to his parents and was much loved. He could attend school without many challenges since his parents provided for his fees and had enough money for his personal effects. However, as they were at home with his parents in one night, six armed robbers attacked them and demanded cash lest they kill all of them on the spot. Wesley’s parents only had $150 in their safe, and his father pleaded with the robbers to accept the available money and spare their lives. Indeed, as Wesley confirmed, his parents only had little money since he had requested them to give him some money during the day, but it was not possible. The armed robbers could not believe that his parents only had $150 but were enraged and threatened to slaughter his mother if his dad did not give them more money. After some lengthy discourse, one of the armed robbers went straight to his mother and split her throat using a knife. Unfortunately, Wesley’s father started to wrestle the robber who had attacked his wife. That is when the other robbers shot his father. After that, the robbers left their house without taking anything and told Wesley that they would return for more money and commanded him to look for more money. After the robbers had left the house, Wesley called the police. However, his two parents died on arrival at the hospital just in front of Wesley. That is when Wesley started to feel insecure since he feared that the robbers would later attack him. After three weeks, five suspects were arraigned to court in connection to the murder of his parents but were later released for lack of evidence. This scenario worsened Wesley’s condition, and that is when he became more depressed. He was indeed more depressed to the extent that he had to marry purposely at the age of 21 as a way of consolation. Unfortunately, after three years, they parted ways, and he was left alone in the house. All the time, he was feeling scared, thinking that the robbers, who were at large, would have an impromptu invasion at home and kill him the same way they did to his parents. His health conditions worsened, and he was taken to a rehabilitation center, where he was released after eight months. Upon returning home, he found new tenants had occupied the house due to his accruing rent arrears. He was forced to seek accommodation from one of his classmates in the town. However, he was very depressed and always reminisced about how robbers killed his parents in front of him, and he could not offer any assistance. He always recalls that he was the one who left the gate not closed on this fateful evening, and that made it easy for the robbers to get into the house and kill his parents. All along, even though he was working at a local company as an accountant, he always feels guilty that he contributed to his parent’s death by leaving the gate unlocked, something that made the robbers quickly attack and kill his parents. He also recalls that the robbers might be trailing him and could likely kill him any time since they were released for lack of evidence. He has been depressed for a long time, often hates himself, and feels that life is valueless.
Coping Confidence Questionnaire (Formal)
The results from this assessment showed that he scored 30 of the possible 72 points. The results indicate that Wesley had low levels of confidence and self-worth and was helpless when faced with any slight challenge. He was also unable to cope with the uncertainties in life and felt that suicide would be the ultimate solution to his anguish.

Mental Health Action Plan

Identified Need	Goals	Referral or Treatment
Physical needs	Increase energy and reduce Wesley’s dependence on taking medication.	Doxy is offering guidance on how Wesley will fight depression without depending on drugs.
Psychological or Spiritual	Look for a good psychiatrist who will offer him better services Doing another analysis of the sickness to ascertain whether the drugs used by the patient were suitable. Having him resume church attendance	Doxy offered the psychiatrist, and so far so good, Wesley has had many appointments with the doctor either physically or through zoom. Ask him to propose the church he felt was suitable for his health improvement and link him with the church leadership for spiritual nourishment and counselling.
Social	Increase Wesley’s socialization ability and help him make more friends. Family counselling. Help him improve his attendance at social events.	Establish social events with other young people and encourage him to be an active participant. Organize with renowned family counsellors to help him get advice on how to improve his social life and take life positively. Encourage him to attend Youth seminars organized by the church to help him improve his socialization and make new friends even of the opposite gender.
Environmental	Help him to look for a more secure place. Make the working environment suitable for his health improvement.	Apply for different community-based organizations that can help him access affordable accommodation. Help him regain hope in life and encourage him to enroll for an undergraduate degree in accounting for career growth. Liaise with his employer to ensure that the working environment is suitable to help him recover.
Progress on Action Plan	Physical Encourage him to partake in workouts or/and participate in games. Currently, completing the dose given ago though, at the same time, Doxy is helping him make other considerations Psychological He had an appointment with a psychiatrist from Doxy The psychiatrist gave him some prescriptions and encouraged him not to remain indoors but to mingle with friends. He started to attend church every Sunday and had an introduction to the youth ministry in the church. Three youths were assigned the responsibility to be his closest friends. Environmental The church leaders helped him reside with the church pastor to make him feel more secure. The company manager at the workplace ensures that Wesley is accompanied most of the time and always gets assistance.

