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Case Study: The Consumer with Psychotic Depression (Jenny)

Introduction

Individuals with an addiction to both legal and illegal drugs often qualify to experience further co-occurrence of mental health disorders. The incidence and prevalence of dependence on a non-dependency illness are continuously higher in many clinical populations and also remains strongly associated with other general community factors. In other societies, comorbidity is estimated and revealed to reach nearly 90percent of the people, making dual diagnoses undoubtedly never disregarded. In any instance, dually diagnosed people typically require increased levels of care and particular diagnostic standards. The conventional approach for managing such patients involves treating the disorder through the most leading medical representation. This paper aims to explore the primary setting of the community components as implemented during mental health interventions. The pragmatic focus is on the activities that are crucial for identifying the competencies of the program providers for Jenny’s case management.

The Structure and Roles of The CMH Team

During the episode of mental health care, there are various reasons for involving community platforms. One such kind includes delivering comprehensive care if primary health care services cannot be accessible or adequate. The components help in enhancing the engagement with and quality of medical care, promoting economic and social inclusion, as well as incorporating family members (Kohrt et al. 2017). The structures include schools, homes, technological, or any other physical platform. These designs are accompanied by some extent of autonomy that allows the organization to be flexible and continue engagement even after the end of prescribed programs. In the case study, the community of meeting a GP was advantageous since Jenny continued to comply with the health worker after the episode ended.

Kohrt et al. (2017) highlighted that the activities include case management, psychoeducation, psychological treatments, psychosocial rehabilitation, and skills training. In CMH settings, crisis monitoring and psychoeducation minimize involuntary cases of hospitalizations. After Jenny’s admission at the community rehabilitation facility, she demonstrated a substantial improvement in insight, and she expressed an enhanced understanding of the illness’s impacts as well as the significance of continuing with her prescription. This change could have resulted from the increased contact treatment for depression due to growing MH literacy.

The facilitators of CMH include various health professionals, community health workers, formal and non-formal service providers from the outside of the health care system. As a whole team, these specialists effectively deliver psychological treatments and mental health services to adults. Community-based episode handling approaches may also be facilitated to become better service consumer autonomy through the provision of consent to initiate psychiatric health management (Payne, Somerton, & Leeks, 2017). Another stakeholder involved is law enforcement, whose involvement is vital to prevent people from having mental disorders from detention to management services. This group of personnel also reduces instances of human rights mistreatments of individuals experiencing mental disorders. Within the Disease Control Priorities, police participation is recommended. In this case, the police and an ambulance had to be called to transport Jenny to the Emergency Department nearby for control and assessment. People with psychosis often receive community counseling by participating in support groups with their peers.

CMHN’s areas of specialty within this team.

Approximately one-third of the world’s population is likely to experience some form of mental health conditions at a point in life. Managed care thus is an increasing practical strategy during these patient’s healthcare to improve the care provided. Some situations require nurses with the role assigned for patients, family education, and emphasis on compliance with disorder management programs and plans. In this role, Heslop et al. (2016) reported that the caregivers identify potential risk factors, patient problems, and the execution of corrective strategies to reduce and prevent loss. That means registered CMHN’s in the advanced and generalist practice roles must employ culturally experienced standards to bring higher value in this arena through a rich combination of expertise, knowledge, and skills.

CMHN’s are qualified uniquely to serve in direct and indirect care roles in the care systems. Among the many mental health disciplines, these nurses combine the psychopharmacological competency, biopsychosocial knowledge, and psychiatric and physical assessment skills to a fundamental patient advocacy perspective as well as a 24-hour responsibility (Odeyemi, Morrissey, & Donohue, 2018). The nurses are knowledgeable at evaluating intricate problems and needs of patients regarding subjects like physical health, psychiatric, and substance abuse over their life. After the assessment, they will treat the illnesses' psychosocial consequences accordingly. As this industry evolves, these professionals need to monitor managed care's concept to ensure that its primary objectives are met.

The nursing activities vary much based on geographic location and service setting. A CMHN may assume a role in directly providing care in facilities like community mental health settings. The nurses may be managing psychotherapy sessions individually to individual patients, groups, or even together with their families over time (Nolan & Petrakis, 2019). In the case of Jenny, the registered nurse had a prescriptive authority to administer as well as monitor the effects of the pharmacologic agents. Nurses are well celebrated as care managers because they evaluate patients, develop appropriate treatment plans, coordinate the access of resources required, and the care provided.

