Mental Health Nursing: Diagnosis, Treatment, and Discharge Planning

This essay discusses the mental health care plan of Katy, a 23-year-old woman diagnosed with Borderline Personality Disorder (BPD). It covers BPD diagnosis, legal status under the NSW MH Act, vulnerabilities, treatment plan, multidisciplinary team, discharge planning, and referrals.

Running head: MENTAL HEALTH NURSING
Mental Health Nursing
Name of the Student
Name of the University
Author Note

MENTAL HEALTH NURSING
Introduction
Katy is a 23 year old woman who has worked as AIN (Assistant in Nursing) and
resides in nurses’ residence. Katy reports that she has been diagnosed with Borderline
Personality disorder (BPD). The following essay is based on the mental health care plan of
Katy. The essay will initiate BPD diagnosis of Katy with reference to DSM-V followed by
her legal status as per the NSW MH Act. The essay will also include her vulnerabilities,
treatment plan in reference to the multidisciplinary team along with discharge planning and
referrals to registered nurses.
Diagnosis
Katy resides in the campus of the hospital New South Wales Australia in the nurses’
residence after her adopted mother died. However, following a get-together with her
biological mother in her birthday, her mood darkened. She is turning up late in work with a
feeling of de-motivation. She has discussed her concern with Res stating her dark thoughts
and her friend takes her to the GP and she was diagnosed with BPD. According to the
American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5) (2019), BPD is diagnosed based on pervasive pattern of instability
within the interpersonal relationships, the self-image of the person. Grande et al. (2016) are
of the opinion that the BPD is also marked by impulsivity that initiates during the early
adulthood. In the virtual reality session highlighted in the video, Katy explains that she hears
voices like someone is calling her by her name and is suffering from visual hallucinations.
She states that she feel scared while stating alone. This can also be related that after her
adopted mother died she moved to Sydney from UK in order to stay close to her biological
mothe (BBC Three, 2017). This related with the DSM-V classification of the BPD that states
that people suffering from BPD make frantic efforts to avoid real abandonment and thus

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reflecting the intolerance to remain alone (Solé et al., 2017). Impulsivity with self-damaging
tendencies is also reflected among the person suffering from BPD (Choi-Kain & Gunderson,
2016). In case of Katy, her virtual reality session showed drawing sketches with no specific
patterns, fumbling with sentences and repeating same sentences over and over again with no
meaning. Her friend also reported that she has also taken attempt to commit suicide.
According to recurrent suicidal gestures are one of the significant feelings of BPD and this is
added with a feeling of emptiness. Thus depending on her current status, she was admitted to
NSW mental health unit as an involuntary patient being classified as Mentally ill under the
section 14 of the Mental Health Act 2007 (NSW) (NSW Government, 2008).
NSW MH Act
Katy is admitted in the NSW mental health hospital under the involuntary care.
According to the NSW Government (2008), a person eligible for the involuntary admission if
the person is suffering from mental illness and due to that illness she is vulnerable towards
self-harm. Involuntary admission is also considered when the person needs immediate
temporary care due to deteriorating behaviour. Katy’s friend Res is concerned about her
current suicidal risk. Katy also feels unsafe alone at home and thus GP recommends Katy’s
admission in the private mental health hospital in Sydney in order to improve her health and
reduce her life risk. Katy simultaneously agrees to this recommendation. Thus overall
admission was involuntary. In case of Katy, it was detention in the mental health ward on
request of both the primary carer (Katy’s doctors) and her friend. Upon admission in the
involuntary ward, proper medical examination is important in order to proceed with the
ongoing treatment. The initial stage of examination upon admission is conducted by
authorized medical officer and this is followed by examination of second medical practitioner
(NSW Government, 2008).

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Risks
Experience of stressful events in life increases the course of prognosis of BPD. In
case of Katy, the loss of her adapted mother in UK and moving back to Australia closer to the
biological mother has created turmoil in life creating mental disturbance and increase in the
severity of BPD. Rowland and Marwaha (2018) stated that bipolar disorder is associated with
mood swings. In between each of the manic episodes, people suffering from BPD feel like
they are on the top of the world or a constant feeling of irritation. During the depressive
episodes, they feel hopeless and sad. In between manic and depressive episodes there are
normal moods (Paris, 2015). The video of Katy showed that there is frequent swings in her as
her speech became distracted from one context to her also her virtual drawings are juxtaposed
(BBC Three, 2017). This frequent mood swings can create a barrier towards effective
application of the therapy plan. Moreover, a constant tenure of depressive episodes can
increase her tendency of self-harm and thereby increasing her suicidal risks.
High rates of irritability or suicidal risk can be treated with antidepressants
monotherapy or other mood stabilizers. However, if the patient refuses to take medication
management additional psychotherapy can be used (Turecki & Brent, 2016). In case of Katy
refusal is unlikely as she seemed cooperative and wanted to recover from her current mental
state of mind. Prospective psychotherapy includes psychoeducation and mindfulness based
therapy for avoiding mood swings (Turecki & Brent, 2016).
Treatment
Her recovery will focus entail increase in her sense of safety, increase concentration
in the work. The therapy plan for Katy will include both pharmacological and non-
pharmacological intervention. The pharmacological intervention for the management of the
BPD include mood stabilizer in order to stable mood swings of Katy. The commonly used

