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David – case study. Sam McCauley Rachael Green Amie Watts Karen Beattie. Introduction to David. David’s in his 20’s and been homeless for around 10 years History of alcohol abuse Admitted to A and E with head injury Malnutrition and feet problems Aggressive and delusional thoughts.
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David – case study Sam McCauley Rachael Green Amie Watts Karen Beattie
Introduction to David • David’s in his 20’s and been homeless for around 10 years • History of alcohol abuse • Admitted to A and E with head injury • Malnutrition and feet problems • Aggressive and delusional thoughts
Underlying Factors & Health Issues • Psychological Underlying Factors and issues • Mental Health (Depression, schizophrenia, anxiety, fear, confusion, distress reduced self-esteem, Vulnerability ). • Alcohol and/or substance abuse and addictions • Past experiences • Homelessness • Physical Underlying Factors and issues • Head injury • Self-neglect / poor self-care, malnutrition, fatigue • Poor/no access to primary care • possible repeated brain injury, possible violence • Mobility, feet and musculoskeletal problems, respiratory problems • Liver damage • Social/Societal Manifestations • Stigma, Stereotyping • Reduced social support network, Family/marital breakdown, physical/mental abuse, Bereavement • ‘Revolving door patient’ • National/local legislation and policies
Working with David • Attempt to gain trust, Offer reassurance, Be calm/’friendly’ • Be professional, Take client-centred approach • Articulate own role/goals/intervention clearly • Obtaining Consent • Enforcement of Mental Health Act (MHA) • Involvement of next-of-kin, family, carer(s) • Information Required - • Previous medical history, Details of NOK/carer(s), Home / address • By interview with David, Police, Voluntary Agencies/NGO’s, Social Services, Charitable organisations • Other Factors/issues • Cultural, Spiritual, Ethnicity • Feelings of low self-esteem perpetuated by ‘uncaring’ society • Access to Healthcare • NHS Walk-In Centres/Helpline • Community Health Teams • Voluntary/Charitable Agencies/Organisations
Goals & Challenges • Short: Addictions/detoxify, Physical problems, Increase self-esteem, Daily structure/routines. • Medium: Effective medication regime, Increase social support network, Group activities. • Long: Achieve independence, Employment (voluntary or paid). • Challenges • Relapse • Side effects of medication • Drug compliance • Society (stigma and prejudice • Addictions • ? social support network • Adjusting into societal ‘norms’ • Overcome by – • 24 hour crisis team • Short/Medium/Long term strategies
MDT • Professionals • Mental Health Team (CPN, Nursing team, ASW, Consultants) for diagnosis, medication, discharge, physical health needs • Community Mental Health Team • Occupational Therapists for Activities of Daily Living • GP for primary health care needs • Podiatrist • Others • Assertive Outreach • Voluntary Agencies (Crisis, Mind, Hearing Voices) • Community Mental Health Team • Supported Housing • Advantages: Shared Notes, Joint approach, Integrated knowledge. • Disadvantages: Poor communication, Poor time management, Case overload, Too many people/organisations for David, Conflict between professionals/agencies involved.