Depression and Suicidal Ideation: Mental Health Case Study

Depression and Suicidal Ideation moral health Case excogitateIntroduction rational wellness nursing is a compound health business practice, beca practise it aims to cumulate the needs of clients with affable health needs, which are usually also complex and require more than a single redress approach. psychogenic health concords usually provide nominateive and therapeutic care adhering to nursing and healthcare principles of almsgiving and non-maleficence, and adhere to the principles published in the national guidance, of client-centred care foc apply on service user need, as enshrined in the National Service Framework for Mental Health (Department of Health, 1999). Mental health nursing usually involves the provision of on-going, stayive therapeutic words and talking therapies, which can include centering ground on launch principles. This role of the affable health nurse involves the formation of a therapeutic relationship with the client, in order to support t he client to ascendment self-management and coping strategies for the ongoing control of their condition and its symptoms, in conjunction with pharmacological treatments.This critical essay will explore the mental health nursing care of a ill-tempered, identify patient encountered in clinical practice, in whose care the germ was directly involved. It explores the provision of Cognitive Behavioural Therapy (CBT) to a single client who had complex health needs and challenging symptoms, reviewing the usefulness and impoundness of the therapy, the yields or projected cause on the clients well world and symptoms, and the issues surrounding such care for the client in relation to rehabilitation and recuperation as part of their mental health journey.The essay will center on on the care of 1 client with depression and suicidal ideation, looking not at the acute phase of mental health care, nevertheless the rehabilitation phase where the client is being supported into ways of ma naging symptoms and returning to a useful, active social life where they can function effectively within society. The essay focuses on the goals and principles enshrined in the NSF for Mental Health (DoH, 1999), that of achieving the best possible standards of health and wellbeing for the client and the best possible control of their symptoms. It will explore the rationales and process of the therapeutic intervention, and use this intervention within a person-centred model of counselling, support and care.Client Background and HistoryThe client, who for the purposes of this essay will be called Lisa (this being a pseudonym used to see to it client confidentiality), is a 19 year old young woman with a history of depression and suicidal ideation. Lisa first presented to the local anaesthetic mental health services at the age of 16, later an acute episode of physical self harm and attempted suicide. Lisas self-harming behaviour give ins the form of shift, usually to the arms, legs and abdomen, although she has been cognise at times to also cut her face and neck. During her first admission, Lisa was diagnosed as having Depression with Psychotic symptoms. She has been managed with a conclave of Fluoexetine and a range of other medications, but is known to film frequent recur due to medication non-compliance.Lisa has a complex personal and social history which goes around way to explaining her current adduce of mental ill health. She was abandoned by her single parent mother at the age of 11, from which time until the age of 16 she spent in local authority care, a mixture of foster homes and care facilities. At age 16 she left care and went on the streets, but at 17 after her third hospital admission was able to get into a social support programme, secure accommodation for herself, and parachuting to attend college. Lisa is still at college, studying beauty therapy. She has a history of sexual abuse, but for the past year and a half has been living a rel atively stable life, with a slap-up social life and a busy college life.Lisa has presented this time with a revert in her Depression, and has butt againstd a strong suicidal ideation, low mood and being very withdrawn and apathetic. She has, this time, attempted suicide through overdose of a friends prescribed medication accompanied by severe cutting to the arms, legs and breasts. After being medically stabilised, she was admitted to the mental health ward, and after two weeks on the ward, fully compliant with her medication, was making some progress towards rehabilitation.DiscussionNorman and Ryrie (2004) describe mental health nursing as a process of working with clients to allow them to develop the skills to regain control over their lives through managing their mental health. Ultimately, mental health nursing supports clients into a phase of recovery (Tschudin, 1995), which means that they are not overwhelmed by their symptoms and can manage them through a combination of medi cation, personal supportive therapies, and other support, in order to lead normal lives within society and carry out personal goals. Mental health nursing is ground upon a range of principles, some of which are scientific, some of which are more holistic (Norman and Ryrie, 2004). Mental health nursing supports clients through the acute phases of their sickness, via crisis management, and through the continuing stages of their illness, through longer-term processes of rehabilitation (Perkins and Repper, 2004). Quite often, mental health service users are viewed in terms of their disease and its treatment, but the provision of true client-centred care should start off with a severe understanding of the client and their condition, their particular needs, and then be followed by a judgement about how best to help them towards recovery on the spectrum of mental health and illness (Perkins and Repper, 2004 Foreyt and Poston, 1999). Recovery cannot be considered as a finite point in time, but as an ongoing counterbalance between the client and their illness, wherein the client aims to achieve the index to function at the level they desire, through accessing appropriate support (Perkins and Repper, 2004 Greenberger and Padesky, 1995)). The judgement about what kind of support is best is establish upon a number of factors, but most often, the decision about which of the many approaches to supportive therapies and counselling will be used is