Healthcare Assignment: Treatment Report on a Client

Question

Task: Case Study for Healthcare Assignment
Name: Talaihla Smith
Date of Birth: 12.07.2006
Talaihla was brought to a local emergency department on an emergency examination authority (Queensland) after consuming a quantity of pills from the bathroom cabinet. She lives with her mother, Karen, and younger brother, Zane, who is nine years old, has behavioural problems and is probably on the autistic spectrum. Talaihla's parents separated when she was nine years old. Her father re-partnered and moved interstate with his new family. Talaihla doesn't hear from him often but does spend holidays with him. The night of the overdose was unexceptional. Karen finished up at Spm from her disability support job and picked up Zane from after school care. Talaihla was in her room when Karen and Zane got home, which was not unusual. She refused to come out for dinner. Talaihla was still angry that her mother had refused to allow her to go a party on a school night earlier in the week. She did come out of her room at 9pm and had a snack Talaihla posted a picture of a handful of pills and a goodbye message on Instagram around 10pm, and a concerned school friend rang karen. Talaihla acknowledged she had taken an overdose, and Karen rang the ambulance. Talalhla refused to talk to the ambulance crew.

Whilst Talaihla was medically cleared by toxicology, she was not cooperative with the triage nurse. She was more forthcoming with you, the acute care team worker. She disclosed that she had started cutting herself on the thighs some six months ago after an incident at a party, which she didn't want to discuss. She said that life really sucked since she started high school. She volunteered that she really hated her body and that everyone thought she was fat and ugly. She won't eat lunch at school and frequently skips dinner. She has recently started making herself vomit after she sneaks out to the refrigerator late at night and eats too much.

She said that a boy had asked her to a party earlier in the week, and she wasn't allowed to go. She sawa picture of him kissing another girl on social media, and then, she decided to kill herself. She occasionally thinks about suicide as everyone talks about it, and a girl who used to be her best friend earlier in the year told her she should go and do it. She hadn't, however, formulated any clear plan.

Analyse the above case study and describe how you would assess and mitigate risk of self-harm, suicide or other risks.

Treatment Plan:
• Outline a plan that will enable the individual to be safely discharged and include recommendations for follow-up and support.
• Outline a prescription for lifestyle advice to enhance the young person’s wellbeing. Letter:
• Write a letter to the individual’s general practitioner (cc appropriate agencies), provide a discharge summary and summarise your follow-up again.
You have been asked to provide a treatment report on a client (A child or adolescent) that can be used in referral or handover. The report can either be based on a previous or current client. The report must contain the following section

1)Background
2)Formulation
3)Treatment plan
4)Letter to Gp.

Answer

Background:
As per the case scenario analysed in this healthcare assignment, 15 years old Talaihla Smith was bought to the emergency department of a local hospital after she attempted suicide after taking a quantity of pills. She stays with her mother, Karen and a younger brother, Zane. It is important to mention that Zane has behavioural issues. In addition to that, he has signs of autism. Talaihla’s parents separated almost six years ago. She doesn’t hear frequently from his father, however, they spend vacations together.

We have been notified that Talaihla has self-loathing tendencies and she hated her body. Everyone thought that she is fat and ugly. This left an impression of excessive consciousness about her body, and which in turn made follow an unhealthy eating pattern. She often skips meals, especially during lunch and dinner. She sometimes eats too much late at night. Recently, due to her overly conscious attitudes towards her body, she happens to vomit after eating too much.

Her self-loathing attitudes had taken a sharp turn as she developed self-harming and suicidal behaviour. Her self-harming behaviour was triggered as she found out that the boy she likes has kissed another girl and posted a photo the same on social media. In addition, she was angry and refused to eat dinner as her mother didn’t allow her to go to a party which that boy will be attending. She tried to kill herself that night. In addition, her habit of eating late at night indicates that she has irregular sleeping pattern. We found no history of substance abuse by the patient. We do not know whether the patient has smoking or drinking habits.

