Sample NURBN2024 Mental Health Recovery Plan Case Study

NURBN2024 Mental Health Recovery Plan Case Study Sample

Scenario: Mental Health Recovery Plan

Note: This is information is a continuation of Bens story from Task 1, all previous information and video still applies Ben, a 25-year-old qualified builder, was brought into the Emergency Department by the Police three days ago following an aggressive episode involving his girlfriend outside their house. Ben behaviour raised concerns, leading the Police to believe that he was mentally unwell and posed a risk to himself and/or others. As a result, Ben was detained and taken to the local health service. Ben has a history of depression and borderline personality disorder, with known suicide attempts. His depression has been ongoing since he was 21 years old. Additionally, he has been using substances since the age of 14. His girlfriend informed the police that his substance use had become much worse & in recent months and that he had started acting strangely Upon admission to the Emergency Department, Ben was found to have a mixture of alcohol, ice (methamphetamine), and cannabis in his system. He was also experiencing a psychotic episode. The healthcare professionals managed his acute symptoms and determined that he is now stable enough to be discharged from the inpatient unit to a community setting. However, given his complex history and current mental state, a comprehensive recovery plan is necessary to support his transition and rehabilitation. Your previous MSE and risk assessment contributed to his care and after 4 days, he is to be discharged in the community.

You have just started in the community and have requested to continue working with Ben at the Community Mental Health Service. Ben has agreed to this as he is comfortable with you, having previously met you in the Inpatient Unit. He has also been taken off the mental health act and is now a voluntary patient Ben’s Current presentation and information: Ben’s symptoms of psychosis seem to be resolved currently prescribed Olanzapine 10mg BD is also prescribed Diazepam 5mg TDS. These medications were also used as part of Ben’s withdrawal from his methamphetamine and cannabis whilst he was in hospital. Ben previously was on Diazepam 10mg TDS. The psychiatrist would like this to be reduced and will review these medications with a view to discontinuing when appropriate.

When in hospital, Ben also started a SSRI called Escitalopram 10mg Daily. The psychiatrist would like this to be monitored [AC1] with an increase to 20 mg if tolerated, Ben was [AC2] previously on other antidepressants before admission and stated, “they did nothing for him”. He has not had Escitalopram before.
Ben still presents as low in mood; he still states his girlfriend will leave him and will lose his job and is embarrassed about how he was brought into hospital. These statements appear to be related to his mood and do not fit delusional content. He has stated that he has no plans to take own his life, but he does on occasion think about if he could just go to sleep and not wakeup as his thoughts “don’t stop” sometimes and he just wants to get away.

Overall, Ben still has till has some mild symptoms of withdrawal, and this has generally been managed well in hospital with an Amphetamine Withdrawal Scale and his regular medication. He currently feels he cannot miss any doses of the Olanzapine and Diazepam, otherwise he may will “lose it”. Ben has discharged, back to his home with his girlfriend. She has been very supportive during his inpatient stay. His girlfriend is worried about future relapse. His mother Cathy has also been supportive to Ben during this time and has volunteered to help where she can. Ben’s workplace has organised him some sick leave. Ben’s girlfriend has discussed with you that his boss is very supportive around mental health issues and wants him back at work when he is ready.

INSTRUCTIONS:

Instructions for Students

Task is focused on creating a recovery plan for Ben mental health, considering his transition from inpatient care to a community setting. This assignment will help you demonstrate your understanding of recovery planning, mental health interventions, monitoring and collaboration. Please carefully read and follow the instructions provided below.

Task Overview: You are required to create a recovery plan for Ben, a 25-year-old individual who was discharged from an inpatient unit to a community setting after a recent aggressive episode and psychotic episode. Your recovery plan should address mental health history, substance use, and recovery goals, considering evidence- based interventions and a include collaborative approach involving Ben, healthcare providers, family, and support network. Recovery plan can follow structured headings of Recovery plan template (provided in assessment resources) Rubric and Scoring: Your submission will be evaluated based on the rubric provided. Each criterion carries a specific point value, and your total score will be calculated out of 60 points and weighted to 50% of total grade.

Solution

Introduction

Ben is dealing with bipolar disorder and he has history of engaging in self-harming behaviour. After improvement in his condition of psychosis, he has been transferred to community care setting. For Assignment Help, this study includes a detailed interpretation of mental health recovery plan to be considered for Ben. Detailed analysis of recovery objectives, intervention risk assessment, and relapse prevention plan has been given here.

Mental health

Recovery goals

As per MSE, Ben has poor personal hygiene and he has anxiety and stress-related issues. He is dealing with emotional instability and issues while communicating about problems faced currently thus goal for Ben is to consider current distress associated with symptoms of substance withdrawal and overthinking are mentioned below.

- To improve emotional resilience and limit anxiety within 6 months through emotional wellbeing activities to ensure a positive mindset.

