Exploring Mental Health and Wellbeing Studies

This assignment involves a detailed analysis of multiple studies related to mental health and wellbeing. The papers cover topics such as depressive symptoms, working alliance, and psychotic patients' risk of violence. The studies also examine the impact of leisure and social activities on mental health in Japan and the relationship between stressful life events and suicidal behavior in major depressive disorder. The assignment requires a thorough understanding of the research findings and their implications for mental health research.

0Running head: ASSESSMENT ANALYSIS IN MENTAL HEALTH
Assessment analysis in mental health
Name of the student:
Name of the University:
Author’s note

1ASSESSMENT ANALYSIS IN MENTAL HEALTH
Introduction:
The main purpose of this paper is to provide a comprehensive consumer assessment for a
consumer with mental health issues and provides details regarding different skills and theories
utilized to conduct the assessment. The consumer assessment is being provided for a patient with
psychotic disorder who I had to assess during my previous clinical experience at a psychiatric
ward. The patient was 65 years old lady called Tracy (pseudonym given due to privacy and
confidentiality) requirement. The consumer assessment process provides an insight into different
types of information such as demographic data, presenting complaint. past psychiatric treatment,
accommodation, family history and other personal factors. This would help to conduct risk
assessment of client, diagnose main issues for patient and find out the problems that need to be
addressed in management plan. The paper also provides a reflective journal to describe the
experience of conducting assessment between patient and any barriers or facilitators during the
interview process.
Psychiatric Nurse assessing: __
Date: 1st October, 2018
Consumer Name: Tracy Williams (Pseudonym)
Date of Birth 5.11.1946
Sex Female
Telephone Home: ----
Telephone Work: -----
Next of Kin Contact person: Daughter
Name: Christina (Hypothetical)

2ASSESSMENT ANALYSIS IN MENTAL HEALTH
Relationship to the consumer: Daughter
Address: Victoria, Australia
PRESENTING COMPLAINT:
The presenting complaint for the patient was that she had become very aggressive and strictly restricted
herself to her home. She has feelings of irritability and did not enjoyed the company of large groups or
people in front of her. She also had the delusion that she was going to die soon. Rothschild (2013)
suggests that symptom of depressed mood and psychosis is found in patients with major depressive
disorder and optimal maintenance treatment is needed for such patient.
PAST PSYCHIATRIC TREATMENT:
Mrs. Tracy was admitted to a private psychiatric unit 5 years ago also and at that the main issue was that
patient had severe symptoms of low mood and depression. This happened right after the death of her
husband. During hospital stay, she was given anti-depressant medication. She stayed at the hospital for 1
weeks and her symptom reduced post treatment. The patient has discontinued antidepressants since then
and no contact has been made in the past 1 year too.
CURRENT PSYCHIATRIC TREATMENT:
On admission to the psychiatric ward currently, the patient is receiving both anti-depressive medication as
well as psychotherapy. Drug treatment with antipsychotics or antidepressant is first line of treatment for
patient with depressive disorder. The patient is also about to attend mindfulness based cognitive therapy
because of symptoms of hallucination and delusion. As the patient symptoms indicate relapse of
depressive symptoms, combination intervention has been provided. Kuyken et al. (2016) suggest that
mindfulness based cognitive therapy is beneficial as a treatment of choice for relapse prevention. Hence,
the intervention given currently might be helpful for Mrs. Tracy too.
ACCOMODATION:
Mrs. Tracy has been living in three bed room apartment where she has been living since her marriage.
Her daughter Christina is married and visits her frequently. Her some lives in different city and visits

