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Introduction

Ben's path to mental health has been chaotic, marked by desperation, borderline personality disorder, and a concerning history of drug addiction, primarily methamphetamine and cannabis. He was admitted to the emergency room after a recent, serious worsening in his mental health, during which he had a distressing psychotic episode. Given the urgency of his position and the complicated nature of his condition, a thorough and well-planned recovery strategy is essential. I support Ben in the community as a committed medical staff member with the Community Mental Health Service. This recovery nursing care plan includes particular therapies, drugs, and tactics to address his urgent demands and maintain his mental well-being over time. This specialised strategy tries stabilising Ben, dealing with his ongoing withdrawal symptoms, and leading to better health outcomes.

Mental Health

Firstly, a significant challenge is Ben's history of depression and borderline personality disorder. These issues frequently cause erratic moods, emotional instability, impulsiveness, and trouble controlling emotions (Paris, 2018). Secondly, concerning self-harm and suicide efforts are Ben's persistent thoughts. These are unmistakable indications of the severe emotional suffering he is going through and point to the urgent need for action to safeguard his safety. Thirdly, his issue is complicated further by having a psychotic episode while he was in hospital. To cope with delusions and hallucinations, psychosis requires specialist treatment. It can be frightening and disturbing (for Nursing et al., 2022).

Lastly, Ben's conflict with intrusive thoughts worsens his mental health problems. These troubling thoughts exacerbate his overall mental pain. The first recovery goal will be to improve emotional stability and impulse control. For this, applying DBT (Dialectical behaviour therapy) strategies, such as skills for coping with distress and exercises for emotional regulation, will be beneficial. People who have borderline personality disorder and emotional dysregulation have been shown to benefit from DBT treatment. It gives people the tools to control their emotions, curb impulsivity, and maintain emotional stability (Barnicot et al., 2022).

The second goal will be to reduce suicidal ideation and self-harm. This can be achieved by performing routine assessments of the risk of suicide, and creating a safety plan with Ben is essential. To manage the immediate danger of self-harm and suicide, regular evaluations and safety preparedness are necessary. Safety strategies may lessen the frequency of suicide behaviours, according to the evidence (Bai et al., 2021). The third and last goal will be addressing Ben’s episodes of psychosis. Collaborating with a psychiatrist to administer antipsychotic medication and providing psychoeducation to Ben about managing hallucinations and delusions will be essential. Antipsychotic medicine must be explicitly used to treat psychotic episodes. Psychoeducation can lessen distress by assisting in comprehending and coping with his experiences. (Pacchiarotti et al., 2020)

Family/Carer

Firstly, Ben's girlfriend worries about him and the possibility of a relapse. Her concern highlights Ben's mental health challenges' critical impact on his relationships and the necessity for continuing support and education. Secondly, although she has been helpful during Ben's inpatient stay, his mother's role in his recovery indicates courage and worry. Although she is a tremendous help, she can encounter difficulties managing her son's illness and guaranteeing his well-being. In this case, the recovery goal will focus on enhancing family understanding and coping. This will be done by planning functional family therapy (FFT) sessions to inform and support Ben's mother and girlfriend, assisting them in comprehending his situation and creating appropriate coping mechanisms. FFT can help family members have an improved awareness of the patient's psychological condition and be more able to support them. This can lessen stress on families and enhance patient outcomes generally (Alexander & Robbins, 2019).

Occupationa & Social

Firstly, Ben's wish to return is a positive step towards recovery but also presents challenges. He may lack the confidence and skills required for his job, and the stress of employment can significantly trigger his mental health symptoms. Secondly, Ben's social network, particularly his girlfriend and mother, plays a pivotal role in his recovery. The stability of his relationships and social support is vital to his well-being. Nurturing these relationships while managing his mental health is a complex task. The first goal will be to develop Ben’s social stability. Ben's participation in social support networks, including peer-led support groups and group therapy, will be promoted to create a reliable social network. Participating in support groups and group therapy might help people feel less alone and stabilise their social lives. Peer-led groups can facilitate exchanging coping mechanisms and experiences, aiding healing (Kelly, 2019). The second goal will be to reestablish Ben’s financial stability. This will be done by assessing Ben's living arrangements and financial situation to ensure stability and support his well-being. Assistance will be provided in finding community resources for housing or financial support if needed. Research by Godinić & Obrenovic (2020) revealed that financial stability can positively impact an individual's mental health.

