Mental Health Nursing: CAMHS Patient Case Study and Analysis

This report presents a detailed case study analysis in mental health nursing, focusing on a 15-year-old patient admitted to a CAMHS inpatient unit with a history of self-harm and impulsive behaviors. The report explores crucial aspects of mental health care, including the therapeutic relationship, health assessment strategies and tools, principles of risk assessment, risk management, and the importance of positive risk-taking. It also addresses relevant legal and ethical considerations, and highlights evidence-based practices required to provide effective care for patients with acute mental health conditions. The analysis examines the patient's background, family dynamics, and the impact of these factors on her mental well-being. Furthermore, it discusses various assessment methods, such as the Mental Status Examination (MSE), and the significance of person-centered care and effective communication. The SOLER model is presented as a tool to enhance communication within the therapeutic relationship. The report emphasizes the importance of early intervention and the need for a comprehensive approach to address the complex needs of the patient.

Written project or case
study for mental health
nursing
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Table of Contents
Topic - Mental health nursing..........................................................................................................3
INTRODUCTION...........................................................................................................................3
SUMMARY OF SERVICE USER..................................................................................................3
Therapeutic Relationship........................................................................................................3
Health assessment strategies and tools...................................................................................6
Principles of risk assessment, risk management and positive risk taking..............................8
Consider relevant legal and ethical issues when delivering and evaluating care.................10
Evidence base required care for and support people with acute mental health conditions. .13
CONCLUSION..............................................................................................................................15
REFERENCES..............................................................................................................................17
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Topic - Mental health nursing
INTRODUCTION
Mental health is considered cognitive, emotional and behavioural well being. It is mainly
related to the perspective of people that how they feel, think and behave (Ewens and et.al.,
2020). It is also determined that mental health may impact on the daily living, physical health
and relationship of a person negatively (Cheung, Fong and Bressington, 2020). The respective
essay is based on the a young girl who is 15 year old and she is just admitted to the CAMHS
(Child and Adolescent Mental Health Services) Tier 4 in patient unit. She is patient of impulsive
as well as high risk behaviour. She also has history of self harm through cutting as well as
overdoses. The topics covered in respective essay are related to the summary of service user,
therapeutic relationship, health assessment strategies and tools and principles of risk assessment,
positive risk taking and risk management (Zhang, Xiao and Chen, 2017). In addition to this it
also include legal and ethical issues related to case and it also include evidence based required to
the care related to case.
SUMMARY OF SERVICE USER
The given case is based on the a 15 years old girl named Susan, she just admitted to the
CAMHS (Child and Adolescent Mental Health Services) Tier 4 in patient unit. She has history
related to self harm by cutting as well as taking overdoses and she also kept in several foster care
but their she also not able to cope up with others. When Susan is 12 years old her natural father
named Jim left the family home and her mother name Janet. Due to which Janet feel depressed
and started drinking alcohol as well as after some time she progressed to use drugs and there is
also regular in and out of men in the family home which also impact on the upbringing of the
Susan (Gerace, 2020). Over the years Janet quit alcohol and get into relationship with Sam when
Susan is 5 years and from Sam Janet has 2 more children. These all situation impact on the
behaviour of Susan as well as she also didn't have nice relationship with others due to which
other also experiencing issues (Shorey and Chan, 2020). Her mother also not cooperate with
Susan due to which she not fell motivated and it also leads to situation when she harm herself by
cutting as well as taking overdoses.
