Mental Health Diagnosis
Case Study Group
Assignment
Theoretical Approaches to Mental Health Practice
HLTH 5150
ISBAR – Identity & Situation
Client: Luke Smith, Age: 17
Mental Health Diagnosis: Within past month diagnosed with depression and social anxiety.
When Luke was aged 10, he was diagnosed with Oppositional Defiance Disorder (ODD).
Reason for referral: Mum seeking support after recent suicide attempt
Current problems: Suicidal ideation, disengagement school, limited support network, complex
dyadic relationship with mum
Symptoms: low mood, loss of interest in pleasure activities, struggling to emotionally regulate,
sleep
Status under Mental Health Act: residing in community no orders in place
ISBAR – Background
Date of referral: 1/04/2022
Diagnosis: Depression
Physical Health Problems: Overweight
Developmental History: reached gross and fine motor milestones at expected age, delayed speech.
Medications: Sertraline 50mg mane
Accomodation: currently lives with Kate (mum) in Port Augusta
Social situation: Part-time work at a pizza shop, limited social interaction
Family involvement : complex dyadic relationship with Kate. Nil involvement of biological father
Forensic history : nil
ISBAR – Assessment
Mental state Examination
* Appearance – A 17 year-old Luke male, appeared older than his age. Increased body habitus, dressed appropriate for the weather in baggy clothing, a blue shirt and black
trousers,. Mildly malodorous. Greasy shoulder length hair.
* Behaviour – subdued, mellow , slowed movements
* Mood – Low, Minimal response to nurse practitioner and psychiatric registrar questions.
* Speech – Normal in rate, tone, and volume
* Affect – broad affect, facial expression is not animated and using hand gestures during conversation
angry and irritable, heightened
* Thought (form and content) – Nil evidence of delusional belief, nil sign of psychomotor retardation.
* Perception – Nil perceptual disturbances noted. Not responding to internal stimuli.
* Cognition function – Oriented to time, place and person. Some memory issues like unable to recall recent things sometimes.
* Insight – Minimal insight
* Judgement – Slightly impaired in regards to making positive decisions relating to treatment.
* Rapport. – Superficially established
ISBAR – Assessment Cont..
Is the person distressed, suicidal or at risk of harming others.
– Distressed, had two separate attempts of ending his life.
– Luke is not at risk of harming others
– Clear ongoing suicidal ideation
What risks to self or others have been identified?
– Highly impulsive
– Ongoing suicidal ideation
Is the person engaged with the treatment plan (medication, therapeutic alliance)
– Has tried Narrative therapy previously.
– Willing to try Cognitive behaviour therapy.
– Recently started on sertraline
Is the person vulnerable to exploitation/abuse/homelessness?
– vulnerable due to drug use
Risk Summary Box
Risk Assessment Risk Category
– Suicide/Self-Harm Level: Low/Medium/High* (indicate which level
applies)
Medium risk suicidality, Previous suicide attempts or High – Chronic
self harm- many significant sucide attempts;via consuming
large quantity of pain relief medication
| – | Violence/Aggression/Criminal Activity Level: Low/Medium/High* (indicate which level |
| applies) High risk of violence towards Mother,, has a complex dyadic relationship with his mother. |
Medium – Chronic |
AssignmentTutorOnline
– Self-Neglect/Exploitation/Vulnerability Level: Low/Medium/High* (indicate which level
applies)
Due to drug addiction, he becomes vulnerable Medium – Chronic
– Absconding Level: Low/Medium/High* (indicate which level
applies)
Low risk of absconding as client lives with mother and mostly stay at home. Low- Chronic
Risk of absconding from school, low attendance at present
ISBAR – Recommendations
1. What are the specific recommendations for treatment.
Integrative therapeutic approach including:
Behavioural activation to help with his depression and emotional disrregulation.
Therapeutic Case management – For supervision, support and informed advise
Parenting capacity sessions – This will help Kate with coping strategies
2. Relevant multidisciplinary considerations.
– He has a psychiatrist that see’s him every six weeks for review
– Social worker also involved for access of social activities, school or work related issues.
– School – Information on how he is coping or behaving at school
– Family (Mum, Kate) – Collateral information
3. Recommendations for ongoing care
Therapeutic framework includes; medication, focus on building a therapeutic alliance with both Kate and Luke, regular case management input including supporting Luke to
re-engage with schooling, regular weekly sessions focusing on behavioural activation. As well as sessions to increase Kate’s parenting capacity, specifically focusing on
supporting Luke to emotionally regulate and engaging in therapeutic limit setting.
4. Timeframe for care
Doctor’s review in 6-12 months, particularly as he is trialing new medication (Setraline) as well as Behavioural Activation Therapy.
Theoretical basis of behavioural activation
Evidenced Based psychotherapy of depression dating back to the 1970s (Kanter et al, 2012)
BA theory suggests that humans develop behaviour as a result of interacting with the environment and of contingencies that increase or reduce the likelihood of repeating specific behaviors in the future’ (Kanter et al. 2012)
BA is informed by early behavioural researchers Charles B Ferster, Peter M Lewinsohn,Lynn R Rehn and Aaron T beck (Martell et al. 2021)
Charles Fester- focussed on the theory underlying the behavioral analysis of depression
Peter Lewinsohn and colleagues – extended the theory and developed behavioural treatment methods for depression
Lynn Rehn = emphasised the importance of reinforcement in the treatment of depression
Aaron Beck- made BA available to a larger clinical audience and included it as integral element of cognitive therapy for depression
How Behavioural activation works
‘When the activities are laid out
in writing, the individual will
seem less overwhelmed, as the
day will be broken down into a
series of manageable chunks
rather than long, shapeless
stretch of time.’
