1 Using relevant literature critically discuss the mental health status of the client in the case study. Your work should make reference to two (2) components of the Mental State Examination (MSE) related explicitly to the case study and the DSM V.
2 Critically discuss two (2) factors which have contributed to the development of the client's current mental health status. You should demonstrate your knowledge of the Stress Vulnerability Model. Your work should clearly identify the contributing factors; make reference to the case study and relevant literature.
3 Respect, empowerment and hope are three (3) positive aspects of mental health recovery. Using relevant literature and the case study, critically discuss how these three (3) principles could positively contribute to the client's journey of recovery. You should demonstrate your knowledge of recovery orientated mental health theory and practice.
The Importance of Mental Health in Individuals
1. Mental health most commonly encompasses the psychological, emotional and social wellbeing and creates an effect on the way by which an individual feels, things, or acts. Thus, mental state examination (MSE) helps in the determination of how a person can handle stress and makes necessary changes, and is essential at every stage of life, beginning from childhood and adolescence, till old age (Jacobi et al., 2014). In other words, the MSE has been identified as an essential assessment that needs to be conducted in psychiatric practice, in order to gain a deeper understanding of the underlying psychological functioning of a client, suffering from an abnormal mental state (Gibbons, Thorsteinsson & Loi, 2015). An analysis of the case study of Chung provides evidence for the fact that his mood, affect and speech are primarily affected, which in turn help in diagnosing his presenting complaints, and formulating an accurate treatment plan. Speech of a patient is most often assessed by making an observation of the spontaneous speech that the person can make, and with the use of certain structured tests that are designed with the aim of assessing specific language functions.
While observing the spontaneous speech of a patient, most often the paralinguistic features of the person such as rhythm, intonation, prosody, phonation, speech, articulation, and loudness, are taken into account (Kraus, Adler & Chen, 2013). In the case study, it was observed that the speech of the patient was purposeful and slow, and there were several repetitions of question, owing to the fact that it was becoming extremely difficult to retrieve proper information from Chung. While mood refers to certain emotional experiences that are prevalent over a persistent time, affect is used to explain the immediate emotional expressions, both of which are intricately associated with speech (Ekkekakis, 2013). Furthermore, he also appeared non-responsive upon enquiry of his health, besides displaying a flat and tearful mood. The case study also suggests that his nonverbal behaviour were related to presence of anxiety.
Although occasional anxiety is a normal part of human life, anxiety disorders are often classified as a group of mental illness that are primarily characterized by significant emotions of fear and apprehensions about future events (Melton et al., 2017). These feelings are most often manifested in terms of physical symptoms such as, shakiness and fast heart. An analysis of the signs that are reported by Chung indicates the presence of panic disorder. This condition is primarily characterized by unexpected and recurrent panic that can be referred to as sudden surges of discomfort, which in turn can get heightened significantly within few minutes. This has been diagnosed in accordance to the DSM-V diagnostic criteria for panic disorder 300.01 (F41.0), according to which an individual experiences recurrent panic attacks during a time when there is abnormal sweating, quickened heart beat, palpitations, shaking, and/or trembling (American Psychiatric Association, 2013). Furthermore, feelings of choking, abdominal pain or nausea, dizziness, numbness, and de-realization are some of the other criteria that lead to a mental disturbance (Carleton et al., 2014). Therefore it can be suggested that Chung is suffering from panic disorder and meets the criteria outline in the diagnostic guidelines.
Analyzing a Case Study of Panic Disorder
2. Vulnerability refers to the common susceptibility of a person to mental illness and this often determined by the early life experiences, and genetic constitution. Moreover, the use of medications, substance abuse, and alcoholism also play an important role in determining this vulnerability. On the other hand, stress refers to certain challenges that a person faces and is generally affected by social support, participation in meaningful activities and presence of coping strategies (McEwen & Morrison, 2013). Some individuals are biologically vulnerable to a range of psychiatric disorders such as, schizophrenia, anxiety disorder, bipolar disorder, or major depression. Greater the vulnerability of an individual to a certain disorder, the earlier is the likelihood of the person to develop the disease and more is its severity. Environmental stress have been found to create a negative impact and make a person more likely to suffer from biological vulnerabilities, thereby worsening the symptoms and resulting in relapses of a disorder. Stressful events most often include loss of a loved one, experience of victimization, or unemployment (Admon, Milad & Hendler, 2013). The tremendous work pressure that Chung faced while working in the Emergency Department and the subsequent medication error that threatened the life of a patient contributed to stress in his life and made him more vulnerable to suffer from the disorder. Social support is another way that reduces the negative impacts of stress on vulnerability and usually comes from establishment of meaningful and close relationship with others. Owing to the fact that Chung was separated from his parents and failed to maintain a healthy relationship with them acted as barriers in solving challenging problems and supporting him in pursuing meaningful life goals. Both of these elements of the stress vulnerability model contributed to the onset of panic disorder. Support from his family members would have facilitated a willing and open discussion in association with resolving personal understanding, and/or disagreements, thereby illuminating conflicting areas that lead to stress in the situation (Kleiman & Liu, 2013).