MENTAL HEALTH NURSING
mood stabilizer for Katy is Carbamazepine, divalproex sodium, lamotrigine, lithium and
valproic acid. However, the medication management of the bipolar disorder will take place
under the controlled supervision of trained psychiatrists (Karanti et al., 2016).
The non-pharmacological intervention that will be helpful for the treatment of BPD in
case of Katy is recovery focused cognitive-behavioural therapy (CBT). Jones et al. (2016)
revealed in their randomised control trial that recovery focused CBT is effective during early
onset BPD. The overall approach is also cost effective and reliable. In order to reduce the cost
of care further, behavioural activation (BA) therapy can be used as a replacement of the CBT.
BA work by activation of the positive behaviour among the subjects by reducing the negative
thoughts like suicidal attempts. BA is simpler in comparison to CBT and can be delivered
easily by junior nurses or health workers with less intensive and costly training (Richards et
al., 2016; Linehan, 2018). Since Katy is unable to attend to work, her financial issue can
create constrain in meeting the basic needs thus cost-effective BA will be best suited for her.
BA also helps in reducing the depressive symptoms. This will help Katy to accept the fact at
the age of 23 that her biological and adopted mothers are sisters. She also remains anxious as
this is evident from her constant feeling of being unsafe along with suicidal tendencies. In
order to cope with such condition, mindfulness based therapy (MBT) can be prove to be
effective. Proper application of MBT helps to reduce anxiety and stress prevalent among the
young adults with BPD (Cotton et al., 2016).
Multidisciplinary team
The multidisciplinary team members that must be recruited in the panel for treatment
of Katy include a psychotherapist and a mental health counsellor and a dietician.
Psychotherapist will help in designing of the person-centred care plan for Katy depending
upon her mental health consequences, her level of mood swings and root cause behind the

MENTAL HEALTH NURSING
anxiety development and consistent state of depression. In order to assist the
psychotherapists, a mental health counsellor is important. The role of the mental health
counsellor is to assist the psychotherapists in order to develop the person-centred care plan
(Inder et al., 2018). The mental health counsellor will make use of his effective
communication skill in order to develop therapeutic relationships with the client and thereby
helping to understand the underlying trauma that is manifestating as mood swings among the
clients (Inder et al., 2018). The role of dietician will be frame a proper diet plan for Katy.
Lopresti and Jacka (2015) stated that abiding proper yet healthy diet plan helps to improve
the physical health state and thereby helping to improve mental health outcome.
Discharge planning
She will be ready for discharge when the self-harm attitude is recovered completely
along with a significant decrease in her mood swings and depressive state of mind (Lee et al.,
2018). The discharge planning for Katy will include proper assessment present social support,
stability of financial income and other daily living resources. Social support is important in
order to reduce the feeling of emptiness (Paris, 2018). Though Katy s employed but her
health condition is increasing her level of absenteeism in work field and creating a financial
barrier. It is still not clear who will be caring for her post discharge, whether her biological
mother or her friend. Proper discharge planning can only be done after the relation with the
primary care giver is known. The discharge care planning will also include education
approaches for the Katy’s primary carer in order to reduce the tendency of self-harm. The
discharge care planning will also focus on the guidelines for medication management along
with healthy diet plan that must be followed while at home (Lee et al., 2018).

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Referrals
Referrals in case of Katy will be community based support where she will be indulged
in group-based activities at the community level. Group based activity at the community level
will help her cope with the new cultural atmosphere of Australia (as he is from UK) and at
the same time will help to increase social engagement and thereby helping to fight against
anxiety and depressive thoughts. People with BPD experiences fear for being alone and thus
social engagement can be proved to be helpful (Paris, 2018). The referrals must be done to
certain non-profit organizations that are working for patients with complex mental health
disease like BPD. Listening to lived experience of the people with the same mental health
complication with promote faster recovery and improved coping skills (Schluter et al., 2017).
Conclusion
Thus from the above discussion, it can be concluded that Katy is suffering from BPD.
It is not clear when BPD was diagnosed. Increase in the severity of BPD occurred when she
shifted from UK to Australia after her adopted mother died. Meeting her biological mother in
Australia and coming to known that both of them were sisters further aided to her increased
severity. Her mainly symptoms include mood swings, anxiety, depressive and a tendency of
self-harm. She was admitted to mental health ward of a hospital through involuntary
admission. Her treatment plan will include both pharmacological and non-pharmacological
intervention. The multidisciplinary team will include psychotherapists, mental health
counsellor and dietician. The discharge planning will require proper education to the family
care giver along with referrals to community based healthcare service for increased level of
social engagement.