- Reducing habit of overthinking and managing outbursts of emotion within 6 months for managing family, occupational personal lifestyle through improving emotional resilience.

Nursing interventions

Emotional resilience-enhancing activities during treatment of mental health disorders provide scope to improve positive emotions and ensure a sense of self-satisfaction (Prakash et al., 2020). Similarly, in context of Ben, focus needs to be placed on improving emotional resilience. Under community care setting a personal wellbeing project is applicable for Ben as it helps to limit symptoms of anxiety and stress by improving resilience. Mental wellbeing training is associated with idea of ensuring positive mental health indications such as well-being and resilience in case of depressive symptoms associated with interpersonal reasons and other causes (Riepenhausen et al., 2022). Key resources to be considered in case of well-being training include community setting and social support. In this context, resilience skills are developed through cognitive behavioural therapy (CBT). Benefits of CBT include better adaptability to adverse situations, positive coping skills, and self-regulation as well as better socialisation ability (Polizzi & Lynn, 2021). In context of case of Ben, application of CBT under wellbeing training can provide opportunities to improve positive thought processes and avoid situations of poor anger management and better self-regulation. Through application of CBT there is also possibility of avoiding issues of poor personal hygiene maintenance and better socialisation can also help improve issues in communication and language. Here community health service provider has the role of assisting Ben to improve self-awareness regarding recovery and deterioration symptoms for self-monitoring. Ben needs to be assisted with using mood chart and other self-monitoring techniques.

Family relationship and occupation

Recovery goals

Based on an assessment of mental health condition and current progress made it can be identified that Ben is dealing with issues to communicate emotions and issues with others and he has manager management issues. Currently Ben is on leave from his workplace as his employer arranged leave for his mental condition and treatment. Poor emotional management and poor hygiene management can impact family and professional life in terms of poor living arrangements and finance management. Due to poor communication and mention management Ben deals with poor relationships with family members such as his mother and girlfriend. Thus based on current situation Ben's goals for improvement are mentioned below.

- Improving positive relationships with family members and colleagues in workplace through enhancing socialisation ability within 6 months.

- Improving living arrangements and personal hygiene through enhancing self-management ability within 7 months.

Nursing interventions

Ben works as a qualified builder and due to substance misuse issues; he becomes unable to manage mention which can significantly impact his professional life. Due to a poor professional lifestyle, there can be poor financial management issues and employment opportunities can become limited. In this context, area to focus on is socialisation for better family relationships and emotional and self-management for better professional life. In this context, mild exercise such as swimming yoga, or meditation can be beneficial. Further engagement with community activities can help to improve socialisation. Meditation is beneficial for dealing with anger management issues in terms of enhancing sense of peace and calm as well as limiting anxiety and agitation due to depressive thoughts (Malakoutikhah et al., 2022). In this context supporting Ben to engage in mediation and other emotional wellbeing activities can help to improve his concentration and anger management ability to avoid negative impact of poor mention management of occupation and family life. Engaging in community activities and socialisation provide scope to avoid long-term mental health issues including Alzheimer's (Morton et al., 2021). As Ben already has a history of substance misuse and depression as well as suicide long-term effects of such conditions cannot be avoided. In this concrete, ensuring socialisation through engaging with community-based activities provides scope to retain emotional wellbeing. Thus guiding Ben to engage in socialisation activities and emotional resilience-enhancing activities as well as monitoring improvement can provide long-term outcomes.

Physical health and medication management

Recovery goals

Ben is currently under medication of Escitalopram 10 mg daily and he has a fear of developing old symptoms thus he thinks that he cannot avoid any dosage of Olanzapine and Diazepam. He is dealing with fear of engaging with substances again as he often overthinks and hallucinates about the situations. Considering physical health, poor personal hygiene is a major concern, and signs of withdrawal which include excessive thrust and weakness. Thus along with medication management, there is a need to focus on limiting signs of withdrawal and a healthy diet as there are also side effects of psychotic drugs. Considering area of physical health and medication management below-mentioned goals are applicable.

- To increase confidence and limit anxiety along with improving personal hygiene within 6 months through counselling and guided assistance.

- Engaging with family-centred activities for limiting anxiety and poor medication management along with following a healthy diet during time of withdrawal.

Nursing interventions

Ben has a history of substance abuse due to withdrawal signs his physical health can be impacted. Thus family centred interventions are beneficial for him. Involvement of family and communication about issues with family help to limit potential recurrence of substance misuse. Smiley in case of Ben communication with family members, specifically his mother, needs to be improved. Thus under supervision of community health service family-centred activities and changes in moods and wellbeing of Ben can be monitored. As he is currently under withdrawal and psychotic medication monitoring of vitals along with symptoms of withdrawal is needed. Ensuring a proper and healthy diet along with mild exercise can help to poop with symptoms of withdrawal. CBT can help Ben to overcome withdrawal stage and return to his old lifestyle. Thus as a community services provider has role to support Ben to access necessary resources and facilities.

