Example of a Mental Health Assessment and Treatment Plan

Example of a Mental Health Assessment and Treatment Plan

 

Case # 2 – Ryan

 

Diagnosis (using the DSM-IV-TR):

 

Axis I: 304.10 Sedative, Hypnotic, or Anxiolytic Dependence, without physiological dependence

Axis II: V 799.9 diagnosis deferred R/O 312:89 Conduct disorder; R/O 301.7 Antisocial Personality Disorder

Axis III: V 799.9 diagnosis deferred

Axis IV: inadequate social support, discord with others, problems with the legal system, 

Axis V: GAF Score 40

Axis I - Symptoms: When seventeen years old, Ryan reported to a clinician completing a psychiatric evaluation, in a psychiatric hospital, that he “loved PCP or angel dust, and that he would rather be dusted than anything else.” He explained that he would take routine trips to ‘New York City to buy drugs.’ He denied any feelings of ‘nervousness.’ Clinician notated that “This wasn’t machismo; he really seemed unconcerned.” He was discharged from the psychiatric hospital into a drug rehabilitation program. This turned out to be an unsuccessful effort to cut down or control Ryan’s substance use. Clinician notated that Ryan convinced his parents to take him home within four weeks, and Ryan stole his parent’s money and disappeared to go back with his friends and drugs. A few years later, the clinician reports that Ryan has been arrested several times for theft, and that he continues to con his parents for money to buy drugs. Ryan, and the information present, does not report any evidence of tolerance or withdrawal. Ryan’s diagnosis is without physiological dependence: no evidence of tolerance or without withdrawal is present. The Addiction Severity Index will measure predictors of substance dependence, and Laboratory tests are a good screening tool and detector of continual use.

Axis II - Symptoms: Ryan’s records indicate that he was truant from school for several months, at the time he was seventeen, and he was in legal trouble. Ryan accompanied other teenagers to the local cemetery to perform satanic rituals, and a “young man was stabbed to death.” Ryan admits to being at the scene, but he denies stabbing the boy. Ryan admitted to stealing skulls from the graveyard for parties. No emotional concern was displayed by Ryan according to the clinician. No other past information is in the record; as such, the diagnosis is being deferred until records or information is received to do a complete history. Records should include bio psychosocial, medical, educational records, and any history of behaviors that would be abnormal or illegal if performed as an adult or caught. Ryan has a history of doing ‘many’ things that he claims to regret, but the Psychiatric notes state that “he was never truly remorseful for anything.” During the 48 hours that he was monitored and evaluated, the hospital documented ‘several things’ that showed Ryan needed help. Ryan told another patient that he was going to get released, get in trouble, and be sent to prison where this client’s father was. He threatened to rape the patient’s father. This caused the patient to get upset and hit others at the hospital. When confronted about his actions, Ryan explained that “he was bored and that it was fun to upset Ann.” Ryan went on to state, “Why should it bother me? She’s the one who’ll have to stay in this hellhole!” A complete structured interview would confirm or rule out a conduct disorder and antisocial disorder. Ryan can be assessed by administering objective tests of antisocial behaviors, impulsivity, and aggression. 

 

Axis III - Symptoms: The medical diagnosis is being deferred until information is gathered to determine his medical history. An up to date Physical should be performed on the client, because of his repeated drug use. 

Axis IV – Problems or Stressors: Ryan does not have an adequate social support system. His parent’s continue to provide him with a way to buy drugs. He has a history of discord with others, and he lacks empathy for the things that he does to them. He has had numerous problems with the legal system: he has been arrested several times for theft, and he was arrested at seventeen.  

Axis V: GAF Score 40. Ryan has major impairment in several areas of his life.

Potential Causes of this condition/disorder: This is based on the current information that was provided; however, more information needs to be obtained.

Ryan displays antisocial personality traits, and a complete history of childhood behavior should be reviewed to determine if he had a conduct disorder, and currently has an antisocial personality disorder. Dramatic Personality disorders are general caused by family-based stressors and genetic predisposition.

Ryan’s substance dependence is likely due to his personality and Psychopathy. His lack of remorse, need for immediate gratification, and antisocial behaviors. Risk factors that might have played a role in this are deviant peers and initial drug experiences.

Treatment Plan: Referral to a psychiatrist for medications. 

Social Problem Skills and Cognitive Behavioral Therapy – Two visits per week (one individual, one group). Ryan needs to take responsibility for his behaviors, and the effect that they have on others. He would benefit from learning how antisocial behavior is self-defeating, and developing effective coping skills to self-monitor. In one year, Ryan’s progress can be assessed by re-administering objective tests of antisocial behaviors, impulsivity, and aggression to determine if progress has been made and if treatment should be decreased.

Ryan needs to develop a program of recovery that is free from addiction. Ryan’s initial treatment should be in-patient, and then he can transfer to a half-way house, and outpatient care.

Why are Young Women Cutting (Self-Injury)?

There is not a lot of research on self-injury among young women; nevertheless, the research that has been done normally only includes women that are 18-26 years old and not younger. Self-injury is more common in women than men; therefore, this paper will focus on women but the information applies to men as well. “Self-injury typically occurs within the age range of 13-23,” because this is when they are developing (p. 76). According to Laurie Craigen and Victoria Foster, “the act of self-injury may be a means of expressing feelings of discontent and anger and a form of psychological resistance articulating a need to be heard and to be taken seriously” (p.77).

It would benefit young women if the research was conducted targeting them when they start the self-injury, because self-injury among young adults is on the rise. Due to a lack of empirical date, it appears that this type of behavior is resistant to treatment (p. 77). Therefore, the article discusses the helpful and unhelpful behaviors the counselor does demonstrate during their sessions with their client. It also discusses the counseling process, and the counseling reflection. The data suggest that, “the most helpful counseling did address these issues” referring to the underlying issues that triggered the self-injury (p.89).

