CBT therapy
MHR 3001 Assignment
Students will be required to address any two of the case scenarios covering the following areas:
Acute mental health conditions and effective engagement
Personality disorder and deliberate self-harm
Dementia care and family interventions
Problematic substance use and physical health
Each essay will have a limit of 2000 words (+/- 10%) and will be equally weighted (50% each)
Module Learning Outcomes
On successful completion of this module the student will be able to
Critically review key mental health conditions and contemporary interventions that demonstrate ethical and value based practice when working with mental health service users
Critically evaluate the influence that stigma can have on mental health recovery
Demonstrate critical understanding of the key service models and appreciate the principles of inter and intra professional practice
Demonstrate understanding of best practice when working together (with service users, carers, the family, others) to recovery.
Critically review the law as its applies in a mental health context (common law; Mental Capacity Act, 2005; Mental Health Act 1983, 2007)
With reference to the chosen two case scenarios address the following areas:
A critical overview of your chosen mental health condition (including reference to aetiology, symptoms and diagnostic criteria) (L/O 1)
A critical review of evidence based interventions for your chosen case study (L/O 1, L/O 3)
The impact of stigma for clients with mental health problems and how this can be addressed (L/O 2)
The role of services and professionals in the recovery process in partnership with mental health service users (L/O 1, L/O 3, L/O 4)
An application of the legal framework in which care is provided for your chosen case study. (L/O 5)
Your answers should refer to the particular case scenario – and reference a range of current academic sources, including appropriate national clinical guidelines.
Scenario 1: Joseph
Acute mental health conditions and effective engagement
Joseph is 19 years old; he is a Geography student in his first year at university. Joseph has been referred to the early intervention service by his GP after he attended the surgery in the company of a family friend who is concerned about recent changes in his behaviour.
Joseph says he’s been having ‘weird experiences’ that have become increasingly more common over the last few weeks. Joseph describes hearing voices which were pleasant at first and easy to ignore but recently they have become more distressing and they preoccupy him. Joseph has started to spend lots of time on his own and says he avoids his friends because he can’t talk to them about what’s happening. He is worried that they won’t understand him and will think that he is mad.
Joseph agrees his behaviour has changed but says he’s just ‘growing up’ and does not like ‘partying’ as much as he used to; he prefers to stay in his university halls room alone listening to music on his iPod and smoking cannabis. He has done this for the past few years and describes it as relaxing him. Joseph plays the guitar to a high standard and composes songs, however he seems to have stopped and he is finding it hard to motivate himself. He has been missing a lot of lectures at university and is worried about getting in trouble about his course.
Joseph is concerned about his situation but doesn’t know what else to do about the exam stress and the voices. He reports that recently he has begun to feel like people are out there to get him and does not feel safe outside his room. Joseph has had thoughts about killing himself in the past but says that’s not happening at the moment.
In addition to the criteria/ areas to be addressed: please ensure you consider the importance of effective engagement when working with people who have acute mental health conditions.
Scenario 2: Chloe
Problematic substance use and physical health
Chloe is a 35-year-old legal secretary who for the past ten days has had very little sleep, and has been constantly active. She recently told a group of friends that she did not menstruate because she was a “of a third sex, a gender above the human sexes.” When her friends questioned her on this, she explained that she has special powers so that she can give birth without having sex.
Chloe has experienced two similar previous episodes like this both alternating with periods of intense depression when she could not bring herself to go to her work. When she feels low she can’t sleep, loses her appetite and struggles to concentrate. At her lowest points Chloe thought about killing herself by walking into the sea or to jump from the top of a building. Chloe has previously said she is concerned about her heavy drinking (7+ bottles of wine a week) as she feels this affects her ability to function at work and has in the past remained abstinent for short periods (up to 2 weeks).
Chloe is worried that she will forget the ideas she is having and has started to write notes to herself everywhere; in her notebooks, on her computer and on the walls of her bedroom. Chloe’s family and friends, who have always known her to be extremely tidy and organised, have been upset to find her flat in total disorder.
Chloe has told her family that her new ideas will change the world and feels that she needs to share them with the “people who will listen”. She has been spending long periods of time over the last 5 days out of her flat and in pubs and wine bars frequented by barristers and solicitors. During this time she reports having used cocaine and alcohol most evenings whilst out however denies she has substance use issues saying it is helping her creativity. Her friends and family are concerned that she may not be returning to her own flat at night and are unsure if she is staying overnight in strangers apartments. This behaviour is very out of character and they are worried.
Scenario 3: Belinda
Personality disorder and deliberate self-harm
Belinda is a 27 year old woman, who has been known to the mental health services since the age of 17. Her presentation has changed very little in ten years. Belinda has frequent uncontrolled outbursts of anger, following which she often says she feels empty and bored. She is currently unemployed and she is often in debt, and impulsively spends money. She lives in a housing association flat with her mother, who contacted the Home Treatment Team because her daughter was threatening to throw herself in front of a bus.
Belinda cuts her arms, thighs and torso. She has also taken repeated overdoses of medication. She was sexually abused as a child by her father, who is serving a prison sentence. Her mother has a history of depression. Belinda has a difficult relationship with her mother, who she sometimes is very dependent on and at other times appears very angry with. Her mother is critical of her daughter’s lifestyle of heavy drinking, substance use and having multiple sexual partners. This leads to heated arguments and sometimes physically aggressive fights between them.
Belinda says that she wants to get married and forms very intense short-term relationships with men which break down quickly. Following relationship breakdowns, she often makes spontaneous, seemingly irrational decisions, for example stealing steaks from a local supermarket, or taking a train to Scotland with no money (she lives in London).Belinda is in distress as her mother has suggested that she should find a flat of her own and move out. She says that her mother is cruel and she needs her.. She tells the team that her mother has always wanted to get rid of her, and she begs them to persuade her mother not to throw her out.
In addition to the criteria/ areas to be addressed: please ensure you consider in relation to the case study relationship between Personality Disorder and deliberate self-harm.
Scenario 4:
Dementia care and family interventions
Myra is an 83 years old woman. Myra has Alzheimer’s dementia and is in residential care. Her parents died when she was young and her husband, Sydney, died ten years ago. She has two children (Trevor and Jean) and eight grandchildren, although contact with them has steadily decreased as her condition deteriorated. Concerns were initially raised 2 years ago when Myra was found wandering 3 miles from her own house in the early hours of the morning. She was unable to find her way home and was dressed only in her nightdress and slippers.
Myra had previously worked as a veterinarian; her passion for animals is evident in the range of pets (dogs, cats and budgerigars) that she and Sydney had kept at their house. Myra is keen on outdoor pursuits and had with her husband been a member of a rambling club. She has always enjoyed meeting other people and had a very active social life. When not engaged in these activities she enjoyed word puzzles and crosswords as a way of “keeping my mind sharp”.
Myra has fluctuating periods of lucidity and confusion, becoming extremely distressed when she is more aware of her deteriorating cognition (on one occasion she was found by healthcare staff screaming and swearing). She has stopped getting involved with activities and having poor concentration / confused thinking finds crosswords and other puzzles very difficult.
Her mobility has become poor over the last 2 weeks and she has fallen on a number of occasions. She is also periodically incontinent (sometimes doubly) and is distressed and confused. She rarely leaves the residential home and seldom has visits from her family, partly as they are an upsetting experience for all concerned. Her family report feeling helpless to help her and struggle to “find the person they know” when visiting.
On one occasion when she was asked to come to the table for her meal, Myra became very confused, crying out and asking for her mother a bank member of staff used a Reality Orientation approach told her that she couldn’t help her because her Mum had died.
