Case Study: Mental Health and Therapeutic Interventions for James

This case study discusses the admission process, therapeutic interventions, nursing process, medication, and communication strategies for James, a patient suffering from mental illness and self-harm.

Essay

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY..................................................................................................................................3
Admission process for James.......................................................................................................3
Therapeutic interventions, underpinned by effective communication skills, within health and
social care settings.......................................................................................................................4
Ways in which occupational therapists can help out patient.......................................................4
Nursing process for James...........................................................................................................5
Medication that can help out James.............................................................................................5
Examination of physical health of James....................................................................................6
Ways of using effective communication and its importance.......................................................6
How to help James regarding his thinking about stepmother?....................................................6
Guilt and shame...........................................................................................................................7
Biopsychosocial theories.............................................................................................................7
Ways in which psychologists can help out patient......................................................................8
Motivational interviews...............................................................................................................8
How to help the patient to deal with his suicidal thought and self-harming?..............................8
Attachment theories that can help out James...............................................................................9
Care plan for James.....................................................................................................................9
Discharge plan...........................................................................................................................10
Ways in which mental nurse can help in James’s recovery.......................................................11
CONCLUSION..............................................................................................................................12
REFERENCES................................................................................................................................1

INTRODUCTION
Emotional, psychological and social wellbeing is considered as a mental health. This
present study is based on a case of James in which he was admitted in an acute admission ward
in mental health after drinking spree. It will discuss different motivational strategies that can
encourage patient for decreasing alcohol and remaining stressed free.
MAIN BODY
Admission process for James
Before discussing a general admission process, it is important to know about an acute
admission. In regard to James, it is found that he was removed as a child from his family because
of domestic violence and now he was admitted to an acute admission ward. Patient is self-
harming and suffering from trauma and it is the main problem for which he needs an acute care.
Acute admission is a process in which patient is admitted to hospital in an urgent basis (Holm
and et.al., 2019). It is called an emergency admission and this admission can occur directly via
general professional. Some common steps that staff or patients need to follow for getting
admission done in medical ward include:
 Reporting to reception of hospital.
 Enquiry about patient’s problem by front office executive.
 Referring to patient to concerned department by front office executive.
 Patient or his family member needs to concern with doctor with case history.
 As per the case, patient is being sent to an emergency or routine admission department.
 Patient’s attendant is referred to admission counter.
 An average length of stay, an estimated bill size and other information are being provided
and informed consent is being taken.
Anatomy and physiology knowledge and an understanding of relative pathophysiology in
relation to mental health care.
It is being stated by monoamine deficiency theory that pathophysiology basis of depression is a
depletion of neurotransmitters serotonin. In addition, it can be said that the Amygdala part of
the brain got affected when person becomes depressed and suffer from mental illness. Serotonin
is the most studied neurotransmitters in depression and it causes depression. In addition, it can be

said that mental illness and depression affect brain and people find difficulties in understanding
anything in an effective manner. Brain's main part stops working and sending signals. There are
some factors that may cause depression and mental illness such as: prenatal damage, genetic,
brain injuries and exposure to toxin.
As it can be said that on the basis of case of James that he is suffering from depression and
borderline personality disorder. It is a serious mental illness that is characteristic by
dysregulation of emotions and impulses. People with borderline personality disorder face
problems in maintaining interpersonal relations, they have self-harming behaviour. Depression
disorders occur with borderline personality disorder (Rao and Broadbear, 2019). It is found that
James self-harmed and he did this because of his breakup as well as poor relations with family.
So, on the basis of this, it can be said that he needs an immediate medical requirement and care.
Therapeutic interventions, underpinned by effective communication skills, within health and
social care settings
Communication plays a vital role in health and social care setting as it makes able to
practitioners and healthcare providers in understanding about patient. As per the information and
communication, they can provide better healthcare to patients and can improve their health.
Some therapeutic interventions as well as communication skills that can be used for treating
James who is suffering from mental illness include: an open-ended question, active listening,
silence as per the situation, paraphrasing, exploring, restating, acknowledgement, summarizing
and offering to self. By having all these skills, James can be engaged in the process of treatment
and care plan.
Ways in which occupational therapists can help out patient
One of the best ways of dealing with patients of borderline personality disorder and depression is
to build trust. For this, it is important for occupational therapists to engage patient in his
interesting activities like listening music, talking, roaming and others. By doing so and helping
out patient, trust can be improved. It can engage James in therapies. Dialectical behaviour
therapy is known as an effective one and it can help out occupational therapists in dealing with
James and improving his health (Wasmuth and et.al., 2020). In this therapy, therapists use skill
based approach in order to teach ways by which they can manage emotions, tolerate distress and
control their anger.