Principles Guiding the implementation of Health Action Plan

People with mental disorders deserve medical attention regardless of their social status. According to WHO (2013), persons with mental challenges deserve essential medical and social services. The services offered to these people must not be based on their race, ethnicity, age, gender, or status in society but must be in line with the principles of equity. People with disabilities must be allowed to access medical services without being exploited. Still, the community must give them opportunities to recuperate and attain the highest possible levels of health improvement. Wesley, who happens to be grappling with a mental disorder, needs to be given access to medical and social attention without looking at his daunting background.

Furthermore, Wesley feels worthless because he has nobody to call a parent and only depends on a meagre salary from his accounting job. Services accorded to Wesley must not be based on his financial status since his salary cannot sustain him and still cater for his medical services. Social services rendered to him must not be dependent on his racial group bearing in mind that he is of an African American race. Wesley, a divorcee, has the right to access medical services now that he is still trying to come to terms with his broken marriage. The church leaders are doing their best to ensure that Wesley feels well accommodated among the church members and workplace and is under continuous monitoring by the church pastor and manager. The psychiatrist, from Doxy Medicare, offering services to Wesley, is conscious that medical services rendered to the patient are not supposed to be based on the patient’s socioeconomic status but with equity. The church, workplace, and psychiatrist are doing their due diligence in ensuring that Wesley gets the necessary support regardless of his daunting background.

Human Rights

As a person with a mental disorder, Wesley must access all human rights under the dictates of the laws protecting people with disabilities. The medical and social interventions accorded to Wesley must be as per the Conventions on the Rights of Persons with Disabilities (WHO, 2013). Wesley is in dilapidated health status and is unconscious of his rights as a patient with a mental disorder. Wesley must be given medical attention without being discriminated against based on his medical situation. The patient must get the necessary assistance to help him live independently in society by offering necessary help without discrimination. Wesley has a right to an inclusive education system to improve his life by furthering his studies. The rights for people with mental disorders are congruent to those living with disabilities. Thus, Wesley must have access to rights safeguarding people with mental illnesses to help him have an independent life while accessing an inclusive education system.

Additionally, Wesley needs protection against all forms of mistreatment. Wesley must be protected against exploiters since he has a mental disorder and lacks sufficient reasoning capabilities to discerning any hazardous ploy meant to exploit him. The patient needs protection from scammers who might lure him and defraud him his few resources. He also needs shielding from exploitation at his workplace and in his community. It is imperative to inform those around Wesley to protect him from abuse and violence. Since he suffers from mental challenges, some of his decisions and actions might be irrational and agitate those around him. Thus, he needs protection from being assaulted. Since Wesley has a mental disorder, he must be protected from being attacked, abused, and exploited.

Evidence-Based Practice

The medical support offered to Wesley must be in line with scientific backing and cultural considerations. According to WHO (2013), mental health approaches and interventions, when offering treatment and prevention services to a patient, must have scientific research backing. For a practice to be deemed ethical, it is imperative to have it having a basis on relevant research data (Cook et al., 2017). The medical attention offered to Wesley must not be dependent on the personal opinion of the service provider but the strict guidance of the research-driven evidence. The psychiatrist from Doxy telecare must use evidence-based psychotherapy when treating Wesley and reduce the opinion-based prejudice of only revisiting the “success.” Evidence-based mental services will help the psychiatrist identify the appropriate decisions and medical tools when making critical medical decisions, especially in a societal-based setting. Evidence-based therapy will significantly help in administering ethical assistance to Wesley and minimize opinion-based biasedness in medication.

