Case Study on Aggression and Ethical Considerations in Mental Health

This case study explores the manifestation of aggression in a patient with mental health issues and discusses the ethical considerations that should be taken into account. It also provides strategies for conflict resolution and assertiveness.

Running head: CASE STUDY
Case Study
Name of the Student
Name of the University
Author Note

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Introduction- Aggression is commonly referred to as harmful social interaction that a
person has with people surrounding him/her, with the intention of causing unpleasant behaviour
or inflicting harm or damage (Moore et al. 2014). Human aggression is typically categorised into
indirect and direct forms. While the former is characterized by intended harmful behaviour that
creates an impact on social relation, the latter is characterized by verbal or physical behaviour
that harms others (Hoeve et al. 2015). This essay will elaborate on a case study where a person
manifesting aggression towards healthcare workers had been admitted to the service. It will also
illustrate the ethical considerations that should be taken into account under such circumstances
and strategies for conflict resolution and assertiveness.
Case study- John had been admitted to the mental health service at the request of his
spouse who complained that he recently started manifesting signs of being aloof and emotionally
absent. His presenting complaints were social isolation and the lack of interest in family life. He
considered his wife’s complaints to be unreasonable and demonstrated a negativistic attitude
towards completion of routine occupational and social task. He complained of being
unappreciated and misunderstood, was argumentative, and demonstrated poor self confidence. In
addition, some other common symptoms were associated with procrastination, stubbornness,
deliberate inefficiency, intentional failure at tasks and pretended forgetfulness.
He had been diagnosed with bipolar disorder five years back, following which he was
forcefully subjected to psychotherapy. This made him display aggression towards healthcare
workers as he considered psychotherapy as a major form of con-artistry. His mother suffered
from severe mood disorder. In addition, John has been addicted to alcohol and drugs since his
teenage years that often made his mood episodes become worse. On further investigation it was
also found that he suffered a trauma due to relocation of his family from their ancestral village to

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the city, following which she had also been subjected to neglect from his parents. Hence, the
aforementioned factors might have increased the likelihood of displaying aggression and resulted
in the onset of passive aggressive personality disorder.
Ethical considerations- The four core principles related to biomedical ethics encompass
beneficence, autonomy, justice, and non-maleficence. There is mounting evidence for the fact
that passive aggressive personality disorder can be effectively treated through the
implementation of psychodynamic methods, the primary objective of which relies on revealing
unconscious content of the psyche, for alleviating psychic tension. However, taking into
consideration the resentment of the patients towards healthcare workers and the misconceptions
that he holds about psychotherapy, there is a probability of conflict. The primary step would be
to intervene even if the patient disagrees, followed by implementation of psychotherapy in order
to maximize health outcomes (Hoagwood, Jensen and Fisher 2014). The autonomy of the patient
must be respected since he has a decision making capacity. Consent must be taken from his
family members as well, prior to the intervention implementation. Therapeutic association with
John must also be grounded on feelings of mutual trust, and there should be a responsibility of
informing him and his family members about the nature of his mental health, expected outcomes,
risks, and benefits of the treatment alternative. Treatment recommendations will also be based on
best professional judgment and John will be delivered services with respect and altitude,
notwithstanding the setting. While involuntary hospitalization or treatment is ethically
controversial, treatment decision without John’s consent can be ethically justified because he
suffers from a severe mental illness, which holds the likelihood of harming self or others (Fazel
et al. 2014). Privacy and confidentiality of the patient will also be protected during the care
regimen.

