Introduction This essay considers a scenario of a troubled 37 year old mother and looks at the support from health organisations and other support services which could be accessed in terms of the impact on the service user and her family. This is a case where Community Care is appropriate and calls for a multi discipline team. How the team would be drawn together is discussed on the basis of the problems highlighted in the scenario and the professional help that might relate.
It is of course something of an estimate as only a detailed assessment and continued evaluation can identify the need in detail.Range of health needs and services that may be accessed impact. Rhoda has been referred to the Community Mental Health Team (CMHT) by her GP. There is nothing to indicate any acute problem and the CMHT approach is appropriate to provide the best solution in supporting Rhonda. However, the indications are that there is a wide range of problems and will require the work of the Multi-disciplinary team. . The first stage of treatment is to carrying out an Assessment of Rhoda. This has already been started by Rhoda’s GP who will have already have carried out a preliminary assessment and referred her to the CMHT.
An assessment involves evaluating the service users mental, physical cultural and spiritual needs as well as their personal needs. Failing to respond adequately, or even to recognise the patients’ needs, can result in those needs not being met and would be a failure of care (Howatson-Jones et al, 2012a) In line with the NMC document record keeping it states that nurses need to record details of any assessments and reviews that are carried out and also make note of any evidence of the arrangements that have been made for future and on-going care. (Barrett et al 2012 p. 14).The community Mental Health team will now carry out further assessment and decide ,along with Rhoda, what treatment or other therapies could help her back to Mental Health. Howatson-Jones et al, (2012b) states that Patients need to be assessed at key points in their care journey and the importance of assessing patients at a number of different times – for example, when they first identify they have a need or when meeting the patient for the first time. The assessment will likely be a Care Programme Approach (CPA).
The care program approach was introduced in 1999 as a framework for the care of service users with mental health problems.The main points were the systematic assessment of individuals health and social care needs, the forming of a care plan, and the appointment of a key worker to monitor the care given (Sainsbury Center, 2005a). The CPA is used for a person’s whose care will likely require support from more than one professional or longer term care. This assessment will involve getting information on Rhoda’s needs this includes mental health/psychological needs, physical health her housing situation her social and family relationships and financial situation also will look at her dietary needs. (Sainsbury Center, 2005b)We know that Rhoda has split up from her partner who was being abusive, has recently seen her GP where it was reported she was feeling low in mood, not have a job currently and from the sound of it does not have much if any money at all. She has 3 children and her mother but there is no mention of her a father.
Her partner has left her in a lot of debt. She also presents as very tearful and speaks in a monosyllabic way. This could indicate depression but may be more complicated. The nurse has been confronted by monosyllabic speech and through patient gentle prompting and allowing enough time will have to try to get beyond this.It is unlikely to indicate a reluctance to be with Community Health in this case but may indicate, embarrassment, low self-esteem or a fear of being judged. It might also be a lack of confidence from the conditioning of previous experience in speaking up. What we can see is that it will almost certainly be difficult for the assessor to get additional information beyond very specific questions drawing conclusions will have to be done with care.
The CMHN have not been told if the GP has prescribed any medication. As the team learn how Rhoda is currently feeling about her situation it may also reveal indications of “not wanting to live”.A counsellor may be needed to resolve any feelings Rhoda might have to do with the ex-partner. As yet it is not clear the extent of the abuse but even a serious abusive relationship may have represented security and Rhoda may still love the partner. The partner may represent a threat be it perceived or real and either Social Services or even the police may need to step in. As Rhoda is struggling to cope and left with debts and little money she might need to be referred to a dietician she (and perhaps the children) might not be eating properly.
“Food insecurity is associated with anxiety and depressive symptoms;… poor coping strategies.” (Ivers 2011) The Community Mental Health team will need to meet with the mother as at first glance it could be said that she is unsupportive. Equally, her words may simply reflect a frustration with the situations and not knowing how to help. The mother’s advice is all very well and does at least highlight the need for resolution. However, without help and support it is unlikely to happen. The assessment will also need to collaborate much of the detail gained from Rhoda and it might also help to fill in gaps where her limited responses have been inadequate.However, the mother’s perspective and feelings will not necessarily reflect how Rhoda is feeling at present. There might be a case for both Rhoda and her mother to come in for counselling together and to be able to work through any issues they have and to set up a care plan to get Rhoda back to “mental health” Specific counselling for Rhoda could well include Cognitive behavioural therapy (CBT).