Additionally, applying evidence-based strategies in mental therapy is reasonable since it makes medications critically appraised before use. When offering treatment to a patient, applying an evidence-based framework makes it possible for the psychiatrist to critically analyze relevant, accessible data and make its appropriate application to the individual patient (Cook et al., 2017). Evidence that has been well censored and fully comprehended can help relevant service providers understand how to serve their patients better. The evidence-based approach applies to medical practitioners and cuts across all the stakeholders who can help improve the living standards of Wesley. Therefore, an evidence-based strategy from all stakeholders, notwithstanding the society and church at large, will help in offering ethical attention to Wesley and alleviate his dilapidated state.

Life Course Approach

The support offered to people suffering from mental disorders must consider the patients’ medical and social needs. The services provided to patients suffering from mental disorders must focus on their medical and social development (WHO, 2013). Wesley was advised to resume attending church services as a way to help him augment his social development. At the church, Wesley has been able to meet and make new friends who prove to be of great significance in making him feel valued in society. The church pastor has also decided to host him for close monitoring, and spiritual guidance to better prepare him to face life. The youth programs in the church will help Wesley develop an optimistic perspective towards his life and eventually recuperate. Consequently, the church offers spiritual guidance and a socialization platform paramount to Wesley’s health improvement.

Mental health services offered to Wesley must be sustainable throughout his life. The psychiatrist assigned to providing medical attention to Wesley has vast experience in handling mental health issues. The psychiatrist is also helping the patient improve his health status for a bright future. The patient is offered therapy that will help him deal with future uncertainties. Wesley has also been encouraged to join an undergraduate course in accounting to help him bolster his career. During the medical therapy, the patient is served with a suitable dosage that will fasten his recuperation without necessarily using a lot of money. Therefore, the medical attention offered to Wesley is meant to help him improve his health currently and in the future.

Multisectoral Approach

The mental assistance offered to Wesley must be well-coordinated by involving relevant organizations and partners. According to WHO (2013), all policies or strategies must be a concerted effort between all relevant bodies such as judicial, housing, medical, social, and employment sectors. For instance, housing, employment, and judicial sectors will provide the patient with contacts to greener areas, healthy life, and better living conditions that will help in the improvement of his mental health. Education, government, and medical sectors will offer evidence-based strategies that will help improve the patient’s socio-emotional intelligence. The latter will help create awareness on the need to fight stigmatization on patients suffering from mental disorders through mental health literacy programs while guiding society about the valuable efforts that need implementation. Therefore, the government, medical, judiciary, employment, and housing sectors play a significant role in administering medical attention to Wesley.

Judicial and social welfare sectors offer protection to patients suffering from mental disorders. Social welfare and judiciary sectors assist people suffering from mental illnesses by giving them legal protection and social support (in cases of financial difficulties). The abovementioned organizations will shield Wesley from being mistreated or discriminated against at his workplace or in the community since he will have legal service catered for by the organizations. In case of financial difficulties, the social welfare sector will help Wesley access financial assistance for his medical and other expenses. Judiciary, social welfare, and medical sectors will help formulate policies and legislation to help patients suffering from mental disorders. The abovementioned guidelines adhere to the United Nations Convention about the Rights of Persons with Disabilities and different organizations that advocate for human rights. Indeed, the judiciary, medical, and social welfare will play a significant role by offering legal assistance and financial support to Wesley.

Empowerment of Patients Suffering from Mental Disorders

People with mental disorders, just like others, need empowerment and incorporation in various activities within society. According to WHO (2013), a person with a mental illness, like the case of Wesley, needs to be accorded opportunities that will make him empowered and self-reliant. Persons living with mental disorders usually have low self-esteem, and for that matter, Wesley needs empowerment to help him believe in himself. Physical activities such as gym, soccer, and running can serve better in helping him divert attention from his agonies. There is a need to incorporate the disabled people’s groups to plan and implement all laws and policies that affect people with mental disorders. By doing so, Wesley and other people with such a disability will be empowered, making them more productive in the long run. Policies must be set to offer empowerment to people living with mental challenges to help the likes of Wesley be motivated in whatever they do for their living.