Formulation:
Self-dissatisfaction in adolescence:
Self-dissatisfaction is banal among the adolescents. Occasional anger and angst is very frequent during this time and often can erupt because of self-dissatisfaction. However, if anger persists, it can again fuel self-destructive behaviours, rendering the person in a vicious cycle of anger and self-loath. Self-destructive behaviour can rise from body-shaming and poor body-image which further leads to unhappiness and overly self-conscious tendencies(Pickhardt, 2013).

It has been noted that the self-destructive behaviour during the time of adolescence stems from four sources, they are mentioned and elaborated below:

• The process of adolescence:
The process of adolescence often causes dissatisfaction. It onsets with a separation from a close one, may be a family member or one of the parents or both. It usually begins around the age of nine to thirteen. The background of our patient perfectly aligns with this timeline. Her parents started to love apart after a divorce, when the girl was exactly nine years old(Pickhardt, 2013).

• Changes in motivation:
The change of motivation takes place, when boy or a girl who is in the stage of adolescent, is being told or instructed what to do and what not to. Our patient’s mother didn’t allow her to go to the party with his friends (which stopped her from meeting the boy he likes) and this lead to more dissatisfaction.

The girl might have thought that her choices are not being respected and admired(Pickhardt, 2013).

• Peer Pressure:
Our patient believes that everyone thinks she is ugly and fat. This thought left her in a peer –pressure(Pickhardt, 2013). She has started to hare herself and hate her body. This condition was further fuelled and aggravated as she found out that the boy she likes has kissed another girl. The latter will not only make her feel jealous, her jealousy will make her feel unwanted, unloved, and undesirable.
• Demanding parents:
This is one of the serious reasons that render the young people hate themselves. However, we were not reported regarding the same in case of our patients.

Dissatisfaction and self-harming behaviour:
Dissatisfaction about oneself often leads to self-destructive behaviour. This often occurs from the conflict between and the differences from reality and private experience and belief(Pickhardt, 2013). The reality is often influenced by family and social issues, as well as changing times and cultures. It is important to note that the destructive tendency of harming oneself is often depressive and neurobiological. It has been noticed in one cohort study that, the girls in adolescence show high impulsivity scores. They tend to focus themselves and seek independence, as well as gratification. When our patient was prevented from attending the party, she thought that her independence is being snatched away or her choices are not being respected and admired(Shek& Yu, 2012). When she left a goodbye message on instagram before committing suicide, she was actually seeking attention from her Instagram followers and friends. We can conclude that this behaviour of self-destructionis regulative. In addition to that they are organized to give importance, validation and power. It can also lead to narcissistic behaviour. In addition, it has been noted that frequent suicide attempts may also be regarded as a way to regulate one’s mood and tackling the inner unrest and distress. While tackling their inner fomentation, they do not tend to seek help from others in most cases and prevent themselves from taking social support. It is important to mention that, our patient’s goodbye message on Instagram was meant to seek validation. It was not a cry for help from her followers and friends. Study reveals that in such cases, self-expression might appear as weakness, loneliness, the need for intimacy. In this context, we can mention that this aggressive behaviour towards their own selves opens them to a frequent sanction. This probably happens to continuously fight against their inner fomentations, as well as to secure their power and importance as a result of their unstable self-image(Shek& Yu, 2012). It is important to remember that one’s surrounding environment often influences the form of self-destruction. In conclusion, self-hatred, self-consciousness, loneliness, seeking love and wanting to be admired is directly linked with suicidal ideation.

Treatment Plan:
Primary Steps to be taken during and after discharge:
It is recommendable to not keep any sharp object near the patient. So that the patient cannot harm herself. It is necessary to address the self-harming tendencies by the patients. The self-harming and suicidal behaviours include cutting the skin with sharp objects, trying to hang herself from the rope, trying to take pills or poisonous substances, biting herself, hitting herself with any object, slapping herself, trying to put herself on fire etc. The self-harming behaviour might also include alcohol consumption, smoking, substance abuse, having an unhealthy lifestyle, etc.

