Introduction
This paper outlines a treatment plan for Mr. Pall. Pall is suffering from a mental health condition instigated by the loss of his girlfriend and child. Mr. Pall is a 28-year old male with signs of hallucinations, suicidal tendencies and a strong sense of hopelessness. Pall also shows extreme signs of anxiety and exudes feelings of self-blame. These feelings have developed into visual and auditory hallucinations. However, Pall’s condition is a development of a mental health condition that he had for the past two years. Within this period, Pall unsuccessfully attempted three suicides. Pall has also had a poor history of compliance to medication, and it has been difficult to retain him in one form of employment. Part of this problem emanates from a lack of confidence and a strong sense of suspicion in his actions. This paper outlines a treatment and discharge plan for Pall, but before that, a mental status examination and an identification of Pall’s risk factors are analyzed.
Mental Status Examination
Pall’s mental status examination reveals a strong sense of social disconnect because he stays in bed most of the days without any meaningful social interaction. During the interview, Pall had an unkempt hair and an unsteady gait, which partially occurred from Pall’s inactivity. Pall was also extremely sad and disorganized because he thought very little of himself. He also blamed his girlfriend for his woes. These feelings caused him to have a flat affect, causing him to appear melancholic. Pall’s speech was however unpressurized, though it sounded a little hesitant and slow. Nonetheless, his speech was well articulated.
Pall’s thought analysis process revealed that he bore signs of suicidal thoughts, though it was difficult to identify the presence of a suicidal plot. It was also difficult to point out a strong sense of tangential or circumstantial speech in his auditory analysis because his arguments were well articulated. His thought process was also well organized and concrete because there was an absence of confabulation or flight of ideas. For instance, Pall was able to give short and informed answers during the interview.
However, amid this composure, Pall showed signs of perceptual disturbance, which bore signs of illusions and hallucinations. From this background, Pall seemed to have an impersonal sense of life. This observation couples with a strong sense of derealization. Illusions were a little difficult to detect but auditory and visual hallucinations were hard to ignore. For instance, during the interview, Pall occasionally moved his eyes towards the door as if to listen to some imaginary person who was out of the room. His impulse control was also weak because he failed to control his cries as he narrated about his son’s death. His sense of concentration was also weak because he could not respond to all questions, and when he tried to, he lost track of them. He could not count back his ideas. However, Pall still did not show signs of memory impairment though he showed a poor sense of judgment and insight into his depressive state. His poor sense of judgment showed from his failure to decide which clothes to wear. His mental analysis revealed several risk factors discussed below.
Risk Factors
Pall runs several risks if his mental status is not treated. Azue (2008) explains that, mental health illnesses may cause disabilities if they remain unchecked for a long time. However, this effect is nothing compared to the reduction in quality of life that a patient experiences. For instance, Pall runs the risk of poorly feeding himself because he already experiences episodes of skipping his medication. Pall also runs the risk of poor self-care and thought disturbances that have lead to increased episodes of hallucinations. These effects are part of the emotional, behavioral and physical health problems cited by Bosmans (2008) as part of the complications brought about by mental health problems. Comprehensively, Pall runs the risk of suffering any of the above risk factors though he also runs the risk of inflicting harm on himself (because the mental status examination revealed that he had suicidal ideas). These problems highlight the risk of suicide.
Nursing Goals
Butler (2008) explains that, the nursing goals of different mental health treatment plans often depend on the nature of the patient’s condition. However, there is a strong emphasis on the clear identification and ascertainment of nursing outcomes. Moreover, the nursing goals should also be easily identifiable by the patients (Elder, 2009, p. 12). The goals should also be realistic, and ideally, they need to be understood in behavioral terms (Butler, 2008). In the context of this study, the ultimate goal of the nursing care intervention is to influence Pall’s behavior to reflect positive health outcomes. Primarily, the main short-term goals of the nursing care plan will be to get Pall out of bed and participate in normal day-to-day activities. The second goal of the nursing care plan will be to see Pall sleep well at night. Lastly, the design of the nursing care plan intends to help Pall receive good nutrition and gain weight. These three nursing goals expect to materialize within one month. However, they depend on the effective implementation of the treatment plan.
