Mental Health Nursing: Trauma-Informed Care for Substance Use Issues

This report addresses the complex interplay of trauma and substance use in mental health nursing, focusing on a case study to illustrate key issues and the application of trauma-informed care principles. It identifies issues such as auditory hallucinations, potential psychosis, and lack of family support, emphasizing the importance of safety, collaboration, and patient empowerment. The report highlights the necessity of a multidisciplinary approach involving psychological counselors and other healthcare professionals to provide comprehensive care. It also underscores the significance of addressing social stigmas, promoting health equity, and integrating evidence-based practices to reduce re-traumatization and substance abuse relapse, advocating for a family-centered approach and vigilant post-treatment monitoring to improve patient outcomes.

Running head: HEALTHCARE
Mental health
Name of the Student
Name of the University
Author note

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Complex trauma can occur due to multiple reasons; it can be a result of a post-
traumatic disorder or PTD or multiple exposures to interpersonal traumas (Briere and Scott,
2015). The reason is very important to identify and at the same time challenging for the
nurses, caregivers and health workers. Nurses play a crucial role in uplifting as well as
promoting the health standards in a community (World Health Organisation, 2019).
Therefore, nurses play a vital role in communicating as well as collaborating with different
health professionals like the pharmacists, general physicians or GPs and health carers and
health workers. Complex trauma care is a critical issue, and cases vary from person to person.
Therefore, it is essential that the nurses and mental health workers come to understand the
person’s problems and views together and hence, Lisa’s case and issues related which has
discussed in detail in the following paragraphs.
In Lisa’s case, according to the given medicinal history, she had been admitted to a
psychiatric hospital last year and had been prescribed anti-psychotic drugs. She had been
visiting a local counsellor for the past six months. However, there were a few apparent issues
when she confronted the local drug service counsellor Jane. Three identifiable issues from the
case of Lisa is: Lisa has been subjected to Auditory and Command Hallucination, as voices
are telling her to protect herself with a knife and sleep in the garden, she further tells that her
boyfriend John has inserted a transmitter in her stomach. Moreover, she has mentioned to the
counsellor she is being spied over by the cameras, in her house, therefore stays outside. These
signs can be an indication of psychosis. She has been lately not taking antipsychotic drugs
correctly, and this aggravates the situation if she continues to avoid taking medications. In
this case, Lisa is having issues with her parents and has also lost connection with her parents.
Therefore, she is not under family care, and it is uncertain.
According to the principles of Trauma-informed care and practice (TICP), it is to
understand that there are main five points: safety of self and others, the impact of the people

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with complex trauma or any issues in the current scenarios are also significant. According to
Moss et al. (2019) it has to understand that the trauma of person is not only substantial or
limited to an individual, but it also has an impact on many families, communities as well as
society.
From the above discussion mentioned the issues that Lisa is facing, the first issue has
great concern over the safety of Lisa and others as she carries a knife with her to protect
herself. Due to the hallucination, and because of hallucination she hears voices. According to
John et al. (2019) various signs and symptoms need to address. Therefore, the voices are
telling her to keep the knife. Keeping a knife with her can be a potential threat to anyone near
her or Lisa can be a threat to herself, which can further lead to complex trauma injury. From
the discussion with the local mental health counsellor, it revealed that she can have psychosis.
Though she had already been in Psychotic hospital, there has been no mention about any
other kind of experience, or the reasons that led her to psychosis. However, the symptoms of
complex trauma are Attachment: In this case, Lisa faces distrust and is highly suspicious of
her surroundings.
Moreover, she is very much agitated with the situation. In cognition, though Lisa can
respond well to all the questions was asked she sounded distracted and lost sometimes.
Similarly, in biological, throughout the video, Lisa was in continuous fidgeting, and her facial
movements were not congruous. The cognitive impairment can lead to various other
problems concerning perception and understanding of the surroundings.
From the second issue, it could be understood that Lisa has stopped taking her anti-
psychotic medicines. This can be one of the reasons she has problems with help regulation

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and physical control of herself. Therefore, according to trauma-informed care and patient
principles, the impact of this could lead to severe mental regulation and conduct. This can
lead to the aggravation of complex trauma. According to Gracia et al., (2016), there could be
several negative health impacts on the patient.
Furthermore, there can be a high possibility if readmission to the hospital because of
the non-adherence to the drugs. From the principle of TICP, it could be understood that the
situation has to be acknowledged by the health workers, which has already acknowledged and
the impact of this has to be understood. However, in Lisa’s case, her informed consent has
been taken, not only that, but Lisa has also responded to the situation well and agreed has
upon the choice treating her mental health problems when the mental health counsellor asked
for her opinion.
From the third issue, it can be understood that she is not under any proper care, as she
has no contact with her parents. Besides, from the video discussion, it could be understood
that Lisa is not taken care of by her boyfriend John as well as he and she sleep in the garden
and she hears voices that are telling her to protect herself from her boyfriend. Therefore, Lisa
immediately needs medical assistance and care, and this needs collaboration from different
health workers so that she could get the right assistance and help.
In Lisa’s case, multidisciplinary collaboration necessary for optimisation of her health
and mental wellbeing as her problems have already addressed to the local counsellor who
takes care of the local people who have any mental problems. Complex trauma care is
different from trauma care, it is because there are many mental disorders, and the
combination of that could give the patient problems on assessing the reality as well as can
make the person confused as well as disoriented. In addition to that, it could also raise
concerns from eating disorders in people who have psychosis (Bartlett et al., 2018).

