Ruby’s story 

Ruby is a 20-year-old woman who presented in Emergency Department (ED) due to changes in her mental health. She was brought in by her mother, Sylvia, who reported that she picked her daughter up from Melbourne and brought her back to Western Sydney after Ruby’s flatmate, Alicia, contacted her about the changes in Ruby’s mental health.

Ruby has been living in Melbourne for the past year, where she works as a shoe sale assistant on a casual basis. She planned to return to Sydney before the end of the year to start her teaching degree in 2024. This was cut short due to the changes in Ruby’s mental health. According to Sylvia, Ruby has been going out and drinking alcohol every night the past few weeks with friends she met recently. Ruby has not had much sleep the past few weeks as she comes home most mornings just sleep for 2 to 3 hours and have a shower before going to work for 9 am. The manager of the shoe shop where Ruby work has warned her that she will lose her job if she continues arriving to work late and smelling of alcohol. Ruby has admitted to her flatmate Alicia that she has been smoking marijuana and experimenting with other illicit drugs with her new friends. Ruby stated, ‘I don’t’ know what I’ve been taking, but it made me feel good.’

Lately, the two friends would get into a verbal altercation when Alicia tried to talk to Ruby about the changes in her behaviour. Ruby would become irritable and angry and would say to Alicia, ‘you’re just jealous that I have met other people and I am enjoying myself without you. I can’t help it if people love me more than they love you. I want to make the most of this before I start uni.’

A few nights ago, Ruby called Alicia at 3 am to pick her up from their local pub. Ruby explained that she felt unsafe to go home on her own because she thought that she was being watched and followed by a guy who was in love with her. When they arrived at their flat, Ruby ran to her room and locked her door. The next day, she did not go to work and did not contact her employer. The manager of the shoe store contacted Ruby and informed her that she is no longer required to work in the store. Alicia thought that she would be devastated by this news as this is her only source of income. But Ruby told Alicia that ‘I was too good for that job anyway. It’s their loss’.

Ruby did not leave the flat for the next few days. Alicia noticed changes in Ruby’s mood. She stayed in her room most of the time. She has not showered in days, ate little amounts of food, and had barely any sleep and would watch TV instead all night or watch YouTube videos on her phone. She stated to her flatmate that ‘I don’t want to sleep; I feel that something bad is about to happen’. One night, Ruby asked Alicia for help as she started to have thoughts of suicide, but with no plan of how she would hurt or kill herself. Alicia felt she had no choice but to contact Ruby’s mum, Sylvia, to ask her for help.

During the interview, Ruby sat next to her mother, slumped with her head on her hands. She would get up and pace while wringing her hands. Although she presented as well-groomed and neat, Ruby was wearing clothes that were big for her small stature. When her mother excused herself to go to the toilet, Ruby opened about her experience to the nurse. She stated that she did not want her mother to know. She told the nurse that she had been feeling unmotivated, loss interest in going to university (when all she wanted was to become a teacher) and has been having suicidal thoughts with no plan. She mentioned that her ‘heart has been beating 100 miles per hour and feels like something bad is about to happen. I don’t know why, and I will do anything to make it stop.’ She mentioned that she was commenced on 20mg of Paroxetine daily by a GP in Melbourne four weeks ago and asked if she should keep taking this medication.

As a nurse advocating for Ruby, topic is caring for consumers with self-harm and relate this topic to her situation and justify why the mental health CNC needs to see her.  

ANSWER

Caring for Consumers with Self-Harm: Advocating for Ruby’s Mental Health Assessment

Introduction

Ruby, a 20-year-old woman, has presented in the Emergency Department (ED) due to concerning changes in her mental health, including self-harm ideation, suicidal thoughts, and a myriad of behavioral and emotional disturbances. This essay focuses on advocating for Ruby’s mental health by addressing the importance of caring for consumers with self-harm tendencies and justifying the need for the Mental Health Clinical Nurse Consultant (CNC) to assess her condition comprehensively.

Caring for Consumers with Self-Harm

1. Understanding Self-Harm and Suicidal Ideation

Self-harm is a complex phenomenon often accompanied by underlying emotional distress and psychiatric conditions. It encompasses deliberate acts of injuring oneself physically as a means to cope with overwhelming emotional pain. Ruby’s disclosure of suicidal thoughts, coupled with self-harm ideation, raises immediate concerns about her mental well-being and safety.

2. Risk Assessment and Safety Planning

Nursing care for individuals like Ruby begins with a thorough risk assessment. This assessment aims to identify the level of risk associated with self-harm and suicide, assess the presence of any immediate dangers, and determine the need for interventions to ensure safety. Safety planning is a crucial aspect of this process, involving strategies to prevent self-harm and facilitate immediate help-seeking.

3. Incorporating a Holistic Approach

Caring for consumers with self-harm tendencies requires a holistic approach that encompasses not only the management of acute symptoms but also the exploration of underlying causes and contributing factors. Ruby’s recent lifestyle changes, substance use, erratic sleep patterns, and altered thought processes indicate the need for comprehensive assessment and intervention.

Justification for the Mental Health CNC Assessment

1. Specialized Expertise

Mental Health Clinical Nurse Consultants possess specialized training and expertise in assessing and managing complex mental health conditions. Given Ruby’s presentation, which includes self-harm ideation, suicidal thoughts, and possible medication concerns, the CNC’s expertise is essential to provide accurate evaluation and intervention.

2. Medication Evaluation

Ruby mentioned being prescribed Paroxetine by a GP in Melbourne. The CNC is well-equipped to assess the appropriateness of the medication, potential side effects, and its role in Ruby’s current mental health status. Adjustments to the medication regimen may be necessary, and the CNC can collaborate with the treating physician for optimal management.

3. Safety and Crisis Intervention

Ruby’s fluctuating mood, suicidal thoughts, and self-harm ideation place her at risk for immediate harm. The CNC can conduct a thorough assessment of her current emotional state and initiate crisis intervention strategies, ensuring her safety and well-being.

4. Collaborative Care

Collaborative care is paramount in managing complex mental health cases. The CNC can work closely with other healthcare providers, Ruby’s mother, and her support network to develop a comprehensive care plan that addresses her unique needs, including therapy, counseling, and ongoing medication management.

Conclusion

Caring for consumers with self-harm tendencies, like Ruby, requires a multi-faceted approach that prioritizes safety, comprehensive assessment, and specialized intervention. Advocating for the Mental Health Clinical Nurse Consultant’s assessment is essential in providing Ruby with the necessary care, support, and treatment to address her self-harm and suicidal ideation, ultimately leading to improved mental health outcomes and a path towards recovery.