Treatment Plan
Pall’s treatment plan derives its origin from the use somatic therapies to treat mental instability. The justification for this methodology is the strong association noted among mental disorders, suicide supports, and antidepressant use. However, since Pall is already on trycylic antidepressants such as Pamelor, Risperidone and Diazepam, this treatment plan will be sensitive to these medications. The treatment steps outlined in this plan work in sequential phases, as explained below.
First, it would be important to emphasize Pall’s physical self-care because it this has a significant bearing on his mental state (McGorry, 2005, p. 120). Here, issues such as Pall’s nutritional program, sleep plan, and exercise need addressing to ensure he has a stable mental status (Woolsey, 2008). Afterwards, Pall should undergo a long-term exposure to atypical antipsychotics because they have fewer side effects, when compared to typical antipsychotics. Moreover, since Pall’s mental condition is not at an advanced stage, the atypical antipsychotics will suit his treatment plan because of their minimal withdrawal symptoms. In addition, considering Pall is already under some atypical medications (such as risperidone); it is advisable to continue with the atypical medications to avoid mixed courses of treatment (Woolsey, 2008).
The first course of treatment is lithium salts, which acts as a maintenance treatment method to reduce the patient’s probability of attempting suicide (Regier, 1993, p. 85). The second drug in the treatment plan is Clozapine because it is a complementary treatment drug identified to reduce the probability of suicide (McGorry, 2005, p. 120). In addition, since Pall exhibits signs of extreme anxiety, his diazepam treatment will continue. The main aim of administering this drug is to ensure Pall remains calm. To guarantee the efficacy of this treatment method, Pall will take benzodiazepines drug because it reduces suicidal attempts as well (McGorry, 2005, p. 120). Though this treatment method is common for patients with borderline personalities, a high level of efficacy is expected.
Since Pall exhibits signs of inactivity, it will be important to introduce a structured and predictable program for undertaking his day-to-day activities (Osbourn, 2001, p. 329). Structure and predictability are crucial in motivating Pall to get off the bed and participate in productive activities. Furthermore, since Pall exhibits signs of extreme anxiety, it will be important to reduce the level of noise (or any environmental disturbances) in his surroundings. Medical studies support this proposal by explaining that, noisy environments tend to aggravate patients with mental instability (Osbourn, 2001, p. 329). This action would go a long way towards ensuring Pall remains calm. Nonetheless, this measure complements the continuation of Pamelor medications because the drug treats depression and mood disorders as well.
In the same spirit, it is important to give extra processing time to Pall (regarding his daily tasks). This action is crucial because Pall needs no pressure when undertaking his daily tasks, or else, he may crack under the pressure of the treatment plan and be excessively aggressive.
Whenever possible, it is crucial to expose Pall to natural lighting and not artificial lighting. Artificial lighting (or too much light) can make Pall’s anxiety levels to escalate, thereby prompting him to be aggressive or resistant to the nursing care plan. Pall should also avoid crowds because crowds aggravate mentally instable people. A calm and peaceful environment would be more appropriate for the patient as he develops better control of his impulses.
However, Pall should be aware about the consequences of his suicidal tendencies through role-playing (Pincus, 2005, p. 271). Due to this reason, Pall’s risperidone treatment continues under the new treatment plan because the drug reduces a patient’s chances of self-injury (Pincus, 2005, p. 271). Pall’s spiritual welfare also needs consideration at this point of the treatment plan because enrolling him in spiritual discussions where he is able to explore his spiritual side will go a long way to ensure he remains emotionally stable. Here, issues such as forgiveness, submission to a higher authority and similar issues need emphasizing. This spiritual framework aims to enlightening Pall about the repercussions of his suicidal behaviors. It is also at this point of the treatment plan where family and community support should be included in the treatment plan. The family and community elements of Pall’s treatment plan are support groups to help motivate him. Close family members and colleagues should also be encouraged to be proactive in Pall’s life to encourage him to be upbeat about his life. Positive self-perception and self-talk should be hereby encouraged to make Pall feel better about himself. This initiative will also minimize his probability of committing suicide. Through this intervention, Pall will feel cared for, and presumably, he will understand that his absence (death) will affect other people as well. Nonetheless, if these interventions fail at the implementation stage, Pall’s aggressive behavior may worsen, and he may cause harm or injury to himself or other people. His chances of breaking the law, killing, destroying property and similar vices are also high (Institute of Medicine, 2006, p. 2).
