Understanding Substance Abuse And Trauma: A Case Study Of Lisa, An Essay.

In addressing this topic, you are required to:

Video link: https://www.youtube.com/watch?v=83i2MWMqph8

1.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;

2.Discuss your chosen issues, using the principles of trauma-informed care and practice (TICP).

3.Identify how your chosen issues should inform the mental health nurse’s collaboration with the person to achieve their personal recovery 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. 

The relationship between substance abuse and mental health

Mental health illnesses had emerged as one of the most important issues that the different individuals of the world are currently suffering from (Reeves, 2015). The problem of substance abuse directly contributes towards different kinds of mental health issues that the individuals commonly face and in some of the severe cases of substance abuse the patients start to lose their sense of time and place as well (Quiros and Berger, 2015). Some of the most important problems that the individuals with sustained substance abuse face are hallucinations, depression, anxiety, a high sense of insecurity, paranoia and others (Isobel, 2015). These are precisely the problems that Lisa, a repeated substance abuser of cannabis and speed faces in the video “Understanding the MSE – Lisa”.

There are various issues or causes which lead to substance abuse like genetics, physical environment, mental health illnesses, peer pressure, trauma and others (Hall et al., 2016). In the video under discussion here, Lisa is a patient who had been under medication for quite some time however she again begins to use substances like speed and cannabis on moving in with her boyfriend (DreamSchemaMedia, 2011). More importantly, she had become psychotic and is afraid that the cameras in her home are watching and also her boyfriend had placed a transmitter in her stomach so as to monitor her (DreamSchemaMedia, 2011). She becomes disillusioned and starts to sleep in the garden shed with a knife under her pillow thinking that her boyfriend Jonah will hurt her. Three of the major factors which have contributed towards her problematic substance use are peer pressure, environment and trauma.

In the video, Lisa mentions to her counselor that her parents did not want her to move out with her boyfriend and ever since she had moved out she had no contact with them (DreamSchemaMedia, 2011). This in turn had created a feeling in her that she is being neglected by her parents and in turn had added to the trauma which she feels at the house of her boyfriend. Kirst, Aery, Matheson and Stergiopoulos (2017) state that trauma or neglect for that matter is one of the major issues or causes which propel the individuals to use drugs like cannabis, speed and others. Another important issue which had caused the problem of substance abuse which Lisa is presently suffering from is environment in which she lives. For example, she is recently moved out of her parent’s home and is living with her boyfriend, Jonah. The house of Jonah has security cameras which make Lisa uncomfortable and also makes her think that she is being watched and the cameras are trying to say something to her (DreamSchemaMedia, 2011). More importantly, this had made her to have hallucinations and she thinks that her boyfriend is trying to harmful although she herself says that he had not given any cause to her to make her think so or has not hurt anybody till now. Thus, in order to cope up with these insecurities or safety concerns she resorts to the usage of cannabis and speed to adjust to her present environment, that is, in the home of her boyfriend, Jonah. Lastly, the factor of peer pressure is another important issue which has made her to resort to the usage of drugs again after undergoing medication for the same. In this regard, it needs to be said that while she was at her parent’s home, they made her to undergo proper medication and also she did not feel the urge to intake drugs. However, the act of her parents not talking to her after she had moved out of their house is another factor which could have contributed in a significant manner towards her substance abuse problem. This had created a sense of abandonment in her mind and in order to adjust the new reality of her life she resorts to the usage of drugs once again.    

