Case Study Essay: Recognizing Signs of Deteriorating Mental Health and Treatment Using Biopsychosocial Model

This case study essay discusses the salient features of John's deteriorating mental health, recognizing signs of deterioration, and treatment using the biopsychosocial model. It also highlights the importance of identifying and managing risks in the clinical setting. The essay emphasizes the need for recognition of the interplay of several factors at the biological, social, and psychological platforms of the concerned patient. The usage of the ‘Mental Health Trial Tool’ may prove to be beneficial in highlighting the required supervision, diagnosis, and resultant treatment. The nurse should engage in empathetic conversation with John, in order to ensure calm and composure in John, along with the establishment of immediate communications with his family, as a principle of provision of family-centered care.

Running head: CASE STUDY ESSAY
CASE STUDY ESSAY
Name of the Student:
Name of the University:
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Executive Summary
The following case essay aims to highlight the salient features regarding the case study of John,
and the existing signs and symptoms pertaining to his deteriorating mental health and resultant
depression. The mental triage tool is an effective way to outline the symptoms of John, followed
by a thorough evaluation of his possible treatment using the biopsychosocial model. However,
the duty of care regarding nurses treating John should be formulated sensitively, considering the
ethical considerations of patient safety and treatment.

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Table of Contents
Introduction..........................................................................................................................3
Discussion............................................................................................................................4
Recognizing signs of deterioration in a Person’s Mental State.......................................4
The Biopsychosocial Model of Care in Mental Health Practice.....................................6
Identifying and Managing Risk in the Clinical Setting...................................................8
Conclusion.........................................................................................................................10
References..........................................................................................................................12

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Introduction
For the provision of optimum treatment pertaining to the enhancement of betterment
concerning the psychological health of a concerned individual, it is of utmost importance that the
clinician or nurse in question adopt collaborative functioning principles in the development of an
adequate diagnosis of the concerned patient, upon which, the ongoing treatment procedure will
be based upon (Rabbitt, Kazdin & Scasselati, 2015). For the formulation and design of the salient
features of a concerned patient’s required treatment procedure, the recognition of the available
signs and symptoms presented by the patient, is imperative and essential (Wahlbeck, 2015). As
opined by the American Psychological Association, the emergence of a distressing mental
disorder in a concerned patient, is not a sudden or unpredictable occurrence, but is the resulting
amalgamation of a several minute behavioral, attitudinal, cognitive and emotional modifications,
which can be observed clearly by the familial relationships in the immediate vicinity prior to the
clinician’s observation (American Psychological Association, 2015). Hence, the need for
optimum recognition of the signs and symptoms pertaining to the mental state of a concerned
patient is of utmost importance for the deliverance of significant treatment procedures, followed
by a maintenance of quality standards and consumer satisfaction in a clinical scenario (Insel,
2014).
The following essay highlights salient features of the case study of John, followed by a
discussion regarding the various signs and symptoms to be noted for observation, in order to
identify his mental state. There is also an adequate discussion of the biopsychosocial model of
case for the purpose of treating the concerned patient John, along with an evaluation, assessment
and management of the various risks pertaining to mental health practice.

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Discussion
The following paragraphs highlight the salient features of John’s case study and his
deteriorating mental health.
Recognizing signs of deterioration in a Person’s Mental State
As opined by the Queensland Government, disorders of mental illnesses imply a
collective occurrence of several detrimental signs and symptoms, pertaining to one’s mental
state, similar to the presence of physiological signs and symptoms during disease conditions
pertaining to the physical aspects of the human body (Vigo, Thornicroft & Atun, 2016). Similar
to any physical illness, psychological illness are also identifiable and quantifiable, which is of
utmost importance for the diagnosis and required treatment for the concerned patient. There is a
primary need for the recognition of several behavioral features presented by the concerned
patient, which would yield aspects regarding his deteriorating mental health (Correll et al.,
2017). According to Beyond Blue, a non government initiative in Australia aiming to provide
care services for mental disorders, the prevalence of several signs and symptoms are indicative
of a patients deteriorating mental state. These include: a feeling of discouragement by the patient
regarding the existence of a bleak future followed by a detrimental view regarding oneself or
incapable for optimum life performance and a sense of denial (Modini et al., 2016). With respect
to John, his deteriorating mental health can be recognized with the presence of depression,
accompanied by a feeling of failure, exhaustion and lack of motivation, due to his recent
deprivation of a job. Upon conductance of conversation with the nurse, he also states a lack of
future for himself and a constant denial of his present condition, further emphasizing his
deteriorating depressive mental health .

