Mental State Assessment and Biopsychosocial Care Model: A Case Study

This case study discusses the mental state assessment of a patient named John and the biopsychosocial care model. It elaborates on recognising signs of deterioration, baseline assessment, and identifying and managing risks. The essay also discusses ethical dilemmas in mental healthcare. The subject is mental health and the course code is not mentioned. The college/university is not mentioned.

Running head: CASE STUDY
Assessment 2
Name of the Student
Name of the University
Author Note

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Introduction- Mental state can be broadly defined as the intellectual capacity, general
mental health, and emotional state of a person, depending on the clinical observations, and by
conducting a thorough interviewing. Mental state most commonly comprises of the
behaviour, mood, memory, judgment, problem solving skills, and contact with the reality
(Caplan, 2013). Thus, any deterioration from this mental state refers to all forms of changes
or alterations that occur in the mental state of the person, thus indicating the need of a closer
monitoring or conduction of frequent clinical reviews (Lamond, Joseph & Proverbs, 2015).
Some mental states have often been attributed to the beliefs, desires, perceptions, and
memories of an individual. While others are often accredited to sub-personal faculties such
as, the visual system and language capabilities. Both the types of mental states and processes
that are related to the states are intentional. Hence, intentionality is in accordance to the facts
that are represented by a mental state. Other paradigms of a mental state are related to hate,
love, pain, pleasure, and different attitudes towards propositions that encompass belief, hope,
and fear. The essay will elaborate on the mental state of a patient John and will further
discuss the biopsychosocial care model, in relation to the case study.
Recognising signs of deterioration- The immediate identifier of the deteriorated
mental state in John can be linked to his injury on the rural property that appears to be an
instance of self-inflicting harm. The fact that he was active and cheerful upon being admitted
to the mental ward is in clear contrast with his sudden apathy and withdrawal. Other
identifiers can be related to the feelings of miserableness and pain as reported by him.
Refusal to adhere to medications prescribed by the doctors and portrayal of a frustration also
demonstrate a sudden worsening of mental health. Recognizing the immediate identifiers is a
crucial aspect of providing care to a patient who is mentally distressed. This can be attributed
to the fact that maintenance of good mental health is considered utmost essential for living a
healthy and long life. While poor mental outcomes can impede a person from leading a

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successful and purposeful life, good mental state can enhance the emotional abilities. Self-
harm, commonly referred to as self-injury has often been defined as the intentional injury to
parts of the body that is done without any suicidal ideations. Owing to the fact the desire to
inflict self-harm upon an individual has often been considered a major symptom of borderline
personality disorder, a mental illness, this should be considered as an important adjunct to
deteriorating mental state (Mehlum et al., 2014). Apathy or lack of enthusiasm and interest, in
combination with social isolation have been strongly connected with mental illnesses.
Withdrawal is a core symptom of schizophrenia and is usually exhibited by people in
response to dejection, disappointment, and stress (Strauss et al., 2013).
Baseline assessment refers to a structured assessment that is conducted upon a patient
by a nursing professional in order to retrieve complete and exhaustive information of the
patient’s physical and mental health status. Baseline examination are generally conducted for
assessing the physical state of a patient and form the initial point of patient-physician contact
(Lindsay & Desforges, 2013). The first assessment should focus on measuring the attention
span of the patient. An inattentive patient is usually not able to provide complete cooperation
and will therefor hinder all forms of testing. Other baseline assessments would encompass
measuring the memory, orientation to place, time and person, judgment, reasoning and verbal
abilities (Dennis & O’Toole, 2014). The baseline mental examination will also be conducted
by utilizing the Montreal Cognitive Assessment (MOCA) that covers a range of cognitive
functions (Memória et al., 2013). Upon obtaining the results of the different evaluation
techniques, the results will be analysed so as to ascertain the current mental state of the
patient.
This will be followed by conduction of a comprehensive Mental State Examination
(MSE). Hence, this would provide an opportunity to observe and describe the psychological
functioning of the patient in a structured way to determine certain domains related to patient

