Case Studies for the Mental Health ‘Case Analysis’ Pick one of the following situations. In each situation the referral has come to you as a social worker in the regional community mental health...

Case Studies for the Mental Health ‘Case Analysis’
Pick one of the following situations. In each situation the referral has come to you as a social worker in the regional community mental health service.
1) Richard is a thirty four year old man who was diagnosed as being clinically depressed two years ago. Richard has been taking anti-depressant medication and while he is no longer feeling as hopeless as before he describes that he is still ‘struggling’ both at home and at work. Richard has been living with Bec (who is thirty one) for the past seven years and reports that everything was fine for the first five years but over the past two years Richard has been finding it hard to ‘keep up’ with Bec, who is very outgoing and loves socialising. Over the past six months Richard has rarely gone out with Bec and her friends and there has been further tension in their relationship lately as Bec has decided she wants to have a child. Richard doesn’t believe he would cope with this responsibility. Richard has a passion for cars and spends much of his time tinkering with his twenty year old Mazda MX5 sports car. His old school friend Tim also has an old MX5 and the two of them often spend their weekends working on their cars in Tim’s garage. Bec is becoming increasingly frustrated with Richard and recently told him that she isn’t sure that she wants to keep living with him. Richard grew up just with his mother, Irene who lives a few suburbs away. Irene often says to Richard that she doesn’t like Bec and thinks that he should come back and live with her while he ‘sorts himself out’. Richard is also in some difficulty in his clerical job with a private health insurance company as he has been taking a lot of ‘sick leave’ lately.

Richard’s GP finds Richard to be a sensitive and likeable man but is concerned that Richard seems to be entering into another ‘depressive’ period. As a result, he has referred Richard to your Community Mental Health Service for further assistance. After a team discussion, you become Richard’s allocated worker.

2) Patrick is a twenty year old man who has been working in a local ‘video’ store since finishing school two years ago. Patrick enjoys this job as he loves movies and he believes that he could make his own films one day. Patrick has retained good contact with his old school friends and goes out with them on a regular basis. Patrick lives with his parents and his younger sister Liz, who is just finished school. Liz has won a prestigious scholarship to study at ANU. Patrick feels intimidated by Liz’s success and lately he has been avoiding her as she makes him feel that he ‘lacks direction’ in his life. Patrick has had a couple of casual girlfriends but finds that he feels more comfortable with his male friends. Over the past few months Patrick has been going out more often with his friends and ‘partying’ quite hard. His parents are becoming increasingly concerned about this but whenever they have tried to talk with Patrick over the past few weeks he has become very angry and walks away.  Last Saturday night they were called to the local Police station as Patrick had been arrested for attacking a stranger in a nightclub. Patrick says that he attacked the man as the man had been ‘reading his thoughts’ with the aim of stealing his movie making ideas. The family GP was convinced that Patrick had experienced a ‘psychotic episode’ and referred him to your community mental health team for additional assessment and support.  The team Psychiatrist believed that Patrick has experienced other episodes over the past few months, prescribed some anti-psychotic medication and referred Patrick to you to provide more ongoing support to Patrick and his family.
3) Margaret is a fifty four year old woman who has just been told by her GP that she has an ‘anxiety disorder’. Margaret was not surprised by this as she had been feeling very anxious for the past couple of years. Two years ago Margaret’s husband died suddenly from a heart attack and the youngest of Margaret’s three children left home eighteen months ago. Now living alone, Margaret found a part time job in a chemist shop six months ago and enjoys the contact she has with the regular customers. Margaret had also started going out for coffee and occasionally dinner with the next door neighbour Samantha, who also lives alone following the death of her husband five years ago.  Margaret believed she had been starting to ‘enjoy life’ again, but a simple argument with a customer at the chemist shop last week had left her feeling more anxious than ever, and also feeling very fatigued and unable to concentrate. Margaret’s GP is concerned with this sudden shift in Margaret and asked the Psychiatrist in your team for advice on medication management. The Psychiatrist has asked you to see Margaret with the aim of helping her ‘sort through her issues’ and to also provide ‘additional support’.

4) Mathew is a twenty year old student in the second year of his Bachelor of Arts degree at ANU. Mathew came to Canberra from Melbourne and has been enjoying living on campus. Mathew had always done well at school, with little effort, and at University he is very engaged in his Philosophy and English subjects. Over the past six months Mathew has been even more energetic than usual. He found that he didn’t need much sleep and was the centre of any party due to his quick wit and sense of adventure. He was very popular with the female students and usually had two or three ‘relationships’ happening at the same time. Over the past few weeks however Mathew had suddenly become very withdrawn and was struggling to get to his lectures. His concentration was poor and he just didn’t want to have any social contact, spending most of his time in his room. One of his girlfriends, Maggie, finally convinced him to let her into his room, where she found him curled up on his bed and tearful. Maggie convinced Mathew to let her take him to the student health centre. The GP at the centre spent just fifteen minutes with Mathew before arranging to have assessed that day at the Adult Psychiatric Unit at Canberra Hospital.  Mathew was admitted to the Unit and after a week in hospital was being discharged for follow up by the local community mental health team. He has been prescribed Lithium and is being seen weekly by one of the team’s Psychiatrists. The Psychiatrist, Helen Jones, has found Mathew hard to engage and wants you to also work with Mathew to aid his ‘transition’ back to study. Mathew’s mother and elder sister are coming up from Melbourne and are also keen to talk with you about Mathew. Mathew isn’t happy about this has he has always found his mother (Pat) to be ‘distant’ and his elder sister (Janet) to be ‘judgemental’. You have a time with Mathew tomorrow and are due to meet his family when they arrive later in the week.