As a care manager, they also monitor the patient’s needs episodically by utilizing psychiatric rehabilitation management skills to prevent relapse. In such a role, a nurse may evaluate patients during a direct encounter or over the telephone to triage the most appropriate level of care. Jenny was initially treated by the GP, Dr. Cook, using Mirtazapine and also raised the option of including an anti-psychotic, Olanzapine 5mg. Dr. Cook later influenced the decision to refer her to the Acute Community Assessment Team, who are credentialed care providers from a contracted facility and a community resource.

Stakeholders collaborating with the CMH Team.

Nurses alone cannot provide the educational and clinical care services required by mental health patients in the current care models. Instead, the systems of ambulatory facilities and physician practices have faced a redesign to enable teams and especially the patients to become active. Successful interprofessional teams have stakeholders including physicians and assistants, nurses serving at various levels, specialized medical assistants, nutritionists, dietitians, pharmacists, social workers, health navigators, mental health workers, community health workers, health coaches, exercise physiologists, informatics specialists, and quality improvement practitioners (Horspool, Drabble, & O’Cathain, 2016).

In this collaborative approach, family members and patients are also included in the advisory board, because they contribute to best care practices not only for the patients but also for their communities. Teamwork results in multiple shared values that help break down barriers and convert disjointed care systems into integrated platforms. Eventually, if the interprofessional team leverages experience, information, technology, and the right teamwork culture, they will provide value to the patients and their families.

Gibbons, Crits-Christoph, and Crits-Christoph (2019) noted that the recent changes in healthcare workers' and its continuous evolution emphasize the critical role of the stakeholders in primary care. The team also focuses on quality outcomes on patients, and the provision of preventive services to the populations served. One of the best ways the accountable organizations seek to minimize health care charges is to encourage care organizations and CMHs, to form and participate in appropriate care programs. By building networks with service providers working together towards coordinated education and services ensures high-quality care to the recipients. These institutions and individuals have financial incentives to ensure prevention of readmissions, unnecessary complications, or even duplicate services provision.

Overall, collaborative mechanisms hold service providers responsible for the patient’s health conditions, thus incentivizing them to keep working efficiently and cooperatively by monitoring between themselves the level of care provided (Maskell et al. 2017). For the CMHs to achieve the goals of producing and delivering the best care to Jenny, the collaborative processes were well-coordinated in a manner that involved the patient’s family in decision making and enabled the next team to access the patients' health records. Through utilizing these practices and an inter-professional care team, her outcomes and family satisfaction were improved.

The main focus on clinical nursing practice.

Clinical Nursing is one professional practice in the health care industry that mainly focuses on providing care to people, families, and their communities. That means the groups of individuals may achieve, maintain, and recover the prime quality of life and life. Rohde and Domm (2018) pointed out that nurses differ from any other providers of health care through their approach and scope of practicing patient care and training. As primary caregivers, nurses can work in various specialties at different prescription levels of expertise. Multiple nurses traditionally offer care as per the ordering range of other physicians, a role that shaped their general image as a care provider. However, these practitioners are permitted by the best powers to enter into independent practice in a range of settings and contexts.

Nurses can develop the appropriate plan of providing care to a patient through collaborative working with therapists, physicians, the patient, the family members of the patient, as well as other participating team members with a focus on managing the illness and improve health status (Bender et al. 2018). In some countries, advanced practicing nurses, including the clinical nurse practitioners and specialists, play a role in diagnosing health issues and prescribing suitable medications or the appropriate therapies.

Jenny was handled by nurses who helped in coordinating the care implemented by other multidisciplinary health teams like the medical practitioner and therapists. The care provided was both interdependent, with the GP, and also independently like a nursing professional. Børsting, Kristensen, and Hanssen (2020) agreed that the authority for their practice in nursing is based upon a social contract that delineates professional rights and responsibilities as well as mechanisms for public accountability. In almost all countries, nursing practice is defined and governed by law, and entrance to the profession is regulated at the national or state level. The goal of this nursing community globally is that its professionals must guarantee high-quality care provision for all people while maintaining their qualifications, code of ethics, competencies, and standards.

The main risk assessment considerations.

