Mental Health Assignment

This paper critically evaluates the case study of a client with mental health disorder, discusses risk factors, and develops a care plan. Find study material and solved assignments on mental health at Desklib.

Running head: MENTAL HEALTH ASSIGNMENT
MENTAL HEALTH ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Mental health can be defined as an integral aspect that determines holistic wellness of an
individual. According a report published by Caplan (2013), it has been estimated that 20% of the
Australian population suffers from a mental health disorder. It has further stated that individuals
aged between 16 to 85 years of age experience one or more mental health disorders in their entire
life time (Jorm, 2014). Studies suggest that out of the 20% Australian population suffering from
a mental health disorder, 11.5% suffer from one disorder, however, 8.5% of the people
experience multiple mental health problems at the same time (Jorm,2014; Caplan, 2013). The
most common mental health disorders in Australia are anxiety disorders, depressive disorders
and substance use disorders (Sunderland et al., 2015). This paper would critically evaluate the
case study of the client Dmitri based on the MSE assessment and diagnose the mental health
disorder. The paper would further discuss in detail the risk factors and develop a care plan for the
client. Also, the paper would critique the interview and identify the potential strengths and
weaknesses of the quality of communication taking place between the mental health nurse and
the client.
Mental State Evaluation (MSE):
According to Caplan (2013), Mental State Evaluation can be defined as the process of
assessing the psychological attribute of an individual and appropriately describing the apparent
mental state and behavior on the basis of the assessment. The MSE clearly includes the objective
clinical observation as well as the subjective description given by the client. On the basis of the
video, the MSE assessment for the client Dmitri can be described as follows:

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Appearance:
The Client Dmitri was observed in the video as a slim built male in his mid 20s. The
client could be identified to be an Asian descent. He was well dressed and wore a black t-shirt
and a flannel button up. He was also wearing black glasses. The hair and moustache were
unkempt and the client was observed to be positioned in a poor posture.
Behavior:
The client maintained a poor posture with his arms crossed and was observed to fidget
with his hands and face. He was cooperative but his responses were slow. He took time to
compile his sentences together.
Mood:
The client appeared to be uncomfortable and scared. He seemed to be irritated with the
voices.
Affect:
The affect was observed to be blunt, flat and distracted. The client seemed to avoid some
of the questions.
Speech:
The client made use of minimal speech. Overall the client appeared to be soft-spoken and
his responses were repetitive and in short sentences. The sentences had no flow and the tone was
observed to be flat. The volume was audible and the client kept saying..’Um’..At times the client
was observed to be hesitant to answer the questions.

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Thought Form:
The responses of the client were irrelevant and the thoughts appeared to be blocked,
vague and empty.
Thought Content:
The thought content of the client could be perceived as delusional, persecutory with a
hint of anti-social urges
Perception:
The client was observed to be disturbed by ‘auditory hallucinations’
Cognition:
Both short term as well as long term memory was observed to be normal. The client was
oriented to the place, person, month and the day. The client was unable to remember the date and
the concentration was found to be poor. He was unable to subtract in the denominations of 7.
Insight:
The patient is aware of his mental health problem and wants the Physician to prescribe
him the medication ‘Olanzapine’
Judgment:
The judgment ability of the patient can be considered normal as he is aware of the fact
that not taking his medication has caused him the problem. He is aware that he only started
hearing the voices in Japan, when he was on a holiday and had run out of his medication.