The study provides an accurate picture of individuals that self-injure, because it takes the time to speak to the individuals and ask them about their counseling and the treatment that they received. The study gathered information through qualitative interviews. The research provides insight for counselors that work with clients that self-injure, because the results show that helpful behaviors displayed by counselors were “respectful listening, understanding, and acting as a friend” (p.82). The results of the data help to educate the counselors, so that they focus on the ‘underlying issues’ through talk therapy. The article made a very good point that if you ignore the underlying reasons behind the cutting, then you are not addressing the needs of the clients. The counselor needs to find out why the client is hurting themselves, and they can do this by asking questions. For example, they could ask “If your wounds could speak, what would they say about you? What are your wounds trying to communicate? What feelings drive you to self-injure? What wounds exist beneath your scars?” (p.91). The counselor needs to be nonjudgmental when responding in order to develop the counselor-client relationship.

The participants were ten woman aged 18-23, and that limits the information that was received through the interviews. Ten participants is not a lot of people, and the participants do not give any insight into counseling experiences of young girls – girls that start to cut prior to 18. More studies need to be done to determine what strategies are effective in treating clients that self-injure, because an effective treatment plan needs to be developed.

 I believe the study would have been better if the participants ranged from 12-23, and if it focused on gathering data from multiple types of therapy. For example, is Dialect Behavior Therapy (DBT) being used as a treatment for young women that self-injure? Is DBT impacting clients that self-injure? How is it impacting them? What would the data show if the research was done? The data is unclear about the treatment approach, and that is a problem, because the number of people that self-injure is on the rise and it is important to have evidence/data that will support the best way to treat the individuals that self-injure.   

My daughter has been cutting for almost two years now, and the information for families is not very comforting or helpful. I have been told she is just trying to manipulate me, and I have been told that she wants attention. I know that she has not cut in a few months, but that is because we have an agreement – if there are no marks she is allowed to be alone (because that is when she cuts), but if she cuts then she needs us (her family) around 24/7. The door to her room cannot be closed, and I check on her when she uses the restroom. I don’t know if it is the right thing to do or the wrong thing to do, and the experts have given us conflicting messages. But, I know that it is hard to do nothing when your child is hurting themselves. My daughter is talking to me more about the thoughts that trigger her to cut, and we made a poster of positive affirmations to counter act the negative thoughts. It is posted on the back of her door. She says that, “I am annoying” and she thinks about losing her privacy when she has the urge to cut and it has helped.

We made tool-kits together, so we could use them if we needed them. She took mine out of my room and as she brought it into hers, she commented “I need it more than you do!” However, I think she liked the tools in my kit (classical music, candles, breathing exercises, and permission slips: Permission to write down the thought and to talk about it at a later time, in a safe place). 

 

Reference

Craigen, L. M., & Foster, V. (2009). "It Was like a Partnership of the Two of Us Against the Cutting": Investigating the Counseling Experiences of Young Adult Women Who Self-Injure. Journal Of Mental Health Counseling, 31(1), 76-94.

Police Assistance During Conflicts

In an article entitled Police response to victims of domestic and non-domestic violence, Dr. Ivan Sun, Professor of Sociology and Criminology at the University of Delaware, observes that “Police are more likely to provide assistance on their own initiative to victims of domestic violence than victims of non-domestic violence;” furthermore, “police respond differently to requests made by victims of domestic and non-domestic conflicts” (2006, p.145 & 148). The manner in which police officers provide assistance and concern for victims is influenced by the dispute; if violence is involved or if violence is not involved, if the victims know each other “domestic violence” or if they are strangers “non-domestic violence” (p. 153). The majority of Sun's article explains the process that he went through to research his theory and discover his findings. So, how did he begin his research?

As a scientist, Dr. Sun introduced his theory “to assess whether police respond differently to victims of domestic and non-domestic conflicts” (p.162). This statement provides the reader with information regarding the population; that he was observing, and the criteria that he set for his research design. For example, in the beginning of the article, he tells us that he is researching the behavior of police when they interact with victims of domestic and non-domestic conflicts (p. 153). Sun’s unit of analysis is the police response. However, there cannot be any confusion about his theory, so he went even further by providing specific insight into: the way that the police respond (if they were called or if they initiated the response), factors that affect the way that police respond (if the victim new the perpetrator or if they did not know the perpetrator), and the police officer’s attitudes toward different citizens characteristics (gender, race, socio-economical status, and so on so forth) (p.146). In order for Sun to come up with a viable theory, he had to do some research on the topic.

Sun researched at least fifty-two sources. He used the sources to collect data that would support his theory. The most recent reference was published in 2004, while the oldest was published in 1968 (p.165-172). The most useful data came from “the Project on Policing Neighborhoods (POPN) conducted in Indianapolis, Indiana, and St. Petersburg, Florida, during the summers of 1996 and 1997” (p. 152). Dr. Sun reported his finding in 2006, so at the time the data he collected was about ten years old. However, the research that was conducted looked at multiple variables within the criteria set forth: the dependant variables were “officer- initiated assistance” and “officer response” assistance, and the independent variables were domestic versus non-domestic conflicts, and the control variables were victim characteristics and officer characteristics (p.153-5). Therefore, the information that he discovered was useful in his research project. After the data was collected and analyzed, Sun had to report his findings.

Sun begins by noting the most common reasons why “police-initiated assistance” which were: to “provide information on how to deal with the problem,” to instruct the victims “to call the police if the problem occurred again,” and to advise the victim to use the legal system (p.157). Three tables were incorporated into Sun’s research article to back up his findings. The tables are important because they compliment the research findings with numbers. For example, Sun points out that “the percentages for domestic conflicts victims are all greater than the corresponding percentages for non –domestic conflict victims” (p.158). His sample of study was 380 victims, and the data was collected by trained observers.