3ASSESSMENT ANALYSIS IN MENTAL HEALTH
once every two months. Since the death of her husband. Mrs. Tracy lives all alone and only maid is there
is to help her in doing household work.
FINANCIAL ARRANGEMENTS:
Mrs. Tracy used to work as an executive manager in a private company. However, she has left job since
the past 10 years because of health issues. Currently, she is dependent on her son and daughter to fulfil all
her financial needs. She is also receiving pension from her husband’s office. There is no other source of
income for her. However, she is not overburdened with any debts. She has few properties in her name too.
During mental health assessment, questions related to financial capacity of client is important so
understand whether a client requires a representative payee or to understand whether other financial help
is needed for patients or not. As Mrs. Tracy has been receiving financial support from her son and
daughter, this is indicative of the fact that stress due to financial issues is not the cause of depression in
patient. The information here represents good functionality of the family in managing internal and
external resources for the family member. This function can act as protective factors for patient like
Tracy. However, there is a need to supportive needs of patient and identify factors that could contribute to
a sense of control and psychological satisfaction with life (Rabelo & Neri, 2015).
HISTORY AS REPORTED BY OTHERS:
More details about the history of mental illness was given by client’s daughter Christina. Mrs. Christina is
a 35 years old lady and she reported that her mother began two withdraw from social gathering since the
past two months. Her mother used to go with her outdoors occasionally. However, since the past two
months, she observed that her mother becomes very irritated whenever she is asked to go outside or
participate in any community functions. Her daughter also revealed that symptoms of aggression and
tendency to harm other have been observed since the past two week. Mrs. Tracy had even tried to harm
her in one or two occasions. Conversation with the client’s daughter also revealed about history of other
health issues for patient such as diabetes, arthritis and hypertension. Her diabetes is poorly controlled and
she has limited movement because of arthritis. Mrs. Christina has also reported that she is having
hallucination and often mumbles something in her room. She is often threatened and gives tense look

4ASSESSMENT ANALYSIS IN MENTAL HEALTH
Father
Mother
Tracy’s
brother
Tracy Tracy’s
Husband
Tracy’s son Christina
Father Mother
whenever she tries to talk with her mother. Her symptom of anxiety and aggression might be linked to
delusions and hallucinations too. The above symptoms are congruent with the explanation given by
Hartley, Haddock and Barrowclough (2012) as the study indicates that link between level of depression
and presence of positive symptoms in patient. Hence, it gives the implication for assessment of anxiety
and depression in the context of psychosis so that diagnosis of psychosis can be made. Focussing on
hallucination alone would not promote recovery in patient and finding causal factors behind depressive
symptom is important.
FAMILY HISTORY: GENOGRAM
Based on information received from Tracy’s daughter, the above mentioned genogram has been created
for the client. This genogram indicates that Tracy has a brother and her husband was a single child.
History of mental illness or psychiatric symptoms was observed in the family members. Based on this

5ASSESSMENT ANALYSIS IN MENTAL HEALTH
assessment, it was found that Tracy’s mother was also a patient with acute depression. She was hospital
multiple times for the management of depressive symptoms. In addition, heart attack was the main cause
of death for Tracy’s father. Her husband’s family did not had any medical history of mental illness.
Tracy’s mother in-law was a hypertensive patient and her father-in law died because of uncontrolled
diabetes. This form of assessment detail is important to understand the impact of family factors on the
cause of depression. Depression may be caused by a combination of biological factors, genetic factors,
psychological factors and social factors. This assessment is linked to the identification of genetic factors
of depression as people with history of depression in their family are at increased risk of depression (Read
et al., 2015).
During the assessment, certain questions were also asked to understand Tracy’s relationship and
attachment with her family members. She was found closely attached to her mother before her death and
currently she values the support she receives from her daughter. However, because of hallucination, she is
facing challenges in taking part in social engagements.
RECOVERY ENGAGEMENT/ RESOURCES/ RELATIONSHIPS:
Resources: The resources that Mrs. Tracy has for recovery includes financial support, husband’s pension
and emotional support from family members.
Abilities and capacities: Patient has good intellectual capacity. However, hallucination affects her ability
to engage in proper decision making.
Community engagement: Currently, her community engagement activity is almost null.
Key relationship: Apart from Tracy’s son and daughter, Tracy’s neighbour is also closely attached to
her. These members can play a role in promoting recovery in patient.
This assessment is relevant with the recovery model of mental illness as it can help in identify those
factors that can support patients to take control of their life (Jacob, 2015).
PERSONAL HISTORY:
EARLY CHILDHOOD DEVELOPMENT:

6ASSESSMENT ANALYSIS IN MENTAL HEALTH
Assessment regarding early childhood development was done to identify significant early life event and
developmental milestones for patient. The findings from the assessment are as follows:
 No history of complication during pregnancy
 Birth through caesarean delivery
 Achieved good grades in academic and good intellectual performance
 Death of mother when was a child is the most significant life event that affected her
development
SCHOOL PROGRESSION:
 Mrs. Tracy could not complete her studies till college. However, the review of school
performance shows good progress till standard VII. But sharp decline in her performance
was seen for standard VIII onwards. This because her mother’s death occurred in the
same year.
 No incidence of bullying or discrimination found in school life
The finding from this section is important because unexpected death of loved ones leads to poor mental
health consequences and this could help to understand the progression of the disorder in patients (Keyes
et al., 2014).
OCCUPATIONAL HISTORY:
 Mrs. Tracy’s first job was a school teacher
 After this, she changed few more jobs before becoming an executive manager for a
reputed company
 She has been unemployed since the past 10 years and this was mainly to support her
husband who was suffering health issues because of poor diabetes control.
RELATIONSHIP HISTORY
 Mrs. Tracy has two children- 35 years old daughter Christina (pseudonym) and 32 year

7ASSESSMENT ANALYSIS IN MENTAL HEALTH
old Steve
 Christina pays a visit to her mother every week and Steve comes after every two months.
 Mrs. Tracy was very attached to her daughter. However, from the past two weeks, she
avoids talking to Christina. This has increased stress and tension for Christina.
DRUG AND ALCOHOL USE:
No reported history of drug and alcohol use found.
FORENSIC HISTORY/LEGAL MATTERS:
No criminal records found and no legal proceedings pending.
MEDICAL HISTORY:
Mrs. Tracy has been diagnosed with Type 2 diabetes and she was hospitalized once because of poorly
controlled blood sugar level. Her past medical history also revealed that she is a patient with arthritis and
hypertension. Mrs. Tracy takes medication for hypertension and diabetes on a regular basis.
PERSONALITY:
Analysis of Mrs. Tracy’s personality reflects her mental states as he looks sad and dejected. Her head is
low and she avoids contact during conversation. Although her dress is tidy, however her hair seems
unkempt.
Tracy’s daughter has also revealed changes in the behaviour of her mother significantly since the past two
weeks. She has been found to very aggressive and developing delusions of dying very often.
CULTURAL BACKGROUND:
The patient is from Catholic family.
SPIRITUAL CONSIDERATIONS:
Because of arthritis, Mrs. Tracy’s mobility level has changed. This has influenced her spiritual needs and
her ability to visit the church.
MENTAL STATUS EXAMINATION:

8ASSESSMENT ANALYSIS IN MENTAL HEALTH
GENERAL PRESENTATION:
To assess general appearance and presentation of Mrs. Tracy, her dress, posture, facial expression,
alertness and grooming was observed (Finney, Minagar & Heilman, 2016). Her dressing was appropriate
for the occasion. However, Mrs. Tracy was gloomy and sad throughout the interventions. She kept her
head down and made eye contact on very few occasions. She was lost in between conversation and was
irritated during questioning too.
THOUGHT CONTENT:
Thought content assessment was done by asking the question ‘What future plans have you made for
yourself?’. The client reported that she had no plans and also mumbled that what’s the use as she is going
to die. This is an indication that delusion has significantly affected well-being for patient. Delusion is the
manifestation of false beliefs in patient and knowledge of the associated co-morbidities associated with
delusion can help to suitable psychological intervention for patient (Shah, Taylor & Bewley, 2017).
STREAM:
Mrs. Tracy’s thought stream was analysed by asking about things that she regret in life. Her comment was
very irrational as her thought stream revealed she was only thinking that she is going to die soon. When
she was asked why she thinks so? She could not give proper answer, but repeated same phrases again.
This assessment finding suggests the possibility of cognitive impairment in patient as disturbance in the
stream of thinking was found (Sethi, 2017).
MOOD & AFFECT:
Impairment in mood and affect was evaluated by means of observation and interview question. The tone
of voice gave idea regarding his current mood. She spoke in a low vice. In addition, affect was understood
by events of aggression and anger in patient when she was asked certain question. Such patients are also
at risk of violence if their violent behaviour is not properly managed (Scott & Resnick, 2013).
PERCEPTUAL ABNORMALITIES:
Perceptual abnormalities have been found in patient and this is understood from patient’s belief about