Some of the major contributing factors in this case scenario is his strained relationship with family members and an absence of any word daily life activities. The fact that, Chung was placed under investigation due to a medication error, and was supervised for a year, besides absence of his parents in the wedding ceremony, creating a negative impact on his life. Birth of his daughter can be considered as another psychosocial stressor that invariably resulted in an elevation of the panic symptoms. The child birth resulted in an infection in his wife that created pain, needed dressing and resulted in impairment in mobility. In addition, his long working hours, a major form of occupational stressor, also resulted in his failure to take proper care of a child and wife, thereby demonstrating a detached relationship with them. Lack of purposeful involvement in essential life areas such as, parenting is a significant contributor to stress (Butcher, Mineka & Hooley, 2013). All of these aforementioned factors made him miserable, worthless and unproductive in taking care of his family and life, thereby aggravating the mental condition. This in turn, directly resulted in a disruption in his thought process, and led to the development of suicidal and hostile thoughts, thereby threatening his life and wellbeing.
The Role of Vulnerability in Mental Illness
3. From the perspectives of people suffering from mental illness, recovery refers to retaining and gaining hope, engagement in life activities, social identity, and personal autonomy, gaining an understanding of one's disabilities and abilities, and creating a positive sense of self-worth. The recovery oriented approach to mental illnesses elaborates on supporting the potential of the affected person for recovery, which is viewed in the form of a personal journey, in place of pre-determined outcomes (Slade et al., 2014). This recovery most often involves development of hope, social inclusion, and empowerment, presence of strong supportive relationship, a secure base, and proper coping skills. Hence, recovery oriented practice views mental illness symptoms in the form of a continuum of the rules and norms, rather than some form of aberration. Research evidences often emphasize on the fact that the journey of an individual to their recovery from mental illness is a personal process, and is intricately associated with the society and community, in which the person resides (Moran et al., 2013). Nurturing and finding hope are one of the key prerequisites to recovery, and include not just a mental attitude that reflects the belief regarding a favourable and desirable outcome, but also demonstrates a willingness to sail through the setbacks and uncertainty. Hope is indispensable to the discovery of Chung and his earnest expectation of returning to normal life. Evidences have illustrated on the fact that all people suffering from mental illness have the capability of recovering from the condition through absolute will power, therefore establishing hope as a major support to the person in the recovery journey (Sklar et al., 2013). Promoting a positive culture that will assist Chung in his healing process is another essential recovery approach. Self-determination and empowerment are imperative in reducing the psychological and social effects of stress. Therefore, confidence needs to be developed in Chung for assisting him in taking assertive decision making. This can also be achieved by accomplishing social inclusion, where his immediate family members will be consulted and advised on the ways by which they can support him in the coping process. Several research studies have highlighted on the disempowering behaviour and attitude that exists in the society, towards people suffering from mental illnesses (Corrigan, Druss & Perlick, 2014). Hence, efforts must be taken to prevent all forms of discrimination and bring about a positive change by reducing the prevalent stigma.
Adopting a empowering and positive attitude will also facilitate the recovery process. This can be directly achieved by engaging in an empathetic verbal and nonverbal communication with the client, in order to help him realise the ways by which he can lead a meaningful and purposeful life. Dignity and respect are also crucial in this context, since they involve sensitivity towards the values, culture and beliefs of the individual (Chambers et al., 2014). Gaining a thorough understanding of the Chinese culture and traditions that are deep-seated in Chung would also help in challenging all forms of stigma and discrimination that exist in the broader community. Addressing his mental health needs, in relation to his cultural preferences and demands, will help in establishment of a sense of belonging to the society, and help him fight with the environmental stressors.
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