• Subject Name : Nursing

Optimal Network for Patients with Severe Mental Illness

Introduction to ASSIST Tool Assessment

There is a close relation between mental illness and substance abuse. Both mental illness as well as substance abuse can affect the development of an individual. Studies have shown that more than 50 % of people who are under the influence of one or the other type of substance abuse, are more prone to develop any of the mental illness in their lifetime (Susukida, 2016). The dosage intake also governs as to how fast the mental illness will develop in the person. These addictions to various substances, tends to rise with the progression of the mental health related issues. The same is shown to have a lager impact in terms of detrimental effects on an individual’s personal as well a social life. To deal with such patients can also be seen a challenging task. Not only there is a difficulty in implementing the treatment modalities on them, but the chances of improvement and fetching better healthcare outcomes are also comparatively less.

There is also a bit hinderance observed in encouraging these individuals in keeping focused on their treatment plan. There is a higher rate of non-adherence in such patients due to lack of focus and positivity. This can also be seen as another attributing factor to getting reduced healthcare outcomes from patients, opposite to as anticipated. In order to manage these situations in a more methodical manner, it is imperative to identify for the factors that are a direct contributed to this pattern observed in individuals suffering from mental illness (Han, 2017). Model of change can be an effective and well-structured approach that can be used in these patients, to analyze the situation better and to enhance the chances of fetching positive healthcare outcomes, post implementation of various healthcare strategies.

Case Study on ASSIST Tool Assessment

The patient in the given case scenario is a 30-year-old veteran who has been diagnosed with schizophrenia, depression, Post-traumatic stress disorder, anxiety and poly-substance use disorder. The patient was engaged in war for 5 years. He got enrolled at an early age, right outside of school. During his tenure in Iraq, he underwent many traumatic experiences that were too strong for him to digest emotionally. It had a great impact on his activities of daily living and when he got back home, he started having auditory as well as visual hallucinations. He has been under vigil for past 8 months now. He is having major withdrawal symptoms as he was on cocaine and other drugs abuse. He is having issues with his medication adherence and is compliant with the healthcare team on an on/off basis. The patient at present however, shows no signs of violence and doesn’t even have any suicidal ideation. He is now can be classified in to moderate category, however, is still not fit to be released back to his normal daily routine. His healthcare team is quite concerned for him and is working on treatment intervention and plan to help him get back to his activities of daily routine, as normal as possible.

Model of Change

Model of change was formulated by Prochaska, to help the clinicians in identifying the issues related to substance abuse in individuals, through the method of analysis of a cyclic phase observed in them (Julien, 2016). This was mainly helpful for developing a specific intervention plan and treatment model for these patients and thus, helping them to get free of these addictions. The plan also has a termination phase which is marked by completion of the treatment of the patient, establishing him fully recovered. As the gravity of impairment is more with mental health tagged along with substance abuse, patients are rarely observed to get to this destination in their treatment phase. The end results can be positive as well as negative.

The use of ASSIST tool reflected on the various drugs that are being abused by Mr. Jones. He is willing to get rid of his habit and therefore, can be stated to be in a contemplation stage (Smith, 2017). The tool also identified that the patient is currently at a moderate risk due to his behavioral choices. He is also well-aware of the fact that in order to be released back to his normal life style he needs to get rid of his addiction completely. The stage of contemplation is a state where a patient is aware of the treatment but does not trust himself whether he will be diligent with the treatment plan or not. They might have mixed feelings on whether they will be able to manage their condition or not. This dilemma is also one of the major hurdles as to why patients fail to move from contemplation stage to action stage.

Patient Goals

The patient is the case study is reluctant to completely stop using any substance. He states that taking these drugs along with the medications prescribed for his mental health are useful for the patient in providing him ease for his auditory as well as visual symptoms. He is also aware that failing to stop using these drugs, he might not be released back to his normal routine. The ASSIST tool has revealed that the patient is at moderate risk. The patient can therefore be tapered off from few of his medications to reduce the detrimental effects on his health (Lorant, 2017). He can also be weaned off from these drugs, with in the facility only to evaluate for the adverse signs and symptoms, so that he can be managed accordingly before being released. It is imperative that the rehabilitation plan also includes providing treatment to correct for the cognitive disabilities the patient might have developed due to mental illness tagged along with substance abuse. This is important to promote a sense of independence as well as enhanced decision- making capacity (Hamann, 2016).The patient has been through multiple and severe traumatic experiences. The use of drugs makes him forget the unbearable pain and also helps him in calming down a bit. Therefore, interventions which will be focused on helping the patient with his traumatic experiences will also be useful in helping the patient from weaning off these substance abuse. These traumatic events can be observed as a trigger for the patient, encouraging him for substance abuse and as the only way out of his miseries.