9ASSESSMENT ANALYSIS IN MENTAL HEALTH
mental health issues. Her attitude has been shaped by cultural stereotypes and she feels that death is the
ultimate consequence of being depressed and socially isolated (Choudhry et al., 2016). However, she
thinks there is no solution to come out of it.
ATTENTION/ CONCENTRATION:
Mrs. Tracy alertness level was observed by Glasgow coma scale. It is a validated tool that gives idea
regarding level of consciousness and alertness in patient. The patient was found to be in a confused state
as she was not orientated as she was not orientated however communication was coherent ( Teasdale et al.,
2014).
MEMORY:
The client’s memory was found to be good as she reported about her relationship with her husband and
her mother.
INSIGHT:
Assessment of insight during mental state examination is done by evaluating whether the patient has good
understanding about his problem or not (Wiger & Mooney, 2014). Moderately impaired insight was seen
as she did not reported about her feelings of depression, but went on saying about the fact that she is gong
to die.
JUDGMENT:
Patient’s poor judgment level from understood from her statement that ‘There is no way to come out of
it’. This suggests poor coping abilities of the client.
RISK ASSESSMENT:
From the above comprehensive assessment of patient, it has been found that combination of depressive
and psychotic symptoms are main issue for patient. Mrs. Tracy has avoided social contact and restricts
herself to her room. She has also engaged in self-harm to others. This may indicate risk of major
depressive disorder and risk of harm to others too. Reducing psychotic symptom is important to prevent
injuries and harm to patient. This is because acute episode of depression may increase risk of suicide in

10ASSESSMENT ANALYSIS IN MENTAL HEALTH
patient (Zalpuri & Rothschild, 2016).
SUMMARY:
The comprehensive assessment gave many clues and hints to understand the risk factor and cause behind
depression. The financial arrangement and occupational history of patient does reveal any lack of
financial support for Mrs. Tracy. However, review of early life events, past and current medical history
and family history suggest that death of loves ones has contributed to the risk of depression and further
deterioration of symptoms in patient.
FORMULATION (Diagnostic):
As per the assessment of patient, it can be said that the patient is suffering from psychotic depression.
This formulation has been done by comparing patient’s issue with DSM V criteria for psychotic and
mood disorder. Acute onset of at least one of the symptoms such as delusion and hallucination is an
indication of psychotic disorder in patient.
PROBLEM DEFINITION AND INITIAL MANAGEMENT PLAN:
The problem for patient can defined in single word as psychotic depression and depression with psychotic
symptoms. The initial management plan for patient is to address delusion and cognitive impairment in
patient by providing cognitive behavioural therapy. In addition, it is planned to gradually increase
patient’s participation in social activities to improve mental health status of patient. Takeda et al. (2015)
supports the fact that participation in social activities can positively influence mental health status in men
and women.
Personal reflection:
In this section, I will discuss about my personal experiences while proceeding with the
assessment process and completing comprehensive assessment for Mrs. Tracy, a patient who
came with symptom of delusion and acute depression. Before the interaction, I recalled all the

11ASSESSMENT ANALYSIS IN MENTAL HEALTH
theories that I had learnt to conduct mental status assessment with patient. Apart from the
validated mental status assessment, I also planned to additional information such as
demographic, cultural and early life experience of patient. This was necessary to find the
contribution of any traumatic life events as a cause of depression (Wang et al., 2015). However, I
encountered real challenges during the interview because I had never come across a patient with
delusion and aggression. Building rapport with patient took time and extracting the information
from patient was difficult. I found the patient was not making eye contact and she was giving
suspicious look to me. At this point, I took the approach to give enough space to patient so that
she responds as per her own will and does not become more aggressive. I also tried to build trust
of patient by giving information about myself, my role during the assessment process and all
process that the institution has to protect the confidentiality of client. Pointing out to the video
camera in the room and use of empathy to communicate helped in building rapport with the
client (Joo et al., 2018).
As the interview proceeded, I gradually started to identify cognitive problem in patient
during the assessment interaction. Although Mrs. Tracy responded well to some initial questions,
however as soon as I started asking question to understand her thought pattern related to illness, I
noticed strong reactions from her. When she was asked ‘What is it that is making you feel you
are dying?’, Mrs. Tracy became very irritated. Her voice tone became very loud and she almost
scolded me by saying how do I know. The situation was very comfortable at this time as I was
having the fear that patient might hit me if I asked any further questions. However, I paused for
time and took the strategy to distract her. I talked about things that might interest her such as her
relationship with her daughter and about good times in her life.