Mental Health Nursing: Case Study Analysis

This article analyzes a case study of Lisa to identify three mental health issues - loneliness, fear, and insecurities. It discusses how mental health nurses can collaborate with patients to address these issues and facilitate recovery.

Running head: MENTAL HEALTH NURSING
MENTAL HEALTH CASE STUDY ANALYSIS
Name of the student
Name of the university
Author note

1MENTAL HEALTH NURSING
Three issues of Lisa identified from the case study
While analyzing the case study of Lisa, several mental and psychological concern that
affected her mental balance and increased her need for psychological treatment were identified.
Lisa was counselled by Jenny, a local drug service under whom she was undergoing treatment
and while sharing her concern, Lisa mentioned her concerns. Within these, the three aspects,
which contributed to her problematic substance use, were her loneliness, her fear and
insecurities.
As mentioned in the case study, Lisa’s parent did not approve of her relationship with
John due to which she separated from her family and moved in with John. Due to this rejection
from her parents, she started feeling lonely and isolated. As per Lindgren et al. (2014),
loneliness and isolation are two primary concern of people suffering from psychological or
mental issues. Lisa was agitated, anxious and fidgeting constantly while communicating to the
local counsellor that indicated towards her loneliness and isolation stage, as she was unable to
make eye contact to the counsellor. The counsellor mentioned that Lisa looked untidy, rough and
does not look like her normal self as well as Lisa also mentioned herself ‘ugly’ that indicated
towards her low self-esteemed and confidence. Therefore, as per the Trauma- Informed Care
Principles, she lacked empowerment (Raja et al., 2015). Further, due to the rejection from her
family, she was not able to continue her medication as her mother used to take care of it,
therefore the only source of her empowerment, her family was not present in the situation, due to
which her substance abuse resumed.
The second issue could be identified from the fact that Lisa repeatedly mentioned her
need of protecting herself from her surrounding environment and close people. Lisa mentioned

2MENTAL HEALTH NURSING
of few voices that repeatedly asked her to protect herself from John. Further she had several
cameras in her house that constantly concerned her of continuous vigilance. This affected her
mental peace as she had to sleep in the garden shed with a knife under her pillow as she had
constant fear of being watched, threatened by some external voices and her boyfriend John that
made her sleep alone in garden at night. As per Pearson et al. (2015) fear plays an important role
in the development of psychological disorder and in case of Lisa, there were multiple stressors
that induced fear in her psychological disorder. While communicating her concerns to the local
counsellor, she mentioned that she is fearful of thinking on her won because she thinks her
boyfriend has inserted transmitter in her stomach, and her thoughts are open to everyone
surrounding. As per Sweeney et al. (2015) fear is a core process, in which discrimination, power,
and control plays an important role. After facing rejection from her family, she was completely
dependent on her boyfriend however due to continuous vigilance, stress and isolation, she
developed fear of staking, violence and threatened of death. As per the Trauma- Informed Care
Principles, trustworthiness, transparency and safety were the principles that were lacking in her
surrounding that may enhance her substance abuse and increased her psychological complication
(Muskett, 2014).
The third aspect, which could have induced her psychological and mental concerns is her
insecurity and stress. While communicating to the local counsellor, she seemed distracted and
was observed having conversation with some virtual individual. She was also distracted while
conversation and asked to repeat several question due to her lack of concentration. She
mentioned that she is unaware of medication program and has not consumed any medicine since
she has moved to her new house with John. Besides, after moving in with John, she has
unintentionally increased her cannabis and speed related substance abuse. Researcher Van der

