Mussa is 48-year-old married man who lives with his wife and 2 (aged 6 and 2 years)
young children. Although Mussa does not have a formal psychiatry history, Mussa
reports that his journey to Australia, 5 years ago, was reported to be painful and
traumatic.
Mussa’s wife, Amina, describes how lately Mussa has become increasingly quiet and
reclusive, which is out of character for Mussa. Amina, reports that this behaviour, has
brought shame on her and their family. She has tried to make him happy and at times,
possibly forcefully, but nothing seems to work.
For the last month, Mussa has been so scared of the police saying that they were looking
for him. Whenever, he hears an emergency siren he panics and tries to hide. Mussa
reports that he has put cameras in the house to ‘protect’ himself from the police and so
that he can see them when they come. Amina, reports that as far as she is aware, he was
not wanted by authorities, nor has Mussa committed any crimes in Australia or Iraq.
Background Information
Mussa has been living in Australia for 5 years since he, and his family were granted
refugee status. Although speaking English was a challenge at the beginning, Mussa
managed to obtain a Certificate 3 in Building and Construction and has been working
for a building company for the 3 years. They struggle financially but are getting by ok.
Upon interview
Mussa reports to the nurse,
• That he is suspicious of the police alleging that they are looking for him. He has
installed CCTV to ‘protect’ himself and panics when he hears these sirens.
• That when he was in Iraq, he was arrested for protesting the government and
was subsequently beaten. Whilst he was in custody, he was injured from a
Grenade attack on the police vehicle he was in, with substantial physical injuries
from shrapnel. Although he was not the target, Mussa blames the police and
authorities for his injuries.
• That he thinks that he is unwell due to the constant harassment from the police.
• Although, his wife Amina is supportive she is exhausted and thinks that this
illness brings shame to her and their entire family.
If the nurse/health worker asks you relevant questions, please provide the
following information:
• Mussa should be avoiding eye contact, looking dishevelled and unkempt, act in
a manner which would be untrusting and suspicious of the nurse and the line of
questioning.• How the experiences of seeking asylum may have triggered stress and
presenting characteristics, symptoms, and behaviours.
• As the conviction grew that Mussa was in danger, he installed CCTV to protect
himself and his family. The sound of sirens has begun to make Mussa panic.
• How the arrest in Iraq, the injury from the grenade attack and injuries sustained
from shrapnel, police beatings, and the overall experience of seeking asylum
has impacted on Mussa current mental health. These experiences made him
suspicious and untrusting. He also felt in imminent danger constantly.
• The situation at home with his wife Amina, who is supportive, but states that
she is exhausted and thinks that this ‘illness’ or situation, has brought shame to
her and their entirely family

For the purpose of this exercise, you will need to perform the role of the student nurse
on placement.
You are a student nurse on an afternoon shift in an acute mental health ward. You are
working with a RN and your first task for the shift is to admit an new person to the unit.
Mr Mussa Ahmed is a new admission to the ward via the emergency department (ED).
Background Information
Mussa is 48-year-old married man who lives with his wife and 2 (aged 6 and 2 years)
young children. Although Mussa does not have a formal psychiatry history, Mussa
reports that his journey to Australia, 5 years ago, was painful and traumatic. Mussa’s
wife Amina, describes that Mussa has lately become quiet and reclusive. Amina reports
that this behaviour, has brought shame on her and their family. She has tried to make
him happy, but nothing seems to work.
The referral letter from the ED team stated the following:
• No history of contact with mental health services or psychiatric illness
• Arrived in Australia as a refugee from Iraq five years ago.
• Mussa has been saying that the police are looking for him. Whenever, he hears
an emergency siren he panics and tries to hide. Amina reports that as far as she
is aware, Mussa is not wanted, nor has he committed any crimes in Australia
or Iraq.
Past medical history:
Surgery to his leg to remove shrapnel from a grenade attack when in Police custody in
Iraq.
Mussa is a new presentation, and this is the first time you are seeing him, therefore
requires initial engagement and mental state examination to help inform further
recovery-oriented service provision. In your interview (video) you need to:
• Therapeutically engage with Mussa.
• Perform a Mental State Examination (MSE), and
• Document a summary of the MSE using accurate professional expression.