(Andrews et al. 2013, p. 90)
Role of Consumer
● The Consumer has to be willing to get better and this starts by booking an appointment with the Pyschiatrist. Participating in
behaviours that promote relief such as self care and good sleep (Johnson, 2022).
● The Consumer need to be aware or open up about their emotions, mood and, behaviours so that the therapist may have an
idea of what is going then determine how they can help them (Tull, 2022).
● Support from close family or friend if not motivated enough (Veale, 2014).
● Doing homework or in between session strategies as advised by the therapist (Chapman, and Rosenthal, 2016).
● It is important to take things slow and set out goals that are achievable. Starting off with a few activities and build them up
slowly every week (McCauley et al., 2016)
● Keeping a list of behaviours that make them feel good and a list of behaviours than make them feel bad then compare
behaviours. This will help replace the negative behaviours with the positive behaviours (Pass, Reynolds and Pimas, 2020).
● Replacing or minimizing behaviours that are unhelpful, for example, replacing spending time on social media with spending
time with family or friends (Villines, 2022).
● Monitoring progress by keeping track of their behavioural changes (Tull, 2022).
● Finally, recognising what they have accomplished increases motivation and the will to keep going (Tull, 2022).
Role of therapist
● Counsellor should have to take informed consent before initiation of behavioural therapy (Best
Counseling Degrees, 2015)
● The relationship between client and therapist should be non- hierarchical, trust developing and
respectful to form a strong rapport (Slovak et al 2015, p.1338).
● Establish therapeutic relationship with the client during counselling and make the environment
comfortable for the client (Okamoto et al 2019, pp. 112-113).
● The therapist should practice with compassion, actively listen and validate the client, and be fully
present in all Behavioural therapy sessions (Best Counseling Degrees, 2015)
● Communicate with the family members to build trustworthy relationship also play important role (Hogue
et al 2020, pp.430-433)
● Supporting clients to express their thought and build up skills to adjust with their situation (Fenn & amp;
Byrne 2013, p.580).
References
Andrews, G, Dean, K, Genderson, M, Hunt, C, Mitchell, P, Sachdev, P, … University of New South Wales. Clinical Research Unit for Anxiety Depression 2013, Management of mental disorders
/ Gavin Andrews, Kimberlie Dean, Margo Genderson, Caroline Hunt, Philip Mitchell, Perminder Sachdev, Julian Trollor., 5th edition., University of New South Wales, School of Psychiatry,
Darlinghurst, NSW.
Chapman, A.L. and Rosenthal, M.Z., 2016. Managing therapy-interfering behaviour: Strategies from dialectical behaviour therapy. American Psychological Association.
Johnson, J., 2022. Behavioral Therapy. [online] Healthline. Available at:
McCauley, E., Schloredt, K., Gudmundsen, G., Martell, C. and Dimidjian, S., 2016. Behavioral activation with adolescents. United Kingdom: Guilford Publications, p.Pg173
Pass, L., Reynolds, S. and Pimas, M., 2020. Brief behavioural activation for adolescent depression. United Kingdom: Jessica Kingsley Publishers, pp.Pg 16-17.
Positive Psychology 2021, Behavioural Activation: Behavioural Therapy for Depression Treatment, as cited on 30th April 2021
https://positivepsychology.com/behavioural-activation-therapy-treating-depression/>
Villines, Z., 2022. Behavioral activation: How it works, examples, and more. [online] Medicalnewstoday.com. Available at:
Reference list continue…..
Best Counseling Degrees. (2015). What Does a Behavioral Counselor Do? [online] Available at:
https://www.bestcounselingdegrees.net/careers/behavioral-counselor/ [Accessed 27 Apr. 2022].
Fenn, K. and Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT: Education and inspiration for general
practice, [online] 6(9), pp.579–585. doi:10.1177/1755738012471029.
Hogue, A., Bobek, M., MacLean, A., Miranda, R., Wolff, J.C. and Jensen-Doss, A. (2020). Core Elements of CBT for Adolescent Conduct
and Substance Use Problems: Comorbidity, Clinical Techniques, and Case Examples. Cognitive and Behavioral Practice.
doi:10.1016/j.cbpra.2019.12.002.
Okamoto, A., Dattilio, F.M., Dobson, K.S. and Kazantzis, N. (2019). The therapeutic relationship in cognitive–behavioral therapy:
Essential features and common challenges. Practice Innovations, 4(2), pp.112–123. doi:10.1037/pri0000088.
Tull, M., 2022. 8 Tips for Using Behavioral Activation to Treat Depression. [online] Verywell Mind. Available at:
support interpersonal skills training’, In Proceedings of the 18th ACM Conference on Computer Supported Cooperative Work & Social
Computing