In CMH practice, issues around risk are increasingly dominant due to the development of a different society characterized by much awareness of risks. This consciousness is equally dangerous and a high profile task during the assessment and management of the patients. Maxwell (2018) asserted that contemporary health policies articulate these services must be motivated by ideologies of safety and quality, with specific emphasis placed on service users, families, or any caregiver, staff, as well as the community. In such contexts, the plan's effectiveness lies in the willingness of every service provider to implement a cohesive framework. The standard for healthcare quality ensures a successful risk management system and continuous health improvement.

Developing a proper safety plan involves consistently identifying policy and critical dimensions for quality practices. Completing the risk assessment should not be dissociated from or unrelated to the improvement of safety plans (Jansson & Graneheim, 2018). While the evaluation is a crucial cornerstone of preparation, it may have limited importance to the practitioners and services users if conducted as an exercise for data collection without following a strategy. Overall, Alder (2017) agree that nurses should take actions that minimize potential risks, including providing the patient advice and approaches of reducing risks, eliminating things that pose risks s well as focusing on non-adherence to the medication prescribed. Notable differences arose when the nurses working in the acute patient settings with Jenny concentrated their strategies on abscission, behavioral observation, de-escalation with significant attention given to the patient’s social context, especially the family.

Evidence from this case proves a presence of confidence and knowledge around positive risk assessment opportunities, with the patient reporting some keenness to go home and gaining weight after her admission. This aspect reflects a routine provision of positive opportunities by the professionals, emphasizing the management of the symptoms, and compliance with the prescription. The nurses must be sure of how best to involve the service user when implementing risk assessment processes and make the approaches person-centered. Higgins et al. (2018) observed that effective management of safety builds on a patient’s strengths and caring factors like resources. The capabilities are considered integral to recovery because it fosters the shared responsibility of achieving safety for service users. The planning also enhances the capacity of increasing self-directed ideas of managing risk when seeking valued goals in life.

Implications of Practicing the Recovery Model.

The psychological recovery model to mental health disorder supports and emphasizes an individual's potential to regaining. This approach is generally considered as a personal drive instead of a set result, and it may involve different aspects. O’Keeffe et al. (2018) reported that supportive relationships and connectedness is one common aspect that consists in being in the presence of people filled with the belief in someone's potential of attaining recovery, and so they stand by the patient. This process requires empathy and mutuality in existing relationships. Embodying emotional availability, respect, and authenticity makes it safer by predicting and preventing violence or shaming. Even though mental health specialists provide a limited type of relationships and also help in fostering hope, relations with family, friends, and the entire community has long-term significance.

Jenny’s case managers play a huge role in connecting her to the required recovering services, such as medical care. This period of combating the feeling of isolation would have been smooth for her if she established a community with others who had similar painful experiences. In the CMH practice, it can be realized through engaging one on one in shared story groups or peer support circles (Lysaker et al. 2018). People with the same outlooks and values in the domain of mental health are particularly significant. One-way connections can be potentially traumatizing, and devaluing and mutual networks help in developing self-esteem.

Leonhardt, Hamm, and Lysaker (2020) noted that finding and fostering hope during recovery include optimism and sustainable beliefs in the willingness to persevere through setbacks and uncertainties. Confidence can start at some point or even emerge steadily like a fragile feeling that fluctuates with depression. Jenny achieved this through positive withdrawal and modifiable social participation in the public space to move to the husband safely and in a meaningful way. The process of nurturing personal psychological space is an opportunity for developing an understanding as well as a broader sense of self. Her ability to move on meant coping with the outlooks of loss, including anger and accepting of lost opportunities. The development of coping strategies like agreeing to use medication and psychotherapy after being fully informed of the adverse effects of not choosing the recovery journey is significant. As such, the patient can manage personal traits and issues by becoming their expert in identifying key stressors and developing proper ways of response or coping.

Conclusion

Various factors often contribute to comorbidity, including shared genetic vulnerability, psychosocial adversities, and mental disorders. Patients who have psychosis may abuse substances to alleviate adverse symptomatology, or the negative symptoms may be a predisposing factor for drug abuse and dependence. Patients with psychosis like Jenny develop increased risks for depression or any other anxiety-related disorders at an old age. Anxious patients end up with negative consequences, including poor mental health conditions despite utilizing mental health services. More specifically, implementing the recovery model plays a significant role in providing integrative health care among dually diagnosed patients. For effective treatment of these populations in the setting needs a multidisciplinary team for a severe psychotic disorder. In this case, the difficulties experienced when treating Jenny’s dual diagnosis were overcome, and so there was no worsening in her prognosis.