Other directions Sun offers include the two choices that police officers have in handling conflicts: “coercive or control approaches and non-coercive or supportive approaches” (p.148). The first selection allows the officer to use his discretion to the amount of power that he or she wishes to exert to get the perpetrator to refrain from being violent (to control themselves). Whereas the latter, is a way for police officers to provide emotional support through assistance and guidance in offering other avenues to deal with the interpersonal conflict that triggered the event (p.148-9).

Since a good researcher is able to identify any problems or shortcomings of the theory that they are researching, Sun made sure that he fulfilled this obligation by noting the two limitations of his findings. First, there were not many victims; as such, Sun reports that it “prohibits meaningful regression analysis of police response to different types of requests made by victims.” Second, he was concerned that “using officer-level variables at the citizen level analysis because it violates the assumption of the variables independence…” (p.164).

There are three important results that Sun points out. The first one is that “police are more active in assisting victims of domestic conflicts than victims of non-domestic conflicts” (p.162). Next, he found that “police respond similarly to requests made by victims of domestic and no-domestic violence.” I believe the author meant to write “non-domestic violence.” As a final point, he notes that “police actions during conflict settlement are significantly affected by one citizen variable, wealth, and two officer variables, education and unit…”(p.163).

In conclusion, Sun provides suggestions on how police departments can improve the way that their police officers handle disputes by making sure that police officers are trained to work with citizens of lower economic status, and by making sure the “effective interventions” are used when helping victims of domestic violence (p.164). Sun’s observation that “Police are more likely to provide assistance on their own initiative to victims of domestic violence than victims of non-domestic violence” has merit, and it is imperative that police officers provide appropriate assistance for victims of “domestic violence” (2006, p.145).

References

Sun, I. Y. (2006). Police response to victims of domestic and non-domestic violence. Journal of Health and Human Services Administration, 29(1), 145-72. Retrieved from http://search.proquest.com/docview/200011727?accountid=13215

Social Support in a Safe Environment: Group Therapy

Counseling groups provide support, self-awareness, and education in a safe environment. By attending groups, members have the opportunity to work on skills that they have learned during individual counseling. This type of setting allows the individual’s to increase their confidence and to build interpersonal relationship skills. Yoni Harel, Zipora Schechman, and Carolyn Cutrona designed a study to “explore the associations among the individual’s attachment style, group process variables (climate and bonding), and objectively documented supportive behavior in counseling groups, as well as the impact on change in members’ perceived social support” (2011, p.1). The study examined the variables that impact an individual’s social support, because there is a connection between an individual’s well-being and the support system that they have. Harel et al. insists that social support “provides hope, increases self-confidence, and is an important buffer against loneliness and stress” (p.1).

So, what variables were looked at and why? The individual and group process variables that effect social support in counseling groups literature review determined that attachment style is important and that it would have an outcome on the individuals social behavior; specifically, “people with high levels of (avoidance and anxiety-italics added) either or both dimensions are viewed as having an insecure adult attachment orientation” (p.2). The individuals with high levels of avoidance and anxiety attachment styles also measured “to be positively associated with self-concealment, self-splitting, and personal problems, as well as maladaptive perfectionism and depression moods” (p.5). Individuals with these attachment styles have the ability to push a counselor’s buttons; bring out negative behaviors, so therapists must remind themselves not to be too confrontational with them. It appears that there are limitations to attending counseling groups for individuals that have high levels of avoidance and anxiety attachment styles. Individuals with these attachment styles need to learn skills through individual therapy, so that they can benefit from counseling groups. As such, counselors need to allow these individuals the opportunity to participate without providing a lot of direction while in the group: instruction or direction should be given on an individual basis privately.

The study used two independent evaluators to assess the types of social supports. The trained evaluators used the Social Support Behavior Code to “assess social support behaviors in the context of helping interactions;” this scale assesses eight types of support: “ (1) emotional support; (2) esteem support; (3) information support; (4) tangible support; (5) social network support; (6) tension reduction; (7) attentiveness; (8) negative behavior” (p.4). There is a difference between the social support behavior (identified above) and the perceived social support which “assesses people’s subjective judgments about the extent to which members of their social network provide social support in times of need;” so another assessment needed to be include that would measure the following areas: “attachment, reassurance of worth, social integration, guidance, reliable alliance, and the opportunity to provide nurture” (p.6). There were one hundred and seventy-eight students participated in the mandatory groups.

Counseling groups are general divided into three stages; and they are, the beginning or initial stage, the middle or working stage, and the ending or termination stage. It is important for the members to trust each other during the beginning stage, because if they don’t then they will not move onto the working stage. The working stage requires the members to “engage in self-exploration, develop insight, and resolve personal difficulties, by questioning each other; sharing personal information, emotions, and experiences; and providing supportive feedback” (p.4). It is the counselor’s responsibility to help the members build the initial bond, so the counselors might have to talk more in the beginning stage then in the middle stage. Once the stage is set the members should start displaying signs of support. The study noted that group size is important, because “the exchange of positive support was more frequent in smaller groups,” so individuals interested in going to counseling groups for support should try and find ones that are not large (p. 9).

Since attachment style is the strongest predictor of an individual’s behavior in counseling groups, individuals should be encouraged to use effective skills and discouraged from using ineffective skills. The study provides useful information. But, it lacks information about the group facilitators, and the methods that they used during the mandatory meetings. Facilitators have the ability to promote more positive outcomes; on the other hand, they have the ability to discourage positive outcomes. For example, if the group facilitators provided the members with instruction on self-confidence, self-acceptance, and self-care it would enhance the individual’s skills and the group skills. Self-confidence enhances self-management, competencies, social skills, and assertiveness training. Self-acceptance changes ones evaluations of the self (e.g., cognitive restructuring or changing personal values); in turn, it changes their evaluations of others. Finally, self-care encourages positive experiences with oneself (e.g., develop positive activities and focus on positive facets of oneself), and these positive experiences can promote positive experiences with the group members. Groups provide an environment for members to work on their skills while interacting with peers; and as a result, counseling groups provide support, self-awareness, and education in a safe environment.

