Mental Health Case Study Report: Addressing Treatment Barriers

This report presents a case study of a 65-year-old woman admitted to the hospital with worsening symptoms of agitation, aggression, and social withdrawal, alongside a recent ankle injury. The case highlights the undertreatment of pain in dementia patients and the resulting behavioral symptoms, as ...Read More

Running head: MENTAL HEALTH
Mental health
Name of the student:
Name of the University:
Author’s note

1MENTAL HEALTH
Overview of the case:
During clinical placement, an elderly woman aged 65 years was admitted to the hospital
with worsening symptoms of agitation, aggression and social withdrawal since the last 2 weeks.
Her husband reports that she also injured her right ankle last night while transferring from bed to
the wheel chair. On assessment, the patient is found to be in severe pain. Although she is
continuing with her antipsychotic drugs, however no pain related medications were given. The
woman is undertreated as pain was the main reason for her aggressive behaviour. However, this
remained under-recognized. Brecher and West (2016) argues that dementia patient with poor
pain control manifest their symptoms through challenging behaviours like social withdrawal and
verbal aggression.
Barriers to effective treatment:
The elderly women needed pain management intervention. Although pain is highly
prevalence in dementia patient, this symptom and the opportunity to provide effective treatment
is hampered because of barriers like challenges in identification of pain. This is mainly because
90% of dementia patient develop behavioural symptoms and most clinicians link it to the
underlying disease process. Other barriers to effective pain management includes lack of training
or education, poor use of guidelines on management of pain, workload demands and poor pain
related communication. Use of psychotropic drugs also masks pain symptoms (Greenwich,
2014).
Method to address the barriers
There are many steps to address the above barriers and provide pain control to patients as
early as possible. Firstly, use of observation and pain assessment tools can help nurse to identify

2MENTAL HEALTH
pain related behaviours. Many staffs lack education and training on pain management in
dementia patients. They can be given education and training so that they can link behavioural
changes with pain. Developing an emotional connect with dementia patient can also help to
decipher pain related behavioural changes.
Role of nurse in addressing mental health problems
Nurse plays an important role in assessment and management of patients with mental
health problems. They can support early detection and initiation of intervention by their
assessment and observation skills. They can use their therapeutic communication and empathy to
stabilize condition of patient and understand their holistic care needs. They promote full recovery
by patient education and developing self-management skills of patient (Bressington et al., 2018).
Learning experience:
Completing this task of discussing about undertreated elderly patient with mental illness
was a useful learning experience for me as it made aware about behavioural symptoms that are
often misdiagnosed by patient. I learnt that pain is a commonly under recognized symptom in
seniors with mental illness which may lead to agitation, social isolation, depression, decreased
appetite and verbal aggression. After gaining this knowledge, I aim to make pain assessment a
priority for seniors with mental health issues during my future practice. My plan for the future is
to learn more about challenging neuropsyschiatric symptoms and current assessment tools that
can assist in identifying, assessing and managing pain in dementia patients. This will make the
pain related cues more explicit and better care can be planned for patients (Lichtner et al., 2016).

3MENTAL HEALTH
References:
Brecher, D. B., & West, T. L. (2016). Underrecognition and undertreatment of pain and
behavioral symptoms in end-stage dementia. American Journal of Hospice and Palliative
Medicine®, 33(3), 276-280.
Bressington, D., Badnapurkar, A., Inoue, S., Ma, H. Y., Chien, W. T., Nelson, D., & Gray, R.
(2018). Physical health care for people with severe mental illness: The attitudes,
practices, and training needs of nurses in three Asian countries. International journal of
environmental research and public health, 15(2), 343.
Greenwich, L. (2014). Barriers to the management of pain in dementia care. Nursing
times, 110(28), 12-16.
Lichtner, V., Dowding, D., Allcock, N., Keady, J., Sampson, E. L., Briggs, M., ... & Closs, S. J.
(2016). The assessment and management of pain in patients with dementia in hospital
settings: a multi-case exploratory study from a decision making perspective. BMC health
services research, 16(1), 427.