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Disorder Impression:
On the basis of the MSE interview, it can be said that the client experiences disturbing
auditory hallucinations that criticize him and affect his ability to perform other activities. The
client appears confused and believes that only he can hear the voices and other people cannot
hear them. Also, the client seems to lack motivation and has reduced social interaction with
friends and also appears to be emotionally depressed. He has been taking Olanzapine as his
medication and on the basis of DSM-V manual appears to be suffering from Schizophrenia
(Frith, 2014).
Identification of Risk Factors:
A total of four risk factors can be identified from the video that relate to the client. The
risk factors must be addressed individually in order to prevent the progression of the disorder
into an uncontrolled stage.
The client appears to be disturbed by the auditory hallucinations and without the
medication is unable to deal with the voices. This might increase his agitation and promote the
development of anxiety related disorders (Boyle, 2014).
As mentioned by the client, the voices criticize him. Also, the client confirms his minimal
interaction with his friends and family, which makes him susceptible to suffer from depression
(Ripke et al., 2014).
The client states his profession as a writer and also mentions that he has not been able to
finish his novel because of the disturbance caused by the voices. This suggests that the client is at
a high risk of experiencing legal or financial problems and even homelessness (Ross, 2014).

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In addition to this, the constant agitation experienced by the client due to the voices might
affect his nutritional intake or sleeping pattern. This would increase the risk of developing
sleeping or eating disorders (Ross, 2014).
Nursing Care Plan:
According to Doenges et al. (2014), a nursing care plan can be explained as a patient
wellness plan that targets the individualized wellness needs of the patient. A nursing care plan
builds upon the diagnosis of the patient and is aligned to the specific needs of the patient. In
addition to this, nursing care plans also help in the process of patient documentation and helps in
prioritizing patient care.
Problem Priority:
In case of this client, the problem priority would be chosen as the disturbed auditory
perception experienced by the patient. It should be mentioned in this context that auditory and
visual hallucinations are the most common symptoms of Schizophrenia.
The nursing diagnosis for the chosen problem can be stated as evaluating the change in
the amount of the incoming stimulus which generates a diminished, distorted, exaggerated and
impaired response to the stimulus. Studies suggest that the most common factors that could lead
to an altered/disturbed sensory perception could potentially includes, external psychological
stress and internal neurological or biological changes. In addition to this, chemical imbalances
such as electrolyte imbalance, activation of ambiguous biochemical factors, altered sensory
reception or perception could be related to the condition of Schizophrenia (Boyle, 2014).
Justification for identification of problem priority:

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During the interview session the client seemed to be extremely disturbed by the auditory
perceptions and found it difficult to concentrate on the questions of the mental health nurse.
Also, the client mentioned that the voices keep criticizing him and limit his ability to work
peacefully. This was the reason held accountable for him not being able to complete his novel
that he had started writing in his high school.
Nursing Goal:
The nursing goal for the client would be to educate the client about strategies that could
help him in actively refrain himself from listening or responding to the ‘voices’. In addition to
this, the client would also be able to rate the frequency of the voices in a scale of 1-10 on being
assisted with mindfulness based therapies such as meditation or yoga. In addition to this, the
patient would also be able to carry out his daily living activities without being interrupted and
would also be able to maintain his social relationships.
Nursing intervention strategies with supporting rationale:
The following table comprises of the list of nursing interventions along with the
supporting rationales backed by scholarly literatures:
Nursing Interventions: Supporting Rationale:
Refer to the voices heard by the client as, ‘Your
voices’ or ‘voices that you hear’. The nurse should
agree with the client on the fact that he has been
hearing voices but also state that the voices are not
audible to the nurse and subtly mention about the
false existence of the voices.
Studies suggest that upon validating the fact that
the voices are unreal, the client would inherently
question about the actual existence of the voices
(Frith, 2014).