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As stated by the Victoria State Government of Australia, the assessment and evaluation
of symptoms is of utmost importance for the recognition of a concerned patient’s mental health
state, followed by necessary guidelines pertaining to the diagnosis and the resultant treatment
which will aid in the betterment of the patient. For the purpose of evaluation and assessment of
symptoms, the collection of baseline information is of utmost importance, for which the usage of
mental health assessment tools is imperative (Pillai et al., 2016). This will not only aid in the
diagnosis of the concerning mental disorder, but will also aid in distinguishing signs and
symptoms between a physiological and a psychological level. Concerning the recognition
evaluation of the deteriorating signs and symptoms of John, the usage of the ‘Mental Health Trial
Tool’ may prove to be beneficial in highlighting the required supervision, diagnosis and resultant
treatment (La Vonne, Zun & Burke, 2015). The triage tool measures ongoing patient symptoms,
by grading in accordance to the magnitude of possible harm infliction and the need for
immediate treatment procedures. Hence, baseline information regarding John’s deteriorating
mental health can be utilized through a conductance of an assessment in which his symptoms
will be graded as Immediate, Emergency, Urgent, Semi urgent and non urgent (Gil et al., 2017).
The rationale behind usage of the ‘Mental Health Trial Tool’ is based upon the principle,
that treatment outlines and outcome of the concerned patient, can be designated based on their
urgency (Sands et al., 2017). Regarding the case study of John, none of his presented symptoms
seem to required classification as ‘Immediate’ due to an absence of immediate feeling of
violence, suicide or self harm presented by the concerned patient. However, as noted during the
end of the concerned case, John expresses a desire to leave treatment procedures, upon his denial
of existing depressive symptoms, and the refusal of which, may lead to implication of harmful,
aggressive behavior. Hence, this particular symptom of John’s may be highlighted as an

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‘emergency’, according to the triage scale, further resulting in alerting of the required medial
workforce for mitigation of the same. According to the case study, John’s symptoms also fail to
require classification as ‘urgent’ or ‘semi urgent’ for which, immediate medical supervision may
be required. However, the presence of possible self harm signs and constant feelings of
discouragement of John regarding his future and self-worth, will required constant medical
supervision, general conventional care and empathetic conversation, as outlined in the ‘non-
urgent’ symptoms in the mental health triage tool. Hence, the rationale behind usage of the
mental health triage scale for assessing John’s symptoms is due to its efficient detailing
regarding the urgency of treatment, followed by highlighting the requirement of further
observation and treatment for the concerned patient.
The Biopsychosocial Model of Care in Mental Health Practice
The biopsychosocial model is a comprehensive an elaborate for the provision of useful
insights concerning the disorders presented by a concerned patient. The model was developed in
the year 1977, by George L. Engel, as an attempt to explain the salient causative factors
regarding a concerned patient’s disease condition as a collaborative interaction amongst three
factors (Rogers, Paxton & McLean, 2014). The aforementioned model is considered as one of
the most defining informative frameworks prior to the 21st century, in clinical medical practice.
In accordance to the biopsychosocial model of care in mental health practice, prior to the
analysis of the symptoms of the concerned patient, along with execution of the required
treatment plan, there is a need for the recognition of the interplay of several factors at the
biological, social and psychological platforms of the concerned patient (Jensen et al., 2015). The
biological factors outline the possible genetic as well as biochemical distortions outlined by the
patient. The interplaying of the patient’s behavior, attitudes and personality highlight the social

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factors, whereas surrounding familial, cultural and social relationships present as social factors of
the concerned patient (Barker et al., 2015). Associating this model with John’s case study, it can
be observed that the major causative factors behind John’s depressive symptoms, are present at
his social, psychological as well as biological platforms. The sudden removal from his job as an
immediate social factor, coupled with his biological phenomenon concerning his debilitating
back aches and possible genetic inheritance from his father, may be a key reason behind John’s
occurrences of depression. Additional psychological factors, as a resultant of the occurrences of
the alternative factor as mentioned above, such as a feeling of hopelessness and constant denial
regarding oneself and one’s future, further seems to aggravate the depressive symptoms of John.
The biopsychosocial model of treatment is considered as one of the best practices
pertaining to the diagnosis and treatment of mental health disorders in clinical practice, due to its
recognition of the usage of humanistic and empathetic models for understanding the mental
shortcomings of the patient, resulting in the provision of a patient-oriented care treatment plan,
rather than the mere provision of medicinal interventions for the alleviation of somatic symptoms
of the concerned treatment (Mitchell et al., 2017). One of the key advantages of this model is the
recognition of a patient’s case history along with the intervening interpersonal relationships, as
essential, in the treatment of a concerned mental health patient. One of the major advantages of
the biopsychosocial model of treatment, making it as one of the best diagnosis and treatment
practices in the field of provision of mental health services, is the recognition of the requirement
of involvement of the patient in the necessary treatment plan (Heery et al., 2015). Hence, the
treatment of the patient, will be determined, not only by the concerned medical professional, but
also the patient himself, who will be equally involved in the formulation and progressions of
diagnostic procedures, through self awareness and evaluation of his own psychological signs and

