Mental Health Nursing: Diagnosis, Treatment, and Discharge Planning

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

MENTAL HEALTH NURSING
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).

MENTAL HEALTH NURSING
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