Diploma of Nursing: HLTENN009 Mental Health Condition Case Study

This case study presents a scenario involving a patient, James, who is experiencing symptoms of bipolar disorder. The assignment requires an analysis of the case based on the Victorian Mental Health Act (2014), focusing on the initial steps of compulsory treatment, patient rights, and the role of the nurse. The solution addresses risk assessment, protective factors, and the definition of bipolar disorder. It also explores diagnostic criteria based on the DSM-5, and the application of recovery principles, including client-centered care, strength-based approaches, and family involvement. The case study concludes with a discussion of referrals to other healthcare professionals to assist in James's treatment and recovery, along with the rationale for these referrals and the steps involved in making them.

Running Head: MENTAL HEALTH CONDITION CASE STUDY 1
MENTAL HEALTH CONDITION CASE STUDY
Name
Institutional Affiliation

MENTAL HEALH CONDITION CASE STUDY 2
Mental health condition case study
Q1. As required by the Victorian Mental Health Act - VMHA(2014) what is the first step in
initiating compulsory mental health treatment for James? and explain the purpose of this
order?
The first step is an assessment order that will grant the medical practitioner the power to
conduct a compulsory assessment on James to determine whether he needs compulsory mental
health treatment. With the order, James can be taken and detained in a designated mental health
facility if necessary (Gooding, 2016)
Q2. According to the VMHA(2014) James should be provided with a statement of his
rights. As the nurse caring for James how would you provide him with his statement of
rights?
First, I will tell James that a statement of rights is a document that stipulates a patient’s
rights while being checked or treated for mental illness under the mental health act, (2014)
(Korean Health Rights Working Group, 2019). I will then explain to him that as a patient, he has
the right to: communicate lawfully, select a nominated person, revoke compulsory treatment,
legal representation and support from a caregiver, a family member or friend in the hearing of
the mental health tribunal, and protest to the mental health complaint commissioner in case he
feels unsatisfied by the care given to him.

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Q3. If James was unable to understand the information about his rights what would you
do?
I would explain the statement of rights to his nominated person (his mother), and later to
James when he is in the position to understand the information. His mother, being the nominated
person, would make decisions concerning medical care on his behalf, including the treatment
method. As a nominated person, his mother has the instructions from James himself on how he
would want to be treated and cared for. His mother would, therefore, help in deciding whether to
proceed with the treatment.
Q4. Circle/tick which 3 of the following would be expected to be listed on James’s
Advanced Statement?
i. Treatment that has been effective in the past√
ii. Treatment that has been less effective in the past√
iii. Contact details for his nominated person
iv. His views and preferences about electroconvulsive treatment√
v. Statement of rights
Q5. What 5 areas of risk would you assess for when completing James’s Risk Assessment?
What level of risk do you consider James to be at (Low/Medium/High)?
List 4 risk factors would you document in James’s notes when writing the risk assessment
to support your decision in rating him as either low/medium/high?

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5 Areas of Risk
1. Self-harm and suicide (Higgins et al., 2015): James is apprehended by the police
when he is found murmuring about how he was going to strangle himself to death. James had
previously attempted to commit suicide. He also shows a lack of interest in taking care of
himself; for instance, he is no longer concerned with his dental hygiene as before.
2. Vulnerability: James is becoming less and less capable of making correct decisions,
which makes him susceptible to being manipulated.
3. Risk to others
4. Mental instability
5. Risk by others
James is at _______level of risk.
James is at a high level of risk.
4 Risk Factors
1. Traumatic head injury
2. Substance abuse
3. Harm to self (de Vries Robbé, 2016)
4. Loss of friends a job due to his mental condition
Q6. What are 7 of James’s protective factors?
1. He has a close family, and a strong friendship circle, which is ready to take care of him
2. James is financially stable. He, together with his partner, plan to buy a house.

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3. He is socially connected. James is known in the community; for instance, we are told
that he is known to the service (the police). He is therefore assured of protection, even from
himself.
4. James has been clear of substance abuse for three years. While his spouse fears he may
have started to abuse methamphetamine, being a former addict, he knows the detrimental effects
of substance abuse, and can, therefore, show restraint.
5. His sense of responsibility, which has earned him the position of supervisor at his job
6. He has no history of hostility.
7. He is hardworking.
Q7.How would you define Bipolar Disorder to James’s mother and explain the difference
between mania and hypomania?
I will tell her that bipolar disorder is a mental condition in which a patient show extreme,
abnormal changes in their mood, level of activity, and energy (Grande, Berk, Birmaher and
Vieta, 2016). I will inform her that mania is the state in a bipolar disorder where a patient
displays a high level of activity and energy utility and tend to be extremely elated. I will then
explain to her that hypomania is a less severe form of mania. I will tell her that it is the state in
which the patient is relatively active and shows a general feeling of pleasure and activity levels
that are less intense compared to mania but are unusual to others.
Q8. Question: In order for James to have been previously given a diagnosis of Bipolar
Disorder he would have had to meet the criteria for Bipolar Disorder using the Diagnostic
Statistical Manual of Mental Disorders (DSM-5). Identify at least 5 symptoms for each
mania and depression as listed under the criteria for Bipolar disorder using the DSM-5.