Physical Health

The case study makes no apparent reference to Ben's physical health problems. However, his substance misuse and mental health issues may negatively affect his physical health. Concerns regarding lifestyle, dietary habits, physical activity, and overall well-being may need to be addressed to guarantee a holistic recovery. Nevertheless, the recovery goal here will be to address lifestyle factors. By working with a dietitian and a physical therapist, create a personalised wellness plan for Ben that considers diet, exercise, and general well-being. Mental health can benefit from improved physical health. According to research by Wickham et al. (2020), a balanced diet and regular exercise can help reduce the hallmarks of depression and enhance general well-being.

Medication

Firstly, the current dose of Olanzapine was initiated during his inpatient stay to address his psychotic symptoms, which have since resolved. Olanzapine can have side effects, including weight gain and metabolic issues (Correll et al., 2018). Therefore, the psychiatrist wants to review and potentially discontinue it. Secondly, the amount of Diazepam that Ben was taking throughout his inpatient stay has been decreased. Reducing benzodiazepine dosage might be difficult because sudden cessation can cause withdrawal symptoms and elevated anxiety (Edinoff et al., 2021). Lastly, Ben's sentences imply that his depressed symptoms are still present, and he still has a low mood. The psychiatrist started escitalopram during Ben's inpatient stay. If it is well tolerated and Ben's mood does not change with the current dosage, the psychiatrist may consider raising it. The first recovery goal will be to optimise Ben’s medication management. This will involve working with the psychiatric team to ensure Ben receives the best prescription for his particular issues and symptoms. Managing mental health conditions like borderline personality disorder, depression, and psychosis sometimes involves medication (Bohus et al., 2021). Working with the psychiatric team guarantees that Ben takes the proper drugs at the appropriate dosages. The second recovery goal will be promoting medication adherence. This would involve organising medication education workshops for Ben and his support group to emphasise the significance of following the prescribed medication regimen. Non-adherence to medication can make treatment less effective. Education on the advantages of taking a drug and any possible adverse effects might boost compliance and enhance results (Cahaya et al., 2022).

Substance Abuse

Ben's history of substance use, beginning at 14, is concerning. Early substance use can have lasting effects on brain development and increase the risk of addiction. The recent worsening of his substance use is a clear indicator of the distress he is experiencing. Substance abuse is often a maladaptive coping mechanism for underlying mental health issues. Ben's fear of "losing it" without his current medication suggests a dependency on substances for emotional regulation. This dependency is a significant challenge to overcome in his recovery journey as it indicates the possibility of potential relapse. For dealing with the issue of substance abuse, the first goal will be to reduce Ben’s dependency on substances.

 Motivational interviewing will be employed to examine Ben's conflicted feelings about substance use and assist him in establishing goals for reducing use. Motivational interviewing is a strategy supported by research to address substance misuse (Frey et al., 2021). It can assist people like Ben in realising the need for change and developing the drive to lessen substance abuse. The second goal will be to develop healthy coping strategies. This will include providing Ben with cognitive-behavioural coping techniques to manage his emotions and distress without abusing drugs. Cognitive-behavioural coping techniques can give people alternate coping mechanisms and help them manage their substance dependency more effectively (Sudhir, 2018).

Risk Assessments

Ben's continuous care and recovery depend heavily on routine assessments of his likelihood of suicide, self-harm thoughts, and general mental health state. Continuous evaluation is essential for tracking his progress and averting possible crises. These evaluations offer insightful information about the dynamics of his mental health and act as early detection tools for any new problems (Singh et al., 2022). Moreover, according to Kaplan et al. (2018), it is also crucial to watch for signals of relapse in substance abuse and mental health problems. Healthcare providers can modify treatment programs and support tactics by identifying early warning indicators. Working effectively with other medical specialists, such as the psychiatrist, is also essential (Malhi et al., 2018).

Discharge Planning

Collaboration is at the core of a successful transition from inpatient care to the community for individuals like Ben, who manage complex mental health concerns (Reising et al., 2021). Engaging Ben, his family, and other healthcare professionals in developing a comprehensive discharge plan ensures that all key stakeholders are aligned in providing the best possible support. Secondly, a fundamental component of this plan should be a detailed medication regimen, follow-up appointments, and a crisis intervention strategy. This inclusion guarantees that Ben's medication management remains consistent and that he is well-prepared to address potential crises should they arise (Mallick‐Searle & Chang, 2018). Lastly, financial stability might considerably impact his mental health and general quality of life. Giving Ben access to assistance and connections to community-based support services is crucial. Community resources can provide ongoing support and treatment, in addition to a community of peers familiar with his difficulties (Shalaby & Agyapong, 2020).