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According to Goncalves et al., (2013), mental health disorders can increase the burden
of communicable as well as non-communicable diseases. It also stated that when it comes to
treatment, there is a presence of community engagement. The report further states that the
mental health care improves the following things like there could be patient centred care,
there will be awareness as well as recognition of mental health problems, it could help to
develop care models in case complex trauma treatments, Community involvement and
engagement in this type issues.
According to Machtinger, Cuca, Khanna, Rose & Kimberg, (2015), there should be
trauma-informed Primary Care, as there are various factors that linked with poor mental
health like Psychological factors, Social factors, Adaptive and Healthy coping behaviours.
Moreover, evidence-based practice or EVP is significantly associated with trauma
care and practice. There are certain cases where there unidentified or unaddressed trauma in a
patient that could lead to the re-traumatisation or re-victimization of people. In Lisa’s case,
her history of traumatic experience vital be analysed thoroughly, which could help the
medical care team to analyse the situation better and effective. It is indeed possible to reduce
the re-traumatisation and recurrence of drug abuse.
Australia is a diverse country, and it has a diverse population in the country, and all
the social stigmas and the social barriers should be overcome so that there could be health
equity among different communities and group and therefore, it is crucial that the more
people get involved in the community service. Another part of the TICP is that
empowerment, and it is to be understood that people like Lisa who are so much involved
mental health problems, Lisa should be subjected to proper treatment and care. As it is
evident in Lisa’s case that she has not been in proper care. After, the proper care and

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treatment Lisa should be involved in some work and should be brought to a normal life,
removing social stigma and biases.
The principles of Trauma Informed Care involve elements of safety, trustworthiness
and transparency, peer support, collaboration and mutuality, empowerment, choice and
cultural support, historical facts and other gender issues. In the case of Lisa, the main
principles Trauma Informed Care will be safety, trustworthiness and transparency as well as
active collaboration (Baker et al., 2016).
Due to separation from her family, Lisa remains distressed and socially isolated.
Thus, a family centred care approach will be best suited for her where Lisa will be
encouraged to indulge in active communication with her parents. Family centred therapy will
promote active recovery for Lisa, and thus facilitation increased social participation (Wilkins,
2015). Lisa will also be educated about her current health conditions, and this will promote
patient’s empowerment and thus boosting her confidence level. According to Marshall et al.
(2015), patients suffering from psychological illness also have poor self-esteem. This video
highlights that Lisa describes herself as ‘Ugly’ and is scared that her boyfriend might murder
her. Through counselling self-esteem and body image confidence of Lisa will be increased
thus promoting patient empowered with self-management skills
The mental health multidisciplinary team member with whom the mental health nurse
would participate to improve the collaborative care planning for Lisa will be a psychological
counsellor. The mental health nurse would assess and simultaneously prioritise the clinical
needs of Lisa.
On the other hand, the psychological counsellor will arrange a counselling session to
elucidate the reason behind her cannabis intoxication or the underlying depression that is
making her taking help of intoxication. The psychological counsellor will also educate and

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empower the patient towards the process of accessing the care. Furthermore, a psychological
counsellor would educate Lisa about the associated risk factors that trigger increased
substance abuse (Shurtleff, 2019). Moreover, the psychological counsellor in assistance to the
mental health nurse would implement patient-centred psychotherapeutic interventions like
mindfulness-based therapy and cognitive behavioural therapy to assist the patient to indulge
in the care plan activities while staying cool and calm and at the same time promoting faster
recovery (Shurtleff, 2019).
Lisa has been open in admitting the fact that she has been smoking cannabis and using
speed smoke. The use of cannabis can lead to hallucinations, loss of identity crisis and create
panic among a person. Furthermore, it could be observed form the video that though she is
responding well to the questions however, she seems distracted and has poor coordination of
her hand and body movements as she is constantly fidgeting. This can cause due to the
smoking habit she has redeveloped. According to Volkow et al., (2016), illegal smoking
marijuana has been linked with acute mental impairment and has established temporary
defects in learning, memory and paying attention and working memory. Apart from taking
cannabis smoke, she is also taking speed smoke. In Lisa’s case, these symptoms are
observable. Effective behavioural therapy procured by the mental health nurse in association
with the psychological counsellor will help to improve the mental well-being of Lisa.
Furthermore, if any case it is possible to contact Lisa’s parents, they should be
contacted and made them aware of Lisa’s current situation. There should be active
involvement of neurologist and medical emergency doctor as well to assist in pre and post
medication treatment. In any medical condition, the presence of the family member would
encourage the patient to recover faster. After her treatment is over, there should be vigilant
monitoring on her lifestyle and other factors so that she does not fall back in her old habits.
Moreover, Lisa should be encouraged to work, for example, she could take dancing and art

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classes, or whatever she likes to do, that will deviate her from substance abuse behaviour.
The anti-psychotic medicinal regime should be re-evaluated and should be recommended.
The following describes the Rationale of the health care treatment in Lisa’s case include:
supportive health care system, therapeutic environment, antipsychotic medication and
cognitive behavioural therapy as well as family therapy.
From the above discussion it could be concluded and inferred that due to avoiding
taking her anti-psychotic medications, she is falling back to her old habits of cannabis
smoking as well as speed smoking. This can aggravate her situation of psychosis. Therefore,
apart from the nursing care she immediately needs collaboration emergency doctors,
neurologist and behavioural therapists. Moreover, it is recommended that she follows a strict
anti-psychotic medicine regime that would help her overcome her anxiety and hallucinations.

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