Identifying Concerns In Lisa's Case Study Essay.

You are required to choose one (1) of the two (2) lived experience video scenarios, to be posted on LEO, both of which demonstrate the potential for the development of problematic substance use, which may interact with the presenting mental health concern.

In addressing this topic, you are required to:

Identify three issues demonstrated in the video which may have contributed to problematic substance use. Ensure you support your choice of issues using current literature;

Discuss your chosen issues, using the principles of trauma-informed care and practice (TICP) (approx. 750 words);

Identify how your chosen issues should inform the mental health nurse’s collaboration with the person to achieve their personal recovery (approx. 750 words) and Critically discuss how the nurse would apply trauma informed care principles, when engaging with the consumer. Choose another member of the mental health multidisciplinary team with whom the mental health nurse would engage in the process of collaborative care planning. Provide a rationale for your choice, using current literature. 
 

Loneliness and Isolation as Primary Concerns

While analyzing the case study of Lisa, several mental and psychological concern that affected her mental balance and increased her need for psychological treatment were identified. Lisa was counselled by Jenny, a local drug service under whom she was undergoing treatment and while sharing her concern, Lisa mentioned her concerns. Within these, the three aspects, which contributed to her problematic substance use, were her loneliness, her fear and insecurities.

As mentioned in the case study, Lisa’s parent did not approve of her relationship with John due to which she separated from her family and moved in with John. Due to this rejection from her parents, she started feeling lonely and isolated. As per Lindgren et al. (2014), loneliness and isolation are two primary concern of people suffering from psychological or mental issues.  Lisa was agitated, anxious and fidgeting constantly while communicating to the local counsellor that indicated towards her loneliness and isolation stage, as she was unable to make eye contact to the counsellor. The counsellor mentioned that Lisa looked untidy, rough and does not look like her normal self as well as Lisa also mentioned herself ‘ugly’ that indicated towards her low self-esteemed and confidence. Therefore, as per the Trauma- Informed Care Principles, she lacked empowerment (Raja et al., 2015). Further, due to the rejection from her family, she was not able to continue her medication as her mother used to take care of it, therefore the only source of her empowerment, her family was not present in the situation, due to which her substance abuse resumed. 

The second issue could be identified from the fact that Lisa repeatedly mentioned her need of protecting herself from her surrounding environment and close people. Lisa mentioned of few voices that repeatedly asked her to protect herself from John. Further she had several cameras in her house that constantly concerned her of continuous vigilance. This affected her mental peace as she had to sleep in the garden shed with a knife under her pillow as she had constant fear of being watched, threatened by some external voices and her boyfriend John that made her sleep alone in garden at night. As per Pearson et al. (2015) fear plays an important role in the development of psychological disorder and in case of Lisa, there were multiple stressors that induced fear in her psychological disorder. While communicating her concerns to the local counsellor, she mentioned that she is fearful of thinking on her won because she thinks her boyfriend has inserted transmitter in her stomach, and her thoughts are open to everyone surrounding. As per Sweeney et al. (2015) fear is a core process, in which discrimination, power, and control plays an important role. After facing rejection from her family, she was completely dependent on her boyfriend however due to continuous vigilance, stress and isolation, she developed fear of staking, violence and threatened of death. As per the Trauma- Informed Care Principles, trustworthiness, transparency and safety were the principles that were lacking in her surrounding that may enhance her substance abuse and increased her psychological complication (Muskett, 2014).

Fear and Insecurity as Contributing Factors

The third aspect, which could have induced her psychological and mental concerns is her insecurity and stress. While communicating to the local counsellor, she seemed distracted and was observed having conversation with some virtual individual. She was also distracted while conversation and asked to repeat several question due to her lack of concentration. She mentioned that she is unaware of medication program and has not consumed any medicine since she has moved to her new house with John. Besides, after moving in with John, she has unintentionally increased her cannabis and speed related substance abuse. Researcher Van der Kolk (2017) has mentioned in their research that insecurity is the feeling which is associated to psychological and mental issues as people affected with it are unable to control their feelings and thinking. Hence, this was the third concern which could have influenced the patient to be addictive of substance abuse. Besides these, another reason for her increased insecurity was the voices, that molded her thoughts and made her believe that people around her were affecting her mental peace and she need to protect herself from those people. Further as per Trauma- Informed Care Principles, while receiving care in the local drug center, her care lacked collaborations with mental healthcare professionals and hence, this would be provided to the patient in her future healthcare service (Wolf et al., 2014). Hence, these were the primary concerns which may have contributed to her problematic substance abuse. 