ANSWER

Initial Assessment and Mental State Examination of Mr. Mussa Ahmed

In the role of a student nurse on an afternoon shift in an acute mental health ward, my first task is to admit Mr. Mussa Ahmed, a 48-year-old married man who recently arrived at the unit via the emergency department (ED). Mr. Ahmed, a refugee from Iraq, lives with his wife, Amina, and their two young children, aged 6 and 2. While he does not have a formal psychiatric history, he reports that his journey to Australia five years ago was marked by pain and trauma. According to Amina, Mr. Ahmed’s recent behavior, characterized by increased quietness and reclusiveness, has brought shame upon their family. She has attempted to uplift his mood, but her efforts have been in vain.

The referral letter from the ED team provides additional insight into Mr. Ahmed’s condition. It indicates that he has no previous history of contact with mental health services or psychiatric illnesses. The letter further reveals that he has been expressing fear of the police looking for him. Emergency sirens trigger panic in him, causing him to seek hiding places. Amina has attested that there is no reason for the police to be searching for him, and he has not committed any crimes in Australia or Iraq. His past medical history includes surgery to remove shrapnel from a grenade attack sustained during his time in police custody in Iraq.

Given this context, I will approach Mr. Ahmed’s initial assessment by employing a therapeutic and compassionate approach, ensuring his comfort and trust. I will perform a Mental State Examination (MSE) to gather essential information regarding his cognitive, emotional, and psychological state.

Therapeutic Engagement

Upon entering Mr. Ahmed’s room, I will introduce myself and explain my role as a student nurse. I will demonstrate active listening and non-judgmental behavior to create an environment in which he feels safe to express himself. I will use open-ended questions and affirmations to encourage him to share his thoughts and feelings.

Mental State Examination (MSE)

Appearance and Behavior
I will observe Mr. Ahmed’s appearance, noting if he avoids eye contact and appears disheveled and unkempt, which might indicate feelings of distress. I will pay attention to any signs of restlessness or psychomotor agitation.

Speech and Language
I will listen to his speech patterns, tone, and content. I will assess for any signs of rapid speech, incoherence, or pressure of speech. I will also note if he speaks softly or hesitates before responding.

Mood and Affect
I will inquire about his emotional state and observe his affect. I will look for congruence between his reported mood and his displayed affect. Given his recent reclusive behavior, I will assess for any signs of depression, anxiety, or elevated mood.

Thought Content
I will explore the content of his thoughts, particularly his concerns about the police. I will ask if he has any beliefs that others are plotting against him or if he feels unusually suspicious. I will also assess for any signs of intrusive or distressing thoughts related to his past traumatic experiences.

Perception
I will inquire about any perceptual disturbances, such as auditory or visual hallucinations. His reported panic upon hearing sirens might suggest heightened sensitivity to external stimuli.

Cognition
I will assess his orientation to time, place, and person. I will also inquire about any difficulties with memory or concentration. Given his past trauma and potential stressors, cognitive impairments could be indicative of underlying psychological distress.

Insight and Judgment
I will assess his insight into his current state and any potential need for support. Additionally, I will explore his decision-making and problem-solving abilities, focusing on whether he is capable of making rational and safe choices.

Summary of MSE
Mr. Mussa Ahmed presents with increased quietness, reclusiveness, and heightened suspiciousness. He exhibits avoidant behavior, avoiding eye contact and displaying signs of distress. His speech is measured and hesitant, reflecting potential emotional turmoil. His affect appears flattened, potentially indicative of underlying depression. He expresses concerns about the police searching for him and demonstrates heightened sensitivity to auditory stimuli, as evidenced by his panic response to emergency sirens. His thought content appears to center around feelings of persecution and suspicion, possibly related to his past traumatic experiences. His orientation and cognitive abilities seem intact. Insight into his condition appears limited, and his judgment appears to be influenced by his heightened state of distress.

In conclusion, Mr. Ahmed’s presentation suggests a complex interplay of trauma, distress, and potentially paranoid ideation. His history of past trauma and the challenges associated with seeking asylum may have contributed to his current mental health state. A comprehensive assessment and ongoing support are essential to provide appropriate care and interventions tailored to his needs. Given the sensitive nature of his experiences, a trauma-informed approach, cultural sensitivity, and collaboration with the healthcare team will be crucial in his recovery-oriented service provision.