Discharge Plan
Pall’s treatment plan includes several aspects of his lifestyle after he leaves the mental health institution. Different aspects of Pall’s discharge plan that he cannot arrange for himself constitutes the majority sections of the discharge plan. For instance, Pall’s place of residence (after discharge) constitutes the provision for a stable housing environment. Preferably, it would be appropriate for Pall to reside in a place where there are people around him who love and care for him (Olfson, 2009, p. 848). A transportation plan arrangement constitutes part of the discharge plan if Pall lacks a reliable mode of transport to his residence. Thirdly, an aftercare referral program will be arranged for Pall after evaluating if he needs any clinical support after discharge. Also, the nearest clinical institution where Pall can be admitted will also be identified. Lastly, any resources (like medications, clothing and the likes) required upon discharge will also be outlined (Spann, 2004, p. 1). If possible, a job placement should be identified where pall can be accommodated and comfortably adapt to his new status.
Application of Mental health Act in Victoria, Australia 1986
The 1986 Victorian mental health act will be applicable in Pall’s mental health treatment plan because it will outline the boundaries and limitations of the entire treatment plan (Elder, 2009). Emphasis lies on the rights and requirements of the patient as well as the limits of the nursing care plan. Instances where the nursing care plan may interfere with the privacy, dignity or self-respect of the patient also outlines the mental health act requirements to ensure the treatment plan is implemented in the least intrusive manner and in the least prohibitive environment (Burke, 2000, p. 813). However, the1986 Victorian mental health act will be most applicable if Pall’s admission to a mental health institution is involuntary. The above dynamics of the 1986 mental health act will therefore be applicable in such a case.
Conclusion
Pall’s mental status examination reveals that his condition is not at an advanced stage. In this regard, timely nursing care is required to prevent the occurrence of severe mental instability, which may consequently lead to a long-term health illness (McGorry, 2008, p. 337). However, the importance of support groups (in the treatment plan) needs a lot of emphasis because mental patients need such supportive frameworks for long-term recovery. However, if the above steps outline the nursing care process, the desired nursing outcomes will be realized.
References
Azue, M. (2008). The Potential to Reduce Mental Health Disparities Through the Comprehensive Community Mental Health Services for Children and Their Families Program. J Behav Health Serv Res, 35(3), 253–264.
Bosmans, J. (2008). Are Psychological Treatments for Depression in Primary Care Cost-Effective? Journal of Mental Health Policy and Economics, 11(1), 3–15.
Burke, J. (2000). The Effect of Patient Race and Socio-Economic Status on Physicians’ Perceptions of Patients. Social Science and Medicine, 50(6), 813–828.
Butler, M. (2008). Integration of Mental Health/Substance Abuse and Primary Care. Rockville: Agency for Healthcare Research and Quality.
Elder, R. (2009). Psychiatric and Mental Health Nursing. Sydney: Elsevier.
Institute of Medicine. (2006). Improving the Quality of Health Care for Mental and Substance-Use Conditions. Washington: National Academies Press.
McGorry, P. (2005). International clinical practice guidelines for early psychosis. The British Journal of Psychiatry, 187, 120–124.
McGorry, P. (2008). Is Early Intervention in the Major Psychotic Disorders Justified? Yes. BMJ, 337, 695.
Olfson, M. (2009). National Patterns in Antidepressant Medication Treatment. Arch Gen Psychiatry, 66(8), 848–856.
Osbourn, D. (2001). The Poor Physical Health of People with Mental Illness. Western J Med, 175(5), 329–332.
Pincus, H. (2005). Depression in Primary Care: Bringing Behavioral Health Care into the Mainstream. Health Affairs, 24(1), 271–276.
Regier, D. (1993). The De Facto US Mental and Addictive Disorders System. Arch Gen Psychiatry, 50(2), 85–94.
Spann, S. (2004). Report on Financing the New Model of Family Medicine. Annals of Family Medicine, 2, 1-21.
Woolsey, L. (2008). Excerpts from: Transitioning Youth With Mental Health Needs to Meaningful Employment and Independent Living. Journal for Vocational Special Needs Education, 31(1–3), 9–18.