based upon both the client need, and the mental health nurses own knowledge about, experience of, and preference for, a particular form of therapy (Puentes, 2004).Mental health nurses, therefore, must have a good understanding of themselves, their philosophical orientation in relation to counselling, and the therapies on offer, and are most likely to provide those with which they have the most familiarity. In this case, the author is describing their own philosophical approach as matching that of their clinical practice ment or, who, as an experienced mental health nurse, is a strong advocate of client centred approaches to counselling. Gamble and Curthouys (2004) describe these approaches as being founded on Rogerian principles that include empathy, genuineness and mat positive regard. Rogers (1957 in Gamble and Curthouys, 2004) invoke that within a therapeutic relationship, which is a supportive relationship between client and nurse, with the express goal of attaining rehabilitation or recovery, there should be definite features which support the client towards functionality. Thus, there needs to be contact between two people, nurse and client, in which the client is in a condition of incongruence, and the nurse a press out of congruence, and in which the nurse displays unconditional positive regard, and empathetic understanding, towards the client (Rogers, 1957 in Gamble and Curthouys, 2004). The nurse must be able to pass by these factors to the client, within the clients frame of reference (Ro gers, 1957 in Gamble and Curthouys, 2004Bryant-Jefferies (2006) argues that the therapeutic relationship must be founded on empathy, and that in order to achieve empathy the nurse must employ active listening, and must attend to all the signs and the kinds of communication which the client displays, providing a sense of being present with the client in whatever experience they are re carve uping or currently experiencing. One of the more challenging aspects of developing such a relationship with the client is the provision of unconditional positive regard, which Bozarth and Wilkins (2001 in Bryant-Jefferies, 2006) describe as an ongoing, unceasing and unflagging warm acceptance of the individual, regardless of what they might say. Some authors describe this as the element of the therapeutic relationship that is most likely to support the client towards recovery (Bozarth and Wilkins, 2001 in Bryant-Jefferies, 2006). In this case, the mental health nurse (the authors mentor) who was t he primary support person for the client, fully aspired to such principles and to the concept of developing the best possible therapeutic relationship with the client. The literature consistently demonstrates that the quality of the therapeutic relationship is unsounded to the client achieving a state of mental health and wellbeing (DoH, 2001 DoH, 2006 Nice, 2004). The author agreed with this and mat that their own therapeutic philosophy was founded upon similar principles, making it appropriate to get involved in the case. The client was also happy to have the author present, as they were involved in there are from admission, and had spent some time observing the client during the acute phase to prevent further self harm.Depression is a surprisingly common, yet often serious mental illness, which can present in a variety of ways, with features such as low mood, lack of enjoyment and interest, reduced energy, sleep disturbance,appetite disturbance, reduced confidence and self-este em, and demoralised intellection (Embling, 2002 p 33). According to Embling (2002), these symptoms can have a significant effect on peoples ability to take part in normal daily life or social activities, and in particular, the low mood and predisposition towards pessimistic thoughts can have a negative partake on thought processes, leading to suicidal ideation (Rollman et al, 2003)..There are a number of individual and social issues which have been shown to have an association with depression, including physical illness (acute and chronic), poverty or low socioeconomic status and deprivation, divorce, bereavement or relationship breakdown, loss of a job or sudden, negative change in circumstances, ethnic minority status, and concomitant mental illness (Embling, 2002). It is a chronic condition which can manifest in acute episodes which are often successfully managed with pharmacological and non-pharmacological support, but the relapse rate is high for many patients (Embling, 2002 ). It can range from mild depression to severe depression or anywhere along a spectrum in between (Rollman et al, 2003). A wide variety of therapeutic approaches have been used in treating this illness, and in Lisas case, she had had some success antecedently with solution-focused brief therapy, but had found herself relapsing once regular, close contact with a mental health nurse had lapsed. Lisa admitted that she felt the time was right to take control of her life and find ways of coping with her illness more independently, and was keen for strategies which would allow her to avoid having such serious relapses, because they themselves had a negative effect on her life and potential career. Therefore, it was agreed that CBT might be the optimal approach. Luty et al (2007) argue that CBT is not always the most efficacious therapeutic plectrum for severe depression, but in Lisas case, it seemed worth trying, particularly as her worst symptoms were related to not maintaining her medi cation, and once she was on her medication, the focus had to be on keeping her well enough to keep taking the tablets. Other literature suggests that CBT is effective in patients who have had a history of sexual abuse (Price et al, 2001) This seemed to hint that the focused approach to support that CBT offered would the right way, particularly as it is so focused on relapse prevention.According to NACBT (2007) cognitive behavioural therapy is the term used to describe a variety of therapeutic or interpersonal interventions, all of which are characterised by a focus on the importance of how clients think, and how this thinking impacts upon their feelings, their responses to stimuli and stressors, and their actions. Its place lies in the fact that it is structured, directive, and also time-limited, strong focusing client and nurse on the current problem, on how the client feels and thinks at the single point in time that therapy is taking