Person Centred Mental Health Care for Schizophrenia

Person Centred Mental Health Care

Disha Gupta

References

Essay:

Ben is a 22 year old male who has been admitted to the acute in patient unit as a compulsory client under the Victorian Mental health Act (2014) who has a diagnosis of schizophrenia.

Question

When using recent research evidence please addresses the following;

1. Identify the rationale and discuss strategies the mental health nurse will use to actively involve Ben and his carers when using the shared decision making process. (While in the acute mental health setting) AND
2. Discuss strategies the mental health nurse, Ben and his carers can utilise to reduce his incidence of relapse in schizophrenia.

Ben is a young adult suffering from schizophrenia that has been brought into an acute as an in-patient unit due to his psychotic behaviour. According to recent change in Victorian Mental Health Act a shared decision making process model which is being utilized within the practice in order for better outcomes. Shared decision making process is where two experts or a team of experts come together in making complex decisions for a patient (Chong WW, 2013). A set of health care providers come together and expand their knowledge and bring expertise in understanding the medical problem in order to provide a diagnosis. As well as the possible interventions and the possible risks of alternatives and potential benefits those are involved with the presented client. (REF). In this case we have Ben who has been “compulsory” admitted into an acute setting, which means this client is in need of serious treatment, which is why the shared decision making process has been put in place in order to achieve the right and hopefully an accurate treatment that works as it engages experts to be involved throughout the process.

Not only a team of experts are involved in this process but, the individual is given the chance to put their values, understandings and preferences forward as well along with the support of family and other support network members (REF). This allows them to feel less inclined to thinking towards that they are being forced into something without their consent. As this gives them an opportunity to explore their wants and needs and together the individual and health care providers can come sometimes to a mutually agreed plan that is right for client.

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In order to plan and look after twenty two year Ben who is currently suffering from mental disorder we must first understand the problem followed by the treatment or action plan. Schizophrenia is an extremely complex disorder, it is occurred due to the imbalances of biochemical present in the brain which causes a person to believe in extraordinary and distorted thoughts, perceptions, emotions, movements and behaviour (REF). The symptoms of schizophrenia are categorized into two major categories, the positive or hard symptoms which include delusion, hallucinations, and grossly disorganized thinking, speech, and behaviour, and negative or soft symptoms as flat affect, lack of volition, and social withdrawal or discomfort (REF). This way it is easier for the health care providers to take further steps for a clients treatment as they have categories which clients fit into.

In order for treatment or a plan to commence the nurse should start the process with a Two way exchange of information which allows the nurse (Clinician) to discuss the suitable treatment options and also any potential risks and benefits which may arise from these options and at the same time it will provide an opportunity to Ben to discuss his values and preferences regarding the treatment plan (REF). The two way communication will help to create a bond between the nurse and Ben which will help the nurse to know more about what Ben wants and this can help the nurse to reassure Ben in times of uncertainty, anxiety or vulnerability (REF).

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There is a strong need to develop an action plan for the treatment option to be executed and measured. An action plan is a document which is will be designed together by Ben and the mental health nurse and this plan should cover the issues being faced by Ben, the interventions which will be put in place and a review system to check the success of the action plan (REF).The plan should provide information about the Ben’s history, routines or symptoms that may assist in the treatment.

Along documentations and communication there are other treatments also available such as medication. Antipsychotic medication treatment, Medication is one of the core foundations of treatment. Once the acute stage of a psychotic episode has passed, most people with schizophrenia will need to take medicine until further notice or until improved conditions where patients are not relied upon these mediations (REF). Antipsychotic medication is used to control the acute symptoms being experienced by the patient. These falls into two groups: typical and atypical antipsychotics (REF). Typical antipsychotics target the more obvious symptoms such as hallucinations and delusions. They work by reducing the disturbing quality of the symptoms and accompanying disruptive behaviour occurred due to imbalances in the brain (REF). In this plan a nurse needs to understand which antipsychotic medications need to be given and what their actions and adverse side effects are. The nurse should never forget to follow the eight rights of drug administration (REF). This step is vital for a mental health nurse because the way each medication is administered will differ between patients. Antipsychotic drugs, like almost all medications, have unwanted effects along with their advantageous effects. During the early phases of drug treatment, patients may be troubled by side effects such as drowsiness, restlessness, not able to keep the body still, muscle spasms, tremor, shaking, dry mouth, or blurring of vision (REF). Most of these can be corrected by lowering the dosage or can be controlled by other medications. Different patients have different treatment responses and side effects to various antipsychotic drugs. As mentioned before a patient may do better with one drug than another.