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Assertiveness and conflict resolution- It forms core behaviour of professional nursing and
empowers the nursing professionals to be heard, while advocating for the patients who are
provided care services. Through therapeutic communication, the opinions, rights, and needs can
be effectively expressed in a manner that demonstrates respect towards others (Price et al. 2015).
Teamwork communication, stress management, problem solving capabilities, and emotional
agility are the necessary skills that will help in resolving conflicts in the service centre. Owing to
the multifaceted components of mental illness, conflict resolution requires gaining awareness of
the difficulties that are faced by a patient. Hence, an empathetic approach of working must be
adopted, where the primary objective would focus on comforting the patient and not controlling
him (Baby, Glue and Carlyle 2014). Due emphasis will also be placed on a compassionate
communication, in addition to a neutral body language that will prevent John from interpreting
this behaviour as deliberately threatening or confrontational, thus promoting patient recovery.
The service should also aim at enhancing the feelings, thoughts and behaviour of John, while
lowering the effect of stressors on his life. Demonstration of mutual respect towards the patient
with the shared objective of solving the mental health crisis would prove imperative in this case
(Heckemann et al. 2015). Respecting the opinions of team members, speaking in a neutral tone,
keeping the statements simple, not displaying arrogance, and demonstrating active listening
skills will also enhance assertive communication.
Managing a patient- Effective communication technique will help in the escalating
aggression. Interaction with the aggressive patient would require judgment, fear, and self control.
Remaining calm, asking open-ended questions, and keeping sufficient distance from the client
would greatly help in this scenario. Maintenance of eye contact will also facilitate gaining a
sound understanding of the source of patient frustration (Ennis, Happell. and Reid‐Searl 2015).

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In addition, John must not be denied the treatment services which are necessary even though he
displays violence aggressiveness. Taking into consideration the security requirements of the
service centre is also imperative in this case scenario.
Conclusion- Aggression occurs either without provocation or reactively and frustration
due to failure to accomplish directed objectives also leads to aggression among humans. In the
case scenario, John held an outlook of being defeated always, which in turn evoked negative and
hostile responses from his family members, who were continuously subjected to his complaints.
While dealing with such a patient, healthcare professionals often feel uncertain about their roles
and responsibility. Thus, the patient needs to be reassured while acknowledging his grievances
and he must also be provided with an opportunity to identify the stressors that adds to his
aggression.

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References
Baby, M., Glue, P. and Carlyle, D., 2014. ‘Violence is not part of our job’: A thematic analysis
of psychiatric mental health nurses’ experiences of patient assaults from a New Zealand
perspective. Issues in mental health nursing, 35(9), pp.647-655.
Ennis, G., Happell, B. and Reid‐Searl, K., 2015. Clinical leadership in mental health nursing:
The importance of a calm and confident approach. Perspectives in Psychiatric Care, 51(1),
pp.57-62.
Fazel, M., Hoagwood, K., Stephan, S. and Ford, T., 2014. Mental health interventions in schools
in high-income countries. The Lancet Psychiatry, 1(5), pp.377-387.
Heckemann, B., Zeller, A., Hahn, S., Dassen, T., Schols, J.M.G.A. and Halfens, R.J.G., 2015.
The effect of aggression management training programmes for nursing staff and students
working in an acute hospital setting. A narrative review of current literature. Nurse education
today, 35(1), pp.212-219.
Hoagwood, K., Jensen, P.S. and Fisher, C.B., 2014. Ethical issues in mental health research with
children and adolescents. Routledge.
Hoeve, M., Colins, O.F., Mulder, E.A., Loeber, R., Stams, G.J.J. and Vermeiren, R.R., 2015. The
association between childhood maltreatment, mental health problems, and aggression in justice‐
involved boys. Aggressive behavior, 41(5), pp.488-501.
Moore, S.E., Norman, R.E., Sly, P.D., Whitehouse, A.J., Zubrick, S.R. and Scott, J., 2014.
Adolescent peer aggression and its association with mental health and substance use in an
Australian cohort. Journal of Adolescence, 37(1), pp.11-21.

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Price, O., Baker, J., Bee, P. and Lovell, K., 2015. Learning and performance outcomes of mental
health staff training in de-escalation techniques for the management of violence and
aggression. The British Journal of Psychiatry, 206(6), pp.447-455.