Factors contributing to Lisa's substance abuse problem

The Department of Health Services had made it mandatory for the service providers to use the “trauma-informed care and practice” principles for the delivery of effective as well as quality services to the patients with different kinds of problems (Isobel & Edwards, 2017). The six important attributes or principles of the concerned framework of care and practice are safety, trustworthiness and transparency, peer support, collaboration and mutuality, empowerment and choice, cultural, gender and historical issues (Bryson et al., 2017). The usage of this care and practice in the particular case of Lisa and the problems that she is facing would reveal insightful information. For example, as per the first principle, that is, safety, Lisa does not feel comfortable or safe in the house she is presently residing in. This is perhaps one of the major reasons why she sleeps in the garden shed with a knife under her pillow. On the other hand, as per the second principle, that is, trustworthiness and transparency, it is seen that Lisa had developed trust issues with her boyfriend and thinks that he had transplanted a transmitter in her stomach to detect her inner thoughts and movements. More importantly, Lisa is not getting adequate amount of support from her peers and as a matter of fact they have stopped interacting with her after she had moved-in with her boyfriend, Jonah. Furthermore, there is no mutuality or collaboration between Lisa and Jonah and this becomes apparent from the trust issues that she had developed. Moreover, Lisa feels that she does not have adequate choice or empowerment in her current situation and in order to empower herself she resorts to the usage of a knife. Lastly, Lisa had issues of substance abuse in the past as well and the net result of this is that when in present situation she faces challenges she once again resorts to the usage of the same. 

The collaborative practice of care had emerged as one of the most important ones within the framework of the contemporary healthcare industry and the counselors are not only required to collaborate in an effective manner with their patients but also with the other healthcare authorities or bodies so as to offer the best quality services to them (Harden et al., 2015). This even becomes apparent from the case of Lisa and her counselor in the video under discussion here. For example, it is seen that the counselor of Lisa tries to analyze the issues which Lisa is facing presently that had led to her substance abuse problem and also the symptoms that she is manifesting so as to offer a more personalized care for her personal recovery. The net result of this is that she takes the help of “Mental State Examination” framework to analyze her present condition. In this regard, it needs to be said that Lisa appears to be disjointed since she normally looks very smart and although she shows no sign of depression yet she is paranoid and seen to be responding to some unseen external stimuli (DreamSchemaMedia, 2011). More importantly, she is disillusioned and not much attentive during the entire course of the session while showing signs of restlessness and agitation (DreamSchemaMedia, 2011). Furthermore, although she is not suicidal yet she thinks that she might harm Jonah if he enters the garden shed in which she sleeps at night. Lastly, even in her present state of mind she is agreeable and is willing to accept the help that her counselor had to offer her by referring her to the mental healthcare authorities (DreamSchemaMedia, 2011).

Trauma-informed care and practice

The counselor of Lisa have been able to identify these symptoms that Lisa had been facing not only on the basis of the MSE tool but also through an effective analysis of the issues that had led to her present state of mind. This is important from the perspective that the effective identification of the issues which caused the substance abuse and other problems that Lisa was suffering enabled her to objectively understand her present state of mind of condition in an effective manner. More importantly, this also helped her to gather adequate information from Lisa for conducting the risk assessment and thereby to analyze the actual state of Lisa. This in turn enabled to decide whether or not she needs specialized care for speeding up the process of her personal recovery and also to ensure that she does not cause any significant amount of harm to herself or for that matter those around her. 

The nurses while applying trauma informed care principles need to take into effective consideration the fact that negative impact of trauma could have lasting impact on the mental health of the patients (Goodman et al., 2016). The nurses while administering trauma informed care to the patients need to take the help of various tools like patient engagement, clinical as well as organized care and others to ensure the wellness of the patients (Levenson, 2017). Basically, the nurses are required to follow various steps for administering effective trauma informed care services like identifying the root issues of the symptoms or problems that the patient is having, take the help of the MSE and risk assessment tools to analyze the extent of threat or danger that these problems present and lastly to recommend specialized care if the situation demands (Carello & Butler, 2015). An important member of the mental health multidisciplinary team to whom the mental health nurses can recommend patients like Lisa is the occupational therapist. The occupational therapists are the qualified professionals who assess the mental condition of the patients in an objective as well as subjective manner and thereby devise recovery plans through which the patients can recover from the mental problems that they are facing (Berliner & Kolko, 2016). This is important because the majority of the counselors lack the technical skills to administer effective recover process to the patients and thus the patients often find it very difficult to recover from the mental health issues that they are facing (Raja et al., 2015). More importantly, the occupational therapists are specially trained to handle the cases of patients who suffer from the problem of substance abuse, hallucinations, pose a significant threat to their surrounding people and others (Hall et al., 2016). In addition to these, the care administered by them is not only in synchronicity with the requirements or stipulations stated by the healthcare services department of the national government but also follow the ethical or moral code of counseling as well (Bryson et al., 2017). On the basis of these, it can be said that recommending or referring Lisa to an occupational therapist would be the best decision on the part of her counselor. 

