Background Information
You are a case manager at the local mental health center. You receive a call from Ruth Perez, Raul’s mother. She asks if you have time to see him if she can bring him into the Center today. “He’s really not acting right for about a week. He’s kinda scaring me. I think he needs to see the doctor,” she explains. You agree to see him in about an hour. When you pull Raul’s file, you remember some more information about him. Although he’s been on your caseload for nearly a year, you’ve only seen him a few times in conjunction with routine visits (like his psychiatric appointments). He has a long history of hospitalizations dating back to when he was 16 years old. Now 40, he resides with his mother, attends day treatment on occasion, and has never worked as far as you know. His current medications, according to his chart, include Haldol, Cogentin, and insulin.
Interview with Client’s Mother
When the Perez family arrives at the Center, Mrs. Perez asks to speak with you first. “I know something’s wrong here. He’s almost always lived with me, and I know his ways. He’s not sleeping right; I hear him pacing at all hours. He’s not taking care of himself. He’s talking to himself sometimes. I’m sure he’s stopped taking his meds. You gotta do something before he goes off in a big way,” she explains hurriedly. “Mrs. Perez, has he threatened you in some way?” you ask. “No, he won’t hurt me. Really, he don’t hurt anybody; he just gets himself hurt. Next thing you know, he’ll start going to the clubs, talking crazy, and make somebody really mad. Then he’ll come home in pieces, lose all his money. One of these days he’ll get himself killed this way,” she replies. “What do you think needs to happen today?” you inquire. “He needs to see the doctor at least. I hate to see him go back to the hospital, but that’s better than him getting himself hurt.” Interview with Client You return to the waiting room and bring Raul to your office. He is dressed in a ragged overcoat, bedroom slippers, and a baseball cap. His hair isn’t very clean, and he has a noticeable body odor. “Raul, do you remember me?” you begin. “I sure do. You’re the pretty new caseworker. Wanna get some lunch?” he smiles. “No thanks, Raul. Did you know your mother is worried about you?” you ask. “That’s because she feeds me dog shit for lunch every day!” The client smiles broadly with this statement. “She’s just worried the neighbors will find out how bad she is.” “Raul, you want me to tell your mother that?” you laugh as well. “No.” “Well, Raul, what have you been doing with yourself lately?” you ask. “Eating wires and lighting fires. Come on baby, light my fire,” he sings. Despite the playfulness of his speech, you notice that he’s displaying very little affect. He is speaking in a monotone, and his laughter doesn’t seem to “spread” to the rest of his face. “How have you been feeling, Raul?” you continue. “I need sex. Been under a hex. Eaten by a T. rex,” he replies, again without any real affect. “Raul, have you been taking your medicine?” The client does not respond and slumps down in his chair, fixing his gaze on his bedroom slippers. “Do you know what day it is today?” you ask. “Don’t know. Don’t care. You got on any underwear?” he replies. “Raul, I’m going to see if the doctor can see you. Is that okay?” you inquire. “Is the pretty lady doctor here today?” he replies.
1. How would you assess Raul’s mother’s concern that he may pose a danger to himself?
2. What are the strengths in this situation?
3. What is your preliminary diagnosis?
4. What are 3 psychosocial and cultural factors that might impact your diagnosis in this case?
5. Which specifiers would be appropriate to add to the diagnosis you have made? Why?
6. Is there any other collateral information you would want before seeing the doctor?
Q