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symptoms (Elliott & Richardson, 2014). Hence, during implementation of the same for the
purpose of provision of John’s mental health treatment plan, John himself will be encouraged to
discuss actively the magnitude of his signs and symptoms and the required procedures which he
may prefer for the purpose of alleviation of the same.
Identifying and Managing Risk in the Clinical Setting
With regards to the clinical scenario of mental health patient, it is imperative to consider
the possibility of risk encountered by the clinical workforce, including nurses, who are key
characters in the provision of adequate treatment and care for the concerned patient. This
pertains to the possible displaying of aggressive and violent behavior by the concerned patient,
or behaviors of self harm, which not only pose to be dangerous for the patient, but also for the
required nursing staff and the resultant comprise in the required treatment and health care
(McKeown & White, 2015). As opined by the Department of Health in the Australian
Government, and also the Royal College of Psychiatrists, there is a need for the implementation
of adequate risk management strategies and practices by the concerned clinical organization
(Kramer, Kinn & Mischkind, 2015). With regards to the case study of John, it is imperative for
the nurse to implement adequate risk management strategies due to the possible self harm
symptoms presented by John. The nurse should communicate the importance of the same,
empathetically, to John’s family, prior to this treatment, through the utilization family-centered
care principles (Coyne, 2015). This would involve updating and communicating with John’s
family regarding the his treatment plans, his symptoms, and the possibility of violent behavior
which will immediate medical response. The factors which may position John at a platform of
higher risk, are predisposing factors, whereas, precipitating factors act as triggers to the current
problem of the patient, that is depression, in this case. Perpetuating factors adhere to the

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maintenance of a common problem, upon their salient establishments (Racine et al., 2015). In
accordance to the case study, we see that John is overcome by a sense of depression and feelings
of hopelessness concerning his future and employment capabilities. It can be observed that John
is a moderate risk patient. Despite an absence of triggers or precipitating and predisposing
factors which cause self harm by John, there is abundant presence of perpetuating factors, since
the loss of a job, his physical incapability and low self esteem is allowing the persistence of
depression and a denial of symptoms, which may cause future aggressive behavior as noted in
the end of the case study. In such situations, the nurse should engage in empathetic conversation
with John , in order to ensure calm and composure in John, along with establishment of
immediate communications with his family, as a principle of provision of family-centered care
(Vohra et al., 2015).
However, with regards to John, there may be a presence of controversy and dilemma,
concerning the conflict of interest between availability of duty of care, and the ethical treatment
John as a right to receive, with regards to the medical workforce. Duty of Care is a legal
framework pertaining to the assurance of adequate safe and healthy occupational environments
by the organizational leaders pertaining to the optimum functioning and safety of the concerned
workforce (Moss et al., 2015). Hence, there is due requirement of a risk assessment and risk
management plan, to be implemented by the concerned medical staff, due to the possibility of
harm inflicted upon the ongoing workforce from the presence of patients who may exhibit
violent of aggressive behavior. However, this above may pose to be a major conflicting scenario
to the concerned patient and their families, since implementation of ethical considerations are
equally important in the management of patient health and safety, in a clinical scenario
(Mestdagh & Hansen, 2014). A patient and the concerned family possess a right for

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compensation regarding the infliction of any form of self harm encountered by the patient, and
hence, the development of a modified duty of care plan may be required to resolve this conflict
(Dimick & Ryan, 2014). As a solution, the organizational management may discuss and
communicate the possible policy frameworks, through initiation of a joint discussion involving a
multidisciplinary approach, involving the clinicians, the nurses as well as the concerned family
of the patient. John’s family must be adequately educated regarding the possible occurrences of
John’s aggressive behavior, which may result in immediate medical emergencies, pertaining to
the safety of the patient as well as the concerned medical staff responsible for discipline of the
required patient care.
Conclusion
Hence, to conclude, the above essay outlines an elaborative and extensive approach, to
the case study of John. With respect to John’s treatment plan, there is an immediate need for the
implementation of adequate assessment and evaluation procedures in order to recognize the
presented signs and symptoms. A mental triage tool can be utilized for assessment of John’s
signs and symptoms, along with the identification of specific behavioral characteristics presented
by him, which are behaving as resultant factors in the exhibition of his depressive mentality.
While the signs and symptoms presented by John may not require immediate medical
emergencies, however, his tendencies of denial, escape and possible self harm, may necessitate
the need for close supervision and the required risk management procedures, as evident from his
act of attempting to leave the hospital scenario.
While the biopsychosocial model seems to be an effective treatment tool for the
management of John’s clinical symptoms, there is a need for the formulation of a sensitive duty

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of care action plan, concerning the ethical issues which are essential to be followed, in the
procedures of treatment provision and care planning for the concerned patient, as well as his
family.

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