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Therapeutic Relationship
This can be describe as the relationship between heath care professional as well as clients
to which health care services are provided. Therapeutic Relationship is refer as that process by
which therapist and patient hope to engage with each other in order to resolve the issues and
problem of the client as well as provide beneficial changes in to clients health (Evans and et.al.,
2018). In this case study Susan is dealing with the serious health issues and mental problem. Due
to issues in life mental health problem have been increased. Therapeutic Relationship will be
significant for resolving the problems of Susan as well as enhancing health. This type of
relationship is the closed and consistent association which exist between two individuals that is
health service provider an client. Both of these individual share information with each other in
order to identify the actual issues as well as the solution that is significant for resolving and
overcoming with the problem (Al‐Natour and et.al., 2020). The main purpose of therapeutic
relationship is to assist and help patient to successfully deal with the issues as well as overcome
with the problem that is affecting. In this therapy is provided to individual with the motive of
providing better and health life. The main purpose of therapeutic relationship is to provide
assistance to individual. In this process, first setting will includes that therapist receiving and
sharing though, emotions, beliefs regarding issues. It is very important for patient of mental
health issues to have proper Therapeutic Relationship with the therapist in order to provide
better and effective solutions to the problems. It is crucial that person who is seeking therapist
have must on individual who is providing therapy (Barry and et.al., 2019). This will lead to have
positive impact in successfully attaining goals and resolving the health issues. Therapeutic
Relationship would engage with the service user that is Susan by effective communication,
therapist needs to have proper information and knowledge about the issues so that correct actions
could be taken. Therapist needs to have correct knowledge and skills so that they can
successfully resolve and overcome the issues of Susan (Sandoval et. al, 2018). It is essential for
therapist to consider person centred care practices in the case of Susan. Person centred care is
significant for provide correct an accurate solution which is significant as per the issues and
problems of Susan. Through person centred care therapeutic relationship will be enhanced and
developed (Patel and et.al., 2018). This will be significant for successfully dealing with the
problem and issues so that correct actions is action for resolving the problems of Susan. It is
crucial that therapist have effective communication skills (Li and et.al., 2020). This will be
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supportive in identifying the issues of Susan as well as motivating her to live a better and health
life. Communication skill will lead to have major impact on improving relationship with Susan.
Trust, empathy and validation will lead to affect Therapeutic Relationship between Susan and
therapist. This will improve understanding of therapist about the issues faced by Susan which
lead to mental health issue and problem of self harming (Sahay, 2018). The sharing of decision
making is always be induced within health patients and professionals that get work all together
by which individual's treatment and care is induced with perfection or in timely frame. In this all
the risk and benefits is explored by which health care and its professionalism is enhanced as
along with this better options for treatment is offered in adequate mode.
SOLER communication model
This is consider as the active listing model that is effective way of physically demonstrate the
interest as well as engagement. This model was developed by Gerard Egan who was professional
management consultant (Hossain, Sultana and Purohit, 2020). This model is majorly used for
clinical counselling and professional settings in all over the world. This model is significant for
different situations as well as help in successfully conducting practices through effective and
better listening (Santangelo, Procter and Fassett, 2018). This theory is helpful as it is depicts the
most effective body language with the motive of employ to make others feel cared.
 S – Sqare : This refer as the practice of face squarely. This is significant for showing the
individual in involved in the communication process and helps in enhancing overall
communication. This process useful in maintain strong relation between individuals.
 O – Open : It is important to keep an open posture. This refers to that individual should
not cross arms and legs while communication process. Open posture will help in making
other people feel engaged and welcome.
 L - Lean : This includes that individual should lean forward while talking or
communicating with others. This shows that person is involved and listening to what
other is trying to say. By using this model it will help in increasing learning capacity.
 E – Eye contact : It is crucial to make eye contact while communicating as it will lead to
enhance the overall communication process. Eye contact shows that individual is
listening properly and not distracted. This help in increase learning capacity.
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 R – Relax : It is significant to stay calm and relaxed while communication process. This
will help in avoiding fidgeting when a person is talking to show as the focused
communication.
The evidence based practices are the basic interventions that induces scientific
consistency by which improvised outcome is attained in relation to healthcare. The mental health
illness is induced in better way by which consistent routine and its improvisation is induced in
satisfactory manner. For this major goal is to robust effectual demonstration by which modified
health program is induced by which authorities also get disbursed in sustained mode.
Health assessment strategies and tools
Individual differences in impulsivity underlie a good deal of the risk taking that is observed
during adolescence and the most dangerous forms of this behaviour are linked to traits of
impulsivity that are evident from the go-to under development (Patterson and et. al., 2018). In
any case, early intervention appears to be ready to minimize the negative impact and impact of
these traits by extending behavioural control and perseverance towards ambitious goals, such as
cognitive achievement (Masa'Deh and et.al., 2020). One type of inhibition, conscious running,
increases sharply during adolescence and poses risks for a difficult turn of events. However, a
study confirmed to show that barriers in mental health during adolescence limit the ability to
control impulsivity suggests that such restrictions are unclear, the most likely scenario better.