Collaboration between mental health patients and nursing professionals is completely dependent on their personal beliefs, thoughts and values depending on which people affected with mental health concern are provided with care (McKenna et al., 2014). To make the mental health collaboration fruitful, both the consumer and nursing professionals should indulge in conversation, identify the needs of the patient and then prepare nursing interventions that could help the patient to recover properly (Mittal et al., 2014). Further, it was also mentioned in the research of Kitson, Athlin and Conroy (2014) that both the nursing professional and the consumer should be able to utilize their knowledge so that effective therapeutic relationship could be developed. In this process, Lisa was counselled by Jenny, the local counsellor at drug center. Lisa took several sessions in this drug center however, with time her substance abuse episode increases and her medication also failed to provide positive result to her psychological condition. Therefore, while collaborating with the mental health care professionals, the primary goal for the care process would be decreasing her stress, fear, insecurity and isolation so that she could focus on the care process properly (McKenna et al., 2014). In this aspect the Trauma- Informed Care Principles would be involved as the core care competency and depending on this aspect the care process of Lisa would be developed (Wall, Higgins & Hunter, 2016). The three primary aspect mentioned in the case study of Lisa was her fear, her insecurities and her isolation from her family. Hence, collaboration between mental health care professionals and Lisa should be focused on addressing these concerns so that her recovery could be made possible (Mittal et al., 2014).

Collaborative Care for Mental Health Patients

Involvement of Lisa in the care process is an important aspect as personal recovery is a subjective process which is achieved through personal expectations, goals and hope that should be developed by the person seeking mental healthcare (Kitson, Athlin & Conroy, 2014). Further, it would the responsibility of the healthcare professionals of the mental health center to address the issues identified and goals developed by Lisa so that achievement of goals and hopes could be understood by the patient (McKenna et al., 2014). Further, in case of Lisa, while developing the care plan a comprehensive and long-term approach would be chosen for the growth and development of the patient and with facilitating patient centered care process, counselling would also be involved in which she would be asked to communicate with her parents, would be asked to become financially stable and independent so that her self-esteemed and confidence could be restored (Mittal et al., 2014).

As per the global practice of recovery based treatment for patients affected with psychological; concerns, there are four aspects of the recovery oriented care process in which, acknowledging and facilitating the concern of the patient, support, their aim goal and their dreams of normal life works as primary pillars of the care process (Wall, Higgins & Hunter, 2016). On the other hand based on the Trauma- Informed Care Principles, Lisa lacked empowerment, trust, transparency, safety and collaboration in her care process (Berliner & Kolko, 2016). Hence, these two care strategies mentioned above would help to develop a support based care process in which she would be empowered to take her decision for the care process. Further, her care process would also be dependent on the mutual decision related care process so that she could develop trust on the care process due to its transparency and achieve her personal recovery related goals effectively (Wall, Higgins & Hunter, 2016). 

In the care process of Lisa, application of Trauma- Informed Care Principles should be achieved. Further, for the recovery model of care for Lisa, interventions would revolve around her insecurity, fear and isolation associated concerns so that through the interventions show could be provided with improved mental health condition. As per the Trauma- Informed Care Principles, there are five principles depending on which patient affected with mental health should be provided with interventions (Berliner & Kolko, 2016). 