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mental state. Some of the major components of the MSE that will be evaluated are namely,
attitude, thought process, thought content, mood and affect, and perception (Ekkekakis,
2013). Attitude is an essential component since it refers to the cooperation or rapport
displayed by a client during the interviewing. Affect will help in assessing the dynamic and
external manifestations of the internal emotional state of John. His mood assessment will also
describe the predominant internal state at a particular time frame. Abnormal or disordered
thoughts would help in the diagnosis of formal thought disorder and would also determine if
John experiences a flight of ideas (House, 2014). Assessment of the thought content would
encompass the majority of the comprehensive MSE and would facilitate gaining a sound
understanding of depressed cognition, suicidal ideation, overvalued ideas, phobias, obsession,
and preoccupation (Barnard & Teasdale, 2014).
The biopsychosocial model of care- The biopsychosocial model refers to a concept
that helps in the development of a sound understanding on the health and illness of
individuals, besides taking into account different factors that pertain to sociology,
psychology, and biology (Pilgrim, 2015). Depression is usually different from the different
mood vacillations that are experienced by people in their lives and is not concomitant with
emotional responses occurring in regular basis. An analysis of the case study suggests that the
‘bad back’ that John has been suffering from created an impact on his personal and
professional life. The fact that John had been terminated from his job of a horticulturist
created a severe impact on his mood and subsequent mental state. Although his boss
suggested the slowdown of the business as the primary reason for the latter’s termination
from job, John considered his back pain as the major contributing factor. Upon further
analysis it was also found that the back pain was responsible for insomnia, which in turn
made John feel fatigued and demotivated to work. Additionally, the pain was also found
responsible for restricting his social interaction with members of the community or

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envisioning other job prospects. The contributing factor can be discussed in terms of the
biopsychosocial model in that back pain, isolation from community, and joblessness stand for
the biological, psychological, and social facets, respectively (Sarafino & Smith, 2014).
An individual suffering from any physical ailment shows an increased likelihood of
suffering from depression. Back pain is a common illness that primarily affects the lumbar
region and makes it difficult for the person to support the entire weight of the upper body part
(Hoy et al., 2014). The consequent symptoms of insomnia experienced by John was another
biological factor. The major psychological factor was social withdrawal and demotivation,
since older people most commonly portray presence of a range of isolating dynamics that
increase with an elevation in their frailty, and results in a possible decline in their status of
health and wellbeing (Girard et al., 2014). Economic struggles have been found to add to the
isolative behaviour among the elderly. Demotivation is used to refer to the lack of enthusiasm
and interest in work (Yapko, 2014). Thus, John did not have any strong reason to accomplish
his goals, which contributed to the development of persistent low mood. The major social
factor was his unemployment. Long-term joblessness has also been related to twice the risk
of developing mental disorders particularly anxiety and depression, when compared to the
employed individuals (McGee & Thompson, 2015). This also contributes to an increase in
their mortality rates. Considering the fact that loss of job would lead to lower family income,
thus subsequently resulting in poor housing, limited social support and lack of food security,
the patient John became depressed.
The biopsychosocial model has been adopted for gaining a sound understanding of the
underlying factors that might have contributed to the condition since the model is grounded
on a dualistic and fractional process that facilitates the conduction of a comprehensive
assessment of the patient being analysed. Introduced by the psychiatrist George Libman
Engel in 1997, the fundamental property of the model is that it considers all illnesses and

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health as major products of interchange between psychosocial, physical, and social factors
(Smith et al., 2013). Hence, it is considered as the best practice due to its deviation from the
biomedical model that only placed an emphasis on the biological variables. Additionally, the
biopsychosocial model is also regarded as a best practice since it is an inclusive model and
helps in exploring all the three fields, thereby creating provisions for complete mental
assessment of the patient (Baranyi et al., 2013). It also takes into account the fact that the
psychopathology of all patients were unique from one another.
Identifying and managing risks- Patient suffering from mental illness are
disadvantaged in that they are subjected to unpleasant symptoms related to their mental
condition and are at an increased likelihood of inflicting self-harm. Hence, conducting an
assessment of the risks that are associated with a particular mental health problem forms a
crucial component of mental healthcare, in relation to best practice. The nurse-in-charge can
ensure that adequate risk assessment strategies have been adopted for treating the depression
that John is currently suffering from by gathering adequate information from reliable sources
regarding his medical and family history (Paniagua & Yamada, 2013). An important step
would be the inclusion of the patient as well as his family members in the plan, in order to
enhance safety and optimal health outcomes. Family members can greatly contribute to the
care that is provided to a particular patient by providing their support and guidance (Meis et
al., 2013).
Hence, the nurse should develop a rapport with John and his family, with the aim of
establishing an effective therapeutic relationship. Demonstrating empathy and establishing a
rapport are the two major strategies that should be implemented in the scenario, with the aim
of ensuring accurate risk assessment. Adorning the role of a successful leader and motivating
other nursing professionals will also facilitate checking the implementation of management
strategies. Listening will also form a critical component of effective communication, while

