NURS 1087 - Analysis In Mental Health Nursing Assignment

Assignment Task

Background Information:

Suicide risk behaviours are major global concerns in mental health with 16 million attempts worldwide and ranking fifteen overall for leading cause of death in Australia. This calls for urgency in addressing suicide risk behaviours. Safety planning intervention (SPI) on the other hand is gaining momentum in suicide management. The Mental health and wellbeing Act (MHWA) 2022 furthermore, calls for collaboration and places an emphasis on lived experiences of consumers and families. 

History of Presenting Complaint (HOPC)

Handover received from Consultant liaison (CL) Psychiatric registrar and collateral documentation received. 32-year-old male, self-presented to Emergency Department (ED) following suicide attempt. John cut his bilateral limbs with a broken bottle immediately following discharge from intensive care unit (ICU) following a suicide attempt via intentional overdose. John has a diagnosis of Borderline Personality Disorder (BPD), alcohol use and psychosocial stressors. He booked a hotel room in the city on 19/03/24 after a period of no contact with family who had reported him as a missing person. John sent emails to his family that evening and took an overdose of diazepam with alcohol. He was found by hotel staff the morning of the 20/03/24 when they entered his room after he had missed check out. Hotel staff also found a suicide note in the room. John was then taken to hospital by ambulance and was Intubated in ED and admitted to ICU. John was extubated on 21/03/24 and reviewed by CL psych who offered voluntary admissions instead of discharging him home with ACIS follow up. CL assessment did not identify acute trigger for suicide attempt, however, long term financial stressors and chronic pain acknowledged as vulnerabilities. John expressed difficulty with decision making and at 1715 on 21/03/2024 John self-discharged against medical advice, advising that he was going to a friend’s house. Peter reports leaving the hospital with intent to complete suicide, found a bottle which he broke and went to an alley way in an attempt to cut his wrists. He reports that he was unable to cut very deeply as the bottle was blunt, he was cold and it was raining and he did not want to die cold and wet as his original plan had been to die in the hotel room warm and with his favourite show playing. He phoned his mother to hear her voice who supported him to make the decision to attend the closest ED. He then presented to ED at 2300 on 21/03/24.

Reports past Diagnosis of BPD, states he identifies better with Complex post-traumatic stress disorder (CPTSD) alluding to but not disclosing childhood trauma. John has been living in the city with his ex-partner, he has continued to pay 50% of rent and sleeping on couch. States partner woke up one day and said she did not want to be in a relationship anymore. John has not worked for a year, “too much time to think”, has investment property with renters in, states rental income not covering mortgage and worried bank is going to take property. The bank has been sending emails which John has not opened. Texts received from VCAT which have not been responded to, concerned about re property damage from previous rental, states damage occurred whilst in dissociated state, also concerned will not being able to rent property in his name due to poor rental record. This weekend John disclosed sexual assault to parents from a past partner following an accident in 2016, John also reported that this occurred whilst he was medicated with painkillers and states “he was the only person who ever claimed to love me”.

On Review

John expressing anger towards the hospital for waking up in ICU, “I had such a warm comforting plan to end it all with my favourite shows on and I woke up with a breathing tube”. “I still want to die”, “I’m so angry, I wish they left me to die”. “When I wake up I can barely breathe, I have no energy to get out of bed”. “I have to pretend to be happy until everyone gets off my back”. “I’ve had this suicide plan on the back burner for years”. Validation of painful emotions. Initially John reluctant to discuss treatment planning, psychoeducation provided about evidence for brief crisis admission and long term re-engagement in therapy. Presented John with several options and agreeable with voluntary admission with plan to discharge to parents with referral to local area mental health services CATT or HOPE.

Psychiatric history

Only one CMI registration in March 2018

No admissions

No formal diagnosis

No previous use of MHA

No aliases

No alerts

Medical history

Reports accident in 2016, injury to ulnar nerve, ongoing full body pain reported as dull throb but worsens in intensity with increased stress.

Medication:

No current medications

No medication for past year

Previously prescribed escitalopram, baclofen and propranolol

Substance use:

Frequent alcohol use

THC use

States will self-medicate with “whatever I can get my hands on”

No forensic history

MSE

32-year-old male, appeared stated age, seen in cubicle 4 lying in bed with sheets covering body

Limited eye contact

Normal r/v/t speech

Labile affect – tearful, angry at times

Hopeless/helpless themes

Denies AH/VH, concerns about harm from others

Nil psychotic symptoms

Chronic SI, nil current plan, ongoing intent to die

Denies thoughts to harm others

Risk:

Acute chronic suicidal ideation, no current plan but states has intent to end life when he gets a chance, has acted on impulses with 2 suicide attempts preceding two days. Ongoing emotional dysregulation, hopeless/helpless themes. Unable to return to previous accommodation sleeping on couch in shared apartment with ex-partner. Agreeable to return to stay with parents.

Protective factors

Supportive parents who he describes as his best friends, has two supportive sisters and plans to return to stay with parents. Also reports that he has two close friends. Parents have indicated capacity and willingness to pay for long term follow up PP and therapy.

Formulation

32-year-old male who self-presented to ED following second suicide attempt in three days immediately following d/c against medical advice from RMH. Attempted suicide via OD which had been long term plan and impulsive cutting of wrists with a broken bottle found in the street. Dx BPD, alcohol use, previously managed by PP and attended DBT programs at TMC, not for last 12 months due to finances. Recent stressors include financial stress, disclosure of sexual assault from 2016, not worked for past 12 months and residing with ex-partner. Reports ongoing intent to die by suicide believing loved ones would be better without him. Participated in treatment planning and agreeable to writer’s recommendation of voluntary admission and discharge to family home with acute/community Mental Health follow up.

Assessment Task:

This written assessment task requires you to utilise John’s vignette above and to critically examine the implications of the Wellbeing Act 2022 in implementing interventions for people with severe mental health issues.

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