Substance abuse

Recovery goals

Ben has overcome habit of substance misuse however signs of symptoms play a significant role in recurrence of habit. Thus signs of withdrawals need to be managed along with popper lifestyle management. Thus ensuring a scheduled lifestyle with mild exercise and socialisation can help Ben to overcome challenges of relapse. Ben has mentioned that he has no intention to harm himself but he is disturbed due to contour thoughts which cannot control. Thus to ensure concentration and lesser anxiety mindfulness training is beneficial in this case. Thus goals for substance misuse are mentioned below.

- Improving emotional resilience through mindfulness training and enhancing daily lifestyle routine of Ben within 6 months.

- Enhancing awareness regarding substance misuse and long-term effects within 2 months.

Nursing interventions

Ben is currently under signs of withdrawal and in this stage, lack of mindfulness can result in a relapse of previous situation. In this context supporting mindfulness activities and patient education regarding long-term and negative impacts of engaging with substances on health can be beneficial. In this context, a collaborative approach by engaging Ben's mother and girlfriend in a discussion regarding substance misuse and ways to consider better lifestyle management can be beneficial. Mindfulness training activities can help to ensure better self-control and enhance adaptability along with improving emotional intelligence and mental clarity (Drigas & Mitsea, 2020). In this context assisting in engaging with mindfulness training in activities can enhance Ben's self-control and ability to adapt to a new and healthy lifestyle pattern. Assisting Ben and his family to understand measures to consider for avoiding substance misuse in case of any type of psychological distress can help to ensure long-term possibility of limiting consumption of substances. Thus a family-centric approach and continuous monitoring of emotional resilience associated with mindfulness training is needed here.

Risk assessment

Ben is needed to be monitored in terms of his behaviour with family members, friends such as his girlfriend, and in his occupational life. Through proper counselling and continuous assessment of behaviour and lifestyle management activities, risk assessment can be done. A timely assessment of lifestyle behaviour and emotional resilience can provide scope to assess risk associated with potentiality of developing bipolar disorders and other psychological issues (Singh et al., 2022). In this context of behavioural assessment, there is the possibility of understanding current mental state and by interpreting interrelationship between family members and occupational performance there is possibility of determining effects of ongoing medication and treatment practises. Similarly in case of Ben through monitoring and assistance of his family members, there is possibility of determining potentiality of any risky behaviour and taking strict action in case of any potentiality of self-harming or anger management issues.

Discharge planning

During discharge, there are certain areas to be considered for avoiding mismanagement of medication, and relapse of situation including patient education and detailed assessment (Gledhill et al., 2023). In this case, while discharging Ben a patient education session follow-up check-up schedule as well as a diet plan and other physical activity and mindfulness training plan needed to be provided. Benefits of patient education during discharge include health empowerment, better health outcomes, and ensuring a better quality of life for patients (Ådnanes et al., 2020). It also reduces rate of readmission and in case of Ben due to symptoms of withdrawal through proper patient education and awareness along with collaboration of family members and his girlfriend; there is a possibility of avoiding situation of relapse. In case of Ben communicating with family members, arranging patient education sessions is beneficial. During discharge, proper details regarding physical exercises and ongoing medication along with therapies to be considered for him need to be communicated properly with family members to ensure collaboration and family centred treatment plan. In case of occupational lifestyle stress factors to be avoided in occupation also need to be communicated with Ben and his family members to reduce recurrence of substance misuse and psychotic condition.

Relapse prevention plan

Developing a relapse prevention plan requires recognising stages of relapse which are mainly three stages emotional, mental, and physical (Ociskova et al., 2022). It also becomes necessary to understand factors resulting from psychological turbulence to cause relapse of any type of psychotic symptoms. In context of Ben, there is a possibility of relapse of substance misuse habit and development of bipolar disorder along with anxiety and stress. In this context, major focus is to monitor triggers which are anxiety and depression as well as losing control over maintaining emotion. In case of any changes in behaviour such as lack of control over emotion and emotional distress, there is a need for further appointments with a psychiatrist and assistance of a community service provider to limit relapse of situation. In this context collaboration and monitoring through family members and friends is necessary as well as continuous socialisation and maintaining a lifestyle with a healthy diet and exercise can be beneficial to avoid relapse of such a situation.

Conclusion

Based on overall analysis it can be identified that in case of Ben, there is need to focus on applying CBT, physical exercises, and mindfulness training to enhance concentration and self-confidence. Engaging in mindfulness activities can help to overcome challenges of poor lifestyle and poor occupational performance. Patient and family-centric approach is considered for discharge planning and relapse prevention step-by-step monitoring of triggers is recommended.

References