Recommendations for follow ups and supports:
How Karen can help her daughter in getting better:
• Adolescence is a crucial time of emotional, psychological and physical growth. It is important for Karen to understand what an adolescent girl go through during such changes (Klaus et al., 2009; Kushal et al., 2021).
• The teens need more attention, affection and positive behaviour from their parents(Klaus et al., 2009).
• It has been noticed that kids and teenagers who find affection from their parents and hear kind words from them, show lower suicide rate or even low tendency of suicidal ideation(Kang et al., 2017).
• It is necessary for Karen to spend more time with her daughter. Spending quality time is important. They can start with doing household chores together or going to the groceries and supermarket. They can even go out with together sometimes during holidays and weekends(Kushal et al., 2021)
• Karen should keep the door open for her daughter, whenever her daughter feels unloved, unwanted, or if she shows self-destructive or self-loathing behaviours.
• Helping her daughter in positive stress management. Help her daughter to identify the feelings and talk about them. Speaking lessens the burden from the shoulder.
• Make her daughter realize the short and long-term costs of self-harm.
• Helping her build better social skill(Kushal et al., 2021).
• Soothe her daughter’s mind in non-injurious (both physically and mentally) and positive way(Kang et al., 2017).
• Respecting her daughter’s boundaries and choices.
• Encouraging her daughter to take her own decision and letting her know when she makes a poor choice or takes a bad decision. It is also necessary for Karen make her daughter realise why and when a decision is bad or poor and how it will impact her and others lives in a short and long run(Kushal et al., 2021).

Lifestyle advice to improve patient’s wellbeing:
What the patient can do:
• Build better social skill and better communication skills("Self-Injury In Adolescents", 2021).
• Speaking about what she is feeling.
• Practicing self-love and self-care.
• She should start journaling on a daily basis("Self-Injury In Adolescents", 2021).
• Involvement in creative activities helps to overcome self-loathing and self-harming tendencies. Practicing artworks, drawing or taking a music or dance class are significant way to overcome self-hatred and self-destructive thoughts("Self-Injury In Adolescents", 2021).

• It is necessary for the patient to practice yoga or another physical workout. In addition to that, the patient must practice breathing exercise regularly. Practicing breathing exercise during anger, angst, mental breakdown helps to elevate the condition("Self-Injury In Adolescents", 2021).

The Role of Cognitive Behavioural Therapy (CBT) to lessen suicidal tendency:
• Cognitive behavioural therapy or CBT increases coping skills that have both healthy long-term and short-term effects(Spirito et al., 2011).
• At the same time, CBT improves interpersonal relationships, problem solving skills. Such problems are often related to family and society. Some of the CBT protocols are designed in a way, that they will teach the patients in improving the skills to tolerate distress, regulate their emotions, and increase inter-personal relationships(Spirito et al., 2011).

• CBT encourages the involvement in enjoyable positive activities. It teaches an individual self-love and self-care(Spirito et al., 2011).
• Cognitive behavioural therapy focuses on schemas that are challenging. It also emphasizes automatic thoughts and getting rid of cognitive distortions(Spirito et al., 2011).

• In addition to that, CBT in adolescents - who are suffering from loneliness, lack of self-love and self-care, self-loathing behaviours – helps to create and maintain healthy relationship with family members, friends and society(Spirito et al., 2011).

• Participants in cognitive behavioural therapy has displayed better coping skills with depression, major depressive disorder (MDD), anxiety, anger issues and loneliness(Spirito et al., 2011).

• Study shows that adolescent participants of cognitive behavioural therapy have shown lesser tendency to commit suicide. It is important to note that those participants already had suicidal tendency and plans on how to commit suicide(Spirito et al., 2011).

• Overall, cognitive behavioural therapy helps in cognitive restructuring by improving brain plasticity (Månsson et al., 2016).