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Assist the client in identifying the times when the
voices are most prevalent and agitating
The use of a grading scale would help the nurse as
well as the client to identify anxiety prone
situations which could be detrimental to the client’s
wellbeing (Ripke et al., 2014)
Administer counseling and prescribed antipsychotic
medication
Counseling would help in reinforcing a positive
perspective and would also improve the level of
social interaction of the client (Ross, 2014)
Critique of the interview:
According to Bramhall (2014), the patient interview session during the Mental State
evaluation forms an integral aspect that helps in the diagnosis of the mental health disorder. The
patient interview serves as a gateway that helps in providing an insight into the wellness of the
patient (Kitson et al., 2013). It is extremely important for the interviewer conducting the
interview to make use of effective communication to evoke a feeling of comfort in the patient so
that the client feels free to state his problem.
Upon observing the video a total of four instances that promote effective communication
between the mental health nurse and the client can be observed and documented. The first
instance can be defined at 0.08s, when the mental health nurse greets the client and introduces
herself to the client by shaking hands. She further mentions that the information conveyed to her
by the client would remain confidential and would be shared with the multidisciplinary team for
the purpose of treatment. This can be identified as the correct process of opening the interview
session and can be said to foster comfort in the patient (Kitson et al., 2013). The second instance,
can be identified at 00.22s, 14:35 s and 14:43s when each time the mental health nurse sought

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permission from the client that whether or not he was okay with sharing his information with the
multidisciplinary team, her calling the doctor for further diagnosis and the client being okay if
kept in the hospital for a few days. This reflects that the nurse had adhered to informed patient
consent at all stages (Bramhall, 2014). The third instance can be identified at several occasions,
the first occasion being at 2:09 minutes when the nurse showed concern about the patient being
distracted and asked about the problem the client was experiencing (Bramhall, 2014). The nurse
maintained eye contact with the client throughout the interview process which reflected her
interest in the client’s problem (Kitson et al., 2013).
On the other hand, two instances of ineffective communication were also observed in the
video. The first instance can be mentioned as the marinating a reserved approach with no
apparent facial expression or warm gestures such as nodding or a smiling. The lack of a warm
verbal gesture during an interview has been studied to interrupt the free flow of communication
between the client and the nurse (Kitson et al., 2013). In addition to this, the nurse was observed
to use long sentences while asking questions. It was clearly evident that the client was already
disturbed because of the voices and was finding it extremely difficult to concentrate. The use of
long sentences while questioning made him lose focus and made it difficult for him to keep a
track o questions and as a result the nurse had to repeat few of the questions more than once
(Bramhall, 2014).
Conclusion:
Hence, to conclude, on the basis of the study it can be mentioned that the client is
suffering from Schizophrenia which is characterized by a group of psychiatric symptoms such as
illogical thinking, possible delusions or hallucinations, withdrawal from reality and social

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isolation. The personal hygiene of the client and the ability of the client to perform other
activities can be observed to be already compromised. It is therefore important to pay attention to
the symptoms of the disease and adapt an effective care approach to promote recovery.

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References:
Boyle, M. (2014). Schizophrenia: A scientific delusion?. Routledge.P.90-95
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard
(2014+), 29(14), 53.
Caplan, G. (2013). An approach to community mental health. Routledge.P.88
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014). Nursing care plans: Guidelines for
individualizing client care across the life span. FA Davis.
Frith, C. D. (2014). The cognitive neuropsychology of schizophrenia. Psychology press.P.64-72
Jorm, A. F. (2014). Why hasn’t the mental health of Australians improved? The need for a
national prevention strategy.
Kitson, A., Marshall, A., Bassett, K., & Zeitz, K. (2013). What are the core elements of patient‐
centred care? A narrative review and synthesis of the literature from health policy,
medicine and nursing. Journal of advanced nursing, 69(1), 4-15.
Ripke, S., Neale, B. M., Corvin, A., Walters, J. T., Farh, K. H., Holmans, P. A., ... & Pers, T. H.
(2014). Biological insights from 108 schizophrenia-associated genetic
loci. Nature, 511(7510), 421.
Ross, C. (2014). Schizophrenia: Innovations in diagnosis and treatment. Routledge.P.44-52
Sunderland, M., Anderson, T. M., Sachdev, P. S., Titov, N., & Andrews, G. (2015). Lifetime and
current prevalence of common DSM-IV mental disorders, their demographic correlates,

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and association with service utilisation and disability in older Australian
adults. Australian & New Zealand Journal of Psychiatry, 49(2), 145-155.