place (Embling, 2002). CBT is based on the t heory that the way an individual behaves is determined by his or her idiosyncratic view of a particular situation, thus the way we think determines the way we feel and behave (Embling, 2002p 34).According to Embling (2002), Beck et al (1979) introduced CBT , suggesting that CBT can treat depression as it helps the client to evaluate and modify distorted thought processes and dysfunctional behaviours (Embling, 2002) p 38). According to NACBT (2007) CBT has expanded within the therapeutic domain to include a range of approaches based upon the sample principles, including, thinking(prenominal) Behaviour Therapy, Rational Emotive Behaviour Therapy , Rational Living Therapy, Cognitive Therapy, and Dialectic Behaviour Therapy, all of which are based on what are exposit as cognitive models of social response. These in turn have been based on philosophical principles derived from Socratic thought, wherein individuals aim to attain a state of calm and tranquillity when challenged by stres sful or difficult situations and experiences (NACBT, 2007). Thus the idea is to modulate the responses to life and experiences which precipitate symptoms of mental illness. The counsellor directs the client to use inductive methods combined with principles of rational thinking and educative approaches, to support behavioural self-managed over the longer term , (NACBT, 2007 Sensky et al, 2000) and to prevent relapses (Bruce et al, 1999). Therefore, in CBT, the nurse provides the client with the ability to explore their behaviours, their responses and their typical symptomatic responses in particular in certain situations, and assists them in developing ways of mediating such responses so that they do not relapse into behaviours characteristic of their illness (Sensky et al, 2000 RCP, 2007 BABCP, 2007).Management of Lisas CareTo begin with, it was really important to ensure that Lisas counselling and therapy was truly person-centred, in order to develop a good relationship between Lis a, the primary nurse and the author (NELMH, 2007 Moyle, 2003). The author hoped that Lisa would respond well to this approach because it would allow for the demonstration of empathy and a good understanding of how her life, previous mental illness and personal circumstances were contributing to her current illness, and therefore would support congruence in provision of support to meet her needs and address her specific bushels. However, the difficulty in achieving congruence here was that the author could not really claim to fully understand the effects of Lisas previous experience of sexual abuse or really relate to her experiences, and in particular, the author found some elements of her history, including the stories she told relating the sexual abuse, as very disturbing. The author discussed this with the nurse mentor prior to the counselling sessions, and discussed how to achieve that true sense of congruence and presence, without communication their own abhorrence of the expe riences that Lisa was relating. It was decided that it would be acceptable to tell Lisa that the author was appalled by these experiences, because this would underline the fact that she should not have had to suffer this abuse and that she was right to seek help in dealing with the effects on her mental health. Therefore, the author was able to enter into this counselling in supportive frame of mind, and able to achieve empathy without communicating negative feelings to the client.The focus of Lisas CBT was on the suicidal ideation/self-harming and the low mood and self-abhorrence that were the main manifestations of her depression. Collins and Cutcliffe (2003) show that one of the most common features displayed by mental health service users with suicidal ideation is hopelessness. This was certainly the case for Lisa, who displayed a sever pessimism about life and her ability to achieve anything like lasting recovery. Her goals to become a beauty therapist seemed unobtainable, and she felt she had no hope of making a new life for herself that was not ruined by her previous life.However, Collins and Cutcliffe (2003) recommend CBT for this kind of pessimistic thinking because it focuses the client on establishing hopefulness within their thought patterns. Other research shows that suicide risk can be reduced if individuals can experience others showing concern for them (Casey et al, 2006). This was supported by the authors and the mentors firm belief in the efficacy of CBT for clients such as Lisa (Joyce et al, 2007). Thus, it was possible to establish an sign level of trust, and through the therapeutic relationship, the author was able to support Lisa in exploring her conditional assumptions (Curran et al, 2006) which led to the ongoing, spiralling pessimism, and then using CBT, we were able to set goals for each counselling session, set homework which focused on self-management, and then reflect on progress as each session followed the previous one (Curran e t al, 2006). The sessions focused on relapse prevention through changing cognitive patterns and schema, rehearsing relapse drills, and ensuring ongoing compliance with medication (Papakostas et al, 2003. While some authors argue for the need for inclusion of family or carers in therapeutic interventions such as (Chiocca, 2007), this was not possible with Lisa because she had no family and although she had a number of good friends made through her college course, none of them knew of her mental illness. The focus was therefore on health education, developing personal skills, and helping Lisa to cope with issues such as her current socioeconomic status (Jackson et al, 2006 Cutler et al, 2004)..ConclusionIf, as Calloway (2007 p 106) suggests nursing is defined as a profession that protects, promotes, and restores health and that which prevents illness and injury, then using such a client-empowering form of therapy, one which is based on the development of realistic coping mechanisms (S alkovskis, 1995 Deakin, 1993), was the right approach with Lisa. Discussion with her revealed that focusing on relapse prevention, within an honest therapeutic relationship which address the factors affecting her mental health, and addressed the ways of thinking and behaviours which led to relapse, was the right approach, because these were, fundamentally, her primary needs. 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