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interacting with the patient (Videbeck & Videbeck, 2013). Hence, effective interpersonal
skills will prove central to the ability of the nurse in the clinical setting.
While predisposing factors put an individual at risks of developing a disorder,
precipitating factors trigger the development of onset of the problem that the person is
currently suffering from. Additionally, perpetuating factors are those that are capable of
maintain the problem, following its establishment (Lievesley, Rimes & Chalder, 2014). An
analysis of the case study suggests that old age, sudden joblessness, and social isolation were
the predisposing, precipitating and perpetuating factors, respectively. This mood disorder
primarily creates an impact on the way by which a person feels, thinks, and behaves, thus
creating a surfeit of physical and emotional problems. John can be considered on at a high
risk since he reports most symptoms of depression that comprise of feelings of tearfulness,
sadness, irritability, frustration, sleep disturbance, agitation, suicidal ideations, unexplained
back pain, and feelings of worthlessness (Martin et al., 2013). Considering the fact that
depression often remains untreated and undiagnosed in the elderly population, there is a need
to provide immediate treatment to John.
Risk management- Management of the diagnosed mental disorder would encompass
different aspects of lifestyle changes, counselling strategies, psychoanalysis and
administration of antidepressants. Owing to the fact that John considered his antidepressants
to be futile in their effectiveness, he must be encouraged by adopting the process of
motivational interviewing to adhere to lifestyle modifications such as moderate physical
exercise, smoking cessation and regular sleep to reduce the severity of his presenting
complaints (Gallo et al., 2016). The nurse should engage in regular personal interaction with
John to help him overcome his troubles in a desired way. Thus, the talk therapy might prove
beneficial in increasing the functioning and enhancing the wellbeing of the person
(Gensichen et al., 2013). The nurse can also engage the patient in psychoanalysis that

7CASE STUDY
elaborates on resolution of mental conflicts (Axelrod, Naso & Rosenberg, 2018). The dosage
of antidepressants (SSRI) should also evaluated and increased (if required).
Ethical dilemmas might arise in relation to caring for the patient with depression
associated to the need for ensuring patient safety, and restoration of a sound mental state
(Weimand et al., 2013). The Mental Health Act encompasses the core principles of assessing
and treating the patient in a least intrusive manner, while supporting them to participate in
decision making and protecting their autonomy and dignity (Victoria State Government,
2014). Patient autonomy is one of the basic principles of caregiving since the right for
making decisions related to medical care is bestowed upon the patients, without the influence
of the care providers (Hess et al., 2015). Thus, although the law allows the nurse to educate
the patient on the potential benefits of the treatment, it does not allow the staff to forcefully
exert any plan of care on the patient. However, John’s decision to leave the hospital and
return home might result in the ethical dilemma since he has been found at an increased
depression risk and might have also had inflicted harm upon himself. Thus, the conflicting
situation might make the healthcare providers coax John to stay at the hospital and continue
his treatment.
Conclusion- The term mental health deterioration is often used interchangeably with
‘risks’ and ‘change’. In other words the need for recognizing and providing an appropriate
response to the clinical deterioration of any patient has been identified as a national priority
by the Australian healthcare system, with the aim of bringing about an improvement in the
safety of the people. Baseline examination of the mental state is also imperative in this
scenario for obtaining a detailed record of the current mental faculties and their functioning.
The MSE would form an essential part of the clinical assessment and would help to unravel
the psychological disturbances that are faced by John. An analysis suggests that the back pain
and its subsequent impacts on unemployment and poor health were responsible for the onset

8CASE STUDY
of depressive feelings in John. To conclude, it can be deduced that John is at a high risk on
the spectrum of the diagnosed mental illness (depression). Hence, efforts must be taken to
implement a proper risk assessment and plan of action for reducing his depressive symptoms
and enhancing his health and wellbeing.

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