 

Reference

 

Harel, Y., Shechtman, Z., & Cutrona, C. (Aug 15, 2011). Individual and group process variables that affect social support in counseling groups. Group Dynamics: Theory, Research, and Practice. Advanced online publication. doi: 10.1037/a0025058

 

Risk Factors for Self-Harm in Adolescents Admitted Into an Inpatient Unit

 

Risk Factors for Self-Harm in Adolescents Admitted Into an Inpatient Unit: A Review of the Literature

           All over the world suicide rates among adolescents is increasing. Some adolescent’s complete suicide and others attempt suicide. For those that engage in self-harming behaviors; attempt suicide but do not die, they are often brought to an emergency room or an inpatient unit for treatment and care. Events like these not only affect the individual, but they affect the family and the community. In fact, it often leaves adults wondering: Why? What did I miss? What are the risk factors for self-harm? How can I help? 

Any adolescent is vulnerable to thoughts of suicide, but not all adolescents attempt suicide. Adolescents that are high risk for attempting suicide, or self-harming behaviors, are the ones that have a predisposition (biological and psychological factors) to suicidal behavior, and they are unable to effectively cope with stressful events. A few examples of stressful events are: dealing with family problems, bullying at school, and relationship issues. According to Lislotte de Kloet, Jean Starling, Cassandra Hainsworth, Ellen Berntsen, Lucy Chapman, & Karen Hancock (2011), “increasing age, female gender, a history of trauma and a diagnosis of depression are well known risk factors for self-harm,” but there study confirmed that “family factors, in particular living with a step parent significantly add to the risk” (p.749). Therefore, it might be beneficial for parents to provide their children with counseling if they are going through a separation or divorce. 

The study reviewed the records for 294 adolescent inpatient patients over a three year period; in order to, “describe risk factors for self-harm for children and adolescents in a mental health inpatient unit” (Kloet et al., 2011, p.751). The researches divided the participants into two groups: patients that self-harmed and patients that didn’t self-harm. The patients admitted for self-injurious behaviors were 150, and the behaviors that they displayed were cutting, poising, strangling, hitting, and harming themselves. The patients reported that they harmed themselves to relieve unwanted feelings. Also, there were 56 patients in the psychiatric unit that were not there for self-harming behaviors, and these patients were considered the control group. That means that they did not attempt suicide, and that they did not attempt to injure themselves.

             According to the study, there are many treatment options but there is no specific program that is mentioned as being effective. The authors express that the knowledge and information contained in the study can be used to develop an effective program. However, they do not give any details on how this can be done.  On the other hand, the report does strongly encourage that that adolescents receive early intervention services for self-harming behaviors before the symptoms escalate to requiring the adolescent to be admitted into a mental health unit. So for right now, the best thing to do is to make sure that adolescents that are self-harming themselves are referred to see a mental health counselor or the school counselor.

References

 

Kloet, D. L., Starling, J., Hainsworth C., Berntsen, C., Chapman, L., & Hancock K. (2011). Risk factors for self-harm in children and adolescents admitted to a mental health inpatient unit. Australian and New Zealand Journal of Psychiatry, 45, 173-181. doi: 10.3109/00048674.2011.595682

Obsessive-Compulsive Disorder (OCD) in Adolescents and Adults

Obsessive-Compulsive Disorder (OCD) is a chronic psychiatric disorder with adverse affects. OCD is associated with significant distress and impairment in functioning. The distress and impairment in functioning impacts not only the individual with the diagnosis, but it impacts their family as well. Due to stigma and lack of recognition, individuals with OCD often wait many years before they receive a correct diagnosis and effective treatment. Since OCD has a wide range of potential severity, it is important to determine if the manifestation of symptoms changes with age of onset.

Agnieszka Butwicka and Agnieszka Gmitrowicsz, 2010, reviewed the existing literature looking at the age of onset and found that, “There is evidence that adult patients with early onset (EO) differ clinically from those with late onset of OCD (LO)” (p.365). In fact, patients with early onset OCD (EOCD) fall into a more severe sub-type. After their review of the literature, the authors’ came up with two purposes for their study, “First, to investigate differences in OCD symptoms between adolescents versus adult patients and second between EOCD versus LOCD groups” (p.366).

Butwicka and Gmitrowicsz reviewed inpatients records for OCD from 1999-2007 from the “Central Clinic Hospital of the Medical University of Lodz” (p.366). The researchers looked at patients with an ICD-10 and DSM-IV diagnosis of OCD. Then, they divided the patients into three groups: group one contained adolescents, group two contained adults that were 19 years or older, and group three contained adults with a diagnosis prior to their 18^th birthday (p.366). The total number of patients was 132. There were 44 patients in group one, 43 patients in group two, and 45 patients in group three. The authors’ looked at several variables between the three groups, and they determined that,

Religious, sexual and miscellaneous obsessions were more frequent in group and somatic less frequent in group one than in group 2. Contamination compulsions were most seldom found in group 1. Cleaning obsessions were more frequent in group 3 than 1. Checking were the rarest and miscellaneous, the most often compulsion among adolescents in comparison to other groups (p.365).

The study shows that there are some differences between the symptoms manifested by the patients and the age of onset. The authors’ noted that there were a few limitations to the study, but they pointed out that these limitations could be used to encourage future studies.

Many patients with OCD experience moderate symptoms; however in severe presentations, this disorder is quite disabling and is appropriately characterized as an example of a severe and persistent mental illness. The manifestation of symptoms varies with age of onset, and the age of onset influences the rates of the patients’ compulsions. Therefore, to decrease the amount of distress and impairment in functioning on the individual with the diagnosis, and the family, it is vital to receive treatment.