References

Alder, J. (2017). Protective factors: bridging the gap between recovery and risk of violence assessment. Mental Health Practice (2014+), 21(3), 15.

Bender, M., Spiva, L., Su, W., & Hites, L. (2018). Organising nursing practice into care models that catalyse quality: A clinical nurse leader case study. Journal Of Nursing Management, 26(6), 653-662.

Børsting, T. E., Kristensen, N., & Hanssen, I. (2020). Student nurses’ learning outcomes through participation in a clinical nursing research project: A qualitative study. Nurse Education in Practice, 43, 102727.

Gibbons, M. B. C., Crits-Christoph, K., & Crits-Christoph, P. (2019). Psychodynamic psychotherapy for depression in community mental health settings. In Contemporary Psychodynamic Psychotherapy (pp. 109-120). Academic Press.

Heslop, B., Wynaden, D., Tohotoa, J., & Heslop, K. (2016). Mental health nurses’ contributions to community mental health care: An Australian study. International Journal Of Mental Health Nursing, 25(5), 426-433.

Higgins, A., Doyle, L., Downes, C., Morrissey, J., Costello, P., Brennan, M., & Nash, M. (2016). There is more to risk and safety planning than dramatic risks: Mental health nurses’ risk assessment and safety‐management practice. International Journal Of Mental Health Nursing, 25(2), 159-170.

Horspool, K., Drabble, S. J., & O’Cathain, A. (2016). Implementing street triage: a qualitative study of collaboration between police and mental health services. BMC Psychiatry, 16(1), 313.

Jansson, L., & Graneheim, U. H. (2018). Nurses' Experiences of Assessing Suicide Risk in Specialised Mental Health Outpatient Care in Rural Areas. Issues In Mental Health Nursing, 39(7), 554-560.

Kohrt, B. A., Asher, L., Bhardwaj, A., Fazel, M., Jordans, M. J., Mutamba, B. B., ... & Patel, V. (2018). The role of communities in mental health care in low-and middle-income countries: a meta-review of components and competencies. International Journal Of Environmental Research And Public Health, 15(6), 1279.

Leonhardt, B. L., Hamm, J. A., & Lysaker, P. H. (2020). The Recovery Model and Psychosis. In A Clinical Introduction to Psychosis (pp. 113-132). Academic Press.

Lysaker, P. H., Hamm, J. A., Hasson-Ohayon, I., Pattison, M. L., & Leonhardt, B. L. (2018). Promoting recovery from severe mental illness: implications from research on metacognition and metacognitive reflection and insight therapy. World Journal Of Psychiatry, 8(1), 1.

Maskell, R., Rudkovska, A., Kfrerer, M., & Sibbald, S. (2017). Collaborative care models for integrating mental health and primary care. University of Western Ontario Medical Journal, 86(2), 13-15.

Maxwell, C. A. (2018). Nursing Considerations in General Evaluation, Risk Management, and Goals of Care. In Geriatric Trauma and Acute Care Surgery (pp. 411-421). Springer, Cham.

Nolan, M., & Petrakis, M. (2019). Delivering family psychoeducation at the mental health acute inpatient service: A practitioner narrative. Journal Of Psychiatric And Mental Health Nursing, 26(3-4), 101-107.

O’Keeffe, D., Sheridan, A., Kelly, A., Doyle, R., Madigan, K., Lawlor, E., & Clarke, M. (2018). ‘Recovery’in the real world: Service user experiences of mental health service use and

recommendations for change 20 years on from a first episode psychosis. Administration And Policy In Mental Health And Mental Health Services Research, 45(4), 635-648.

Odeyemi, C., Morrissey, J., & Donohue, G. (2018). Factors affecting mental health nurses working with clients with first‐episode psychosis: A qualitative study. Journal Of Psychiatric And Mental Health Nursing, 25(7), 423-431.

Payne, G., Somerton, K., & Leeks, A. (2017). Community based mental health services in action. Fundamentals of Mental Health Nursing: An Essential Guide for Nursing and Healthcare Students, 196.

Rohde, E., & Domm, E. (2018). Nurses’ clinical reasoning practices that support safe medication administration: An integrative review of the literature. Journal Of Clinical Nursing, 27(3-4), e402-e411.

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