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References (journals)
Cotton, S., Luberto, C. M., Sears, R. W., Strawn, J. R., Stahl, L., Wasson, R. S., ... &
Delbello, M. P. (2016). Mindfulness‐based cognitive therapy for youth with anxiety
disorders at risk for BPD: A pilot trial. Early Intervention in Psychiatry, 10(5), 426-
434.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). BPD. The Lancet, 387(10027), 1561-
1572.
Inder, M. L., Crowe, M. T., Moor, S., Carter, J. D., Luty, S. E., Frampton, C. M., & Joyce, P.
R. (2018). Three‐year follow‐up after psychotherapy for young people with
BPD. BPDs, 20(5), 441-447.
Jones, S. H., Smith, G., Mulligan, L. D., Lobban, F., Law, H., Dunn, G., ... & Morrison, A. P.
(2015). Recovery-focused cognitive–behavioural therapy for recent-onset BPD:
randomised controlled pilot trial. The British Journal of Psychiatry, 206(1), 58-66.
Karanti, A., Kardell, M., Lundberg, U., & Landén, M. (2016). Changes in mood stabilizer
prescription patterns in BPD. Journal of affective disorders, 195, 50-56.
Lee, H. J., Lin, E. C. L., Chen, M. B., Su, T. P., & Chiang, L. C. (2018). Randomized,
controlled trial of a brief family‐centred care programme for hospitalized patients
with BPD and their family caregivers. International journal of mental health
nursing, 27(1), 61-71.
Lopresti, A. L., & Jacka, F. N. (2015). Diet and BPD: a review of its relationship and
potential therapeutic mechanisms of action. The Journal of Alternative and
Complementary Medicine, 21(12), 733-739.

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Richards, D. A., Ekers, D., McMillan, D., Taylor, R. S., Byford, S., Warren, F. C., ... &
O'Mahen, H. (2016). Cost and Outcome of Behavioural Activation versus Cognitive
Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-
inferiority trial. The Lancet, 388(10047), 871-880.
Rowland, T. A., & Marwaha, S. (2018). Epidemiology and risk factors for BPD. Therapeutic
advances in psychopharmacology, 8(9), 251-269.
Schluter, P. J., Lacey, C., Porter, R. J., & Jamieson, H. A. (2017). An epidemiological profile
of BPD among older adults with complex needs: A national cross‐sectional
study. BPDs, 19(5), 375-385.
Solé, E., Garriga, M., Valentí, M., & Vieta, E. (2017). Mixed features in BPD. CNS
spectrums, 22(2), 134-140.
Turecki, G., & Brent, D. A. (2016). Suicide and suicidal behaviour. The Lancet, 387(10024),
1227-1239.

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References (websites)
American Psychiatric Association. (2019). BPD. Access date: 9th August 2019. Retrieved
from: https://www.psychiatry.org/patients-families/bipolar-disorders/what-are-
bipolar-disorders
BBC Three (2017). Borderline Personality Disorder | My Mental Health In VR Ep 1. Access
date: 9th August 2019. Retrieved from: https://youtu.be/GcquU1B_NSc
National Institute of Mental Health. (2019). Borderline Personality Disorder. Access date: 1st
August 2019. Retrieved from: https://www.nimh.nih.gov/health/topics/borderline-
personality-disorder/index.shtml
NSW Government. (2008). Mental Health Act 2007 No 8. Access date: 1st August 2019.
Retrieved from: https://www.legislation.nsw.gov.au/inforce/bb9dde66-bc52-ea95-
89d4-8a3c5dd9507b/2007-8.pdf

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References (books)
Choi-Kain, L. W., & Gunderson, J. G. (2016). Borderline Personality and Mood Disorders.
Springer-Verlag New York.
Linehan, M. M. (2018). Cognitive-behavioral treatment of borderline personality disorder.
Guilford Publications.
Paris, J. (2015). A concise guide to personality disorders. American Psychological
Association.
Paris, J. (2018). Clinical features of borderline personality disorder. Handbook of Personality
Disorders: Theory, Research, and Treatment, 2, 419.