Instead, it is argued that lack of involvement in adult behaviour poses a much greater risk to
young people than a fundamental deficit in mental development. Moving forward with
translational research will help you find different ways to ensure that young people grow into
adulthood. Health strategies useful in enhance learning and understanding capacility of
individual through which they can understand case of patient.
While the adolescent participates in modern and risky exercises, it is argued that PFC has
not developed in a place where risks can be systematically assessed and where power over risks
can be exercised busy enough to keep away from unfortunate results (Hennessy and Cocoman,
2018). In particular, the prefrontal cortex (PFC) and its connections to other brain areas are
believed to be fundamentally deficient in order to provide the most suitable control for juvenile
behaviour.
The Knowledge Set and Mental Status Check (MSE) are the most important demonstration
tools that a physician needs to obtain data to find out in detail. Despite the fact that these sensory
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devices are normalized on their own, they essentially remain emotional predictions that begin
from the moment the patient enters the workplace (Aass and et.al., 2020). Mental Status Check
or MSE consists of an assessment of the current mental capacity with the help of evaluation of
the behaviour, general appearance, beliefs as well as perceptions of the patient. This status check
is useful because it provides valuable information for the diagnosis as well as assessment of the
disorder that the patient is suffering from as well as the response to treatment. As a result, the
patient receives the proper support and they gradually start recovering from the condition.
Therefore, it can be said that MSCs are important in a health care setting.
Information gathered through the emotional state is usually considered by the patient’s
report, and usually cannot be verified by target estimates (Baird and et.al., 2020). As a result,
one of the meetings may be gathering valid and compelling information. Legacy refers to how
the information thinks about an unaltered real truth that the interrogator must reach and reveal.
The problems that may affect the introduction of the validity of the meeting can be
arranged as patient-related variables and interrogator-related components (Collet and et. al.,
2018). Trust refers to the way in which data collected from different questions or similar
meetings contradict each other (Nguyen et. al, 2018). Consistent quality is the level at which a
dataset will be stable regardless of changes in the detail of the information field. Different
meeting methods show that they ensure a mix of the validity and consistent quality of the
information collected. The open review (“Tell me about your rest”) seemed to have better
validity but not as strong a quality as the concluded studies (“Do you have trouble dozing?”).
Various prevention predictions have explained that centralization of family-mediated
contraindications from childhood surviving adulthood has critical effects (Hill et al., 2014). The
adolescent stage is an important time period because some psychological disorders have a
median duration and further increase during this period (Kessler et al., 1994). While several
journalists are often used to discuss the impact of avoidance programs on children's
psychological well-being, studies of the impact of expectation programs on adult emotional well-
being have largely been based on self-reporting measures (Grant and et.al., 2020). This paper
outlines the use of three perspectives - self-assessment on cases, an informed witness report on
cases, and administrative practice reports - to assess the subsequent 15-year effects of the Family
Bereavement Program (FBP) centralization of prevention with families who have suffered the
death of their parents (Sandler, Wolchik, Ayers, Tein and Luecken, 2013). The assessment
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addresses the impact of FBP on long-term emotional well-being and the deposed parent fifteen
years of system cooperation.
The parent section of the program highlights the parents' abilities to empower the family to
rebuild itself as a strong and stable state, where there is a good match, the rules are strictly
enforced and where their experiences and feelings are seen (Lee, 2016). The program promotes
parental resilience by providing a strong gathering environment that encourages them to see their
goals self-identified and directing them to challenge the intellectual loopholes that cause misery.
The youth / youth part of the program encourages children to successfully adapt their disobedient
attitudes just like the stressors of everyday life, to challenge negative assessments of their life's
pressures, and to use multifunctional claims about their power over negative periods (Haine ,
Ayers, Sandler, Wolchik and Weyer, 2003). Hypothetically, by consolidating the multifunctional
abilities of the protectors and children used, they will stimulate a course of useful results over
time, resulting in lower levels of emotional well-being problems in fifteen years. after the truth
for both the guardian and the children (Baiden and Evans, 2020). Therefore, it can be said that
this is useful and helps in identifying the disorder that the patient is dealing with. Susan should
be provided with the required support looking at her condition so that she can recover from the
same. It can be said that if Susan receives the required mental health nursing support from the
staff, she will be able to live peacefully and a healthy life.
