Bachelor of Nursing UMH207: Understanding Mental Health T2’2023 ASSESSMENT 3 Name: Jasmine Cooper MRN: 210735 Gender: Female D.O.B: 02 November 1990 Allergies: NKA Marital Status: Married Admitting Doctor: Amelia Ong Aboriginal and Torres Strait Islander: No SITUATION: Jasmine (Jas), 32 years old, was brought into Emergency Department (ED) by ambulance. She called the ambulance after an intentional overdose of her prescribed medications and cutting her left wrist. She smelt heavily of alcohol when she arrived in ED. Jas was drowsy with an unsteady gait but was hemodynamically stable. The ED Psychiatrist reviewed Jas and admitted her involuntarily under the Mental Health Act. She is awaiting medical clearance before transfer to the acute mental health unit. ADMISSION ASSESSMENT On assessment, Jas was initially guarded and did not want to engage. She said she was tired but cooperated and responded to the clinician’s questions. She appears dishevelled, with a strong smell of alcohol and multiple superficial wounds and scars on both lower arms. She reported feeling “hopeless” and “helpless”, labile during the conversation, and slurred and pressured speech. She denied any intentions to kill herself but reported taking the tablets to help her sleep. She said she had been stressed lately due to multiple stressors, including losing her job two weeks ago and her wife leaving her with their son. Jas expressed that she did not want to stay in the hospital but could not guarantee her safety at home. Collateral information from Lisa (wife): – Three weeks ago, Jas was fired from her work as a kitchen aid due to misconduct. Lisa reported that she found it out from Jas’s manager as she would not tell her what happened. – Before this, Jas was overspending and bought new home appliances. She maxed her credit limit and spent most of her savings. Lisa suspected Jas had stopped taking her medications, but Jas denied it. – After being fired from work, Jas will stay all day in the lounge and drink at least 5L of cask wine. She was up all night and would ruminate about how she was fired unfairly and stated that her previous manager was jealous of her, as everyone liked her as she was the “cool” employee. She also believes she is better than the restaurant chef and stated she has a “god tongue” that all other restaurants were begging her to be their head chef. – Jas’s thoughts are derailed even when she is sober. She will respond oddly to a question or jump from one topic to another. – There will be occasions when Jas verbally abuses her. Lisa tried to understand her situation, but she had enough and left the house with Jacob (stepson) 4 days ago. – Lisa said that this is how she presents when her mental state deteriorates, and Jas will benefit from a short hospital admission to restart her medications and stabilise her mental state. At baseline, Jas is funny and friendly. – Lisa reported that Jas would like to walk under the sun and listen to music when distressed. She will also benefit from fidget toys when she is anxious. Jas loves Jacob, and he keeps her grounded. – Lisa requested to be updated on Jas’s progress. Bachelor of Nursing UMH207: Understanding Mental Health T2’2023 BACKGROUND: Mental Health – Jas was diagnosed with schizoaffective disorder (SAD) when she was 20. Then she has had multiple mental health admission since then. Most of her admissions are due to aggression and self-harm. – She used to be case managed by the local community mental health under a community treatment order (CTO). Her care was transferred to her general practitioner (GP), including monthly depot administration. However, Lisa has not received her depot for more than three months. Medical – Nil medical or surgical history. – Height: 172 cm Weight: 71kg Abdo Circumference: 28 inches Social: – Jas identifies as a lesbian and is married to Lisa. They lived in a 2-bedroom apartment with Jacob (4 years old) until Lisa and Jacob moved out four days ago. – Highly functional, previously worked as a sales assistant, factory worker, deli assistant, and recently as a kitchen aid. PROGRESS: After medical clearance, she was transferred to the in-patient mental health unit with a security escort. Jas protested to remain in the hospital and threatened to harm herself, becoming agitated. She said she was physically and sexually assaulted by a male patient when she was last admitted. She does not trust any male staff and demands to be discharged. She does not want Lisa to be involved in her care and excludes her as a contact person during admission. She declined to complete all other admission papers. Jas became verbally abusive towards the staff and assaulted two different consumers. She refuses oral medications. Hence, the multidisciplinary team decided to administer the medication via injection (intramuscular). After two weeks, Jas sporadically agrees to take her oral medication. While there are some improvements in her mental state, she still presents with aggression and grandiosity. The treating team requested to extend Jas’s inpatient order to prescribe her a depot and discharge her on a CTO. —end— Disclaimer: This fictitious case study has been designed for student assessment only.