3MENTAL HEALTH NURSING
Kolk (2017) has mentioned in their research that insecurity is the feeling which is associated to
psychological and mental issues as people affected with it are unable to control their feelings and
thinking. Hence, this was the third concern which could have influenced the patient to be
addictive of substance abuse. Besides these, another reason for her increased insecurity was the
voices, that molded her thoughts and made her believe that people around her were affecting her
mental peace and she need to protect herself from those people. Further as per Trauma- Informed
Care Principles, while receiving care in the local drug center, her care lacked collaborations with
mental healthcare professionals and hence, this would be provided to the patient in her future
healthcare service (Wolf et al., 2014). Hence, these were the primary concerns which may have
contributed to her problematic substance abuse.
How these issues helped mental health nurses to recover her condition
Collaboration between mental health patients and nursing professionals is completely
dependent on their personal beliefs, thoughts and values depending on which people affected
with mental health concern are provided with care (McKenna et al., 2014). To make the mental
health collaboration fruitful, both the consumer and nursing professionals should indulge in
conversation, identify the needs of the patient and then prepare nursing interventions that could
help the patient to recover properly (Mittal et al., 2014). Further, it was also mentioned in the
research of Kitson, Athlin and Conroy (2014) that both the nursing professional and the
consumer should be able to utilize their knowledge so that effective therapeutic relationship
could be developed. In this process, Lisa was counselled by Jenny, the local counsellor at drug
center. Lisa took several sessions in this drug center however, with time her substance abuse
episode increases and her medication also failed to provide positive result to her psychological
condition. Therefore, while collaborating with the mental health care professionals, the primary

4MENTAL HEALTH NURSING
goal for the care process would be decreasing her stress, fear, insecurity and isolation so that she
could focus on the care process properly (McKenna et al., 2014). In this aspect the Trauma-
Informed Care Principles would be involved as the core care competency and depending on this
aspect the care process of Lisa would be developed (Wall, Higgins & Hunter, 2016). The three
primary aspect mentioned in the case study of Lisa was her fear, her insecurities and her isolation
from her family. Hence, collaboration between mental health care professionals and Lisa should
be focused on addressing these concerns so that her recovery could be made possible (Mittal et
al., 2014).
Involvement of Lisa in the care process is an important aspect as personal recovery is a
subjective process which is achieved through personal expectations, goals and hope that should
be developed by the person seeking mental healthcare (Kitson, Athlin & Conroy, 2014). Further,
it would the responsibility of the healthcare professionals of the mental health center to address
the issues identified and goals developed by Lisa so that achievement of goals and hopes could
be understood by the patient (McKenna et al., 2014). Further, in case of Lisa, while developing
the care plan a comprehensive and long-term approach would be chosen for the growth and
development of the patient and with facilitating patient centered care process, counselling would
also be involved in which she would be asked to communicate with her parents, would be asked
to become financially stable and independent so that her self-esteemed and confidence could be
restored (Mittal et al., 2014).
As per the global practice of recovery based treatment for patients affected with
psychological; concerns, there are four aspects of the recovery oriented care process in which,
acknowledging and facilitating the concern of the patient, support, their aim goal and their

5MENTAL HEALTH NURSING
dreams of normal life works as primary pillars of the care process (Wall, Higgins & Hunter,
2016). On the other hand based on the Trauma- Informed Care Principles, Lisa lacked
empowerment, trust, transparency, safety and collaboration in her care process (Berliner &
Kolko, 2016). Hence, these two care strategies mentioned above would help to develop a support
based care process in which she would be empowered to take her decision for the care process.
Further, her care process would also be dependent on the mutual decision related care process so
that she could develop trust on the care process due to its transparency and achieve her personal
recovery related goals effectively (Wall, Higgins & Hunter, 2016).
Application of Trauma- Informed Care Principles in the care process for Lisa
In the care process of Lisa, application of Trauma- Informed Care Principles should be
achieved. Further, for the recovery model of care for Lisa, interventions would revolve around
her insecurity, fear and isolation associated concerns so that through the interventions show
could be provided with improved mental health condition. As per the Trauma- Informed Care
Principles, there are five principles depending on which patient affected with mental health
should be provided with interventions (Berliner & Kolko, 2016).
While developing her care process, the first issue of her loneliness and isolation would be
addressed by providing her empowerment and confidence. As per Rajaram, Barnard and
Bilimoria (2015), empowerment holds utmost importance in treatment of patients affected with
psychological issues. They suffer from inferiority complex, low esteemed and less confidence
due to which, empowerment helps them to identify their goals for recovery (Fogel & Greenberg,
2015). In this case of Lisa, she would be asked to communicate with her parents to address her
isolation and loneliness issues. She also mentioned in her counselling session that her mother