References

 

Butwicka, A., & Gmitrowicz, A. (2010). Symptom clusters in obsessive–compulsive disorder (OCD): influence of age and age of onset. European Child & Adolescent Psychiatry, 19(4), 365-370. doi:10.1007/s00787-009-0055-2

Peer Supported Recovery: A review of the Literature

In the article entitled Pathways to Recovery (PTR): Impact of Peer-Led Group Participation on Mental Health Recovery Outcomes, the author’s observe that the manner in which the PTR is run significantly influences how the consumer will recover (Fukui, 2010, p.42). Recovery is the process that an individual goes through when they are changing the negative impact of a mental illness into a positive state of life. Recovery is influenced by the way the consumer perceives their life, because it is a highly individualized process and their cooperation with mental health professionals is affected by the individual’s perception. This study helps to show that change is possible.

According to Sadaaki Fukui, Lori J. Davidson, Mark Holter, and Charles Rapp (2010), the “study examined the positive effects on recovery outcomes for people with severe and persistent mental illness using peer-led groups based on Pathways to Recovery” (p.42). Peers provide support because they have a common understanding of the issues surrounding mental illness and the impact of recovery. The author’s looked at three of the best peer-led approaches: Wellness Recovery Action Planning (WRAP), the Recovery Workbook, and Pathways to Recovery. The first two approaches have shown a positive impact on consumers with a mental health diagnosis. The third approach, PTR, has been used since 2002, and this study examined its outcomes.

Sadaaki Fukui, Lori J. Davidson, Mark Holter, and Charles Rapp (2010), hypothesized “that PTR peer-led group participants would experience improved outcomes in these areas;” they go explain the areas to be, “recovery outcomes of self-esteem, self-efficacy, perceived social support, spiritual well-being, and psychiatric symptoms for participants using PTR within a peer-led group” (p.43).

The methods used for the study consisted of a single group research design. The participants were divided into six consumer-run organizations (CROs), and the groups met for twelve weeks (p.44). The activities offered in PTR include actively communicating interest and concern, using words and actions to communicate empathy and respect, practicing attending skills, communicating availability, following up on requests, avoiding defensiveness, maintaining a professional manner, answering questions honestly, maintaining a positive attitude, and practicing intentional encouragement (Table 1, p.45). The facilitators were trained to use the PTR approach, provided support, and they were supervised. The individuals were pretested before the PTR group sessions began, and afterwards they received a posttest. The measurements were taken using the Rosenburg Self-Esteem scale, the General Self-Efficacy Scale, Multidimensional Scale of Perceived Social Support, the Spirituality Index of Well-Being, the Modified Colorado Symptom Index, and Paired Hotelling’s T-square test (p.44). There were forty-seven participants in the beginning, but by the end of the study fifteen had dropped out (p.44).

Sadaaki Fukui, Lori J. Davidson, Mark Holter, and Charles Rapp (2010) report that the “Findings revealed statistically significant improvements for PTR participants in self-esteem, self-efficacy, social support, spiritual well-being, and psychiatric symptoms” (p.46). PTR encourages participants to set goals and to achieve them. It also includes activities on social support and spirituality. This type of approach seems to impact the symptoms that the consumers report. The author’s acknowledge that “It may be that the symptoms do not necessarily lessen but the consumer’s reaction to them changes” (p.47). The limitations to the study are: the sample is small, the group was only twelve weeks, it relied on self-report measures, and there was no control group (p.47).

Despite the limitations of the study, the research is promising because it encourages the consumer to actively engage in their care and personal decisions through peer support. It also shows that Recovery is an individual process, and it is influenced by the way the consumer perceives their life. Therefore, PTR arouses consumer’s hopefulness and optimism about their recovery; and reduces the likelihood that individual will feel alone through their recovery, because it provides peer-support.

                                                                 

References

Fukui, S., Davidson, L. J., Holter, M. C., & Rapp, C. A. (2010). Pathways to Recovery (PTR): Impact of Peer-Led Group Participation on Mental Health Recovery Outcomes. Psychiatric Rehabilitation Journal, 34(1), 42-48.

STIGMA: Mental Illness

I am sure that there are times in our life when we can all be sad or blue. In fact, I bet we have all seen movies about a madman and his crime spree, with the underlying cause of mental illness. Perhaps, we might make jokes about people being crazy or nuts, even though we know that we shouldn’t.  But, one of the biggest problems that I see in society is Stigma; specifically, associated with mental illness. Stigma is a sign of disgrace or discredit towards another individual; it is meant to, set that individual apart from others. Stigma can lead to discrimination if the individual suffers unjust or prejudicial treatment because of their mental health diagnosis.  So, what can be done about it?

 First, there needs to be more education on mental illness. We have all had some exposure to mental illness, but do we really understand it or know what it is? A mental illness can be defined as a health condition that changes a person’s thinking, feelings, or behavior. These changes cause the person distress and difficulty in functioning. As with many diseases, mental illness can be severe in some cases and mild in others. Individuals who have a mental illness don’t necessarily look like they are sick; especially, if their illness is mild. There are many different mental illnesses, including: depression, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, and obsessive-compulsive disorder, to name a few. Each of these illnesses will alter the person’s thoughts, feelings, and/or behaviors in distinct ways. These differences can make others feel uncomfortable; and for some people, they don’t like to feel uncomfortable, so they stigmatize or discriminate against the person that is different.

Another step that can be taken to combat stigma, is to stop using the term mental illness and to start using the term neurological disorders. Mental illness infers that the person is mentally ill, but science and technology shows us that there is a biological explanation for both the psychological and physical dimensions associated with a mental health diagnosis.

Did you know that “not all brain diseases are categorized as mental illnesses”?  “Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses” (US Dept. of Health). Interestingly, the lines between mental illnesses and these other brain or neurological disorders is blurring somewhat. The National Institute on Mental Illness reports that “As scientists continue to investigate the brains of people who have mental illnesses, they are learning that mental illness is associated with changes in the brain’s structure, chemistry, and function and that mental illness does indeed have a biological basis. This ongoing research is, in some ways, causing scientists to minimize the distinctions between mental illnesses and these other brain disorders” (US Dept of Health). Let’s look at this?