Care Plan

The best possible care plan for the patient can be motivational interviewing.This will help the clinician in providing a patient centered care approach (Zisman, 2017). This process will also enable patient’s autonomy and will thus ensure equal and positive participation of the patient.This will also be helpful for the patient to reflect back on his own reasons as to why he needs this change in his habit. The therapist can encourage the patient by providing him with detailed information about substance abuse and the repercussions or the same, if the patient prolongs it addiction, especially at this young age. This method can be self-motivating for the patient as it will enable him to evaluate for his own driving factors that might help in promoting his interest in the treatment care plan. This therapy has been shown to be fruitful in both cases of mental illness issues as well as substance abuse (Osei, 2017).

This therapy mainly provides an effective treatment method that can be used to promote the desire for change in patients and is thus, helpful in maintaining their engagement in the process religiously. This is to be carried out in most professional manner possible as the patient himself is not aware of his current situation and does not have a clear state of mind as well as decision-making. It is not only used to provide the patient the required counselling, but is also helpful in providing the patient a clear pathway and a clear picture as to where the treatment plan leads to interms of progress (Shannon, 2019).It is also useful for the patient in our case study as it will help him inestablishing in his social circle with an ease. This will also be helpful in decreasing the impact of potential harms such as suicidal ideation, death from drug overdose and so on.

Conclusion on ASSIST Tool Assessment

The paper helped largely in identifying the connecting links between the presence of habit of substance abuse and patients diagnosed with one or another mental health related issue. They can be strongly observed to co-exist in maximum number of individuals suffering from mental health related issues. Main root cause however, is the ineffective treatment methods and the scarcity of these methods in specialized sects of population, to be implemented on a larger scale. Although for the given case study we were able to identify for a proper methodical approach by working in collaboration with our patient. The use of Model of Change was made and it reflected that our patient Mr. Jones was in a contemplation stage. Although the patient was well aware of the repercussions of his actions and wanted to work together in order to free himself of his habit of substance abuse. The ASSIST tool helped the clinician in pointing out the areas of concerns to be pondered upon. It also streamlines the underlying factors and thus assisted the clinician in defining a more patient -centered care plan for the Mr. Jones. It also enabled the doctor in identifying the drugs that the patient was taking and might have been harmful for hos health, given his current health status. Currently the patient is at a moderate risk and can be managed through outpatient department visits on regular basis.

References for ASSIST Tool Assessment

Hamann, J., Kohl, S., McCabe, R., Bühner, M., Mendel, R., Albus, M., & Bernd, J. (2016). What can patients do to facilitate shared decision making? A qualitative study of patients with depression or schizophrenia and psychiatrists. Social Psychiatry and Psychiatric Epidemiology51(4), 617-625.

Han, B., Compton, W. M., Blanco, C., &Colpe, L. J. (2017). Prevalence, treatment, and unmet treatment needs of US adults with mental health and substance use disorders. Health Affairs36(10), 1739-1747.

Julien, D., O’Connor, K., &Aardema, F. (2016). The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change. Journal of Dffective disorders202, 187-196.

Lorant, V., Nazroo, J., Nicaise, P., & Title107 Study Group. (2017). Optimal network for patients with severe mental illness: A social network analysis. Administration and Policy in Mental Health and Mental Health Services Research44(6), 877-887.

Osei-Bonsu, P. E., Bolton, R. E., Stirman, S. W., Eisen, S. V., Herz, L., &Pellowe, M. E. (2017). Mental health providers’ decision-making around the implementation of evidence-based treatment for PTSD. The Journal of Behavioral Health Services & Research44(2), 213-223.

Shannon, S., Breslin, G., Haughey, T., Sarju, N., Neill, D., Lawlor, M., &Leavey, G. (2019). Predicting student-athlete and non-athletes’ intentions to self-manage mental health: testing an integrated behaviour change model. Mental Health & Prevention13, 92-99.

Smith, C., Myles, H., &Galletly, C. (2017). Developing a metformin prescribing tool for use in adults with mental illness to reduce medication-related weight gain and cardiovascular risk. Australasian Psychiatry25(4), 387-390.

Susukida, R., Crum, R. M., Stuart, E. A., Ebnesajjad, C., &Mojtabai, R. (2016). Assessing sample representativeness in randomized controlled trials: application to the National Institute of Drug Abuse Clinical Trials Network. Addiction111(7), 1226-1234.

Zisman-Ilani, Y., Roe, D., Scholl, I., Härter, M., &Karnieli-Miller, O. (2017). Shared decision making during active psychiatric hospitalization: Assessment and psychometric properties. Health communication32(1), 126-130.

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