The health prevention is basically get processed with support of landscape by which
evident induction is induced by making efficient utilisation of risk and resources. In actually
highlights the rate of prevention through which skill gap and its knowledge enhancement is
induced and it is directly translated on the basis of clinical practice. With the use of applyiying
tools of health prevention person able to solve their health issue.
Principles of risk assessment, risk management and positive risk taking
Principles of risk assessment can be describe as the standard and process that is
significant for providing rules for reducing and managing risk. This is significant for providing
better planning for safety measures and practices for successfully managing risk as well as
enhancing overall performance of individual (Levecque and et.al., 2017). Principles of risk
assessment is significant for provide guidance as well as direction to successfully managing risk
in more significant manner. It is essential for considering principles of risk assessment in order to
correctly to reducing the issues as well as overcoming with the issues that is related to risk.
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There are different principles of risk assessment such as structured professional judgement,
actuarial risk assessment and so on. Both of these principles of risk assessment is mention below-
 Structured professional judgement - The structured professional judgement can be
describe as the approach which is significant for determining and understanding the
mitigate the risk for interpersonal violence posed by individual people (Ignacio et. al,
2016). This is evidence based guidelines which is significant for systematize exercise of
discretion. This first guidance of structured professional judgement was first published in
1994. This principle of risk assessment can be describe as the combination of actuarial
tools and unstructured clinical judgement (Gavin et. al, 2018). This is majorly rely on the
expert's capability to identify the risk of an individual which is based on personal
experiences as well as knowledge.
 Actuarial risk assessment – This can be describe as the statistical tool or method that is
effective for estimating the risk regarding to occurrence of the particular risk. Actuarial
risk assessment can be describe as the methods are touted as more accurate as compare to
clinical judgement alone (Lai and et.al., 2020). Risk management is very important and it
will lead to provide better and effective ways for successfully resolving the risk that
could cause major impact on physical and mental health of individual. By identifying
risks personal can able to formulate strategies and use those tools and technique which
benifical for solving issue of Susan.
Risk management can be describe as the process which is significant in identifying and
analysing the risk that could impact on individual. It is essential to successfully managing the
various risk which is affecting person. Risk management can be describe as the process that
includes identification of risk, assessing risk and controlling threats or issues that could harm
person. This will help in successfully managing and determining risk that will help in correctly
managing different risk and overcoming them in order to successfully resolve the issues and
improve health condition of the person (Daigle et. al, 2016). In this case Susan there are
different risk that is associated with health of person. It is essential for therapist to successfully
manage risk as well as overcome all these issues that is affecting over the heath of Susan
(Stanhope and Lancaster, 2019). Risk management in the case of Susan includes risk of self
harm, sexual abused by step father, over dose of medication and so on. These are the major risk
that is affecting health of Susan and this needs to be managed correctly.
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Positive risk taking refers can be define as the consideration of what could go wrong and
what actions needs to be taken if something does. This is significant in determining the practices
which is significant for safeguarding individuals as well as it is duty of care that is consider by
support provider that must work effectively (Duell and Steinberg, 2020). In this case Susan,
positive risk taking includes the issues of self harm. Susan is conducting different practices for
harming herself and it can lead to serious physical injury and impact on her mental health.
Through positive risk taking health care provider will be able to determine the potential harms or
benefits that could be attain for exercising the health care practices. So it is important to take
correct measures for successfully resolving the issues and reduce self harm. There are chances
that Susan can carry out self harm practices which lead to danger to her life. It is essential that
proper protection is provided to her with the motive of keeping her safe for her step father. As
per the evidence risk consist of any kind of harms which have potential impact on health or well-
being of the Susan (Wong and Yang, 2020). Risk assessment will includes methods such as
health care provider in order to reduce harms.
There are 5 P’s of assessment that is significant for correctly and effectively functioning the
required practices. 5 P’s are mention below –
 Professional – it is important that every perform who provides or contribute to care of
patient practices must be professional. This will help in effectively conducting practices
as well as reducing any type of risk.
 Processes – This can be describe as the step or actions that needs to be taken while
successfully performing health care practices. It is important that individual is well
aware about the process for correctly performing task.
 Patterns – There is always a pattern of doing anything and its is crucial that care provider
is correctly considering the pattern for reducing risk factors.