• Discuss how and why the Mental Health Act applies to the case scenario.

• Summarise and identify specific examples of legal and ethical issues in relation to the consumer’s rights.

• As the registered nurse looking after the consumer, explain how you advocate for their rights. • Compare the concepts of mental health, mental illness and mental disorder. Determine which category the consumer in the case scenario fits

• Identify and illustrate the main symptoms of the mental health condition as outlined in the case (this can be done in table form)

• Determine a medication that may be clinically indicated for the consumer in the case scenario. Provide a rationale for why it is indicated.

• Evaluate and explain three (3) techniques you would use to develop trust and rapport and begin a therapeutic relationship with the consumer when first admitted to the hospital.

• Express how you would explain the need to give the consumer an intramuscular medication.

• Given the consumer’s mental state at this time, identify one (1) technique you would use to ensure your safety (during the explanation about the intramuscular medication outlined above).

ANSWER

Understanding the Application of Mental Health Act: A Case Study Analysis

Introduction

The Mental Health Act plays a crucial role in the assessment, treatment, and care of individuals experiencing mental health crises. This essay examines how and why the Mental Health Act applies to the given case scenario involving Jasmine Cooper, a 32-year-old woman admitted to the Emergency Department (ED) after an intentional overdose and self-harm. It also delves into specific legal and ethical issues related to the consumer’s rights, outlines the advocacy role of the registered nurse, compares mental health concepts, identifies symptoms of the mental health condition, proposes a clinically indicated medication, discusses techniques for building rapport, explains the administration of intramuscular medication, and addresses safety concerns.

Application of Mental Health Act

The Mental Health Act applies to Jasmine’s case as she was admitted involuntarily under the act due to her intentional overdose, self-harm, and compromised mental state. The act empowers healthcare professionals to detain and assess individuals whose mental health poses a risk to themselves or others. In this scenario, Jasmine’s threats of self-harm, agitation, and past instances of aggression make her eligible for involuntary admission, ensuring her safety and appropriate assessment under legal authority.

Legal and Ethical Issues and Advocacy for Consumer’s Rights

Jasmine’s case presents legal and ethical issues such as informed consent, patient autonomy, and safety concerns. Her refusal of oral medications and the need for intramuscular administration raises issues of medical consent. As a registered nurse, advocating for her rights involves respecting her autonomy while prioritizing her safety and well-being. Collaborating with the multidisciplinary team and respecting her right to make decisions about her treatment while ensuring her safety is essential.

Comparison of Mental Health Concepts

Jasmine’s history of schizoaffective disorder places her within the category of mental disorder. Mental disorder refers to conditions that significantly disrupt an individual’s thoughts, emotions, or behaviors. In Jasmine’s case, her history of admissions, aggression, self-harm, and grandiosity align with the characteristics of a mental disorder.

Main Symptoms of Mental Health Condition

Clinically Indicated Medication

A clinically indicated medication for Jasmine’s schizoaffective disorder is an atypical antipsychotic, such as risperidone. This medication helps manage her psychotic symptoms, mood fluctuations, and aggression. Risperidone acts on neurotransmitter imbalances, reducing the severity of her symptoms and promoting stability.

Building Rapport and Therapeutic Relationship

Three techniques to build rapport and initiate a therapeutic relationship with Jasmine are active listening, empathy, and validation. Active listening shows genuine interest, empathy conveys understanding of her feelings, and validation acknowledges her experiences.

Administration of Intramuscular Medication

Explaining the need for intramuscular medication involves using simple language, discussing its benefits, and addressing concerns. Emphasizing that this approach ensures timely and effective treatment and that she will not need to take oral medication can help alleviate her worries.

Ensuring Safety During Explanation

Considering Jasmine’s history of aggression and agitation, ensuring safety during the explanation involves maintaining a respectful distance, remaining calm, and having security personnel nearby if necessary.

Conclusion

Understanding the application of the Mental Health Act, addressing legal and ethical issues, advocating for consumer rights, and implementing appropriate interventions are essential in Jasmine’s case. By comprehensively addressing legal, ethical, and therapeutic aspects, healthcare professionals can provide effective and compassionate care for individuals with complex mental health conditions.