There is a need to encourage Wesley to be informed of all legal rights enshrined to people living with mental problems. By being familiar with all the laws about his mental health status, Wesley will know when to seek legal redress should his rights be infringed. Empowerment also entails recognition and enforcement of rights associated with people with mental disorders in helping them lead independent lives and look for better ways of assimilating Wesley into the community. The church is a better way of incorporating Wesley into a community that will always yearn to help him improve his health status. Wesley and other people suffering from mental disorders must be allowed to access better jobs and competitive remuneration. Social security policies will help to safeguard Wesley’s income by helping him manage his finances wisely. There is also a need to allow Wesley to have access to higher education, such as an undergraduate degree in accounting, to help him be more empowered for better job opportunities. Better structures need to be set aside to help Wesley access educational support, legal security, financial guidance, and assimilation into society.

Verification

Wesley’s self-report shows that he is feeling better after being embraced by the church fraternity. He is actively involved in youth ministry activities, enabling him to meet and make new friends that encourage him. The church pastor, where the patient fellowships, confirms that they have rolled out a plan to offer relevant assistance to Wesley and other people who have a mental illness to help them recover and start a new life. The patient has received three emails from the Doxy healthcare facilities indicating the progress of the psychiatrist treatment. He has another appointment with the psychiatrist after three days.

Summary of the Options and Actions for the Execution of Mental Health Plan

Human health is worth augmenting in the quest for improved human development. Socio-economical inequalities, climatic change, and environmental unsustainability in society hamper human growth. The abovementioned challenges make people develop psychological challenges, and if care is not taken in advance, these people get depressed, thus facing mental disorders. This study shows that people suffering from mental illnesses are unproductive at work and need speedy medical attention. In the case study, Wesley was significantly depressed and always felt that his life was worthless. Clinical interview, mental status examination, McGill Quality of Life Questionnaire-Expanded, WHOQOL-BREF are admissible in establishing patients’ mental health status.

Exclusionary and Intercultural Barriers

Based on his current level of study, Wesley does not have the edge over others when looking for a better job. Wesley’s salary is not sufficient to allow him further his accounting course. The patient also states that his lack of finances incapacitates him from accessing some medical prescriptions. Wesley is also skeptical about his integration into the community, fearing that he will be racially discriminated against now that he is an African American.

Cognitive Reaction

From Wesley’s scenario, it is clear that many people have mental illness and are not aware of where to seek help in society. Such patients suffer physically, financially, and psychologically in isolation and, to the extremes, commit suicide. Wesley only knew that the best solution was relocating to his friend’s house for consolation. There is a need for health service providers to make their services more affordable by looking for financiers that can help offset some of their patients’ bills. Healthcare service providers must dedicate their time to improve patients’ physical health and give them suitable referrals where necessary. During the assessment, I was interested to know what caused Wesley to have a low score in WHOQOL-BREF. He stated that his place of residence was not conducive to him since he is an introvert. He said that he struggled to cope with the new environment at his friend’s house, thus the low score.

Emotional Reaction

During the assessment, I felt empathy for Wesley as he narrated all he had been undergoing. I wondered how many such unreported cases are in society and how many lives of young people have been lost due to lack of access to counseling services. Patients suffering from mental disorders must have access to health care without any exploitation regardless of their socioeconomic status. The patients must be protected by law against victimization. The church has a significant role in uplifting an individual’s spiritual needs and emotional intelligence, as in Wesley’s case. People should seek assistance when emotionally distressed as a way to reduce such detrimental cases of mental sickness. Society has a cardinal obligation of identifying people suffering emotionally and link them to the appropriate assistance.

References

Cook, S. C., Schwartz, A. C., & Kaslow, N. J. (2017). Evidence-based psychotherapy: Advantages and challenges. Neurotherapeutics, 14, 537-547. Web.

HDR. Human development report 2015. United Nations Development Programme. Web.

WHO. Mental health action plan 2013-2020. World Health Organization. Web.

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