Nursing process for James
There are 4-5 steps of nursing process such as: assessment, diagnosis, identifying causes, risk
factors, assessment and evaluation.
An early assessment: Identification of the main problem from which patient is suffering
by analysing patient’s history or admission form. From assesssment, it is known that James has
taken overdose of alcohol and that is why admitted to an emergency ward.
Nursing diagnosis: Alcohol abuse and mental health (Toney-Butler and Thayer, 2022).
Causes: Knowing causes is one of the main element of nursing process. In regard to
James, it is known that poor relation with girlfriend and living alone due to domestic violence
was the main reason of current mental illness situation.
Risk factors: For protecting patient from severe problem, it is important to know risk
factors. Some risk factors that are associated with James’s current situation include: mental
illness and anxiety.
Evaluation: It includes questioning about alcohol use and patient should be screened for
medical as well as behavioural complications.
Nursing management: On the basis of assessment and evaluation, patient is being
screened with audit tool, educated about harm to alcohol and self-harm and referring to medical
health counsellor (Lotfi and et.al., 2020).
Medication that can help out James
Examination of physical health of James
Some physical health measures that are being taken to know severity of current problem
and drinking spree include: blood pressure, cardiovascular check-up, digestion check-up, cancer
test, voice box check and others.
Some symptoms that can help out nurses and doctors in knowing as whether patient have
overdose of alcohol on regular basis or not. If patient has high blood pressure, liver disease,
stroke, weakened immune system, memory problem and dementia then patient needs to be given

an immediate care. Alcohol misuse directly affect nervous system, heart, pancreas, lever and
brain (Wood and et.al., 2018). Heavy alcohol consumption can lead high blood pressure that is
the main risk factor for heart attack. On the basis of case of James, it can be said that he is
suffering from depression and anxiety and it can become worst into emotionally unstable
personality disorder.
So, in regard to James, it is important for nurse to know as whether he consumes alcohol
on regular basis or not. It is known that he lives alone as he was removed from his family so
there are possibilities that he is alcohol addicted.
Ways of using effective communication and its importance
An effective communication plays a vital role in nursing and medical care plan as it makes
patient feel comfortable and valued. For providing better care, nurses need to engage patients and
it is possible only when patient is comfortable and trust on nurse and by making use of an
effective communication method, patient can be engaged. One of the best mode of an effective
communication with patient is face to face. By communicating with patient face to face and
talking on interesting topic, patient can be made feel comfortable (Sibiya, 2018). Some ways and
things that need to be considered while communicating with patient and James in this case
include: Making interaction easier, showing him proper respect, having patience, giving ample
time to patient to talk and share his feelings and listening to patient calmly. By making use of
7C’s of communication and making communication clear and concise, James can be engaged
(Kerr and et.al., 2022).
How to help James regarding his thinking about stepmother?
Education and family involvement approach is one of the best ways of supporting James.
By involving his step mother in the process of counselling, he can be encouraged to interact and
know more about her.
Guilt and shame
It is important for nurse and doctors to know as whether patient is guilt about alcohol use
or not. Care plan selection relies on this main point. If patient is guilt, then nurses can make
patient sure that he will be fine in sometimes and can enjoy a healthy life. If patient has no guilt,
then there are possibilities as he will start alcohol after getting discharged and it can affect his
mental as well as physical health in a negative manner to the great extent. By asking some

questions, nurses and doctors can know about this feeling of patient. In regard to James, it is
known that he has no guilt and when his step mother visited and did all of his cleaning and
laundry then also he complaint about her and said that he is trying to control his life (Snoek and
et.al., 2021). Some questions that can be asked include: Have you ever felt guilty about alcohol
use? Have you ever felt that you should cut down on your drinking? By knowing answers of
these questions, it can be known as whether patient is guilty or not. So, on the basis of this, it can
be said that James has no guilt about whatever he has done and he blames his family for his
condition. So, on the basis of this, it can be said that James needs counselling on an urgent basis
Biopsychosocial theories
Biopsychosocial model can help out nurses in selecting better care plan for James. This
model states that psychological, biological and social environment factors play a vital role in
disease and health. In regard to James, it is known that emotional psychological factor has
affected him to the great extent. His emotions and feelings for his girlfriend and breaking with
her is one of the main causes of drinking spree (Bilevicius and et.al., 2018). Along with this, as
per socioeconomic factor, it is known that when he was child, he was removed from his house
due to domestic violence. In this regard, it can be said that now he has no capacity to live away
from people to whom he loves. He needs strong relation with his relatives, family members and
beloved. He lives alone since childhood and it has affected his health and it is the reason as he
started consuming alcohol. As like this, cultural and socio environment factors can be known by
using biopsychosocial model. It can help out nurse and doctors in developing care plan and
nursing interventions as well (Wiss, 2019).
Ways in which psychologists can help out patient
Psychologist have knowledge about engaging patients who are suffering from mental
illness. They can provide counselling to James and by making him feel comfortable, they can
provide appropriate medical services.
Motivational interviews
In regard to motivational interview, it can be said that it is a technique that can help out in
addressing ambivalence and increase patient’s motivation to change harmful behaviour and habit
(Hayaki and et.al., 2020). There are number of reasons of using this technique in the case of
James such as: understanding addiction, improving overall health of James, reducing substance
abuse, increasing chances of maintaining employment and living a healthy life and decreasing

