This assignment is a critical evaluation of the engagement and psychosocial assessment of a client living with psychosis in the community. It provides a critical and analytical account which encapsulates assessments, psycho education, problem solving, implementation and evaluation of strategies used. I will also use Gibbs (1988) model of reflection to reflect on my assessment process and how learning can be taken forward in terms of my own practice development and that of the service setting.
My client l shall call Emily a pseudo name used to maintain confidentiality in accordance with the Nursing and Midwifery Council (NMC) 2002 Code of Professional Conduct that outlines guidelines of confidentiality. Emily was initially on the acute ward where l started the process of engagement with her before she was discharged under our team in the community to facilitate early discharge. Emily was suitable for psychosocial based interventions (PSI) and this was identified as part of her care plan in order to provide support in adapting to the demands of community living and managing her illness. PSI should be an indispensable part of treatment and options of treatment should be made available for clients and their families in an effort to promote recovery. Those with the best evidence of effectiveness are Cognitive Behavioural Therapy (CBT) and family intervention. They should be used to prevent relapse, to reduce symptoms, increase insight and promote adherence to medication, (NICE 2005).
Emily is 33 year old woman with a diagnosis of schizophrenia. She was referred to my team to facilitate early discharge from the ward as part of her discharge. She lives in supported housing and had had several hospital admissions and some under the mental health act. Emily was being maintained in the community on medication but it was felt that there was still an amount of distress in her life and that her social functioning was suffering as a result. Emily presented with both delusional and hallucinatory symptoms and as part of her treatment cognitive approaches were considered to help alleviate the distress and modify the symptoms. Emily was brought up in a highly dysfunctional family. Both her parents had problems with drugs and the law. Emily had been introduced to drugs at an early age but due to her illness she had stopped using them at the age of 30 when she went into supported accommodation. There was family history of schizophrenia as her grandfather had it and he had killed himself. Emily identified that her problems started in 2007 when her grandfather passed away as she was close to him and had lived most of her life with her grandparents. I completed a time line to look back at while she talked about her life history (see Appendix 1). It is vital that the client is allowed to tell their story with the minimum intervention from the practitioner and the timeline can be used to examine if there are any links to their relapses and psychotic episodes (Grant et al 2004).
In the community setting we have a variety of patients with different diagnosis of mental health problems. The rationale for choosing this patient is that she had had various interventions such as medication changes and a lot of experience with the mental health professionals including compulsory treatment under the mental health act (1983).All these factors are likely to have an impact on the individual’s degree of willingness to engage in psychological interventions (Nathan et al, 2003).Hence initially it was a challenge to engage Emily and establish a relationship and build rapport. (Nelson 1997) states rapport is built by showing interest and concern and be particularly careful not to express any doubts about what the patient tells you.
The development of a therapeutic relationship is critically important in work with persons with schizophrenia, which maybe difficult with patients struggling with...