Collaborative care and personalized recovery

To conclude, the trauma-informed care and practice had emerged as one of the most important ones within the framework of the contemporary care methods which are being used by the healthcare professionals for administering treatment services to them. More importantly, the counselors or the healthcare professionals taking the help of this framework are not only required to comply with its different principles but at the same time identify the different issues that have led to the present condition of the patients. In addition to this, the counselors are also required to take the help of the MSE framework for analyzing the present condition of the patients and thereby determining whether they need advanced care or not. 

References

Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child maltreatment, 21(2), 168-172. Retrieved from https://journals.sagepub.com/doi/abs/10.1177/1077559516643785?journalCode=cmxa

Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S., ... & Burke, S. (2017). What are effective strategies for implementing trauma-informed care in youth inpatient psychiatric and residential treatment settings? A realist systematic review. International journal of mental health systems, 11(1), 36. Retrieved from https://doi.org/10.1186/s13033-017-0137-3

Carello, J., & Butler, L. D. (2015). Practicing what we teach: Trauma-informed educational practice. Journal of Teaching in Social Work, 35(3), 262-278. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/08841233.2015.1030059

DreamSchemaMedia, (2011). Understanding the MSE - Lisa [Video]. Retrieved from https://www.youtube.com/watch?v=83i2MWMqph8

Goodman, L. A., Sullivan, C. M., Serrata, J., Perilla, J., Wilson, J. M., Fauci, J. E., & DiGiovanni, C. D. (2016). Development and validation of the Trauma?Informed Practice Scales. Journal of Community Psychology, 44(6), 747-764. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/jcop.21799

Hall, A., McKenna, B., Dearie, V., Maguire, T., Charleston, R., & Furness, T. (2016). Educating emergency department nurses about trauma informed care for people presenting with mental health crisis: A pilot study. BMC nursing, 15(1), 21. Retrieved from https://doi.org/10.1186/s12912-016-0141-y

Harden, T., Kenemore, T., Mann, K., Edwards, M., List, C., & Martinson, K. J. (2015). The Truth N’Trauma Project: Addressing community violence through a youth-led, trauma-informed and restorative framework. Child and Adolescent Social Work Journal, 32(1), 65-79. Retrieved from https://link.springer.com/article/10.1007/s10560-014-0366-0

Isobel, S. (2015). ‘Because That's the Way It's Always Been Done’: Reviewing the Nurse-Initiated Rules in a Mental Health Unit as a Step Toward Trauma-Informed Care. Issues in mental health nursing, 36(4), 272-278. Retrieved from https://www.tandfonline.com/doi/abs/10.3109/01612840.2014.982842

Isobel, S., & Edwards, C. (2017). Using trauma informed care as a nursing model of care in an acute inpatient mental health unit: A practice development process. International journal of mental health nursing, 26(1), 88-94. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/inm.12236

Kirst, M., Aery, A., Matheson, F. I., & Stergiopoulos, V. (2017). Provider and consumer perceptions of trauma informed practices and services for substance use and mental health problems. International Journal of Mental Health and Addiction, 15(3), 514-528. Retrieved from https://link.springer.com/article/10.1007/s11469-016-9693-z

Levenson, J. (2017). Trauma-informed social work practice. Social Work, 62(2), 105-113. Retrieved from https://doi.org/10.1093/sw/swx001

Quiros, L., & Berger, R. (2015). Responding to the sociopolitical complexity of trauma: An integration of theory and practice. Journal of Loss and Trauma, 20(2), 149-159. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/15325024.2013.836353

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