A healthy brain takes in information, processes it, and causes a response. The US Department of Health describes the process as “The basic functional unit of the brain is the neuron. A neuron is a specialized cell that can produce different actions because of its precise connections with other neurons, sensory receptors, and muscle cells. A typical neuron has four structurally and functionally defined regions: the cell body, dendrites, axons, and the axon terminals”. This description is the way the brain takes in information, processes it, and causes a response is simple. So, why is this important?

            Did you know that “not all brain diseases are categorized as mental illnesses”?  “Disorders such as epilepsy, Parkinson’s disease, and multiple sclerosis are brain disorders, but they are considered neurological diseases rather than mental illnesses,” because Neurons communicate using both electrical signals and chemical messages, when there is a problem with the chemical messages, the neurotransmitters, an individual can develop a mental health diagnosis. But, when there is a problem with the electrical signals an individual can develop epilepsy, Parkinson’s disease, or multiple sclerosis. An example of this would be epilepsy, when a seizure happens there are too many messages that are going around the brain at once, all at the same time. It's as if two different messages are going around the circle at once during a game of telephone. This makes it very likely that the messages are going to get mixed up. During a seizure, the neurons send mixed up messages to your body, so the body does things that you don't want it to (stair off-petite mal, fall to the ground shaking-grand mal). If epilepsy, Parkinson’s disease, and multiple sclerosis can be defined as a brain disorders, then I don’t see why a mental health diagnosis is called a mental illness. 

We can combat stigma by providing education, and by changing the terms that we use to identify a person with a mental health diagnosis from mental illness to neurological disorders. Mental illness infers that the person is mentally ill, but science and technology shows us that there is a biological explanation for both the psychological and physical dimensions associated with a mental health diagnosis. Our society needs to adopt a biological, psychological, and social approach to treating individuals with a mental health diagnosis. By taking this kind of approach, our society can treat the whole person and reduce stigma.

 References

US Department of Health and Human Services. (2012). National Institute on Mental Illness. Retrieved from http://www.nimh.nih.gov/neurological/index.shtml

Cell Phone Etiquette

                Everyone has, probably, seen someone with a cell phone. Do any of these scenarios sound familiar: “Business professional who appears to be talking to themselves in the middle of a crowded room; the car driver talking on a cell phone while attempting to turn a corner; people walking across a busy street with their heads down, rapidly pushing the keys on a smart phone” (Simpson, 2010, p 81). Technology today, allows people to communicate more frequently and with greater ease then in the past. It appears that, “The advancement of communications and online technologies is so rapid that the social conventions in their appropriate or inappropriate use have not always had time to develop before problems have arisen” (Simpson, 2010, p 82). However, there are dangers to “using a mobile phone when driving, among other things, disturbs driving through a diminished field of attention, longer detection times to, e.g., changes in dynamic traffic conditions, longer braking reaction-times to brake lights of preceding vehicles and greater lateral deviations on the road” (Svenson, 2005, p.14). As with anything, there are pros and cons, so what are the consequences to poor cell phone etiquette?

            In order, for people to understand poor cell phone etiquette they need to understand a few terms. A cell phone is: “A mobile phone or mobile (also called cell phone and handphone) is an electronic device used for mobile telecommunications (mobile telephony, text messaging or data transmission) over a cellular network of specialized base stations known as cell sites,” (Cell Phone, 2003). So, what does “Etiquette” mean? It is “a code that governs the expectations of social behavior” Examples of modern day etiquette are:

 

“Modern etiquette codifies social interactions with others, such as: Greeting relatives, friends and acquaintances with warmth and respect, Refraining from insults and prying curiosity, Offering hospitality to guests, Wearing clothing suited to the occasion, Contributing to conversations without dominating them, Offering assistance to those in need, Eating neatly and quietly, Avoiding disturbing others with unnecessary noise, Following established rules of an organization upon becoming a member, Arriving promptly when expected, Comforting the bereaved, Responding to invitations promptly, Accepting gifts or favors with humility and to acknowledge them promptly with thanks (e.g. a thank-you card)” (Etiquette, 2003).

           

Of course, it is important to be safe when using any type of technology device; “Courtesy in the use of technology should also take into consideration whether or not your use is distracting or embarrassing others;” (Simpson, 2010, p. 86) therefore, “using one hand to hold a cell phone while driving a moving vehicle is not a safe practice (Simpson, 2010, p. 82). Cell phones not only allow people to call one another, but it is also a way for user’s to surf the web, read e-mails, and find information. Due to the many uses of a cell phone the line to what is social acceptable and unacceptable is blurred.

This leads to the next point: What behaviors are not appropriate or out of line?  There are many things that each one of us does to keep on task, or keep us busy, and these behaviors are acceptable as long as they are not bothering the people around us. “ What is annoying is the common practice of answering a cell phone call during a meeting or social gathering rather than silencing the phone before it starts” (Simpson, 2010, p. 89). So, simply put: Shut off a cell phone prior to entering into a meeting, convention, restaurant, theatre, and so on so forth. Many students find it necessary to speak on their cell phone, or text, while in school. This has many school boards and educators concerned. Due to these concerns, some school’s have policy’s on cell phone use. Different teachers, instructors, might have different rules, so it is important to find out what they are if you are a student.  

 There is no doubt that inequality exists. There is also no doubt that groups and individuals advance their own interests; this can be seen by the struggle over control of societal resources. It can also be seen through the role of coercion: those who choose to talk and or text because everyone else is doing it. This is a form of peer pressure. Powerful people exploit the idea of peer pressure by designing ads to justify why everyone should have a cell phone. This increases demand, and increases the company’s profit. This increases the cycle of power, money, and capitalism that influence control over the little people in society.