Since Ben is in an acute phase of a schizophrenic episode first and foremost role of a nurse is to perform a mental health assessment or examination. A mental health nurse needs to perform and present symptoms and the level of risk that may cause to the patient and other people around (REF). In order to understand a person’s mental health situation, there are guidelines an clinician or a mental health care provider needs to follow. One of many assessment tools includes “PAMSGOTJIMI”, abbreviation of: Perception, Affect, Mood, Speech, General Behaviour, Orientation, Thought, Judgment, Insight, Memory, and Intelligence. Or even “ABCT”, abbreviated for Appearance, Behaviour, Cognition and Thought process (REF). Are great for mental health assessment of a client which needs to undergo a treatment plan, by following these guidelines a nurse can understand and develop a better understanding of a client’s current situation in order to create the right plan.

A compliant cycle of antipsychotic medications plays an important part in the treatment of schizophrenia and at the same time non-compliance with the medications can result in relapse. This is why along side of Antipsychotic medications is the need for social interventions, including education and support for patients and carers, so that cares and individuals are on the same pages of understanding one another better. Social skills training and the care provided by day hospitals and centres such as community based voluntary and involuntary services etc (REF).

Cognitive behavioural therapy (CBT) can help patients gain a degree of control over their symptoms as this helps them by understanding the links between their thought processes and subsequent behaviour. Which then helps them to move on and look at ways of changing and managing their thoughts and behaviours (REF).

Family interventions largely help in reducing levels of stress and in the management of contributing factors to patient relapse (REF). As we know our families are the closest people we have got in our lives, which in return gives the individuals a sense of security and makes them feel secure by having family help them through tough time gives them the hope and strength to improve their wellbeing. Giving carers information about schizophrenia is helpful in its management. Support and information needs to be ongoing, both in everyday situations and also at times of crisis (REF).

As mentioned before, carers and families have always played an important role in the management of people with very serious mental disorders. With the increasing focus on maintaining patients in the community as well as in acute settings, these roles are assuming to achieve high importance. This means that Ben’s carers’ needs and concerns require are most likely to be on a higher level of attention. In order to achieve and target the correct procedure, there are a few simple actions that can be taken for instance, a need for further and ongoing education on schizophrenia for Ben and its management and interventions as a carer or family needs to be informed about in order to look out for in various situations (REF). Regular contact with clinical teams that offers both support and advice about the patient and is responsive to carers concerns (REF). Also a faculty or services of support for carers’, as they can possibly go through their own feelings such as emotional burden because they feel that its an extra responsibility to look after a mentally challenged person. Guilt and frustration is also another where the carer or family feels that nothing is working and may feel like giving up. Such services can be provided through support groups or individually. Also there is a need for a service that works in partnership with the carers and patients both, and through this way, it will be optimising the patient’s care and allowing patients to continue living in the community (REF).

Anyone undergoing an illness is not one of the greatest feelings to be going through, which is why it is very important to understand the cause, and the reasoning behind the problem. Followed by an thorough assessment by the right health care providers. As well as having solid treatment plan with goals those need to be achieved by the end of it all. Ben is young and by having support around him, from family and friends and services provided by hospitals or community facilities is the right way to improve his mental wellbeing. With the right techniques and action plans clients like Ben can rapidly improve their mental and physical wellbeing, and as a nurse, it’s very important to understand the basic needs and requirements of each client and the correct form of assessment is highly necessary in order to keep a record of each patients history of improvements and development.