 Purpose – It is essential that purpose of performing task is clear to everyone. Clear
mission and purpose will lead to high performance.
 Patients – It is important to a have knowledge and understanding about the patient in
order to correctly perform required task.
The risk taking is induced as by weighing up potential benefits and facilities that produce
harm to the selected actions that is overcome by one another. In this exercising harms is
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managed and controlled so that perfect amount of modifications and changes in health care is
induced with adequacy.
Consider relevant legal and ethical issues when delivering and evaluating care
A legal and ethical issue is considered as situation which needed a person or company to
select among the alternatives that may be right (ethically) or wrong (unethically). In respect of
this legal and ethical issues are considered as situation which generally takes place when any
activity is done with is not right ethically. In the case of Susan there are several situation take
place which are related to the legal and ethical issues while delivering as well as evaluating care,
from which some are mentioned below:-
 Mental Health Act – The respective Act is developed in 1983 by parliament of the United
Kingdom and it is applied to people of England and Wales (Happell and et.al., 2020). It
generally considered reception, treatment and care of a person who is diagnosed with
mentally disordered. In this medical professional has the power according to which they
detain, assess as well as treat mental health patient in order to ensure safety of normal
public. In respect of the case of Susan she is patient of mental disorder in which she
harms herself by cutting and overdoses. But she also have not have effective relationship
with other due to which ward people, cousins and other are experiencing issues. So
according to this act medical professional can take action on Susan and take her into
special care for treatment.
 Equality Act 2010 – It is considered as Act which is developed by government of United
Kingdom in order to protect the rights and power of every citizen. According to this
legislation no person can do discrimination from other on the basis of age, disabilities,
gender, sexual orientation, race, maternity or pregnancy and many more. In respect of
Susan, her mother Janet and step father Sam do discrimination as they know she is metal
health patient but they not take care of her. Due to which Susan not believe in
relationship and she is unhelpful in relationship which affect others (Happell and et.al.,
2019).
 Deprivation of Liberty safeguarding – The respective legislation is developed by United
Kingdom government in year 2018 according to which every person has right to liberty
as well as security of an individual (Horgan and et.al., 2020). According to this, patient of
medical health who has lacks of capacity can go the care centre in order to keep
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themselves safe as well as others. In respect of case of Susan, she is mental health patient
and she has unhelpful relation with other due to which other experience several issues.
Due to this, her mother Janet moves her to the mental health care centre where Susan also
creates issues and it is demanded to move her to CAMHS (Child and Adolescent Mental
Health Services) (Rice, Stalling and Monasterio, A., 2019).
 Safeguarding children, the Children’s Act – It is developed by United Kingdom
government in year 1989 in order to promote the safeguard the welfare of the children
according to the issues or situation (Rio and et.al., 2020). In addition to this it is also
consistent along with the duty in order to promote upbringing of children by its family
members. In respect of given case of Susan, according to her she experienced sexual
assault from her step father Sam but not get proofed as well as her mother also not
support her and say she is affecting their life negatively and making it difficult. Due to
this she sends to feel demotivated and discouraged as well as due to it she attempt self
harm such as cutting and taking overdoses. Due to this she also sent to the mental health
care centre (İnan and et.al., 2019).
 The Children’s Act – The respective act is developed by parliament of United Kingdom
that allocates responsibilities and duties to the local authorities, parents, courts and other
agencies at the United Kingdom. The main purpose of the respective Act is to safeguard
as well as promote welfare of the children so that they leave their life happily and
effectively (Altman, Gorman and Chávez, 2018). In addition to this, it also related to
reforming law related to respect to the children’s homes, voluntary homes as well as
voluntary organizations in order to make provision related to respect to fostering, day
care and child minding for the young children as well as adaption or connected purposes.
In the case of Susan, she is experienced harassment from her step father as well as she is
also experiencing mental illness due to which she tries to harm herself by cutting and
taking overdoses (Shpigelman and HaGani, 2019).
 Gillick competency and Fraser guidelines – Gillick competence is considered as
guideline which concerned with child’s capacity to the consent. On the other hand, Fraser
guidelines are utilized specifically to choose if a child can consent to the contraceptive or
any sexual health advice as well as treatment. In addition to this it also including
confusing them so they can lose critical details essential for the obtaining consent. These
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