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Mania:
1. Decreased need for sleep: insomnia, feeling rested after a few hours of sleep,
daytime fatigue, irritability, and yawning.
2. Flight of Ideas or subjective experience that thought are racing: speaking of a lot
of ideas at a go, speaking with a high pitch, not pausing at the appropriate punctuation as one
speaks, speaking with a sense of urgency, and talking about things that do not fit the occasion
(Severus & Bauer, 2013).
3. Distractibility: racing thoughts, inability to sustain a conversion, lack of concentration
on a particular activity, being disorderly, and daydreaming
4. Inflated self-esteem or grandiosity: sense of entitlement, proud, dismissive of other
people’s thoughts and ideas, belief of invulnerability, and being boastful of oneself.
5. Increased talkativeness or pressure to keep talking: increase in talking speed, lack
of restraint to speak for an extended period, talking over others, speaking loudly, and speaking in
an emphatic manner
Depression:
1. Depressed mood most of the day: persistent sadness, lack of interest in things around
them, extreme fatigue, hopelessness, and, hallucinations
2. Loss of interest or pleasure in almost all activities: general fatigue, withdrawal,
sadness, irritability, and less verbal and non-verbal expression.
3. Significant weight loss: fatigue, loss of appetite, reduced body mass, general body
weakness, and a decrease in body fluids (Shiel, 2019).
4. Insomnia or hypersomnia nearly every day: increased sleepiness, daytime fatigue,
restlessness, narcolepsy-like symptoms, and lack of sleep at night.

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5. Psychomotor agitation or retardation: Increased speed of talking, pacing, twitching,
tapping, and emotional distress.
Q9. Question: It is important that health care professionals provide care and treatment
that is in keeping with recovery principles including being; client centred, strength based
and care that involves the family. Identify how you would ensure this is achieved for James
and his family and provide practical examples of how you would do so.
Eg. Maintain confidentiality – I would ask family to move away from common areas
(perhaps into interview room/private space) to maintain their right to privacy and
confidentiality when talking about James’s progress/treatment.
Answer:
Cultural sensitivity – I would ensure that James’ cultural heritage is upheld. The care
provided would be in a manner that relates to the needs and hopefulness of James and his family.
Furthermore, I would take time to explain procedures to James to ensure that he is satisfied with
medical care (Turker et al., 2012).
Compassion – I would encourage James’s family, and friends and the medical staff to be
empathic and sensitive to his condition. I would also make sure that he gets all the support he
needs to hasten his recovery. In addition, I would treat him in a manner that does not suggest that
he may be mentally compromised. Instead, I would ensure that he remains optimistic (Arkansas
State University, 2017).
Autonomy – the care given to James will be one that respects him, and also according to
his preference. I would, therefore, patiently explain the medical procedure to him. I would also

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see to it that he is not given any medication that is not prescribed or that is yet to be approved,
without his knowledge and consent.
Q10. Question: Considering James’s presentation and current symptomatology identify 3
additional health professions you might refer James to, and discuss why you would make
this referral, to assist James with his treatment and recovery. How would you make this
referral?
Answer:
Referral to which Health Professional
1. A radiologist
2. A psychologist
3. An occupational therapist
Why referral is made?
1. James suffered a traumatic head injury due to a motor vehicle accident five years
ago. He has had chronic pain as a result. A CT scan for any form of brain injury, or damage
to the cranium will be in order, to help in his treatment.
2. Because of the head injury, and due to his previous drug use, James may benefit
from the help of a psychologist. It will also help put his partner's mind at rest since she has
been worried that he may have reverted to methamphetamine abuse. Furthermore, a
psychotherapy might help assess if he needs mental health care or not.
3. An occupational therapist will advise James on how to go about his
occupation, especially now that he has been promoted to the level of supervisor at his job.
This will help him deal with the pressure of the new position, which would otherwise
negatively affected his mental health.

MENTAL HEALH CONDITION CASE STUDY 9
How would you make these referrals?
1. For a head injury check-up, I would first tell James that he needs to have a head check-
up and explain to him the importance of the CT scan. I would make a phone call to the
radiologist and inform him or her of James’ condition. I would inform the radiologist about his
accident and pain, and book an appointment for him. I would also formulate the necessary
referral forms for him.
2. For a psychotherapy referral, I would advise James to talk to a psychologist and
explain to him why he needs to do so. I would then call the psychology department and explain
James' condition to them. I would then book an appointment, and prepare the necessary
documents for James
3. For occupational therapy, I would advise James to talk to an occupational therapist and
explain to him why he needs to do so. I would then call the office of the therapist and explain
James' condition to them. I would then book an appointment, and prepare the necessary
documents for James

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References
Arkansas State University. (2017). w to Care for Patients With Mental Health Problems.
Retrieved from; https://degree.astate.edu
de Vries Robbé, M., de Vogel, V., Wever, E. C., Douglas, K. S., & Nijman, H. L. (2016). Risk
and protective factors for inpatient aggression. Criminal Justice and Behavior, 43(10),
1364-1385.
Gooding, P. (2016). From deinstitutionalisation to consumer empowerment: Mental health
policy, neoliberal restructuring and the closure of the ‘Big bins’ in Victoria. Health
sociology review, 25(1), 33-47.
Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The
Lancet, 387(10027), 1561-1572.
Higgins, A., Doyle, L., Downes, C., Nash, M., Morrissey, J., Brennan, M. & Costello, P. (2015)
Risk assessment and safety planning within mental health nursing services: an
exploration of practices, policies and processes. Dublin: Health Service Executive
Korea Health Rights Working Group. (2019). Statement on Health Rights in the New
Constitution. Journal of Preventive Medicine and Public Health, 52(3), 145.
Severus, E., & Bauer, M. (2013). Diagnosing bipolar disorders in DSM-5.
William C. Shiel Jr., MD, FACP, FACR. (2019). Weight Loss: Symptoms & Signs. Retrieved
from; https://www.medicine net.com

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