This aims to target the negative thoughts the client is feeling. The therapy uses a structured process to identify the source of negative feelings and develop strategies to establish more positive responses by working collaboratively.(Barker 2009) The role of other professionals . A number of other external professionals are likely to be involved in Rhoda’s care. The Social Services department would be able to help with family problems and living arrangements. Their specialist knowledge and help may be able to resolve her predicament about her child care and living circumstances, especially as she has no money currently (Care Directions, 2011) The Citizens Advice Bureau (CAB) could help Rhoda with her financial and legal problems and point her in the right directions to receive other appropriate help.They provide a lot of free and confidential advice on a range of things which might be of use to Rhoda.
(Citizens advice bureau,2012) The children are a worry for Rhoda who makes it clear that she feels threatened by the possibility that social services will take them away from her. We do not know if this is because she perceives herself as being a bad mother, whether there are real problems with care and behaviour in both the community and the family or if it is just behaviour at school as highlighted by a teacher.But the school could be a source of considerable support Again, Rhoda may have heard from the teacher and totally misread the situation and collaboration will be needed. Some bad behaviour by the children would hardly be surprising in the circumstances. If the school can be involved, understanding and supportive then at least it could be got under control and Rhoda reassured. They may even be able to give Rhoda some strategies and increase her confidence and self esteem. Perhaps with a 17 year old it might be well to consider if drugs or alcohol may have a part to play and if so specialist help might be needed Model of care.The model of care normally used would be the Recovery model.
The aims of this model are to encourage people with mental health conditions to look beyond survival and existence. It is to enable them to move forward and create new targets and to form new relationships which give their life meaning and purpose The model is in line with the Nursing and Midwifery Councils framework for mental health nurses which says they should practise in a holistic, non-judgemental and caring manner which avoids assumptions.It helps to support social inclusion… also to work in partnership with the service users carers families … and to promote health and wellbeing and give the service user choices that promote self-care and safety.
Tee et al The recovery model stresses that while service users may not have complete control of their symptoms, they can have control over their own lives There are a number of factors that have been identified to help service users on the way to recover. Some of these have been identified as acceptance, emotional – people being there for the person, finding a reason to live, taking control and having choices and safety and security.(Faulkner and Layzell 2000 quoted in Tee et al) Rhonda needs to accept her condition (but not as hopeless) and it will help if her mother can be made to see that what Rhoda is suffering is a medical condition and start by supporting her daughter with encouragement and practical things such as child care and ideas ofr family meals or outings. Under the heading of Safety and Security must be considered financial security.
Clearly the matter of money is a major problem and until dealt with it may be difficult for Rhoda to deal with other issues as the security of herself and the children could easily overshadow other problems, however serious.Social Services may be needed to check if she is getting all the benefits she is entitled to. However, solving the matter of immediate income will not necessarily address the problems she faces because of being left in debt. While we don’t know the full extent or nature of these debts it is normally possible to negotiate a manageable solution if the creditor is approached with the full facts and some plan for the future. A commonly used resource for such matters is the Citizens Advice Bureau.Again she may well need support and a hand holder to approach them and explain the situation.
But if the contact can be established and she achieves even limited success it will boost her confidence and put some light at the end of the tunnel. Establishing a good living environment may need the help of Social Services. They may need to sort out accommodation out for Rhoda in a safe environment away from any threat or influence of her abusive partner who has left her. Food security can be an important consideration and is often associated with such cases.“Food security exists when everyone at all times have physical, social and economic access to sufficient, safe and nutritious food that meets their dietary needs and food preferences for an active and healthy life” (Ivers 2011) Depression can lead to a failure to participate in the workforce and so in turn this will keep people in food insecurity and poverty (Lent M Et Al 2009). Substantial work or any employment is not necessarily easy to solve but she may be having difficulty in making the first move to approach agencies or job seekers and may not have the basics such as skills at interview and a CV.Counselling or therapy may be able to help build self-esteem and confidence and a specialist in the field could help to identify what she might be able to do. Hand in hand with this could be child care problems and support may be needed in this area.
Her mother or the extended family may also be able to help and more willing once they see that there is a plan and a positive move by Rhoda. Often a person with depression will feel worthless and boring (Barker 2009) and it is important that reasons to live, not just in the sense of staying alive but in terms of engaging with others and taking an active role in society.Many of the above consideration will help to achieve this. At the heart of this will be good relationships with family, a social circle and not least the therapeutic relationship with the multidisciplinary team established under the care plan. . Conclusion What we don’t know is if the family in general and Rhonda in particular have any focus other than what might be called “survival”. It is unlikely and this is where voluntary organisations and activities such as Youth Clubs or Youth Cafes may be able to help to direct their energies to something positive and help to restore a little pride and self-worth.
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