6MENTAL HEALTH NURSING
used to take care of her medication and after she left her parents’ house, she lost track of her
medicine and have not taken any medication from last 2 weeks. Hence, it is important to include
empowerment in her mental health care process so that she could overcome her stress, loneliness
and isolation. Further, she would be provided with communication and n=behavioral therapy so
that through these interventions, her social inclusion and communication ability with other could
be improved. To address her fear and insecurities, she would be involved in the cognitive
behavioral therapy in which she would be asked to involve in therapeutic sessions of painting,
gardening, and music (Fogel & Greenberg, 2015). These sessions would help to relieve her stress
and she would be able to gain trust in the transparent care process by controlling her negative
nerves. Further, as per Rajaram, Barnard and Bilimoria (2015), inclusion of cognitive behavioral
therapy would help her to relieve her stress and she would be able to collaborate in mutual
decision making process and develop goals and strategies to achieve them as per the recovery
model of care. In this process, besides the nursing professional, psychiatrist would be involved
from the multidisciplinary team so that the interventions, developed by the nursing professional
could be improved and evaluation of those interventions to determine its ability to address Lisa’s
care need could be identified (Fogel & Greenberg, 2015). Further involvement of a psychiatric in
the care process would help to counsel the patient time to time so that relapse of her substance
abuse could be controlled to enhance the effectiveness of care process.

7MENTAL HEALTH NURSING
References
Berliner, L., & Kolko, D. J. (2016). Trauma informed care: A commentary and critique. Child
maltreatment, 21(2), 168-172.
Fogel, B. S., & Greenberg, D. B. (2015). Psychiatric care of the medical patient. Oxford
University Press.
Kitson, A. L., Athlin, Å. M., & Conroy, T. (2014). Anything but basic: nursing's challenge in
meeting patients’ fundamental care needs. Journal of Nursing Scholarship, 46(5), 331-
339.
Lindgren, B. M., Sundbaum, J., Eriksson, M., & Graneheim, U. H. (2014). Looking at the world
through a frosted window: experiences of loneliness among persons with mental ill‐
health. Journal of psychiatric and mental health nursing, 21(2), 114-120.
McKenna, B., Furness, T., Dhital, D., Park, M., & Connally, F. (2014). Recovery-oriented care
in a secure mental health setting:“striving for a good life”. Journal of forensic
nursing, 10(2), 63-69.
Mittal, D., Corrigan, P., Sherman, M. D., Chekuri, L., Han, X., Reaves, C., ... & Sullivan, G.
(2014). Healthcare providers’ attitudes toward persons with schizophrenia. Psychiatric
rehabilitation journal, 37(4), 297.
Muskett, C. (2014). Trauma‐informed care in inpatient mental health settings: A review of the
literature. International journal of mental health nursing, 23(1), 51-59.

8MENTAL HEALTH NURSING
Pearson, J., Naselaris, T., Holmes, E. A., & Kosslyn, S. M. (2015). Mental imagery: functional
mechanisms and clinical applications. Trends in cognitive sciences, 19(10), 590-602.
Raja, S., Hasnain, M., Hoersch, M., Gove-Yin, S., & Rajagopalan, C. (2015). Trauma Informed
Care in Medicine. Family & community health, 38(3), 216-226.
Rajaram, R., Barnard, C., & Bilimoria, K. Y. (2015). Concerns about using the patient safety
indicator-90 composite in pay-for-performance programs. Jama, 313(9), 897-898.
Sweeney, A., Gillard, S., Wykes, T., & Rose, D. (2015). The role of fear in mental health service
users’ experiences: a qualitative exploration. Social psychiatry and psychiatric
epidemiology, 50(7), 1079-1087.
Van der Kolk, B. A. (2017). Developmental Trauma Disorder: Toward a rational diagnosis for
children with complex trauma histories. Psychiatric annals, 35(5), 401-408.
Wall, L., Higgins, D. J., & Hunter, C. (2016). Trauma-informed care in child/family welfare
services. Melbourne, Vic: Australian Institute of Family Studies.
Wolf, M. R., Green, S. A., Nochajski, T. H., Mendel, W. E., & Kusmaul, N. S. (2014). ‘We’re
civil servants’: The status of trauma-informed care in the community. Journal of Social
Service Research, 40(1), 111-120.