Cell phones are just starting to see social order in society; partly due to the negative impact of cell phones. Cell phones are a distraction to drivers and have increased the number of accidents; in turn, they have caused disorganization among society. Due to this federal laws are being considered, to control the use of cell phones (and texting) while driving. Cell phones started off with a “hands-off approach or laissez-faire” this means that they “assumed that the current arrangement in society were natural and inevitable” (Andersen, 2009, p 14). If an individual has a cell phone great, and if not that is okay, because it is survival of the fittest in our society. It is not hard to understand the reasons why cell phones have become popular: it is due to the social interaction that is seen in society. People behave on what they believe, not on what is objectively true; therefore, cell phones are viewed as a priority despite what is going on around the individual. “People interpret one another’s behavior and it is these interpretations that form the social bond” an example of this is: just as cigarettes were once considered “cool” despite the negative medical consequences; cell phones are the new in for not only teenagers, but for all people (p16-17). Hence, ignoring the thoughts and feelings of those around an individual with a cell phone is a new behavior associated with the cell phone, and this behavior is tolerated as being acceptable because so many people do it.

There are eight causes of social change and technological innovation is one of them. Technological innovation can be the changes that are currently seen with technology devices; such as, the cell phone, the home computer, the laptop, and so on so forth. Technology will continue to expand on the creations of today; to create a better tomorrow. With the new technological advances there will come new concerns and problems. There is no doubt that laws will be passed to limit the dangers that technology will have on others. The problem is that it takes time to see where the dangers lie, and to create laws to protect people from technology. No matter what theory a person believes is right; in regards to cell phones, the fact is using a cell phone while driving is dangerous. So, as with anything, there are pros and cons. Perhaps, we can take into consideration the overall effect our behavior will have on another individual prior to doing it, and that way we will be using positive cell phone etiquette.

 

References

Andersen, M.L. & Taylor, H.F. (2009). Sociology: The Essentials (5th ed.). Belmont, CA: Thomson/Wadswoth

Cell phone. (n.d.) The American Heritage® Dictionary of the English Language, Fourth Edition. (2003). Retrieved March 23 2010 from http://www.thefreedictionary.com/cell+phone

Crapanzano, V. (2001). The Etiquette of Consciousness. Social Research, 68(3), 627-649. Retrieved from

Immigration

Martin Luther King said, “The ultimate measure of a man is not where he stands in moments of comfort and convenience, but where he stands at times of challenge and controversy” (Strength to Love, 1963). Immigrants have been coming to the United States, since 1492 when Columbus sailed the ocean to find a trade route through Asia. Since then, there have been stories of achievement and success, and of failure and terror. Many of the issues that trigger the stories of failure and terror can be related to fear, which leads to discrimination and harassment. For this case study, I have decided to look at the role of Human Service Leaders when it comes to multicultural issues. In Clinton County 92.9% of the population is white, 4.2% is black, .4% is American Indian, 1.2% is Asian, 2.6% Hispanic, and there are no native Hawaiian and other Pacific Islander persons (Census Statistics, p.1). Compared to other counties, our county, is less multicultural. As Human Service Leaders, we should strive to understand immigration, discrimination, and harassment, because the demographics in the United States are changing (and because we have the power to make a difference).

A person can be discriminated or harassed because of their race, religion, ethnicity, economic status, gender, age, sexual orientation, or physical ability. For individuals in the human service field we are governed by a code of ethics. Most organizations have policies on employee’s refraining from any sort of discrimination and harassment. The NASW code of ethics states, “Social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color sex sexual orientation, age, marital status, political belief, religion, or mental or physical disability” (Manning, 2003, p.295-6). Statement 17 of the Ethical Standards for Human Service Professionals is very similar to the NASW code of ethics. Human Service Leaders need to promote a work environment that is free from discrimination and harassment, so that clients cannot only learn by their example, but so they can feel comfortable coming in for services. This can be accomplished by management setting an example of what behavior is appropriate, and they can provide training and assistance to stop (put an end to) behaviors that are inappropriate.

Human Service Leaders can help their clients, families, by asking questions and offering support. For example, are both parent’s immigrants or just one, because it appears that it is harder for families when both parents are immigrants. They have to learn the language and culture alone (normally with less supports). An example of cultural differences is: families from Italy tend to openly express affection and warmth. But, families in Britain are more orderly and polite, so an individual might feel out of place because they are confused with the customs’ of the cultures. When families migrate, they face major challenges. Suddenly they are surrounded by people whose language, culture, and clothing is different from their own. Now they stand out in a crowd, and people fear other people that are different. As a result, they may be treated disrespectfully; and in time, they may have become victims of prejudice. A few of the challenges that immigrants face are: ridicule, an identity crisis, a culture gap, a language barrier, and so on so forth. So, what can we do?

The role of a Human Service Leader is to advance “Action and reform” in order to improve the social sector of society. This is contradictory to the roles of the United States Government and most organizations which promote “Conformity and compliance.” These unrelated roles can blur the boundaries between helping and harming members of society (p.5).  The Human Service Leader is responsible to the community and to society. But, the ethical starting point is the leader, it is us, as leaders we have our own ethical morals and values and our actions/behaviors will speak to our standards (Manning, 2003, p.16). We need to make a conscious effort to promote a personal, work, and living environment that supports all people. Martin Luther King, made a good point when he said, “Nonviolence means avoiding not only external physical violence but also internal violence of spirit. You not only refuse to shoot a man, but you refuse to hate him.”

Two things to remember:

1.                       How to view ridicule: no matter what you do, you are never going to be popular with everyone. People who enjoy ridiculing others will always find an excuse to do so. So don’t waste your breath trying to correct their prejudiced views. Prejudiced comments only expose the speaker’s ignorance, not the victim’s so-called faults. This does not mean that you should always be silent, because in some instances silence can mean that you condone what is being said.

2.                       How to view cultural background; as a barrier that divides one from others, or as a bridge that links one to others? When an individual is familiar with two cultures, and they can speak two or more languages, then they have a real advantage. Their knowledge of the two cultures increases their ability to understand people’s feelings and to answer some of the questions that they may have. The individual’s circumstances are an advantage rather than a liability. It’s important to  view cultural background as a bridge that connects people together rather than a barrier.

