Creating A Personalized Treatment Plan For Joanne: A Case Study

Joanne is a 45-year-old divorcee with a long history of depression. She has had three prior suicide attempts: she has overdosed twice and attempted to slice her wrists. She sees a psychiatrist monthly and is prescribed medication. She is not compliant with her medication. She works a high stress job (60–70-hour week) and has no hobbies. She finds all her satisfaction in her work. She has not dated since her divorce 15 years ago. The divorce was due to her husband admitting to being a homosexual. One child is from that marriage, a 13-year-old daughter. Seven years ago, Joanne had an affair with her sister’s husband. Her sister never found out and Joanne ended the relationship after a year because of guilt, but the husband continues to pursue her. Joanne comes by your office unexpectedly to tell you how much she appreciates you and just wants you to know how important you are to her. In further questioning, she admits to having a gun in her car. She refuses to stay and talk. She “just wants to go for a drive.”

The following areas must be addressed:

• Describe the presenting problem and identify the immediate crisis. Address every detail that indicates the imminent nature of this client’s plan.
  
  
• Identify the precipitating event(s).
  
  
• List in detail all the risk factors in this current situation and clearly explain why this is a VERY HIGH-risk client.
  
  
• Identify the material, personal, and social resources available to the individual and the challenges related.
  
  
• Give a step-by-step intervention plan for the given crisis and the VERY HIGH-RISK client. Suggest several interventions that this person needs in the next 3 months. After stabilization, what does the focus of therapy need to be?
  
  
• Discuss any spiritually based aspects related to the crisis. Be sure to cite references you use.

Using Kolski et al. as a guide, formulate a treatment plan personalized to the problems and interventions based on this case. Remember, everything you have reported will be justification for your treatment plan. Make sure you cover all of the issues that you

Presentation of the problem

This is the study about Joanne, a 45 years old women who has been divorced. She is a patient of depression. Previously multiple suicide attempts have been made by Joanne. Three times she attempted it. She is currently under the supervision of a psychiatrist. The medicine given by the psychiatrist is not taken adequately by Joanne. Joanne has limited social interaction. Another essential point is that she has a firearm in her car. She does not want to have any conversation about her firearm.

There are different precipitating event those need be focused. There are some reasons to be concerned about the mental health of Joanne. According to the case study, Joanne has a high stressed Job (Shvartsman, & Beckmann, 2015) at present. She works for almost 60-70 hours per week. She has got no hobbies and tries to find optimum satisfaction at work. Since her husband was homosexual they got a divorce. She lives alone and has no companion. Another significant precipitating event is that Joanne had a relationship 7years ago with the husband of her sister. This was mainly due to the Homosexual (Shenkman & Shmotkin, 2013) nature of her husband. They had a long affair but Joanne ended the relationship due to a feeling of guilt. Her sister never found out about their relationship. After the break up her brother in law still follow her and wants to get back into the relationship. Joanne has mental instability (Huh & Lee, 2018). Due to the lack of companion and social interaction she is having depression and going to a psychiatrist for treatment on a monthly basis. She does not take the medication prescribed by the psychiatrist in a proper manner.

If holistic analysis of Joannes health is done then it is observed that she has got many risk factors.

The first risk factor is that Joanne has depression. Due to the depression, she has attempted suicide on three previous occasions. This depicts that she is highly prone to suicide. Second Due to her depression and mental instability she is going to a psychiatrist for treatment of her mental health. Since Joanne is having the problem of depression for a long time. The main risk is that she is not effectively taking the prescribed medicine of the medical professional. Due to the depression, the suicidal tendency (Lheureux, Truchot & Borteyrou, 2016) in Joanne may trigger at any point. The third risk factor is that she has a guilt feeling from her previous relationship with her brother in law. Depression is directly related and can be triggered by guilty feeling. The fourth reason is that Joanne has no social circle and in fact, she has got no particular hobby. Joanne is workaholic and tries to find satisfaction in her work ,working for 60-70 hours a week. The fifth risk factor is that Joanne is 45years old. Due to the mid-life crisis, there may develop a high risk of suicidal tendency. The sixth factor is that Joanne has not dated since separation from her homosexual (Shenkman & Shmotkin, 2013) husband. This implies she is losing hope. The seventh risk factor is her impaired behavior. She suddenly visits the doctor to depict her affection towards her Psychiatrist. The eighth and one of the most important risk factor is that Joanne possesses a firearm which is a huge reason for concern. Due to her depression and previous suicide tendency it may have fatal results.

Events of Precipitation

It is essential to point out the different resources needed for Joanne. The first resource is the psychiatrist. Joanne is seeking help from the mental health professional who may help Joanne in overcoming this situation. Joanne has a daughter from her ex-husband. This implies that she has responsibility and emotional attachment that may help to fight depression and stress (Sandner & Matthies, 2016). The third resource is that Joanne has developed affection for the psychiatrist. She may find mental support and social involvement through her psychiatrist. The fifth point is that in case of emergency Joanne may seek help from the national suicide hotline or her local crisis centre.

The intervention plan is one of the most essential elements that is considered for the treatment of the mental condition of Joanne.

The first intervention will be to reduce the depression level of Joanne and to manipulate her to surrender the firearms to the authority. Since she previously attempted suicide for three times the firearm increases the risk. Joanne does not make any proper conversation with her counsellor about the firearm. It is necessary to make appropriate intervention by discussing with the authority. Hospitalization may be done that will separate her from the firearm and reduce the risk factor (Kyle, 2013).