While developing her care process, the first issue of her loneliness and isolation would be addressed by providing her empowerment and confidence. As per Rajaram, Barnard and Bilimoria (2015), empowerment holds utmost importance in treatment of patients affected with psychological issues. They suffer from inferiority complex, low esteemed and less confidence due to which, empowerment helps them to identify their goals for recovery (Fogel & Greenberg, 2015). In this case of Lisa, she would be asked to communicate with her parents to address her isolation and loneliness issues. She also mentioned in her counselling session that her mother used to take care of her medication and after she left her parents’ house, she lost track of her medicine and have not taken any medication from last 2 weeks. Hence, it is important to include empowerment in her mental health care process so that she could overcome her stress, loneliness and isolation. Further, she would be provided with communication and n=behavioral therapy so that through these interventions, her social inclusion and communication ability with other could be improved. To address her fear and insecurities, she would be involved in the cognitive behavioral therapy in which she would be asked to involve in therapeutic sessions of painting, gardening, and music (Fogel & Greenberg, 2015). These sessions would help to relieve her stress and she would be able to gain trust in the transparent care process by controlling her negative nerves. Further, as per Rajaram, Barnard and Bilimoria (2015), inclusion of cognitive behavioral therapy would help her to relieve her stress and she would be able to collaborate in mutual decision making process and develop goals and strategies to achieve them as per the recovery model of care. In this process, besides the nursing professional, psychiatrist would be involved from the multidisciplinary team so that the interventions, developed by the nursing professional could be improved and evaluation of those interventions to determine its ability to address Lisa’s care need could be identified (Fogel & Greenberg, 2015). Further involvement of a psychiatric in the care process would help to counsel the patient time to time so that relapse of her substance abuse could be controlled to enhance the effectiveness of care process. 

References

Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child maltreatment, 21(2), 168-172.

Fogel, B. S., & Greenberg, D. B. (2015). Psychiatric care of the medical patient. Oxford University Press.

Kitson, A. L., Athlin, Å. M., & Conroy, T. (2014). Anything but basic: nursing's challenge in meeting patients’ fundamental care needs. Journal of Nursing Scholarship, 46(5), 331-339.

Lindgren, B. M., Sundbaum, J., Eriksson, M., & Graneheim, U. H. (2014). Looking at the world through a frosted window: experiences of loneliness among persons with mental ill?health. Journal of psychiatric and mental health nursing, 21(2), 114-120.

McKenna, B., Furness, T., Dhital, D., Park, M., & Connally, F. (2014). Recovery-oriented care in a secure mental health setting:“striving for a good life”. Journal of forensic nursing, 10(2), 63-69.

Mittal, D., Corrigan, P., Sherman, M. D., Chekuri, L., Han, X., Reaves, C., ... & Sullivan, G. (2014). Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatric rehabilitation journal, 37(4), 297.

Muskett, C. (2014). Trauma?informed care in inpatient mental health settings: A review of the literature. International journal of mental health nursing, 23(1), 51-59.

Pearson, J., Naselaris, T., Holmes, E. A., & Kosslyn, S. M. (2015). Mental imagery: functional mechanisms and clinical applications. Trends in cognitive sciences, 19(10), 590-602.

Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma Informed Care in Medicine. Family & community health, 38(3), 216-226.

Rajaram, R., Barnard, C., & Bilimoria, K. Y. (2015). Concerns about using the patient safety indicator-90 composite in pay-for-performance programs. Jama, 313(9), 897-898.

Sweeney, A., Gillard, S., Wykes, T., & Rose, D. (2015). The role of fear in mental health service users’ experiences: a qualitative exploration. Social psychiatry and psychiatric epidemiology, 50(7), 1079-1087.

Van der Kolk, B. A. (2017). Developmental Trauma Disorder: Toward a rational diagnosis for children with complex trauma histories. Psychiatric annals, 35(5), 401-408.

Wall, L., Higgins, D. J., & Hunter, C. (2016). Trauma-informed care in child/family welfare services. Melbourne, Vic: Australian Institute of Family Studies.

Wolf, M. R., Green, S. A., Nochajski, T. H., Mendel, W. E., & Kusmaul, N. S. (2014). ‘We’re civil servants’: The status of trauma-informed care in the community. Journal of Social Service Research, 40(1), 111-120.