Letter to the individual’s general practitioner:
To,
Dr. George Paul,
General Practitioner,
Designation: xyz,
Address: abc,

Sir,
I hope you are doing well. I am writing to you to let you know that Talaihla Smith, a fifteen year old girl tried to commit suicide by taking quantitative amount of pills. She had been admitted to the emergency section of the local hospital. It is important to mention that she has self-harming and suicidal tendency and needs close surveillance after her discharge from the hospital emergency section. She stays with her mother, Karen and a younger brother, Zane.

Talaihla’s parents separated almost six years ago. She doesn’t hear frequently from his father, however, they spend vacations together. Talaihla has self-loathing tendencies and she hated her body. Her self-harming behaviour was triggered as she found out that the boy she likes has kissed another girl and posted a photo the same on social media. In addition, she was angry and refused to eat dinner as her mother didn’t allow her to go to a party which that boy will be attending. She tried to kill herself that night.

We have prescribed cognitive behavioural therapy to improve her social skill, behaviours, and lifestyle. We hope that CBT will significantly improve her coping skills that have both healthy long-term and short-term effects. We are anticipating that CBT will improve her interpersonal relationships, problem solving skills related to family and society. It will also improve her skills to tolerate distress, regulate their emotions, and increase inter-personal relationships.

We recommend that the CBT for our patient must be designed in such a way that it will emphasize automatic thoughts and getting rid of cognitive distortions. Participants in cognitive behavioural therapy has displayed better coping skills with depression, major depressive disorder (MDD), anxiety, anger issues and loneliness. We expect the same for our patient.

With regards,
Dr. Miss Jane Stuart,
Designation: ABC
Address: XYZ

References
Kang, B., Kang, J., Park, H., Cho, Y., Hur, Y., &Sim, W. et al. (2017).The Mediating Role of Parental Support in the Relationship between Life Stress and Suicidal Ideation among Middle School Students. Korean Journal Of Family Medicine, 38(4), 213. https://doi.org/10.4082/kjfm.2017.38.4.213
Klaus, N., Mobilio, A., & King, C. (2009).Parent–Adolescent Agreement Concerning Adolescents' Suicidal Thoughts and Behaviors. Journal Of Clinical Child & Adolescent Psychology, 38(2), 245-255. https://doi.org/10.1080/15374410802698412
Kushal, S., Amin, Y., Reza, S., &Shawon, M. (2021). Parent-adolescent relationships and their associations with adolescent suicidal behaviours: Secondary analysis of data from 52 countries using the Global School-based Health Survey.Healthcare assignment Eclinicalmedicine, 31, 100691. https://doi.org/10.1016/j.eclinm.2020.100691
Månsson, K., Salami, A., Frick, A., Carlbring, P., Andersson, G., Furmark, T., &Boraxbekk, C. (2016).Neuroplasticity in response to cognitive behavior therapy for social anxiety disorder. Translational Psychiatry, 6(2), e727-e727. https://doi.org/10.1038/tp.2015.218
Pickhardt, C. (2013). Adolescence and Self-Dissatisfaction.Psychology Today.Retrieved 24 November 2021, from https://www.psychologytoday.com/us/blog/surviving-your-childs-adolescence/201301/adolescence-and-self-dissatisfaction.
Self-Injury In Adolescents. Aacap.org. (2021).Retrieved 24 November 2021, from https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Self-Injury-In-Adolescents-073.aspx.
Shek, D., & Yu, L. (2012). Self-Harm and Suicidal Behaviors in Hong Kong Adolescents: Prevalence and Psychosocial Correlates. The Scientific World Journal, 2012, 1-14. https://doi.org/10.1100/2012/932540
Spirito, A., Esposito-Smythers, C., Wolff, J., &Uhl, K. (2011).Cognitive-Behavioral Therapy for Adolescent Depression and Suicidality. Child And Adolescent Psychiatric Clinics Of North America, 20(2), 191-204. https://doi.org/10.1016/j.chc.2011.01.012