It is important for Human Service Leaders to continually look forward and grow. There is no reason that Leaders have to reinvent the wheel, because there are a number of publications out there that can help them expand on their knowledge, and help them make plans to grow and set the example for other. Moral Vision provides individuals with the tools necessary to overcome or endure the trials/problems that the individual is facing.

I believe that it is important for Human Service leaders to take care of themselves, because the work that they do can be both mentally and physically draining (it can be compared to the work done by Social Workers). Dr. Sarah Wendt explains that “Working as a social worker or teacher can be challenging. These social care professionals can be regularly exposed to conflict, poverty, trauma and tragedy as part of their work responsibilities.” A lack of goals, ambition, and drive can cause an individual to become complacent. Dr. Wendt goes on to explain that “Social workers and teachers often have poorer psychological and physical health, as well as lower job satisfaction levels, than professionals working in many other occupations,” so it is important for people in these types of fields to take care of themselves (p. 317).

Human Service Leaders need to pay attention to their moral vision, because if they don’t there values of what they will and won’t do might be blurred. For example, this could lead to an individual conforming to a discriminating view point and condoning racial jokes.  A deep self-awareness enables professionals to balance their personal and professional lives. In doing so, they will be able to maintain a balance between their personal life and professional life.

References

Council for Standards in Human Service Education adopted 1996. Ethical Standards for Human Service Professionals. Retrieved September 4, 2012, from http://www.nationalhumanservices.org/ethical-standards-for-hs-professionals.

Manning, Susan. (2003). Ethical Leadership in Human Services: A Multi-Dimensional Approach. Pearson, Allyn and Beacon, New York.

US Department of Commerce. (2012). Census Statistics. Census Chart. Doi: http://quickfacts.census.gov/qfd/states/36/36019.html

Wendt, S., Tuckey, M. R., & Prosser, B. (2011). Thriving, not just surviving, in emotionally demanding fields of practice. Health & Social Care In The Community, 19(3), 317-325. doi:10.1111/j.1365

Children with Multiple Mental Illness Diagnoses

This reaction paper is based on a newspaper article from the New York Times. The media piece covers the trials and problems that surround a family that has a child with multiple diagnoses. At the time the article was written, in 2006, Haley was ten and diagnosed with “bipolar disorder with psychotic features, obsessive-compulsive disorder, generalized anxiety disorder and Tourette’s syndrome;” the family explains how the illness “dominates every moment, every relationship, and every decision.”

The Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) diagnostic criteria for bipolar disorder is “the essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of one or more Manic Episodes or Mixed Episodes. The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode” (American Psychiatric Association).

The American Psychiatric Association defines OCD :

 “As the presence of obsessions, compulsions, or both. Obsessions are defined by (1) and (2) as follows: 1. Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and cause marked anxiety and distress. 2. The person attempts to suppress or ignore such thoughts, impulses, or images or to neutralize them with some other thought or action. Compulsions are defined by (1) and (2) as follows: 1. Repetitive behaviors (eg, hand washing, ordering, checking) or mental acts (eg, praying, counting, repeating words silently) in response to an obsession or according to rules that must be applied rigidly. 2. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a way that could realistically neutralize or prevent whatever they are meant to address, or they are clearly excessive.”

The Diagnostic and Statistical Manual of Mental Disorders provides the following diagnosis of Generalized Anxiety Disorder (GAD):

“A. At least 6 months of "excessive anxiety and worry" about a variety of events and situations. Generally, "excessive" can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically corresponds to the situation. B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met. C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms: 1. Feeling wound-up, tense, or restless, 2. Easily becoming fatigued or worn-out, 3. Concentration problems
4. Irritability, 5. Significant tension in muscles.”

The Diagnostic and Statistical Manual of Mental Disorders provides the following diagnosis of Tourette Syndrome (TS), for a person to be diagnosed with TS, he or she must:

“1. Have both multiple motor tics (for example, blinking or shrugging the shoulders) and vocal tics (for example, humming, clearing the throat, or yelling out a word or phrase), although they might not always happen at the same time. 2. Have had tics for at least a year. The tics can occur many times a day (usually in bouts) nearly every day, or off and on. 3. Have tips that begin before he or she is 18 years of age. 4. Have symptoms that are not due to taking medicine or other drugs or due to having another medical condition (for example, seizures, Huntington disease, or post viral encephalitis).”

Having a diagnosis is an answer, for the families, but it rarely makes the symptoms go away. After the diagnosis, the battle begins to find the right amount of medication. However, over time the patient can adapt to the medicine and the trial and error of finding a medication will begin again.

The article did a good explaining that some friends and relative members might stay away from the family because the behaviors of the child make them feel uncomfortable, and people fear what they do not know. Haley tries to hold herself together while she is at school, but when she gets home she often can’t hold herself together, so her family feels the brunt of her behaviors.

 The article also described the feelings that parents can have of “guilt, anger, and helplessness, and that siblings can feel “neglected, resentful or pressure to be problem-free themselves.” There is normally a financial strain on parents that have a child with multiple mental health diagnoses because of the care and attention that they need. In this case, the mother lost her job because she needed to take off to take care of her daughter, but the family really needed the income.

This article is useful to all individuals, because mental illness effects one out of every four people. The descriptions described in the article help individuals to understand what it is like to have a mental diagnosis, and it describes the effect that diagnosis has on the whole family. The article was written in 2006; and as a society, we have a long way to go to decrease the stigma that surrounds individuals with a mental health diagnosis.

 

References

Belluck, Pam (2013). Living with Love, Chaos, and Haley. New York Times. Doi: http://www.nytimes.com/2006/10/22/health/22kids.html?_r=0

American Psychiatric Association. (2013). DSM-IV TR. Doi: http://www.psychiatry.org/practice/dsm/dsm-iv-tr