The second point of intervention may establish a level of trust within Joanne so that she may find hope. If she has lost trust in the counsellor then the counsellor may be changed. Forceful hospitalization may increase the level of stress. On the other hand, if clinical intervention is performed by developing trust and restoring faith in Joanne that will result in the holistic development of Joanne's Mental health ("Australian College of Mental Health Nursing 41st International Mental Health Nursing Conference - ‘Mental Health Nurses: shifting culture, leading change’", 2015).

The third is efficient monitoring of the holistic health condition of Joanne. The psychiatrist discussing with Joanne's friends and families may implement an effective monitoring plan.

The fourth step is that to make Joanne understand the importance of the prescribed medication. The medication should be properly taken by Joanne for holistic health development.

The fifth step of the Intervention plan should be to help Joanne in achieving long-term mental stability. After the primary care is performed by different mental therapies (Fisher, 2013) including a support structure and copying mechanism from stress may be applied to Joanne.

 The sixth step is that the psychiatrist should work with Joanne to perform therapies so that she may reduce her working hours. This might reduce the level of stress and depression.

The seventh step may be to perform proper counselling and to know about the hobbies of Joanne. It may help to restore the hope in Joanne.

The spiritual aspects of Joanne must be known before implementing the treatment plan. According to the researchers, it is seen that spiritual component sometimes acts as a coping mechanism against stress, depression, and addiction. Joanne may be prescribed to have the spiritual session with her clinician. On the other hand, if she practices the Spiritual aspect (Solovtsova & Sirotina, 2017) alone that might have a negative impact on her. The spiritual aspect may give her mental support to cope with the depression she is going through at the moment. So spirituality might be performed by Joanne under the supervision of a mental health professional.

Problem1: Joanne is showing behavior that implies that she is developing suicidal tendencies. Moreover, she has got a firearm with her as well and she is showing sudden affection towards the clinician.

Goal1: A Holistic safe environment for Joanne by the implementation of effective therapy.

Objective 1: To compel Joanne to surrender her firearm.

Intervention: If proper authorities are contacted By the psychiatrist of Joanne, they should admit her in the hospital setting to mitigate the present crisis.

Objective 2: Identification of positive aspects of Joannes life to have a holistic mental development (Ross, 2018) of Joanne.

Intervention: Through proper counselling sessions the positive components of Joannes life should be discussed.

Problem 2: Joanne is suffering from clinical depression. This increases the risk factors for performing suicide.

Goal1:  Joanne should maintain an active and positive daily routine.

Objective 1: Prescribed medication should be taken by Joanne on a daily basis. The medical journal should be maintained by Joanne

Intervention: Perusal of the medical journal should be done by the Psychiatrist on a daily basis

Objective 2: Through effective counselling sessions the negative aspects of life should be replaced with positive aspects.

Goal2: Support structure and copying mechanism should be implemented in an effective manner.

Objective1: To develop hobbies of Joanne outside the work premises.

Intervention: Reports should  be given by Joanne to the clinician about the performance of activities on a weekly basis.

Objective2: Joanne Will contact her clinician during an emergency situation.

References

Australian College of Mental Health Nursing 41st International Mental Health Nursing Conference - ‘Mental Health Nurses: shifting culture, leading change’. (2015). International Journal Of Mental Health Nursing, 24, 1-49. doi: 10.1111/inm.12172

Fisher, J. (2013). The use of psychological therapies by mental health nurses in Australia. Journal Of Psychiatric And Mental Health Nursing, 21(3), 264-270. doi: 10.1111/jpm.12079

Huh, M., & Lee, W. (2018). The Relationship between Attachment Instability and Mental Health: Mediating Role of Dispositional Envy. International Journal Of Emergency Mental Health And Human Resilience, 20(1). doi: 10.4172/1522-4821.1000391

Kyle, J. (2013). Spirituality: Its Role as a Mediating Protective Factor in Youth at Risk for Suicide. Journal Of Spirituality In Mental Health, 15(1), 47-67. doi: 10.1080/19349637.2012.744620

Lheureux, F., Truchot, D., & Borteyrou, X. (2016). Suicidal tendency, physical health problems and addictive behaviours among general practitioners: their relationship with burnout. Work & Stress, 30(2), 173-192. doi: 10.1080/02678373.2016.1171806

Ross, S. (2018). Integrative Neuronutritional Therapy Metabolic Brain Parameters in Mental Health. Holistic Nursing Practice, 32(1), 51-55. doi: 10.1097/hnp.0000000000000250

Sandner, T., & Matthies, D. (2016). The effects of stress intensity and stress type on inbreeding depression in Silene vulgaris. Evolution, 70(6), 1225-1238. doi: 10.1111/evo.12929

Shenkman, G., & Shmotkin, D. (2013). The hostile-world scenario among Israeli homosexual adolescents and young adults. Journal Of Applied Social Psychology, 43(7), 1408-1417. doi: 10.1111/jasp.12097

Shvartsman,, E., & Beckmann, M. (2015). Stressed by Your Job: Does Personnel Policy Matter?. Schmollers Jahrbuch, 135(4), 429-463. doi: 10.3790/schm.135.4.429

Solovtsova, I., & Sirotina, E. (2017). Spiritual education of school students: the aspect of value-sense interaction. St.Tikhons' University Review. Series IV. Pedagogy. Psychology, 47, 32-43. doi: 10.15382/sturiv201747.32-43