risk of alcohol related risks like financial, legal and sexual. Some motivational questions that can
be asked from James include:
 Tell me about drug use as what do you like most about drug or alcohol that you use?
 What are some negatives sides of consuming alcohol?
 How do you feel after having alcohol?
 Do you feel that your relations can be improved if you quit alcohol?
 What it has cost to you?
 Do you believe that by decreasing alcohol consumption, you can get better employment
opportunities?
By getting answers of these questions, James’s point of view regarding alcohol consumption
can be known (Balbi and et.al., 2019).
How to help the patient to deal with his suicidal thought and self-harming?
For helping out patients in dealing with suicidal thoughts, counsellor and nurses should
make him feel comfortable. By making him feel comfortable, nurses can engage them in theie
interesting activities such as: reading books, swimming, playing games and others, patients can
be engaged (Enoksson and et.al., 2021). By cooperating them in performing their functions and
making them feel sense of belongingness, they can be made feel comfortable. It increases trust.
By educating them about consequences of suicide and self-harm, patient can be protected.
Attachment theories that can help out James
There are number of theories of attachment that can help out James in improving his
health. An attachment theory, developed by Bowlby states that there is a lasting psychological
connectedness between human beings. His ethological theory of attachment states that infants
have an innate need to develop or create an attachment bond with caregiver. Infants often have
attachment with their primary caregivers and the person who takes care of them. At the time of
discriminate attachment period, children often create strong attachment to one individual and
experience separation distress when parted from person. In regard to James, it can clearly be said
that in his childhood and early age, he was removed from his own family and suffered domestic
violence (McNemar, 2018). He was in need of caregiver and attachment of parents. After

growing up, he came into a relationship and recently broke up with his girlfriend whom he loved.
So, on the basis of his separation from his beloved person and family members, it can be said
that he has become addicted to alcohol as people believe that by having alcohol they can make
themselves feel better and remove loneliness.
Care plan for James
In regard to care plan, it can be said that it is a formal process that helps out nurses in
identifying existing needs as well as recognising potential risks. An effective care plan provides
clear communication among patients, nurses and healthcare providers for achieving better health
care outcomes. James is admitted because of drinking spree and overdose of alcohol and for him
an effective care plan would be:
Nursing interventions Reason of using it
Identifying the main cause of current
problem, explaining consequences of
overdose of alcohol.
Patient in acute care and withdrawal of alcohol may
face difficulties in knowing what is happening. By
quitting alcohol directly, he may face some anxiety
attack problems. So, by educating James about ways of
decreasing alcohol and importance of doing this, he
can be protected from severe health diseases.
Developing trusting relationship
through honest and frequent contact
Helping out patient in decreasing distrust. It can help
out nurses in increasing engagement level of patient in
treatment process (Minian and et.al., 2018).
Maintaining a calm environment. By promoting diversity, nurses can decrease stress.
Monitoring patient for signs of
depression
It can help out patients from suicidal attempts.
Barbiturates This medicine and drug can help out James in alcohol
withdrawal. Patient needs to take it as per prescribed
method.
By using all these interventions, James can be protected from severe mental and physical health
disease.

Discharge plan
Client name: James
Diagnosis: self-harm, suffering from trauma, depression and alcohol misuse
Treatment: Encouraging patient to live with family members and taking counselling in
a timely manner.
Cognitive processing therapy
Prolonged exposure therapy
Medications need to take after discharge: Sertraline and paroxetine
Outcomes achieved during treatment: Increased level of trust, social engagement

Issues that may arise after discharge: Unhappiness, social isolation.
Ways in which mental nurse can help in James’s recovery
By educating James regarding consequences and negative impacts of alcohol consumption,
he can be protected from severe health problems. He can be encouraged for improving relations
with his family. By making use of family approach model and involving family members in
counselling and treatment process, James can be prevented from mental illness. As it is known
that he needs strong relation with his friends, family members and beloved person so, by
encouraging him as well as educating family members about importance of improved relations,
he can be protected from severe health disease (Tranter and Robertson, 2021).
James can be provided with harm reduction information, overdose prevention so that he can
prevent himself whenever he thinks about taking overdose of alcohol. Teaching basis
phlebotomy skills can also help out James with addiction and safely using drug of choice. Mental
nurse needs to promote diversity and encouraging everyone to treat each other’s in a fair manner.
People who lives alone and are addicted also need information about ways to dispose of syringes
as well as other drug administration items in a safe manner (Stott and Priest, 2018). Lack of
information can put James and other person at risk. So, by educating via direct communication
with patient, James can be prevented from mental illness.
CONCLUSION
It has been summarised from the above study that nursing care plan plays a vital role in
protecting patients from getting affected with severe health problems. It has shown effectiveness
of attachment theories and ways by which patient can be encouraged for improving relations and
living a healthy life.

REFERENCES
Books and journals
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functioning among individuals with borderline personality disorder (BPD) and self‐
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