Relapse Prevention Plan

One of the most important step is to work with Ben to create a relapse prevention plan. This strategy should involve identifying potential setbacks that could hinder his progress, coping mechanisms for difficult circumstances, and a list of emergency contacts he may contact in an emergency (Turecki et al., 2019). A proactive strategy like this would give Ben the knowledge and tools to continue his recovery. Secondly, involving Ben's family and network of friends is crucial. Family members and loved ones may be a tremendous source of support and encouragement, especially when spotting early warning signs and giving Ben any necessary emotional support. Their active involvement in the relapse prevention strategy improves its efficacy and builds a more complete support network for Ben (Ong et al., 2021).

Lastly, it is essential to schedule routine follow-up appointments to guarantee that the relapse prevention plan stays applicable and flexible. These meetings offer the chance to keep tabs on Ben's development, spot any new problems, and change the plan as necessary. Due to the unpredictable nature of mental health and rehabilitation, periodic reviews are necessary to ensure Ben's relapse prevention plans adapt to meet his evolving needs (Menon & Kandasamy, 2018).

Conclusion

Ben's complicated mental health issues necessitate a multifaceted approach to recovery that addresses emotional stability, suicide risk reduction, psychosis management, family support, social and occupational reintegration, physical well-being, medication optimisation, substance abuse mitigation, and ongoing risk assessments. Ben's path to better mental health will depend on cooperation between his family, loved ones, and healthcare professionals. A strong relapse prevention plan will also be essential. Ben will receive the all-encompassing care required for his well-being and rehabilitation from evidence-based therapies and ongoing monitoring. With the use of these tactics, we can assist him in moving from inpatient care to a more secure and rewarding existence in the community.

References

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Bai, S., Babeva, K. N., Kim, M. I., & Asarnow, J. R. (2021). Future directions for optimizing clinical science & safety: Ecological momentary assessments in suicide/self-harm research. Journal of Clinical Child & Adolescent Psychology , 50 (1), 141-153.

Barnicot, K., Redknap, C., Coath, F., Hommel, J., Couldrey, L., & Crawford, M. (2022). Patient experiences of therapy for borderline personality disorder: Commonalities and differences between dialectical behaviour therapy and mentalization-based therapy and relation to outcomes. Psychology and Psychotherapy: Theory, Research and Practice , 95 (1), 212-233.

Bohus, M., Stoffers-Winterling, J., Sharp, C., Krause-Utz, A., Schmahl, C., & Lieb, K. (2021). Borderline personality disorder. The Lancet , 398 (10310), 1528-1540. 

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Correll, C. U., Newcomer, J. W., Silverman, B., DiPetrillo, L., Graham, C., Jiang, Y., & Kahn, R. S. (2020). Effects of olanzapine combined with samidorphan on weight gain in schizophrenia: A 24-week phase 3 study. American Journal of Psychiatry , 177 (12), 1168-1178. 

Drake, R. E., & Wallach, M. A. (2020). Employment is a critical mental health intervention. Epidemiology and Psychiatric Sciences , 29 . 

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Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: Uses, Dangers, and Clinical Considerations. Neurology International , 13 (4), 594-607.

for Nursing, O. R., Ernstmeyer, K., & Christman, E. (2022). Psychosis and Schizophrenia. In Nursing: Mental Health and Community Concepts [Internet] . Chippewa Valley Technical College.

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Mallick-Searle, T., & Chang, H. (2018). The importance of nurse monitoring for potential opioid abuse in their patients. Journal of Applied Biobehavioral Research , 23 (1), e12129.

Menon, J., & Kandasamy, A. (2018). Relapse prevention. Indian Journal of Psychiatry , 60 (Suppl 4), S473.

Ong, H. S., Fernandez, P. A., & Lim, H. K. (2021). Family engagement as part of managing patients with mental illness in primary care. Singapore Medical Journal , 62 (5), 213-219. 

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Paris, J. (2018). Differential diagnosis of borderline personality disorder. Psychiatric Clinics , 41 (4), 575-582. 

Reising, V., Diegel-Vacek, L., Dadabo, L., & Corbridge, S. (2021). Collaborative care: integrating behavioral health into the primary care setting. Journal of the American Psychiatric Nurses Association . 

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Turecki, G., Brent, D. A., Gunnell, D., C., R., Oquendo, M. A., Pirkis, J., & Stanley, B. H. (2019). Suicide and suicide risk. Nature Reviews Disease Primers , 5 (1), 1-22.

Wickham, S., Amarasekara, N. A., Bartonicek, A., & Conner, T. S. (2020). The big three health behaviors and mental health and well-being among young adults: A cross-sectional investigation of sleep, exercise, and diet. Frontiers in Psychology , 11 , 579205.

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